Heterochronous Suture Line Recurrences in the Jejunal Pouch following Total Gastrectomy for Stage II Gastric Cancer: A Case Report and Literature Review

• Main Authors: Takamichi Yokoe, Michio Sato, Masashi Yahagi, Murat Dogru, Hiroto Fujisaki, Masaharu Ogura, Hiroshi Kawamata, Fumitaka Asahara, Shin Takayama, Hirohisa Harada, Yoichi Tanaka, Jun Miyauchi, Junichi Matsui
• Format: Article
• Language: English
• Published: Karger Publishers 2020-03-01
• Series: Case Reports in Oncology
• Subjects: local recurrence; gastric cancer; suture line recurrence
• Online Access: https://www.karger.com/Article/FullText/505392

We report the case of a 65-year-old male who developed heterochronous local recurrences of gastric cancer in the jejunal pouch (J-pouch) four times after total gastrectomy. He underwent total gastrectomy, J-pouch, and Roux-en-Y reconstruction for stage II gastric cancer in 2005. Four local recurrences appeared on the esophago-jejunal anastomosis, the suture line within the pouch, the esophago-jejunal anastomosis, and the anastomosis between the jejunum and Y-loop, which were resected by partial excision or endoscopic submucosal dissection. Suture line recurrence of gastric cancer is rare. The common features for each recurrence included the surgically negative resection margins, observation of the same histopathological subtype, absence of remote metastasis or peritoneal seeding, and the recurrence on the anastomotic suture line, suggesting that the cause of recurrence was the implantation of exfoliated cancer cells probably in the suture line. However, there is no established procedure for preventing implantation recurrence currently, the effectiveness of lumen lavage is suggested.