Surg Today DOI 10.1007/s00595-014-1037-7
CASE REPORT
Peritoneal colon cancer metastasis to bilateral inguinal hernia repair sites: report of a case Michihiro Kudou · Yasutoshi Murayama · Hirotaka Konishi · Ryo Morimura · Shuhei Komatsu · Atsushi Shiozaki · Yoshiaki Kuriu · Hisashi Ikoma · Takeshi Kubota · Masayoshi Nakanishi · Daisuke Ichikawa · Hitoshi Fujiwara · Kazuma Okamoto · Chouhei Sakakura · Osamu Kojima · Eigo Otsuji
Received: 4 October 2013 / Accepted: 12 May 2014 © Springer Japan 2014
Abstract We report a rare case of peritoneal metastasis from colon cancer being found in the bilateral sites of inguinal hernia repair. The patient was an 85-year-old man who underwent colonoscopy for a positive fecal occult blood test, with a subsequent diagnosis of ascending colon cancer. He had undergone mesh plug repair for bilateral inguinal hernias at another hospital 6 years previously. We performed laparoscopy-assisted right hemi-colectomy and found nodes in the bilateral scars from the inguinal hernioplasty. Biopsy confirmed that both of the nodes were peritoneal metastasis, leading to the assumption that cancer cells disseminated within the abdominal cavity had been implanted at the repair sites, although the mechanism for this was unclear. A relationship between inflammation and peritoneal metastasis has been reported; thus, we speculated that local inflammation resulting from chronic stimulus of mesh plugs and peritoneal trauma caused peritoneal metastasis at the repair sites. Keywords Peritoneal metastasis · Colon cancer · Inguinal hernia · Inflammation
M. Kudou · Y. Murayama (*) · H. Konishi · R. Morimura · S. Komatsu · A. Shiozaki · Y. Kuriu · H. Ikoma · T. Kubota · M. Nakanishi · D. Ichikawa · H. Fujiwara · K. Okamoto · C. Sakakura · E. Otsuji Division of Digestive Surgery, Department of Surgery, Kyoto Prefectural University of Medicine Graduate School of Medical Science, 465 Kajii-cho Hirokoji Kawaramachi, Kamigyo-ku, Kyoto 602-8566, Japan e-mail: [email protected] O. Kojima Kojima Clinic, 1-1 Sugaharacho, Ikeda-shi, Osaka 563-0055, Japan
Introduction Recent advances in treatments directed at colon cancer have resulted in the combination of chemotherapy and surgery achieving long-term survival, even for patients with advanced disease. Promising results have been reported for stage IV colon cancer patients, especially those with resectable liver metastasis, with 5-year survival rates improving by 8 % from 2001 to 2010 [1, 2]. However, the prognosis of colon cancer patients with peritoneal metastasis remains poor. According to a previous study, 5.0 % of colon cancer patients already have peritoneal metastasis at the time of diagnosis and synchronous peritoneal metastasis is considered an indicator of poor prognosis [3]. Therefore, elucidating the mechanism of peritoneal metastasis and establishing effective therapy is important. Inflammation was reported to be associated with the implantation of cancer cells in the peritoneum. We report a case of peritoneal metastasis found in the bilateral scars of inguinal hernioplasty, which suggests a relationship between the inflammation associated with peritoneal trauma and peritoneal metastasis.
Case report An 85-year-old man, who visited his primary care doctor regularly for management of hyperlipidemia, underwent colonoscopy for investigation of anemia and a positive fecal occult blood test. Based on the colonoscopy biopsy findings, ascending colon cancer, with moderately to welldifferentiated adenocarcinoma was diagnosed (Fig. 1). His medical history included a mesh plug repair for bilateral inguinal hernias, done 6 years previously in another hospital, but there was no history of any other disease.
