内容紹介
A Case of Locally Advanced Gastric Cancer in Which the Patient Underwent Curative Gastrectomy after Treatment with Systemic Chemotherapy with Bi-Weekly S-1/Docetaxel
Summary
Here, we report the case of a patient with advanced gastric cancer complicated by pyloric stenosis and direct invasion into the pancreas who underwent curative resection after bi-weekly S-1/docetaxel(DS)therapy after gastrojejunostomy. A 73-year-old man consulted a general practitioner because of indigestibility, and upper gastrointestinal endoscopy indicated gastric cancer. He was referred to our hospital. Gastric cancer, whole stomach tumor(LMU), 150×80 mm, Type 3, T4a(SE), N2, M0, stageⅢB was diagnosed, and surgery was performed. The tumor was seen to directly invade the pancreas and the middle colic artery intraoperatively, so only a gastrojejunostomy was performed. After the operation, the patient was treated with DS therapy for 13 courses, and the response was defined as non-complete response(CR)and non-progressive disease(PD). During the second laparotomy, a curative operation was performed via distal gastrectomy because frozen-section diagnosis revealed that no cancer cells were present at the oral margin. Postoperatively, the tumor was diagnosed as LM, 10×7 mm, 10×2.5 mm, pType 4, pT2(MP), pN0, pM0, CY0, stageⅠB. The patient is now receiving S-1 adjuvant chemotherapy and is still alive 2 years and 4 months after the first operation.
要旨
初回手術時に非切除となり胃空腸吻合を施行したが,bi-weekly S-1/docetaxel(DS)療法後に根治手術を施行し得た局所進行胃癌の1例を経験したので報告する。患者は73歳,男性。胃もたれあり前医を受診,幽門狭窄伴う進行胃癌にて手術目的に紹介された。LMU,Circ,150×80 mm,Type 3,T4a(SE),N2,M0,stageⅢBの診断で手術を施行した。しかし膵,中結腸動脈に浸潤を認め,Devine gastrojejunostomyを施行した。DS療法13コース施行後画像上non-CR/non-PD,ycT4a(SE),N1,M0,stageⅢBと診断し,初回手術から1年9か月後再手術を施行した。肉眼的に癌は消失し,迅速診断で断端陰性を確認し,Devineの切離ラインを延長し幽門側胃切除術を施行した。胃内容停滞を認めたが保存的に軽快し術後29日で退院。病理標本では胃壁は全層で線維化し,粘膜筋板および固有筋層に腫瘍が島状に残存し,LM,10×7 mm,10×2.5 mm,pType 4,pT2(MP),pN0,pM0,CY0,p-stageⅠBであり,化学療法の効果判定はGrade 2であった。術後S-1を内服し,術後6か月の現在無再発生存中である。切除不能と判断されても新規レジメンが奏効した症例では,根治切除可能となることがあることを念頭に置き手術を考慮すべきである。
目次
Summary
Here, we report the case of a patient with advanced gastric cancer complicated by pyloric stenosis and direct invasion into the pancreas who underwent curative resection after bi-weekly S-1/docetaxel(DS)therapy after gastrojejunostomy. A 73-year-old man consulted a general practitioner because of indigestibility, and upper gastrointestinal endoscopy indicated gastric cancer. He was referred to our hospital. Gastric cancer, whole stomach tumor(LMU), 150×80 mm, Type 3, T4a(SE), N2, M0, stageⅢB was diagnosed, and surgery was performed. The tumor was seen to directly invade the pancreas and the middle colic artery intraoperatively, so only a gastrojejunostomy was performed. After the operation, the patient was treated with DS therapy for 13 courses, and the response was defined as non-complete response(CR)and non-progressive disease(PD). During the second laparotomy, a curative operation was performed via distal gastrectomy because frozen-section diagnosis revealed that no cancer cells were present at the oral margin. Postoperatively, the tumor was diagnosed as LM, 10×7 mm, 10×2.5 mm, pType 4, pT2(MP), pN0, pM0, CY0, stageⅠB. The patient is now receiving S-1 adjuvant chemotherapy and is still alive 2 years and 4 months after the first operation.
要旨
初回手術時に非切除となり胃空腸吻合を施行したが,bi-weekly S-1/docetaxel(DS)療法後に根治手術を施行し得た局所進行胃癌の1例を経験したので報告する。患者は73歳,男性。胃もたれあり前医を受診,幽門狭窄伴う進行胃癌にて手術目的に紹介された。LMU,Circ,150×80 mm,Type 3,T4a(SE),N2,M0,stageⅢBの診断で手術を施行した。しかし膵,中結腸動脈に浸潤を認め,Devine gastrojejunostomyを施行した。DS療法13コース施行後画像上non-CR/non-PD,ycT4a(SE),N1,M0,stageⅢBと診断し,初回手術から1年9か月後再手術を施行した。肉眼的に癌は消失し,迅速診断で断端陰性を確認し,Devineの切離ラインを延長し幽門側胃切除術を施行した。胃内容停滞を認めたが保存的に軽快し術後29日で退院。病理標本では胃壁は全層で線維化し,粘膜筋板および固有筋層に腫瘍が島状に残存し,LM,10×7 mm,10×2.5 mm,pType 4,pT2(MP),pN0,pM0,CY0,p-stageⅠBであり,化学療法の効果判定はGrade 2であった。術後S-1を内服し,術後6か月の現在無再発生存中である。切除不能と判断されても新規レジメンが奏効した症例では,根治切除可能となることがあることを念頭に置き手術を考慮すべきである。