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Yu GY, Gao XH, Xia LJ, Sun DB, Liu T, Zhang W. Implantation metastasis from sigmoid colon cancer to rectal anastomosis proved by whole exome sequencing and lineage inference for cancer heterogeneity and evolution analysis: Case report and literature review. Front Oncol 2022; 12:930715. [PMID: 36203423 PMCID: PMC9530747 DOI: 10.3389/fonc.2022.930715] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2022] [Accepted: 08/15/2022] [Indexed: 11/13/2022] Open
Abstract
It was estimated that 70% of patients with colorectal cancer were found to have viable exfoliated malignant cells in adjacent intestinal lumen. Exfoliated malignant cells had been reported to implant on raw surfaces, such as polypectomy site, anal fissure, anal fistula, hemorrhoidectomy wound, and anastomotic suture line. Tumors at anastomosis could be classified into four groups: local recurrence, local manifestation of widespread metastasis, metachronous carcinogenesis, and implantation metastasis. However, all of the previous studies only reported the phenomena of implantation metastasis at anastomosis. No study had proved the origin of anastomotic metastasis by genomic analysis. In this study, a 43-year-old woman presented with persistent hematochezia was diagnosed as having severe mixed hemorrhoids. She was treated by procedure for prolapse and hemorrhoids (PPH), without receiving preoperative colonoscopy. Two months later, she was found to have sigmoid colon cancer by colonoscopy due to continuous hematochezia and received radical sigmoidectomy. Postoperative histological examination confirmed the lesion to be a moderately differentiated adenocarcinoma (pT3N1M0). Six months later, she presented with hematochezia again and colonoscopy revealed two tumors at the rectal anastomosis of PPH. Both tumors were confirmed to be moderately differentiated adenocarcinoma without lymph node and distant metastasis and were finally removed by transanal endoscopic microsurgery (TEM). Pathological examination, whole exome sequencing (WES), and Lineage Inference for Cancer Heterogeneity and Evolution (LICHeE) analysis demonstrated that the two tumors at the rectal anastomosis were probably implantation metastases arising from the previous sigmoid colon cancer. This is the first study to prove implantation metastasis from colon cancer to a distal anastomosis by WES and LICHeE analysis. Therefore, it is recommended to rule out colorectal cancer in proximal large bowel before performing surgery with a rectal anastomosis, such as PPH and anterior resection. For patients with a suspected implanted tumor, WES and LICHeE could be used to differentiate implantation metastasis from metachronous carcinogenesis.
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Affiliation(s)
- Guan Yu Yu
- Department of Colorectal Surgery, Changhai Hospital, Naval Medical University, Shanghai, China
- Hereditary Colorectal Cancer Center and Genetic Block Center of Familial Cancer, Changhai Hospital, Shanghai, China
| | - Xian Hua Gao
- Department of Colorectal Surgery, Changhai Hospital, Naval Medical University, Shanghai, China
- Hereditary Colorectal Cancer Center and Genetic Block Center of Familial Cancer, Changhai Hospital, Shanghai, China
| | - Li Jian Xia
- Department of Gastrointestinal Surgery, The First Affiliated Hospital of Shandong First Medical University, Ji'nan, Shandong, China
| | - De Bin Sun
- Department of Medicine, Genecast Biotechnology Co. Ltd, Wuxi, China
| | - Tao Liu
- Department of Anorectal Surgery, Zaozhuang Central Hospital, Shandong, China
| | - Wei Zhang
- Department of Colorectal Surgery, Changhai Hospital, Naval Medical University, Shanghai, China
- Hereditary Colorectal Cancer Center and Genetic Block Center of Familial Cancer, Changhai Hospital, Shanghai, China
- *Correspondence: Wei Zhang,
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Murata S, Yamamoto H, Yamaguchi T, Kaida S, Ishida M, Kodama H, Takebayashi K, Shimizu T, Miyake T, Tani T, Kushima R, Tani M. Viable Cancer Cells in the Remnant Stomach are a Potential Source of Peritoneal Metastasis after Curative Distal Gastrectomy for Gastric Cancer. Ann Surg Oncol 2016; 23:2920-2927. [DOI: 10.1245/s10434-016-5219-y] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/30/2023]