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Fig. 1 Colonoscopy showed a uniformly elevated tumor in the ascending colon
He was referred to our hospital for further investigations and treatment. We performed contrast-enhanced computed tomography scans (CECT) and positron-emission tomography (PET)-CT scans for staging. CECT showed that the primary tumor was indistinct with no evidence of invasion to other organs (Fig. 2b), the liver hypovascular tumor was at segment 4 (Fig. 2a), there was swelling in the regional lymph nodes (Fig. 2c), and there was a 15-mm node in the right groin area (Fig. 2d). PET-CT revealed high uptake in the primary tumor, liver tumor, and right groin area (Fig. 3a, b, c). We speculated that the liver tumor was metastasis from the ascending colon cancer and that the node in the right groin area was lymph node metastasis, peritoneal metastasis, or the effect of chronic inflammation. We staged the cancer as
Fig. 2 Contrast-enhanced computed tomography (CT) scan findings a A hypovascular tumor was seen in segment 4 of the liver. b The primary tumor was indistinct with no evidence of invasion to other
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Surg Today
T4a, N2a, M1a, Stage IVa based on the 7th edition of the Union for International Cancer Control TNM classification [4]. We scheduled two-stage surgery with neo-adjuvant chemotherapy before the second surgery to achieve radical cure. Laparoscopic-assisted right hemi-colectomy and D3 lymph node dissection were performed for the primary tumor. The operation time was 244 min and blood loss was 70 g. During the surgery, we found nodes in the bilateral scars of the inguinal hernioplasty (Fig. 4a, b, c), but there was no visible sign of other nodes or ascites through the laparoscope. Although we thought that the nodes were probably resectable, this could have resulted in exposing the mesh, which would have necessitated another bilateral inguinal hernia repair. Therefore, we decided that if both nodes were diagnosed as peritoneal metastasis on biopsy we would resect them simultaneously with repair of the bilateral hernia again for R0 resection in the second surgery for liver metastasis. Furthermore, we would check for other peritoneal metastasis in the abdominal cavity during the laparotomy in the second surgery. The pathological diagnosis was moderately to welldifferentiated adenocarcinoma (50 × 32 mm) invading the subserosa (T3). Three of the 28 dissected regional lymph nodes were positive for metastasis (N1b). Lymphatic invasion was negative and venous invasion was positive. Both of the peritoneal nodes were metastasis (M1b) (Fig. 5a, b). The pathological stage was redefined retrospectively as stage IVb. Because the excised
organs. c Swelling was observed in the regional lymph nodes (arrow). d A 15-mm node was seen in the right groin area (arrow)
Surg Today
Fig. 3 Positron-emission tomography (PET)-CT scan showed high uptake by the liver tumor in segment 4 (a), the primary tumor (b), and a node in the right groin area (c)
Fig. 4 Laparoscopic imaging findings. a Two nodes were found in the bilateral scars of inguinal hernioplasty (arrow). No other nodes were found in the abdominal cavity. b Close-up image of the right node. c Close-up image of the left node
peritoneal metastases were too small, we could not check the background of the nodes for chronic inflammation in the peritoneum around the repair sites and to see if the mesh had been exposed. The patient was discharged from hospital after an uneventful recovery. He received XELOX (oxaliplatin and capecitabine) as neo-adjuvant chemotherapy in preparation for the second surgery for hepatectomy, but this was discontinued because he suffered nausea and anorexia. After this event, he and his family decided against the second surgery and the curative therapy because of his advanced age. At the time of writing, 8 months after his operation, the patient is just taking capecitabine and tumor progression is being controlled.
