title: Surgical resection of colorectal recurrence of gastric cancer more than 5 years after primary resection.
abstract: BACKGROUND
  Intestinal metastasis from gastric cancer is rare, although the most common cause of secondary neoplastic infiltration of the colon is gastric cancer. However, little data is available on recurrence or death in patients with gastric cancer surviving >5 years post-gastrectomy. Here we report two cases of lower intestinal metastasis from gastric cancer >5 years after primary resection and discuss with reference to the literature.
  
  
  METHODS
  Case 1: A 61-year-old man with a history of total gastrectomy for gastric cancer 9 years earlier was referred to our hospital with constipation and abdominal distention. We diagnosed primary colon cancer and subsequently performed extended left hemicolectomy. Histological examination revealed poorly differentiated adenocarcinoma resembling the gastric tumor he had 9 years earlier. The patient refused postoperative adjuvant chemotherapy and remained alive with cancerous peritonitis and skin metastases as of 17 months later. Case 2: A 46-year-old woman with a history of total gastrectomy for gastric cancer 9 years earlier presented with constipation. She also had a history of Krukenberg tumor 3 years earlier. We diagnosed metastatic rectal cancer and subsequently performed low anterior resection and hysterectomy. Pathological examination revealed poorly differentiated tubular adenocarcinoma, resembling the gastric tumor. The patient remained alive without recurrence as of 17 months later.
  
  
  CONCLUSIONS
  We found 19 reported cases of patients with resection of colon metastases from gastric cancer. Median disease-free interval was 74 months.
  
  
  CONCLUSIONS
  Resection of late-onset colorectal recurrence from gastric cancer appears worthwhile for selected patients.
authors.affiliation: Department of Surgery, Obihiro Kosei General Hospital, W7 S8, Obihiro City, Hokkaido 080-0016, Japan; Department of Gastroenterological Surgery II, Graduate School of Medicine, Hokkaido University, N15W7, Kita-ku, Sapporo, Hokkaido 060-8638, Japan. Electronic address: drnoji@med.hokudai.ac.jp.
authors.forename: Takehiro
authors.initials: T
authors.lastname: Noji
authors.affiliation: Department of Surgery, Obihiro Kosei General Hospital, W7 S8, Obihiro City, Hokkaido 080-0016, Japan.
authors.forename: Yoshiyuki
authors.initials: Y
authors.lastname: Yamamura
authors.affiliation: Department of Surgery, Obihiro Kosei General Hospital, W7 S8, Obihiro City, Hokkaido 080-0016, Japan.
authors.forename: Jun
authors.initials: J
authors.lastname: Muto
authors.affiliation: Department of Surgery, Obihiro Kosei General Hospital, W7 S8, Obihiro City, Hokkaido 080-0016, Japan.
authors.forename: Aki
authors.initials: A
authors.lastname: Kuroda
authors.affiliation: Department of Surgery, Obihiro Kosei General Hospital, W7 S8, Obihiro City, Hokkaido 080-0016, Japan.
authors.forename: Junkichi
authors.initials: J
authors.lastname: Koinuma
authors.affiliation: Department of Surgery, Obihiro Kosei General Hospital, W7 S8, Obihiro City, Hokkaido 080-0016, Japan.
authors.forename: Tatsuya
authors.initials: T
authors.lastname: Yoshioka
authors.affiliation: Department of Surgery, Obihiro Kosei General Hospital, W7 S8, Obihiro City, Hokkaido 080-0016, Japan.
authors.forename: Katsuhiko
authors.initials: K
authors.lastname: Murakawa
authors.affiliation: Department of Surgery, Obihiro Kosei General Hospital, W7 S8, Obihiro City, Hokkaido 080-0016, Japan.
authors.forename: Setsuyuki
authors.initials: S
authors.lastname: Otake
authors.affiliation: Department of Gastroenterological Surgery II, Graduate School of Medicine, Hokkaido University, N15W7, Kita-ku, Sapporo, Hokkaido 060-8638, Japan.
authors.forename: Satoshi
authors.initials: S
authors.lastname: Hirano
authors.affiliation: Department of Surgery, Obihiro Kosei General Hospital, W7 S8, Obihiro City, Hokkaido 080-0016, Japan.
authors.forename: Koichi
authors.initials: K
authors.lastname: Ono
keywords: Colonic metastasis; Gastric cancer; Late onset; Surgical resection