Unexplained neoplastic anastomotic recurrence after right hemicolectomy: a case report

Area of Science:

• Gastroenterology
• Surgical Oncology
• Colorectal Surgery

Background:

• Anastomotic recurrence of colon cancer is a known complication.
• Potential causes include inadequate surgical margins, tumor cell implantation, and altered anastomosis biology.
• This study presents a case of unexpected early local recurrence after colon cancer surgery.

Observation:

• A 68-year-old man with invasive G2 adenocarcinoma underwent right hemicolectomy.
• Endoscopy two months post-surgery revealed a thickened mucosal area at the anastomosis.
• Biopsies confirmed adenocarcinoma with the same grade as the primary tumor.

Findings:

• The patient underwent a second surgery with resection of the ileum and transverse colon.
• Histopathology confirmed adenocarcinoma (G2) penetrating the muscular layer.
• Resection margins and lymph nodes were free of tumor, suggesting recurrence was localized to the anastomosis.

Implications:

• Tumor cell implantation is a plausible cause for anastomotic recurrence, especially when margins are clear.
• This finding underscores the need for vigilance in detecting and managing early recurrences.
• Further research into preventative strategies for tumor cell implantation during colorectal surgery is warranted.