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Costi R, Santi C, Bottarelli L, Azzoni C, Zarzavadjian Le Bian A, Riccó M, Sarli L, Silini EM, Violi V. Anastomotic recurrence of colon cancer: Genetic analysis challenges the widely held theories of cancerous cells' intraluminal implantation and metachronous carcinogenesis. J Surg Oncol 2016; 114:228-36. [PMID: 27158137 DOI: 10.1002/jso.24282] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2015] [Accepted: 04/20/2016] [Indexed: 12/29/2022]
Abstract
BACKGROUND AND OBJECTIVES Anastomotic recurrence (AR), whose etiopathogenesis is attributed to intraluminal implantation of cancerous cells or metachronous carcinogenesis, is a major issue for patients undergoing colon cancer (CC) resection. The objective of the study is to throw some light on AR etiopathogenesis and to identify risk factors of AR in selecting patients to undergo early endoscopy. METHODS An analysis of clinical and histopathological parameters, including MSI and LOH of seven sites (Myc-L, BAT26, BAT40, D5S346, D18S452, D18S64, D16S402) was performed in primary CC and AR of 18 patients. They were then compared to 36 controls not developing AR. RESULTS A genetic instability was present in 16/18 patients, with distinct genetic patterns between primaries and ARs. LOH at 5q21 and/or 18p11.23 were found in both primary and AR in >50% of cases, but this rate was no different from control population. CEA resulted as associated with AR (P = 0.03), whereas N status presented a borderline result (P = 0.08). CONCLUSIONS Our findings challenge present theories about AR development. No "genetic marker" has been found. CEA and, to a lesser extent, N status, appear associated with AR. Rectal washout is seemingly meaningless. Iterative resection should be recommended since a long survival may be expected. J. Surg. Oncol. 2016;114:228-236. © 2016 Wiley Periodicals, Inc.
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Affiliation(s)
- Renato Costi
- Dipartimento di Scienze Chirurgiche, Università degli Studi di Parma, Azienda Ospedaliero-Universitaria, Parma, Italia
| | - Caterina Santi
- Dipartimento di Scienze Chirurgiche, Università degli Studi di Parma, Azienda Ospedaliero-Universitaria, Parma, Italia
| | - Lorena Bottarelli
- Dipartimento di Scienze Biomediche, Biotecnologiche e Traslazionali-S.Bi.Bi.T., Università degli Studi di Parma, Azienda Ospedaliero-Universitaria, Parma, Italia
| | - Cinzia Azzoni
- Dipartimento di Scienze Biomediche, Biotecnologiche e Traslazionali-S.Bi.Bi.T., Università degli Studi di Parma, Azienda Ospedaliero-Universitaria, Parma, Italia
| | | | - Matteo Riccó
- Dipartimento di Scienze Biomediche, Biotecnologiche e Traslazionali-S.Bi.Bi.T., Università degli Studi di Parma, Azienda Ospedaliero-Universitaria, Parma, Italia
| | - Leopoldo Sarli
- Dipartimento di Scienze Chirurgiche, Università degli Studi di Parma, Azienda Ospedaliero-Universitaria, Parma, Italia
| | - Enrico Maria Silini
- Dipartimento di Scienze Biomediche, Biotecnologiche e Traslazionali-S.Bi.Bi.T., Università degli Studi di Parma, Azienda Ospedaliero-Universitaria, Parma, Italia
| | - Vincenzo Violi
- Dipartimento di Scienze Chirurgiche, Università degli Studi di Parma, Azienda Ospedaliero-Universitaria, Parma, Italia
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Conzo G, Mauriello C, Gambardella C, Cavallo F, Tartaglia E, Napolitano S, Santini L. Isolated repeated anastomotic recurrence after sigmoidectomy. World J Gastroenterol 2014; 20:16343-16348. [PMID: 25473193 PMCID: PMC4239527 DOI: 10.3748/wjg.v20.i43.16343] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2013] [Revised: 02/09/2014] [Accepted: 06/23/2014] [Indexed: 02/06/2023] Open
Abstract
Repeated anastomotic recurrence (AR) of colonic cancer is uncommon. We report a case of a double-isolated AR after sigmoidectomy. In 2003, a 60-year-old woman underwent stapled sigmoid resection for a moderately differentiated adenocarcinoma. Further rectal bleeding occurred after six months, and colonoscopy detected an AR. Thus, an additional stapled colorectal anastomosis was performed. Ten months later, a colonoscopy detected a circumferential AR that prompted the completion of a second colorectal resection, with a double-stapled colorectal anastomosis. Twenty-four hours after surgery, a massive pulmonary embolism occurred, and the patient died within a few hours. At present, only six cases of repeated isolated AR have been described. Repeated segmental colorectal resections are generally associated with a favourable prognosis, with a median survival rate of 45 mo (range, 13-132 mo). Repeated isolated ARs are rare, and segmental colorectal resections are generally associated with long-term disease-free survival.