Discussion Most previous reports, mainly case reports, of peritoneal metastasis implanted or prolapsed into the hernia sac, have described the relationship between peritoneal metastasis associated with colon cancer and inguinal hernia [5, 6]. Case reports of peritoneal metastasis to the repair sites of inguinal hernia, as in the present case, are rare: to the best of our knowledge, only three other cases have been reported. In two of these cases, metastasis was attributed to gastroenterological cancer, and in one, to malignant lymphoma [7–9]. The present case is the first of peritoneal metastasis to “bilateral” repair sites. We found the nodes in the bilateral scars of inguinal hernioplasty incidentally,
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Surg Today
Fig. 5 Microscopic examinations revealed that the primary tumor was moderately to well-differentiated adenocarcinoma, involving the cecum and terminal ileum, and invading the subserosa (a). Both
of the peritoneal nodes were attributed to peritoneal metastasis (b). (hematoxylin and eosin stainings,×1)
during laparoscopic surgery, which was continued because we did not suspect peritoneal dissemination, although any other metastatic lesions in the abdominal cavity might have prompted conversion to laparotomy. The likelihood of peritoneal metastasis developing in bilateral repair sites is very low; therefore, other factors may have contributed to the implantation and growth of tumor cells in this location. These factors may include chronic inflammation of the mesh plug or peritoneal trauma. Two routes have been suggested for peritoneal metastasis [10]. The first is direct adhesion, in which tumor cells disseminate into the abdominal cavity, then adhere to mesothelial cells or endothelial cells, whereby peritoneal metastasis develops through a multistep process. The second is the lymphogenous route, in which disseminated tumor cells invade lymph vessels through stomata, the origin of lymph vessels, and proliferare at the sub-mesothelial lymph sinus. The peritoneal metastasis in our patient may have been initiated through these routes. The relationship between inflammation and peritoneal metastasis has been reported. Yu et al. [11] demonstrated that inflammatory cytokines (IL-1β and TNF-α) enhanced tumor cell adhesion in biological tests. Peritoneal trauma may also enhance peritoneal metastasis. Van den Tol et al. [12] reported that the inflammatory response to surgical trauma enhanced tumor recurrence and that neutrophils played an important role in this process. Nishizaki et al. [13] reported that human catalase derivatives enhance this response. Ceelen et al. [14] summarized the molecular mechanisms and potential preventive measures associated with each step of the peritoneal metastatic cascade. They reported that inflammation cytokines (TNF-α, IL1-β, and IL-6) and epidermal growth factor (EGF) enhanced the expression of ICAM-1 and other adhesion molecules on mesothelial cells, which resulted in the adherence of tumor cells. Moreover, mesothelial cells produce heparin-binding
growth factors namely, basic fibroblast growth factor, heparin-binding EGF-like growth factor, and two spliced variants of VEGF, which are upregulated by IL-1β, TNF-α, and IL-1β. They suggested that growth factors may stimulate peritoneal tumor growth. Wound exudation on the peritoneal surface may also promote tumor growth by entrapping malignant cells by fibrin clots [14]. In summary, although the mechanism of peritoneal metastasis at bilateral repair sites remains unclear, we speculate that chronic inflammation and peritoneal trauma contributed to the implantation of tumor cells in this unusual location. This case appears to support the relationship between inflammation associated with peritoneal trauma, and peritoneal metastasis.
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Conflict of interest Michihiro Kudou and other co-authors have no conflict interest.
References 1. Simmonds PC, Primrose LN, Colquitt JL, Poston GJ, Rees M. Surgical resection of hepatic metastases from colorectal cancer: a systematic review of published studies. Br J Cancer. 2006;94:982–99. 2. Kanas GP, Taylor A, Primrose JN, Langeberg WL, Kelsh MA, et al. Survival after liver resection in metastatic colorectal cancer: review and meta-analysis of prognostic factors. Clin Epidemiol. 2012;4:283–301. 3. Watanabe T, Itabashi M, Shimada Y, Tanaka S, Ito Y, Ajioka Y, et al. Japanese Society for Cancer of the Colon and Rectum (JSCCR) guidelines 2010 for the treatment of colorectal cancer. Int J Clin Oncol. 2012;17(1):1–29. 4. Union for International Cancer Control, TNM Classification of Malignant Tumours. 7th edition, (2009). 5. Takahisa H, Jiro N, Tetsuo N, Eiji O, Takahiro M, et al. A case of sigmoid colon carcinoma presented with a strangulated inguinal hernia. J Jpn Surg Assoc. 2009;70(9):2751–5. 6. Suefumi A, Yoshimasa W, Kotaro N, Takeshi S, Taro Y, et al. A case of transverse colon carcinoma metastasized to an inguinal hernia SAC. J Jpn Surg Assoc. 2008;69(9):2337–40.
