内容紹介
Three Patients with Gastric Cancer Who Underwent Surgery during Ramucirumab Treatment
Summary
According to the REGARD and RAINBOW trials, ramucirumab(RAM)was introduced as second-line therapy for advanced or metastatic gastric cancer. RAM may impair wound healing due to the inhibition of angiogenesis; details on the postoperative course of patients who underwent surgery during RAM treatment remain unclear. Between 2011 and 2016, 93 patients with incurable gastric cancer were treated with RAM in our institute. Among them, 3 patients underwent surgery after RAM treatment. Case 1: A 74-year-old man with liver metastasis from gastric cancer was treated with a paclitaxel(PTX)plus RAM regimen. Perforation of the stomach was observed 3 days after final RAM administration. He was successfully treated with omental repair and discharged 19 days after surgery. Case 2: A 31-year-old woman with peritoneal recurrence after total gastrectomy received the PTX plus RAM regimen as second-line treatment. Stenting was performed for rectal stenosis. Perforation of the rectum just proximal of the stent was observed 5 days after final RAM administration. Ileostomy was performed. Closure of the perforation was not obtained until the patient died 210 days after surgery. Case 3: A 60-year-old man with remnant gastric cancer received the PTX plus RAM regimen. Accidentally, the enteral feeding tube was removed. Six weeks after the cessation of RAM administration, the enteral feeding tube was inserted under general anesthesia. He was discharged 4 days after surgery. If surgery is required in patients receiving RAM treatment, sufficient drug withdrawal is desirable. If emergency surgery is needed, less invasive procedures should be selected to the maximum extent possible.
要旨
REGARD試験,RAINBOW試験の結果から,進行再発胃癌に対する二次治療としてramucirumab(RAM)が導入された。RAMは血管新生を阻害することから創傷治癒遅延の懸念があるが,その詳細については未だ明らかではない。2011～2016年までにRAMが投与された進行再発胃癌93例のうち,RAM投与後に手術が施行された3例を経験したので,RAM投与後の術後経過について検討した。症例1は74歳,男性。胃癌,肝転移に対してpaclitaxel(PTX)+RAM療法施行中,RAM最終投与3日目に胃穿孔を認め,大網被覆術を施行した。経過良好で第19病日に退院した。症例2は31歳,女性。胃全摘後腹膜再発,直腸狭窄に対してステント挿入後,PTX+RAM療法施行中,RAM最終投与5日目にステントの口側に穿孔を認め,回腸双孔式人工肛門造設術を行った。穿孔部の閉鎖は得られずドレナージを継続し,第210病日に死亡した。症例3は60歳,男性。残胃癌に対しPTX+RAM療法施行中,空腸瘻自然抜去のためRAMを6週間休薬の後に腸瘻造設術を施行。経過良好で第4病日に退院した。RAM投与後に手術を行う際には可能であれば十分な休薬期間を置くことが望ましく,やむを得ず緊急手術が必要な症例では極力侵襲の小さい術式を選択すべきである。
目次
Summary
According to the REGARD and RAINBOW trials, ramucirumab(RAM)was introduced as second-line therapy for advanced or metastatic gastric cancer. RAM may impair wound healing due to the inhibition of angiogenesis; details on the postoperative course of patients who underwent surgery during RAM treatment remain unclear. Between 2011 and 2016, 93 patients with incurable gastric cancer were treated with RAM in our institute. Among them, 3 patients underwent surgery after RAM treatment. Case 1: A 74-year-old man with liver metastasis from gastric cancer was treated with a paclitaxel(PTX)plus RAM regimen. Perforation of the stomach was observed 3 days after final RAM administration. He was successfully treated with omental repair and discharged 19 days after surgery. Case 2: A 31-year-old woman with peritoneal recurrence after total gastrectomy received the PTX plus RAM regimen as second-line treatment. Stenting was performed for rectal stenosis. Perforation of the rectum just proximal of the stent was observed 5 days after final RAM administration. Ileostomy was performed. Closure of the perforation was not obtained until the patient died 210 days after surgery. Case 3: A 60-year-old man with remnant gastric cancer received the PTX plus RAM regimen. Accidentally, the enteral feeding tube was removed. Six weeks after the cessation of RAM administration, the enteral feeding tube was inserted under general anesthesia. He was discharged 4 days after surgery. If surgery is required in patients receiving RAM treatment, sufficient drug withdrawal is desirable. If emergency surgery is needed, less invasive procedures should be selected to the maximum extent possible.
要旨
REGARD試験,RAINBOW試験の結果から,進行再発胃癌に対する二次治療としてramucirumab(RAM)が導入された。RAMは血管新生を阻害することから創傷治癒遅延の懸念があるが,その詳細については未だ明らかではない。2011～2016年までにRAMが投与された進行再発胃癌93例のうち,RAM投与後に手術が施行された3例を経験したので,RAM投与後の術後経過について検討した。症例1は74歳,男性。胃癌,肝転移に対してpaclitaxel(PTX)+RAM療法施行中,RAM最終投与3日目に胃穿孔を認め,大網被覆術を施行した。経過良好で第19病日に退院した。症例2は31歳,女性。胃全摘後腹膜再発,直腸狭窄に対してステント挿入後,PTX+RAM療法施行中,RAM最終投与5日目にステントの口側に穿孔を認め,回腸双孔式人工肛門造設術を行った。穿孔部の閉鎖は得られずドレナージを継続し,第210病日に死亡した。症例3は60歳,男性。残胃癌に対しPTX+RAM療法施行中,空腸瘻自然抜去のためRAMを6週間休薬の後に腸瘻造設術を施行。経過良好で第4病日に退院した。RAM投与後に手術を行う際には可能であれば十分な休薬期間を置くことが望ましく,やむを得ず緊急手術が必要な症例では極力侵襲の小さい術式を選択すべきである。