内容紹介
A Case of Rectal Cancer with Multiple Pulmonary and Liver Metastases Could Be Resected through Chemotherapy
Summary
The patient was a 47-year-old man, whose chief complaint was melena. He visited a nearby hospital, and further evaluation showed rectal cancer invading the prostate, with multiple lung and liver metastases. The clinical diagnosis was cT4b(prostate), cN1, cM1b(H2, PUL2), cStage Ⅳ. We performed colostomy in the transverse colon prior to chemotherapy. He was administered 1 course of mFOLFOX6 plus bevacizumab and 7 courses of FOLFOXIRI plus bevacizumab. The primary tumor showed PR. The liver metastases were localized and shrunken, while the lung metastases disappeared. Approximately 6 months after the start of chemotherapy, a laparoscopic total pelvic exenteration and ileal conduit were performed following the diagnosis of ycT4b(prostate), ycN1, ycM1a(H2), ycStage Ⅳ. About 3 months later, a partial resection of the left liver lobes(S1 and S5/S8)was performed laparoscopically. He has been cancer-free for 8 months.
要旨
患者は47歳,男性。下血を主訴に近医を受診し,精査にて直腸Rbに直腸癌を認め,前立腺への浸潤,肺および肝臓に多発転移を認めた。cT4b(前立腺),cN1,cM1b(H2,PUL2),cStage Ⅳの診断にて横行結腸に双孔式人工肛門造設後にmFOLFOX6+bevacizumabを1コース,FOLFOXIRI+bevacizumabを7コース行った。原発巣の治療効果判定はPR,両肺の結節は消失,肝転移巣も限局化し縮小した。化学療法開始後約6か月後にycT4b(前立腺),ycN1,ycM1a(H2),ycStage Ⅳの診断にて腹腔鏡下骨盤内臓全摘術,回腸導管造設術を施行した。術後約3か月後に腹腔鏡下肝左葉切除,S1およびS5/S8部分切除を行い,初回手術から8か月間cancer-freeの状態である。
目次
Summary
The patient was a 47-year-old man, whose chief complaint was melena. He visited a nearby hospital, and further evaluation showed rectal cancer invading the prostate, with multiple lung and liver metastases. The clinical diagnosis was cT4b(prostate), cN1, cM1b(H2, PUL2), cStage Ⅳ. We performed colostomy in the transverse colon prior to chemotherapy. He was administered 1 course of mFOLFOX6 plus bevacizumab and 7 courses of FOLFOXIRI plus bevacizumab. The primary tumor showed PR. The liver metastases were localized and shrunken, while the lung metastases disappeared. Approximately 6 months after the start of chemotherapy, a laparoscopic total pelvic exenteration and ileal conduit were performed following the diagnosis of ycT4b(prostate), ycN1, ycM1a(H2), ycStage Ⅳ. About 3 months later, a partial resection of the left liver lobes(S1 and S5/S8)was performed laparoscopically. He has been cancer-free for 8 months.
要旨
患者は47歳,男性。下血を主訴に近医を受診し,精査にて直腸Rbに直腸癌を認め,前立腺への浸潤,肺および肝臓に多発転移を認めた。cT4b(前立腺),cN1,cM1b(H2,PUL2),cStage Ⅳの診断にて横行結腸に双孔式人工肛門造設後にmFOLFOX6+bevacizumabを1コース,FOLFOXIRI+bevacizumabを7コース行った。原発巣の治療効果判定はPR,両肺の結節は消失,肝転移巣も限局化し縮小した。化学療法開始後約6か月後にycT4b(前立腺),ycN1,ycM1a(H2),ycStage Ⅳの診断にて腹腔鏡下骨盤内臓全摘術,回腸導管造設術を施行した。術後約3か月後に腹腔鏡下肝左葉切除,S1およびS5/S8部分切除を行い,初回手術から8か月間cancer-freeの状態である。