術後8か月でport site metastasisを含めた腹膜播種再発をきたした進行S状結腸癌の1例

Peritoneal dissemination with port site metastasis occurring after initial laparoscopic sigmoidectomy

　患者は，61歳，女性．2003年10月に腹腔鏡下S状結腸切除術を行った．術中洗浄細胞診は陰性．下腹部全体に大網の癒着を認め，剥離に難渋した．間膜処理の際，S状結腸間膜を損傷した．2型，4.0×3.8cm，mod，se，n1（＋），stage Ⅲa．2004年6月にCT，PET検査を施行．左下12mmポート留置部に一致した腹壁腫瘤と腹腔内に多発する腫瘤を認め，port site metastasis，腹膜播種再発と診断した．比較的早期にport site metastasisを含めた広範な腹膜播種再発をきたしたことが，腹腔鏡下手術に特徴的な再発の可能性も考えられた．

A 61-years-old woman with sigmoid colon cancer underwent laparoscopic sigmoidectomy at our institution in October, 2003. Inraoperative peritoneal lavage cytology was negative. We had difficulty dissecting the firm ad-hesion of the greater omentum in the lower peritoneal cavity. During the course of extracting the intestine, the mesocolon was damaged. Pathological finding confirmed that the tumor was resected curatively and the staging was T4, N1, M0. Eight months after the initial operation, multiple disseminated tumors and port site recurrence at the right lower abdomen were detected on CT scan and positron emission tomography.