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CyclinD1, CDK4, and P21 expression by IEC-6 cells in response to NiTi alloy and polymeric biomaterials. MATERIALS SCIENCE & ENGINEERING. C, MATERIALS FOR BIOLOGICAL APPLICATIONS 2012. [DOI: 10.1016/j.msec.2012.05.049] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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Kim HR, Lee WY, Jung KU, Yun HR, Cho YB, Yun SH, Kim HC, Chun HK. Early surgical outcomes of NiTi endoluminal compression anastomotic clip (NiTi CAC 30) use in patients with gastrointestinal malignancy. J Laparoendosc Adv Surg Tech A 2012; 22:472-8. [PMID: 22670638 DOI: 10.1089/lap.2011.0406] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND The NiTi endoluminal Compression Anastomotic Clip (CAC™) 30 (NiTi CAC 30) (NiTi Alloys Technologies, Ltd., Netanya, Israel) is a new device with shape-memory characteristics. We aimed to investigate the safety and early surgical outcomes of NiTi CAC 30 for intestinal anastomosis in patients with gastrointestinal malignancy. SUBJECTS AND METHODS Fifty patients operated on with NiTi CAC 30 were matched for sex, age, body mass index, operation type (open versus laparoscopy), operation name, and anastomosis type with patients in a control group operated on with a stapling device between November 2009 and May 2010. Early clinical outcomes were investigated. RESULTS One misfired case of NiTi CAC 30 was excluded. Between the two groups, no significant differences were observed in demographics except for previous abdominal operation history. The results of early clinical outcomes were investigated, including operation time, estimated blood loss, time to first flatus, first defecation, and discharge, and complications. No differences were noted. Postoperatively, migration started in 1 patient between 3 and 5 days, 11 patients between 6 to 7 days, and 37 patients after 8 days. The expulsion of 31 cases occurred between 2 and 3 weeks, postoperatively. The NiTi CAC 30 was expulsed within 1 week in 4 patients and between 1 to 2 weeks in 8 patients. An expulsion occurred in 1 case at over 4 weeks. No problems related to early migration and expulsion were observed, and no anastomotic leakage and bleeding occurred. CONCLUSIONS Intestinal anastomosis with the NiTi CAC 30 was safe and feasible without anastomotic leakage and reoperation compared with the stapling technique.
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Affiliation(s)
- Hyoung Ran Kim
- Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine , Seoul, Korea
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Costi R, Azzoni C, Marchesi F, Bottarelli L, Violi V, Bordi C. Repeated anastomotic recurrence of colorectal tumors: Genetic analysis of two cases. World J Gastroenterol 2011; 17:3752-8. [PMID: 21990958 PMCID: PMC3181462 DOI: 10.3748/wjg.v17.i32.3752] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2010] [Revised: 10/26/2010] [Accepted: 11/02/2010] [Indexed: 02/06/2023] Open
Abstract
AIM: To investigate genetics of two cases of colorectal tumor local recurrence and throw some light on the etiopathogenesis of anastomotic recurrence.
METHODS: Two cases are presented: a 65-year-old female receiving two colonic resections for primary anastomotic recurrences within 21 mo, and a 57-year-old female undergoing two local excisions of recurrent anastomotic adenomas within 26 mo. A loss of heterozygosity (LOH) study of 25 microsatellite markers and a mutational analysis of genes BRAF, K-RAS and APC were performed in samples of neoplastic and normal colonic mucosa collected over the years.
RESULTS: A diffuse genetic instability was present in all samples, including neoplastic and normal colonic mucosa. Two different patterns of genetic alterations (LOH at 5q21 and 18p11.23 in the first case, and LOH at 1p34 and 3p14 in the second) were found to be associated with carcinogenesis over the years. A role for the genes MYC-L (mapping at 1p34) and FIHT (mapping at 3p14.2) is suggested, whereas a role for APC (mapping at 5q21) is not shown.
CONCLUSION: The study challenges the most credited intraluminal implantation and metachronous carcinogenesis theories, and suggests a persistent, patient-specific alteration as the trigger of colorectal cancer anastomotic recurrence.
