title: Pelvic recurrence after Miles' operation for anastomotic recurrence in a patient with stage I rectal cancer invading the proper muscle layer: Case report.
abstract: We performed D2 low anterior resection in a patient with stage I rectal cancer [pathological diagnosis: proper muscle (pm) invasion, n0, lymphatic invasion (ly), (-); venous invasion (v), (-); anal margin, (-)]. The tumor recurred at the anastomotic site approximately one year later and was treated with Miles' operation [pm, n0, ly (+); v (-); deep border of the primary tumor (-)]. The tumor marker CEA increased to 50.4 ng/ml at four months after surgery and pelvic local recurrence was detected. Since then, the patient has been receiving chemoradiotherapy on an out-patient basis. Cytokeratin immunostaining of all the lymph nodes collected during the two operations showed clusters of occult neoplastic cells (ONCs) in the perinodal fat around the nodes harvested at the first operation. These findings suggest that the risk of local recurrence of rectal cancer is increased even in stage I disease if ONCs are found in the perinodal fat. Further studies are required to examine the relationship between local recurrence and extranodal ONCs in patients with primary rectal cancer.
authors.affiliation: Department of Surgery, Tokai University Hachioji Hospital, Hachioji, Tokyo 192-0032, Japan. hoshikawa.tatsuhiko@hachioji-hosp.tokai.ac.jp
authors.forename: Tatsuhiko
authors.initials: T
authors.lastname: Hoshikawa
authors.forename: Masaya
authors.initials: M
authors.lastname: Mukai
authors.forename: Yasuhisa
authors.initials: Y
authors.lastname: Oida
authors.forename: Takayuki
authors.initials: T
authors.lastname: Tajima
authors.forename: Goryu
authors.initials: G
authors.lastname: Morikawa
authors.forename: Tomoki
authors.initials: T
authors.lastname: Nakamura
authors.forename: Megumi
authors.initials: M
authors.lastname: Motojyuku
authors.forename: Masato
authors.initials: M
authors.lastname: Nakamura
authors.forename: Hiroyasu
authors.initials: H
authors.lastname: Makuuchi
mesh_terms: D000368:Aged; D000714:Anastomosis, Surgical; D006801:Humans; D007633:Keratins / Q000032:analysis; D008297:Male; D018482:Muscle, Skeletal / Q000473:pathology; D009361:Neoplasm Invasiveness; D009364:Neoplasm Recurrence, Local / Q000175:diagnosis* / Q000473:pathology; D009367:Neoplasm Staging; D010388:Pelvis / Q000473:pathology; D012004:Rectal Neoplasms / Q000175:diagnosis* / Q000473:pathology / Q000601:surgery*; D016896:Treatment Outcome
chemical_list: D007633:Keratins