Mesogastrium recurrence as expression of the fifth metastatic route of gastric cancer.

e commend Xie and colleagues [1] on their innovative hypothesis of Metastasis V as the new fifth route used by gastric cancer to develop local recurrence. We would like to lend more support to this topic by reporting our experience. In April 2007, a 70 year-old man was submitted to curative total gastrectomy for adenocarcinoma of stomach fundus staged as pT2b pN1 pM0 G1 according to the AJCC sixth edition. He received adjuvant radiochemotherapy. 6 years later, a 4 cm in length wall thickening of the left half of the transverse colon was evident on abdominal CT scan; endoscopic biopsy revealed adenocarcinoma. At laparotomy, the colonic lesion was observed infiltrating the Roux-en-Y entero-enteric anastomosis tailored 6 years before as well as the adjacent abdominal wall. En-bloc resection of the mass was performed along with restoration of small and large bowel continuity: definitive histology yielded the unsuspected diagnosis of peritoneal metastasis of gastric cancer invading transve