Surg Today 7. Masato I, Yukifumi K, Hiroyuki M, Kuniaki O, Shouhei O, Hiroyuki I, et al. Distant peritoneal metastasis to a mesh-plug prosthesis in gastrointestinal cancer patient: report of a case. Surg Today. 2003;33:864–6. 8. Bouillot JL, Aouad K, Alexandre JH. Parietal mesh abscess as an original presentation of cancer of the caecum. Dig Surg. 1999;16:158–60. 9. Pocard M, Vaillant JC, Fritsch S, Aoudjhane M, Najman A, Parc R. Possible first report of distant peritoneal metastases from a nodal mesenteric lymphoma after laparoscopic inguinal hernia repair. Eur J Surg Oncol. 1999;25(6):635–6. 10. Yutaka Y, Yoshio E. Molecular mechanism of peritoneal metastasis: review. JPN J Gastroenterol. 2000;97:680–90. 11. Yu G, Tang B, Yu PW, Peng ZH, Qian F, Sun G, et al. Systemic and peritoneal inflammatory response after laparoscopic-assisted
gastrectomy and the effect of inflammatory cytokines on adhesion of gastric cancer cells to peritoneal mesothelial cells. Surg Endosc. 2010;24:2860–70. 12. van den Tol MP, ten Raa S, van Grevenstein WM, van Rossen ME, Jeekel J, van Eijck CH. The post-surgical inflammatory response provokes enhanced tumour recurrence: a crucial role for neutrophils. Dig Surg. 2007;24:388–94. 13. Nishizaki C, Nishikawa M, Yata T, Yamada T, Takahashi Y, Oku M, et al. Inhibition of surgical trauma-enhanced peritoneal dissemination of tumor cells by human catalase derivatives in mice. Free Radic Biol Med. 2011;51:773–9. 14. Ceelen WP, Bracke ME. Peritoneal minimal residual disease in colorectal cancer: mechanisms, prevention, and treatment. Lancet Oncol. 2009;10:72–9.
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CASE REPORT
Peritoneal colon cancer metastasis to bilateral inguinal hernia repair sites: report of a case Michihiro Kudou · Yasutoshi Murayama · Hirotaka Konishi · Ryo Morimura · Shuhei Komatsu · Atsushi Shiozaki · Yoshiaki Kuriu · Hisashi Ikoma · Takeshi Kubota · Masayoshi Nakanishi · Daisuke Ichikawa · Hitoshi Fujiwara · Kazuma Okamoto · Chouhei Sakakura · Osamu Kojima · Eigo Otsuji
Received: 4 October 2013 / Accepted: 12 May 2014 © Springer Japan 2014
Abstract We report a rare case of peritoneal metastasis from colon cancer being found in the bilateral sites of inguinal hernia repair. The patient was an 85-year-old man who underwent colonoscopy for a positive fecal occult blood test, with a subsequent diagnosis of ascending colon cancer. He had undergone mesh plug repair for bilateral inguinal hernias at another hospital 6 years previously. We performed laparoscopy-assisted right hemi-colectomy and found nodes in the bilateral scars from the inguinal hernioplasty. Biopsy confirmed that both of the nodes were peritoneal metastasis, leading to the assumption that cancer cells disseminated within the abdominal cavity had been implanted at the repair sites, although the mechanism for this was unclear. A relationship between inflammation and peritoneal metastasis has been reported; thus, we speculated that local inflammation resulting from chronic stimulus of mesh plugs and peritoneal trauma caused peritoneal metastasis at the repair sites. Keywords Peritoneal metastasis · Colon cancer · Inguinal hernia · Inflammation
M. Kudou · Y. Murayama (*) · H. Konishi · R. Morimura · S. Komatsu · A. Shiozaki · Y. Kuriu · H. Ikoma · T. Kubota · M. Nakanishi · D. Ichikawa · H. Fujiwara · K. Okamoto · C. Sakakura · E. Otsuji Division of Digestive Surgery, Department of Surgery, Kyoto Prefectural University of Medicine Graduate School of Medical Science, 465 Kajii-cho Hirokoji Kawaramachi, Kamigyo-ku, Kyoto 602-8566, Japan e-mail: [email protected] O. Kojima Kojima Clinic, 1-1 Sugaharacho, Ikeda-shi, Osaka 563-0055, Japan
Introduction Recent advances in treatments directed at colon cancer have resulted in the combination of chemotherapy and surgery achieving long-term survival, even for patients with advanced disease. Promising results have been reported for stage IV colon cancer patients, especially those with resectable liver metastasis, with 5-year survival rates improving by 8 % from 2001 to 2010 [1, 2]. However, the prognosis of colon cancer patients with peritoneal metastasis remains poor. According to a previous study, 5.0 % of colon cancer patients already have peritoneal metastasis at the time of diagnosis and synchronous peritoneal metastasis is considered an indicator of poor prognosis [3]. Therefore, elucidating the mechanism of peritoneal metastasis and establishing effective therapy is important. Inflammation was reported to be associated with the implantation of cancer cells in the peritoneum. We report a case of peritoneal metastasis found in the bilateral scars of inguinal hernioplasty, which suggests a relationship between the inflammation associated with peritoneal trauma and peritoneal metastasis.
