内容紹介
Advanced Gastric Cancer(Stage Ⅳ)Leading to Perforation during Chemotherapy with S-1 plus Cisplatin
Summary
A 60-year-old man was diagnosed with advanced gastric cancer(Type 3)with multiple liver and lymph node metastases. The clinical stage was determined to be T3(SS), N2, M1, P0, H1, Stage Ⅳ, and a chemotherapy regimen of S-1 plus cisplatin(CDDP)was selected for treatment. During 3 courses of chemotherapy, the patient complained of severe abdominal pain, and an urgent laparotomy was performed with a tentative diagnosis of perforated gastric cancer. Surgical findings revealed a 5-mm perforation in the upper part of the anterior wall of the stomach, from the center of the tumor. Although we detected a metastasis only in S6 of the liver, we decided to perform total gastrectomy, D1 lymphadenectomy, and Roux-en-Y reconstruction. Pathological findings demonstrated that cancer cells were replaced by fibrosis, and tumor response after treatment was determined to be Grade 2. No lymph node metastasis was observed. The patient received chemotherapy with S-1 4 weeks after the operation, without any perioperative complications. The patient is alive 12 months after the operation, without any enlargement of the liver metastasis.
要旨
症例は60歳,男性。多発肝転移と大動脈周囲リンパ節転移を伴うStage Ⅳ胃癌と診断し,SP療法[S-1+CDDP(S-1 80 mg/m2+CDDP 60 mg/m2)]を開始した。治療効果を認めていたが,3コース目施行中に胃穿孔を起こし緊急手術を施行した。手術所見では,胃体上部前壁に約5 mm大の穿孔部を認め,肝S6のみに転移巣の残存を認めた。原発巣切除術が可能と判断し,胃全摘術(脾臓温存,D1+郭清,Roux-en-Y再建)を施行した。摘出標本では,腫瘍の潰瘍底に穿孔を認め,病理学的所見では,穿孔部の組織学的治療効果判定はGrade 2であり,周囲は瘢痕化していた。郭清リンパ節には転移は認めなかった。術後経過は良好で,術後4週目よりS-1単剤による治療を再開,肝転移巣の増大はなく術後12か月経過,生存中である。
目次
Summary
A 60-year-old man was diagnosed with advanced gastric cancer(Type 3)with multiple liver and lymph node metastases. The clinical stage was determined to be T3(SS), N2, M1, P0, H1, Stage Ⅳ, and a chemotherapy regimen of S-1 plus cisplatin(CDDP)was selected for treatment. During 3 courses of chemotherapy, the patient complained of severe abdominal pain, and an urgent laparotomy was performed with a tentative diagnosis of perforated gastric cancer. Surgical findings revealed a 5-mm perforation in the upper part of the anterior wall of the stomach, from the center of the tumor. Although we detected a metastasis only in S6 of the liver, we decided to perform total gastrectomy, D1 lymphadenectomy, and Roux-en-Y reconstruction. Pathological findings demonstrated that cancer cells were replaced by fibrosis, and tumor response after treatment was determined to be Grade 2. No lymph node metastasis was observed. The patient received chemotherapy with S-1 4 weeks after the operation, without any perioperative complications. The patient is alive 12 months after the operation, without any enlargement of the liver metastasis.
要旨
症例は60歳,男性。多発肝転移と大動脈周囲リンパ節転移を伴うStage Ⅳ胃癌と診断し,SP療法[S-1+CDDP(S-1 80 mg/m2+CDDP 60 mg/m2)]を開始した。治療効果を認めていたが,3コース目施行中に胃穿孔を起こし緊急手術を施行した。手術所見では,胃体上部前壁に約5 mm大の穿孔部を認め,肝S6のみに転移巣の残存を認めた。原発巣切除術が可能と判断し,胃全摘術(脾臓温存,D1+郭清,Roux-en-Y再建)を施行した。摘出標本では,腫瘍の潰瘍底に穿孔を認め,病理学的所見では,穿孔部の組織学的治療効果判定はGrade 2であり,周囲は瘢痕化していた。郭清リンパ節には転移は認めなかった。術後経過は良好で,術後4週目よりS-1単剤による治療を再開,肝転移巣の増大はなく術後12か月経過,生存中である。