A Case Report of Surgical Resections with Local and Systemic Chemotherapy for Three Recurrences of Colon Cancer Occurring Ten Years after Colectomy

A 56-year-old Japanese woman who underwent a curative resection of ascending colon cancer at 43 years of age was found to have a tumor in her lower left abdominal cavity by computed tomography at 53 years of age. The tumor in the omentum was resected and identified as an adenocarcinoma compatible with metastasis from the primary ascending colon cancer. Although the patient received adjuvant chemotherapy with tegafur uracil and calcium folinate, liver metastasis was detected 9 months after the first recurrence. A segmentectomy and hepatectomy was performed, and histopathological findings indicated metastasis from the primary colon cancer. A third recurrence was detected in the right abdominal cavity 7 months after the second surgery. The patient received 5 cycles of combination chemotherapy consisting of folinic acid, fluorouracil and irinotecan before the third operation. The metastatic tumor resection together with intraperitoneal chemotherapy was performed, and histopathological findings indicated metastasis from the primary colon cancer. After the third surgery, the patient received adjuvant chemotherapy consisting of 5 cycles of folinic acid, fluorouracil and oxaliplatin. The patient is well with no evidence of recurrence 12 months after the third recurrence. This case suggests that colon cancer can be dormant for over 10 years and that long-term follow-up is required after curative resection. Aggressive local as well as systemic chemotherapy may be required for the management of colon cancer recurrence.