Case report An 85-year-old man, who visited his primary care doctor regularly for management of hyperlipidemia, underwent colonoscopy for investigation of anemia and a positive fecal occult blood test. Based on the colonoscopy biopsy findings, ascending colon cancer, with moderately to welldifferentiated adenocarcinoma was diagnosed (Fig. 1). His medical history included a mesh plug repair for bilateral inguinal hernias, done 6 years previously in another hospital, but there was no history of any other disease.
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Fig. 1 Colonoscopy showed a uniformly elevated tumor in the ascending colon
He was referred to our hospital for further investigations and treatment. We performed contrast-enhanced computed tomography scans (CECT) and positron-emission tomography (PET)-CT scans for staging. CECT showed that the primary tumor was indistinct with no evidence of invasion to other organs (Fig. 2b), the liver hypovascular tumor was at segment 4 (Fig. 2a), there was swelling in the regional lymph nodes (Fig. 2c), and there was a 15-mm node in the right groin area (Fig. 2d). PET-CT revealed high uptake in the primary tumor, liver tumor, and right groin area (Fig. 3a, b, c). We speculated that the liver tumor was metastasis from the ascending colon cancer and that the node in the right groin area was lymph node metastasis, peritoneal metastasis, or the effect of chronic inflammation. We staged the cancer as
Fig. 2 Contrast-enhanced computed tomography (CT) scan findings a A hypovascular tumor was seen in segment 4 of the liver. b The primary tumor was indistinct with no evidence of invasion to other
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Surg Today
T4a, N2a, M1a, Stage IVa based on the 7th edition of the Union for International Cancer Control TNM classification [4]. We scheduled two-stage surgery with neo-adjuvant chemotherapy before the second surgery to achieve radical cure. Laparoscopic-assisted right hemi-colectomy and D3 lymph node dissection were performed for the primary tumor. The operation time was 244 min and blood loss was 70 g. During the surgery, we found nodes in the bilateral scars of the inguinal hernioplasty (Fig. 4a, b, c), but there was no visible sign of other nodes or ascites through the laparoscope. Although we thought that the nodes were probably resectable, this could have resulted in exposing the mesh, which would have necessitated another bilateral inguinal hernia repair. Therefore, we decided that if both nodes were diagnosed as peritoneal metastasis on biopsy we would resect them simultaneously with repair of the bilateral hernia again for R0 resection in the second surgery for liver metastasis. Furthermore, we would check for other peritoneal metastasis in the abdominal cavity during the laparotomy in the second surgery. The pathological diagnosis was moderately to welldifferentiated adenocarcinoma (50 × 32 mm) invading the subserosa (T3). Three of the 28 dissected regional lymph nodes were positive for metastasis (N1b). Lymphatic invasion was negative and venous invasion was positive. Both of the peritoneal nodes were metastasis (M1b) (Fig. 5a, b). The pathological stage was redefined retrospectively as stage IVb. Because the excised
organs. c Swelling was observed in the regional lymph nodes (arrow). d A 15-mm node was seen in the right groin area (arrow)
Surg Today
Fig. 3 Positron-emission tomography (PET)-CT scan showed high uptake by the liver tumor in segment 4 (a), the primary tumor (b), and a node in the right groin area (c)
Fig. 4 Laparoscopic imaging findings. a Two nodes were found in the bilateral scars of inguinal hernioplasty (arrow). No other nodes were found in the abdominal cavity. b Close-up image of the right node. c Close-up image of the left node