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Stumpf M, Junge K, Rosch R, Krones C, Klinge U, Schumpelick V. Suture-free small bowel anastomoses using collagen fleece covered with fibrin glue in pigs. J INVEST SURG 2009; 22:138-47. [PMID: 19283617 DOI: 10.1080/08941930802713001] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
BACKGROUND Several studies investigating anastomotic healing could objectify that the regularly used suture material leads to an impairment of wound healing due to ischemia at the anastomotic line. This study was initiated to test a hypothesis that a reduction of suture material leading to suture-free glued intestinal anastomoses is feasible and enables an improved wound healing. MATERIALS AND METHODS Three different types of anastomoses were carried out at the small bowel of 16 pigs. Standard hand-sewn anastomoses, anastomoses with loose-fitting skin staples, and suture-free glued anastomoses using a fibrin covered collagen fleece. When the animals were killed, both gross inspection of the parietes, bursting pressure and tissue for histological study became the basis for evaluation. Analyses were also made regarding the collagen I/III ratio and the expression of MMP 1 and 13. RESULTS Four leakages at the stapled, one at the sutured, and one at the glued anastomoses occurred. All other anastomoses healed without complications. The bursting pressure did not differ significantly between the groups. The macroscopic inspection and the microscopic examination both showed an improved healing pattern for the material reduced techniques without onset of a deep ulcer at the anastomotic line as seen at the conventional sutured anastomoses. These findings were supported by the immunohistochemical studies. CONCLUSIONS These observations suggest that a suture-free bowel anastomoses using collagen fleece covered with fibrin glue is technically feasible. Obviously, a reduction of foreign body material at the anastomotic line avoids unnecessary ischemia and thus supports a physiological improved wound healing process.
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Affiliation(s)
- Michael Stumpf
- Department of Surgery, Medical Faculty of Rheinisch-Westfalischen, Technical University, Aachen, Germany.
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The effect of a hyaluronan-carboxymethylcellulose membrane vs. polyglactin 910 mesh on intra-abdominal tumor formation in mice. Dis Colon Rectum 2008; 51:1403-7. [PMID: 18418651 DOI: 10.1007/s10350-008-9299-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2007] [Revised: 12/10/2007] [Accepted: 01/06/2008] [Indexed: 02/08/2023]
Abstract
PURPOSE Hyaluronan mediates growth of SW620 colon cancer cells. Because hyaluronan is the active ingredient in Seprafilm, we hypothesized that Seprafilm would affect intraperitoneal tumor growth in a mouse model of peritoneal seeding. METHODS Immunodeficient mice underwent laparotomy and intraperitoneal inoculation of 10(5) SW620 cells. Seprafilm (n = 22), Vicryl mesh (foreign body control; n = 24), or no material (sham; n = 19) was placed under the incision. Mice were killed after four weeks and tumors were dissected, counted, and weighed. RESULTS Ninety-five percent of mice in the sham group and 96 percent in the Vicryl group developed intraperitoneal tumors. In contrast, only 64 percent of mice in the Seprafilm group developed tumors (P = 0.024), and these tumors were smaller than those in the sham group; (Seprafilm = 42 +/- 9 mg vs. sham = 82 +/- 17 mg; P = 0.05). In contrast, tumors in the Vicryl group were dramatically larger (349 +/- 49 mg; P < 0.001 vs. sham or Seprafilm). CONCLUSIONS Despite previous data that suggested that hyaluronan increases colon cancer cell growth, we found that Seprafilm decreased tumor formation and tended to decrease size in this model. In contrast, Vicryl mesh increased tumor formation and size. Our results suggest that Seprafilm does not promote intraperitoneal tumor growth, especially compared with Vicryl mesh.
