Local recurrence at the site of the Lone Star device through implantation of exfoliated cells during local excision for early rectal cancer: A case report

• Published in: International journal of surgery case reports 2022-04, Vol.93, p.106891-106891, Article 106891
• Main Authors: van Lieshout, A.S., Grüter, A.A.J., Smits, L.J.H., Tanis, P.J., Tuynman, J.B.
• Format: Article
• Language: English
• Subjects: Anal metastasis; Case Report; Implantation of exfoliated cells; Local recurrence; Lone star retractor; Rectal cancer; TAMIS
• ISSN: 2210-2612; 2210-2612
• DOI: 10.1016/j.ijscr.2022.106891

Invasive procedures for colorectal cancer can cause iatrogenic tumor cell seeding. Implantation of these exfoliated cells in the surrounding tissue can result in locoregional cancer recurrence. This has been described in endoscopic procedures and major surgical resections, however recurrence in iatrogenic lesions of the anal canal during minimal invasive rectal surgery has not been shown in literature yet. This is the first reported case of recurrent rectal cancer that developed into an anal metastasis at the site where hooks of the Lone Star Retractor disrupted the epithelial lining of the anal canal during a local excision of early rectal cancer using TAMIS. A 57 year old male was diagnosed with a high risk early stage rectal adenocarcinoma. He was treated with transanal minimally invasive surgery (TAMIS) with the use of a Lone Star retractor and he received subsequent chemo-radiotherapy. 23 months later the patient developed a bleeding mass bulging out of the anus. A true cut and incision biopsy was performed and the pathology report revealed localization of adenocarcinoma at the anal canal which was similar to the earlier diagnosed rectal carcinoma. The patient underwent an abdominal perineal resection and left-sided lymph node dissection. This shows that local recurrence through implantation of exfoliated tumor cells can occur in iatrogenic lesions of the anal canal not only in major but also in minimal invasive rectal surgery. Careful tissue handling and rectal washout may reduce the chance of this implantation metastasis. •Recurrent rectal cancer can occur at the site of an iatrogenic anal lesion.•Anal metastasis can develop due to implantation of exfoliated rectal tumor cells.•Iatrogenic local recurrence occurs in both major rectal surgery and local excision.•Careful tissue handling and rectal washout may reduce the chance of recurrence.