peritoneal metastases were too small, we could not check the background of the nodes for chronic inflammation in the peritoneum around the repair sites and to see if the mesh had been exposed. The patient was discharged from hospital after an uneventful recovery. He received XELOX (oxaliplatin and capecitabine) as neo-adjuvant chemotherapy in preparation for the second surgery for hepatectomy, but this was discontinued because he suffered nausea and anorexia. After this event, he and his family decided against the second surgery and the curative therapy because of his advanced age. At the time of writing, 8 months after his operation, the patient is just taking capecitabine and tumor progression is being controlled.
Discussion Most previous reports, mainly case reports, of peritoneal metastasis implanted or prolapsed into the hernia sac, have described the relationship between peritoneal metastasis associated with colon cancer and inguinal hernia [5, 6]. Case reports of peritoneal metastasis to the repair sites of inguinal hernia, as in the present case, are rare: to the best of our knowledge, only three other cases have been reported. In two of these cases, metastasis was attributed to gastroenterological cancer, and in one, to malignant lymphoma [7–9]. The present case is the first of peritoneal metastasis to “bilateral” repair sites. We found the nodes in the bilateral scars of inguinal hernioplasty incidentally,
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Surg Today
Fig. 5 Microscopic examinations revealed that the primary tumor was moderately to well-differentiated adenocarcinoma, involving the cecum and terminal ileum, and invading the subserosa (a). Both
of the peritoneal nodes were attributed to peritoneal metastasis (b). (hematoxylin and eosin stainings,×1)
during laparoscopic surgery, which was continued because we did not suspect peritoneal dissemination, although any other metastatic lesions in the abdominal cavity might have prompted conversion to laparotomy. The likelihood of peritoneal metastasis developing in bilateral repair sites is very low; therefore, other factors may have contributed to the implantation and growth of tumor cells in this location. These factors may include chronic inflammation of the mesh plug or peritoneal trauma. Two routes have been suggested for peritoneal metastasis [10]. The first is direct adhesion, in which tumor cells disseminate into the abdominal cavity, then adhere to mesothelial cells or endothelial cells, whereby peritoneal metastasis develops through a multistep process. The second is the lymphogenous route, in which disseminated tumor cells invade lymph vessels through stomata, the origin of lymph vessels, and proliferare at the sub-mesothelial lymph sinus. The peritoneal metastasis in our patient may have been initiated through these routes. The relationship between inflammation and peritoneal metastasis has been reported. Yu et al. [11] demonstrated that inflammatory cytokines (IL-1β and TNF-α) enhanced tumor cell adhesion in biological tests. Peritoneal trauma may also enhance peritoneal metastasis. Van den Tol et al. [12] reported that the inflammatory response to surgical trauma enhanced tumor recurrence and that neutrophils played an important role in this process. Nishizaki et al. [13] reported that human catalase derivatives enhance this response. Ceelen et al. [14] summarized the molecular mechanisms and potential preventive measures associated with each step of the peritoneal metastatic cascade. They reported that inflammation cytokines (TNF-α, IL1-β, and IL-6) and epidermal growth factor (EGF) enhanced the expression of ICAM-1 and other adhesion molecules on mesothelial cells, which resulted in the adherence of tumor cells. Moreover, mesothelial cells produce heparin-binding
growth factors namely, basic fibroblast growth factor, heparin-binding EGF-like growth factor, and two spliced variants of VEGF, which are upregulated by IL-1β, TNF-α, and IL-1β. They suggested that growth factors may stimulate peritoneal tumor growth. Wound exudation on the peritoneal surface may also promote tumor growth by entrapping malignant cells by fibrin clots [14]. In summary, although the mechanism of peritoneal metastasis at bilateral repair sites remains unclear, we speculate that chronic inflammation and peritoneal trauma contributed to the implantation of tumor cells in this unusual location. This case appears to support the relationship between inflammation associated with peritoneal trauma, and peritoneal metastasis.