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Funahashi K, Koike J, Saito N, Shiokawa H, Shirasaka K, Teramoto T. A rare case of repeated anastomotic recurrence due to tumor implantation after curative surgery for sigmoid colon cancer. World J Surg Oncol 2007; 5:91. [PMID: 17683596 PMCID: PMC1994957 DOI: 10.1186/1477-7819-5-91] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2007] [Accepted: 08/06/2007] [Indexed: 01/29/2023] Open
Abstract
Background Anastomotic recurrence is often experienced at colocolic or colorectal anastomoses. Tumor cell implantation has been reported as the mechanism of anastomotic recurrence. However, anastomotic recurrence occurring repeatedly after curative surgery is rare. We herein report a rare case of repeated anastomotic recurrence after curative surgery for sigmoid colon cancer. Case presentation A 51-year-old man underwent radical surgery for sigmoid colon cancer. However, anastomotic recurrence developed three times during three years and six months after the initial operation in spite of irrigation with 5% povidone-iodine before anastomosis. The serum carcinoembryonic antigen (CEA) level had been within normal limits after sigmoidectomy. Finally, the patient underwent abdominoperineal resection. The clinico-pathological findings revealed that possible tumor cell implantation caused these anastomotic recurrences. The patients survived without recurrence during the follow-up period of seven years and nine months. Conclusion We experienced a rare case of repeated anastomotic recurrence due to possible tumor implantation after curative surgery for sigmoid colon cancer; however the prognosis was ultimately very good. CEA monitoring was insensitive for detection of anastomotic recurrence in this case.
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Affiliation(s)
- Kimihiko Funahashi
- Division of Gastroenterological Surgery, Toho University Omori Medical Center, Tokyo, Japan
| | - Junichi Koike
- Division of Gastroenterological Surgery, Toho University Omori Medical Center, Tokyo, Japan
| | - Naoyasu Saito
- Division of Gastroenterological Surgery, Toho University Omori Medical Center, Tokyo, Japan
| | - Hiroyuki Shiokawa
- Division of Gastroenterological Surgery, Toho University Omori Medical Center, Tokyo, Japan
| | - Kentaro Shirasaka
- Division of Gastroenterological Surgery, Toho University Omori Medical Center, Tokyo, Japan
| | - Tatsuo Teramoto
- Division of Gastroenterological Surgery, Toho University Omori Medical Center, Tokyo, Japan
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Buenestado-Garcia J, Piñol-Felis C, Reñé-Espinet JM, Pérez-Holanda S, Viñas-Salas J. Silk suture promotes colon cancer in an experimental carcinogenic model. Dig Liver Dis 2002; 34:609-10. [PMID: 12502221 DOI: 10.1016/s1590-8658(02)80099-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
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Rebuffat C, Rosati R, Fumagalli U, Varoli F, Roviaro G, Peracchia A. Experimental oesophagogastric anastomosis: preliminary report of a new compression device that also fragments. Br J Surg 1996; 83:1616-9. [PMID: 9014690 DOI: 10.1002/bjs.1800831140] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Fifteen Beagle dogs underwent oesophagogastric anastomosis with a new device which enables a 'sutureless' compression anastomosis. The device fragmented and was passed in bits anally without causing obstruction. Immediate bursting pressure, tested in five dogs, was between 175 and 190 mmHg. The anastomoses of the remaining dogs were examined macroscopically and microscopically from day 6 to day 30. Healing was excellent with good muscular apposition and minimal residual inflammation.
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Affiliation(s)
- C Rebuffat
- Department of General Surgery, Ospedale San Giuseppe, Italy
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Uff CR, Scott AD, Pockley AG, Phillips RK. Influence of soluble suture factors on in vitro macrophage function. Biomaterials 1995; 16:355-60. [PMID: 7662820 DOI: 10.1016/0142-9612(95)93852-5] [Citation(s) in RCA: 48] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
Suture materials may interact with immune competent cells and thereby affect localized immunity. Macrophages are central to the inflammatory response and coordinate wound healing. They are also involved in the clearance of foreign material, bacteria and malignant cells. We studied the influence of soluble factors associated with silk, steel, nylon, polyglactin, polydioxanone and chromic catgut sutures on macrophage adherence, phagocytosis and the production of lysozyme and tumour necrosis factor. Soluble factors from suture materials influenced macrophage behaviour in vitro causing cellular activation, functional impairment and alterations in secreted levels of the cytokine tumour necrosis factor and the bactericidal agent lysozyme. Of the six materials studied, polyglactin had the most extreme effect, causing significant inhibition of cell adherence and lysozyme production. Silk also exerted a considerable effect on macrophages, significantly inhibiting adherence. In contrast, steel and polydioxanone media caused minimal inhibition of macrophage function although, as with all materials, they did activate the cells. This study has demonstrated that sutures release immunotoxic factors which considerably influence macrophage behaviour in vitro. These effects may have important clinical implications.
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Affiliation(s)
- C R Uff
- Professorial Surgical Unit, St. Bartholomew's Hospital, West Smithfield, London, UK
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