内容紹介
Successful Treatment of a Patient Using mFOLFOX6 after Laparoscopic Surgery for Rectal Cancer with Peritoneal Dissemination
Summary
A 58-year-old man underwent laparoscopic surgery for rectal cancer(rectal sigmoid)complicated by intestinal obstruction. He had no liver metastasis. Although many nodules suspected to have arisen from peritoneal dissemination were observed in the pelvic cavity, we performed anterior resection assuming that the primary lesion was resectable. The surgical findings were sSE, sN2, sP3, sStage Ⅳ, and histopathological findings were signet-ring cell carcinoma, pSE, pN2, pP+, pStage Ⅳ. After 8 courses of adjuvant chemotherapy with modified 5-fluorouracil/Leucovorin/oxaliplatin(mFOLFOX6), carcinoembryonic antigen(CEA)decreased to a normal level, and positron emission tomography-computed tomography(PET-CT)showed no abnormal accumulation that suggested metastasis. To evaluate the effectiveness of this procedure, laparoscopic peritoneal biopsy was performed 5 months after surgery, revealing histopathological disappearance of the peritoneal dissemination lesion. The patient has been followed up and has been receiving S-1 for 1 year after the first surgery. No evidence of recurrence has been observed.
要旨
症例は58歳,男性。腸閉塞を伴う直腸癌(RS)に対して腹腔鏡下に手術を行った。肝転移はなく,骨盤腔内に腹膜播種を疑う多数の結節を認めたが,主病巣は切除可能と判断し前方切除術を施行した。手術所見はsSE,sN2,sP3,sStage Ⅳで,病理組織学的にはsignet-ring cell carcinoma,pSE,pN2,pP+,pStageⅣであった。術後補助化学療法としてmFOLFOX6療法を計8コース施行したところCEAは正常化し,PET-CTでも転移を疑う異常集積を認めなかった。効果判定のため術5か月後に腹腔鏡下腹膜生検術を施行し,病理組織学的に腹膜播種病巣の消失を認めた。現在初回手術後1年が経過し,S-1投与にて経過観察中であるが再発を認めていない。
目次
Summary
A 58-year-old man underwent laparoscopic surgery for rectal cancer(rectal sigmoid)complicated by intestinal obstruction. He had no liver metastasis. Although many nodules suspected to have arisen from peritoneal dissemination were observed in the pelvic cavity, we performed anterior resection assuming that the primary lesion was resectable. The surgical findings were sSE, sN2, sP3, sStage Ⅳ, and histopathological findings were signet-ring cell carcinoma, pSE, pN2, pP+, pStage Ⅳ. After 8 courses of adjuvant chemotherapy with modified 5-fluorouracil/Leucovorin/oxaliplatin(mFOLFOX6), carcinoembryonic antigen(CEA)decreased to a normal level, and positron emission tomography-computed tomography(PET-CT)showed no abnormal accumulation that suggested metastasis. To evaluate the effectiveness of this procedure, laparoscopic peritoneal biopsy was performed 5 months after surgery, revealing histopathological disappearance of the peritoneal dissemination lesion. The patient has been followed up and has been receiving S-1 for 1 year after the first surgery. No evidence of recurrence has been observed.
要旨
症例は58歳,男性。腸閉塞を伴う直腸癌(RS)に対して腹腔鏡下に手術を行った。肝転移はなく,骨盤腔内に腹膜播種を疑う多数の結節を認めたが,主病巣は切除可能と判断し前方切除術を施行した。手術所見はsSE,sN2,sP3,sStage Ⅳで,病理組織学的にはsignet-ring cell carcinoma,pSE,pN2,pP+,pStageⅣであった。術後補助化学療法としてmFOLFOX6療法を計8コース施行したところCEAは正常化し,PET-CTでも転移を疑う異常集積を認めなかった。効果判定のため術5か月後に腹腔鏡下腹膜生検術を施行し,病理組織学的に腹膜播種病巣の消失を認めた。現在初回手術後1年が経過し,S-1投与にて経過観察中であるが再発を認めていない。