Ultra-late recurrences of gastro-intestinal carcinoma after primary resection : the mechanism of dormancy

Curative resection of limited gastro-intestinal carcinoma does not always mean curation with tumor-free long-term survival. We present two cases of ultra-late recurrence 14 years after initial treatment. In the first case a 50-year-old male underwent in 1997 a subtotal esophagectomy with tubulation of the stomach for a local- ized Barrett carcinoma. Postoperative staging showed a poorly dif- ferentiated adenocarcinoma, pT1N1 (stage IIB). In May 2011, 14 years after the initial resection, multiple bone metastases were di- agnosed and a biopsy confirmed the poorly differentiated carcino- ma with the same characteristics as the primary tumor. Investiga- tions showed no evidence for a new primary tumor. The second case is a 52-year old man who underwent a low ante- rior resection for a small rectal cancer in 1997, histologically a well differentiated adenocarcinoma, stage IB (pT2N0). In December 2011 multiple metastases were diagnosed and a biopsy showed a metastasis from a mucinous carcinoma, suggestive for a colorectal carcinoma. There was also no evidence for a new primary tumor. Although the prognosis of limited esophageal and colorectal cancer is good, recurrence is always possible and an ultra-late recurrence may exceptionally occur. The mechanism of tumor dormancy is described. (Acta gastroenterol. belg., 2013, 76, 251-254).