Pathogenesis of recurrences on the suture line following surgical resection for carcinoma of the colon

In digestive cancerology there is a rather high rate of recurrences on the suture line, especially the colo-rectal anastomosis. These recurrences usually are believed to be due to an incidental surgical graft or to a surface graft favored by the operation; however, arguments exist against such an interpretation. The proposed pathogenesis is based upon the early spontaneous migration of cancerous cells in the lymph vessels. At the moment of the surgical operation such cells wander far outside resection limits. Cells brought back at random on the suture line, where the lymphatic network is interrupted, are stopped and their proliferation gives a recurrence. The same mechanism may be responsible for recurrence at bottom of vagina following Wertheim's operation or for recurrence in cutaneous scars after Halsted's suture. This “lymphatic way” hypothesis of spontaneous arrival of cells on suture line after intervention exonerates the surgeon.