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Conflict of interest Michihiro Kudou and other co-authors have no conflict interest.
References 1. Simmonds PC, Primrose LN, Colquitt JL, Poston GJ, Rees M. Surgical resection of hepatic metastases from colorectal cancer: a systematic review of published studies. Br J Cancer. 2006;94:982–99. 2. Kanas GP, Taylor A, Primrose JN, Langeberg WL, Kelsh MA, et al. Survival after liver resection in metastatic colorectal cancer: review and meta-analysis of prognostic factors. Clin Epidemiol. 2012;4:283–301. 3. Watanabe T, Itabashi M, Shimada Y, Tanaka S, Ito Y, Ajioka Y, et al. Japanese Society for Cancer of the Colon and Rectum (JSCCR) guidelines 2010 for the treatment of colorectal cancer. Int J Clin Oncol. 2012;17(1):1–29. 4. Union for International Cancer Control, TNM Classification of Malignant Tumours. 7th edition, (2009). 5. Takahisa H, Jiro N, Tetsuo N, Eiji O, Takahiro M, et al. A case of sigmoid colon carcinoma presented with a strangulated inguinal hernia. J Jpn Surg Assoc. 2009;70(9):2751–5. 6. Suefumi A, Yoshimasa W, Kotaro N, Takeshi S, Taro Y, et al. A case of transverse colon carcinoma metastasized to an inguinal hernia SAC. J Jpn Surg Assoc. 2008;69(9):2337–40.
Surg Today 7. Masato I, Yukifumi K, Hiroyuki M, Kuniaki O, Shouhei O, Hiroyuki I, et al. Distant peritoneal metastasis to a mesh-plug prosthesis in gastrointestinal cancer patient: report of a case. Surg Today. 2003;33:864–6. 8. Bouillot JL, Aouad K, Alexandre JH. Parietal mesh abscess as an original presentation of cancer of the caecum. Dig Surg. 1999;16:158–60. 9. Pocard M, Vaillant JC, Fritsch S, Aoudjhane M, Najman A, Parc R. Possible first report of distant peritoneal metastases from a nodal mesenteric lymphoma after laparoscopic inguinal hernia repair. Eur J Surg Oncol. 1999;25(6):635–6. 10. Yutaka Y, Yoshio E. Molecular mechanism of peritoneal metastasis: review. JPN J Gastroenterol. 2000;97:680–90. 11. Yu G, Tang B, Yu PW, Peng ZH, Qian F, Sun G, et al. Systemic and peritoneal inflammatory response after laparoscopic-assisted
gastrectomy and the effect of inflammatory cytokines on adhesion of gastric cancer cells to peritoneal mesothelial cells. Surg Endosc. 2010;24:2860–70. 12. van den Tol MP, ten Raa S, van Grevenstein WM, van Rossen ME, Jeekel J, van Eijck CH. The post-surgical inflammatory response provokes enhanced tumour recurrence: a crucial role for neutrophils. Dig Surg. 2007;24:388–94. 13. Nishizaki C, Nishikawa M, Yata T, Yamada T, Takahashi Y, Oku M, et al. Inhibition of surgical trauma-enhanced peritoneal dissemination of tumor cells by human catalase derivatives in mice. Free Radic Biol Med. 2011;51:773–9. 14. Ceelen WP, Bracke ME. Peritoneal minimal residual disease in colorectal cancer: mechanisms, prevention, and treatment. Lancet Oncol. 2009;10:72–9.
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