Abstract
Metastasis to the abdominal wall including port sites after laparoscopic surgery for colorectal cancer is rare. Resection of metastatic lesions may lead to greater survival benefit if the abdominal wall metastasis is the only manifestation of recurrent disease. A 57-year-old man, who underwent laparoscopic surgery for advanced mucinous adenocarcinoma of the cecum 6 years prior, developed a nodule in the surgical wound at the lower right abdomen. Although tumor markers were within normal limits, the metastasis to the abdominal wall and abdominal cavity from the previous cecal cancer was suspected. An abdominal computed tomography scan did not provide detective evidence of metastasis. 18F-fluorodeoxyglucose positron emission/computed tomography (18F-FDG PET/CT) was therefore performed, which demonstrated increased 18F-fluorodeoxyglucose uptake (maximum standardized uptake value: 3.1) in the small abdominal wall nodule alone. Histopathological examination of the resected nodule confirmed the diagnosis of metastatic mucinous adenocarcinoma. Prognosis of intestinal mucinous adenocarcinoma is reported to be poorer than that of non-mucinous adenocarcinoma. In conclusion, this case suggests an important role of 18F-FDG PET/CT in early diagnosis and decision-making regarding therapy for recurrent disease in cases where a firm diagnosis of recurrent colorectal cancer is difficult to make.
Highlights
Metastasis to the abdominal wall including port sites after laparoscopic surgery for colorectal carcinoma (CRC) is rare
The rate was reported as 1.3% in a randomized clinical trial by the Colon Cancer Laparoscopic or Open Resection Study Group [1] and 2.4% in the CLASSIC trial [2]
We report a case in which 18Ffluorodeoxyglucose positron emission/computed tomography (18F-FDG PET/CT) was very useful for early diagnosis and planning a theraupetic strategy for a case of mucinous adenocarcinoma metastasis at a laparoscopic port site
Summary
Metastasis to the abdominal wall including port sites after laparoscopic surgery for colorectal carcinoma (CRC) is rare. The prognosis is not clearly defined in the literature, resection of metastatic lesions may lead to greater survival benefit if the abdominal wall metastasis is the only manifestation of recurrent disease. It can be difficult to diagnose a lesion in the abdominal wall as recurrence of disease on the basis of clinical characteristics alone. In November 2008, an abdominal computed tomography (CT) scan revealed a small nodule in the abdominal wall, which was difficult to interpret as metastasis of the cecal cancer (Figure 1). For the PET scan, the patient, whose blood glucose level was 103 mg/dl, received 181.8 MBq of 18F-FDG intraverously. The small nodule was diagnosed as a solitary metastasis of the cecal cancer at the previous port site (Figure 2).
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