Recurrence of Gastric Cancer in the Jejunum Close to the Ana
Due to both the development of novel imaging technologies and specialized endoscopic resection techniques, many patients with mucosal and submucosal gastric cancers have been treated not with conventional surgeries, but with endoscopic mucosal resection or endoscopic submucosal dissection. On the other hand, many patients with invasive gastric cancer still need laparoscopic or open surgery, and some patients, unfortunately, develop locoregional and/or distant recurrence.

A 61-year-old man with anemia and melena was referred to our hospital. Endoscopy showed a polypoid tumor partially covered with coagula in the upper body of the stomach, leading to the diagnosis of gastric adenocarcinoma, tubular well-differentiated type, with forceps biopsies. After imaging studies for staging, the patient underwent laparoscopic total gastrectomy with esophago-jejunostomy. Pathological studies of the resected stomach showed a node-positive (n:6/57) Borrmann type I gastric cancer in the lesser curvature, 68 × 68 mm in size, with tubular and papillary growth extending from the luminal surface to the serosa of the stomach. Both surgical margins were pathologically negative. The patient recovered uneventfully and was discharged on the 9th postoperative day. Due to the massive lymph node involvement, the patient was scheduled to receive adjuvant chemotherapy using capecitabine and oxaliplatin. The patient, however, developed intra-abdominal abscess around the spleen, leading to the readmission with antibiotics therapy and the abandonment of adjuvant chemotherapy.

Only 23 weeks after the operation, the patient again developed melena and anemia (Hb 7.4 g/dL). Gastrointestinal endoscopy revealed an oozing polypoid mass around the anastomotic site. Pathological examination revealed papillary adenocarcinoma similar to that of the primary gastric carcinoma. After confirming no distant and regional metastases and normal tumor marker levels, the patient underwent resection of the presumed recurrence in the jejunum with Roux-en-Y reconstruction. Neither peritoneal dissemination nor lymph node metastases were observed. Macroscopically, the tumor was located in the jejunum 1 cm apart from the anastomotic site. The pathological study showed that the tumor was composed of atypical cells extending from the luminal surface with papillary growth to the muscle layer with tubular growth. Normal jejunal mucosa was observed between the esophagus and the tumor. The patient recovered uneventfully and was discharged 2 weeks after the operation.