内容紹介
A Case of Advanced Transverse Colon Cancer with Nephrotic Syndrome Treated with Curative Resection and Complete Adjuvant Chemotherapy
Summary
A 74-year-old woman was diagnosed as having transverse colon cancer after diagnosis of nephrotic syndrome caused by membranous nephropathy. Although she had hypoproteinemia and hypoalbuminemia, we judged that she had no major nutritional problem. In previous, similar case reports, the use of human serum albumin and fresh-frozen plasma was suggested to be important to avoid complications in the perioperative period. Thus, we used the same in our patient in the perioperative period. In addition, we paid special attention to perioperative nutrition management and used total parenteral nutrition in perioperative period. We performed laparoscopic assisted right hemicolectomy. On the 15th day after the surgical resection, the patient was discharged without any problems. We considered that postoperative adjuvant chemotherapy with XELOX(CapeOX)should be performed because the TNM pathological stage was pStageⅢb. Regarding adjuvant chemotherapy for gastrointestinal cancer with nephrotic syndrome, no previous reports detailed the indications for postoperative adjuvant chemotherapy. Upon introduction of adjuvant chemotherapy, we determined adaptation in accordance with the general adaptation criteria. While observing the patient's progress with a nephrologist, we safely completed the scheduled 8 courses adjuvant chemotherapy.
要旨
症例は74歳,女性。膜性腎症に伴うネフローゼ症候群の診断を契機に,進行横行結腸癌の診断に至った。術前に低蛋白・低アルブミン(Alb)血症を認めたが,他のパラメータで栄養状態は保たれていた。過去の報告を参照し,周術期にAlb製剤や新鮮凍結血漿を使用し,低蛋白・減塩食と中心静脈栄養の併用で周術期の栄養管理を行った。腹腔鏡補助下結腸右半切除術を施行した。特に問題なく経過し,術後15日目に退院となった。pN2,pStageⅢbであり,術後補助化学療法としてXELOX(CapeOX)療法を行った。ネフローゼ症候群を併存する消化器癌に対する化学療法について詳述する資料は検索し得ず,一般的な適応基準に則り適応を判断し,腎臓内科医と併診しながら予定した8コースを安全に完遂し得た。
目次
Summary
A 74-year-old woman was diagnosed as having transverse colon cancer after diagnosis of nephrotic syndrome caused by membranous nephropathy. Although she had hypoproteinemia and hypoalbuminemia, we judged that she had no major nutritional problem. In previous, similar case reports, the use of human serum albumin and fresh-frozen plasma was suggested to be important to avoid complications in the perioperative period. Thus, we used the same in our patient in the perioperative period. In addition, we paid special attention to perioperative nutrition management and used total parenteral nutrition in perioperative period. We performed laparoscopic assisted right hemicolectomy. On the 15th day after the surgical resection, the patient was discharged without any problems. We considered that postoperative adjuvant chemotherapy with XELOX(CapeOX)should be performed because the TNM pathological stage was pStageⅢb. Regarding adjuvant chemotherapy for gastrointestinal cancer with nephrotic syndrome, no previous reports detailed the indications for postoperative adjuvant chemotherapy. Upon introduction of adjuvant chemotherapy, we determined adaptation in accordance with the general adaptation criteria. While observing the patient's progress with a nephrologist, we safely completed the scheduled 8 courses adjuvant chemotherapy.
要旨
症例は74歳,女性。膜性腎症に伴うネフローゼ症候群の診断を契機に,進行横行結腸癌の診断に至った。術前に低蛋白・低アルブミン(Alb)血症を認めたが,他のパラメータで栄養状態は保たれていた。過去の報告を参照し,周術期にAlb製剤や新鮮凍結血漿を使用し,低蛋白・減塩食と中心静脈栄養の併用で周術期の栄養管理を行った。腹腔鏡補助下結腸右半切除術を施行した。特に問題なく経過し,術後15日目に退院となった。pN2,pStageⅢbであり,術後補助化学療法としてXELOX(CapeOX)療法を行った。ネフローゼ症候群を併存する消化器癌に対する化学療法について詳述する資料は検索し得ず,一般的な適応基準に則り適応を判断し,腎臓内科医と併診しながら予定した8コースを安全に完遂し得た。