内容紹介
A Case of Surgery after Chemotherapy for Cecal Cancer with Onset of the Stenosis of the Colostomy
Summary
The patient was 55-year-old woman, undergoing Hartmann operation by the sigmoid colon diverticulum perforation, 2 years later visited our hospital with abdominal pain. Although lower endoscopy and histological examination could not be performed due to stoma stenosis, we diagnosed cecal carcinoma, liver metastasis, distant lymph node metastasis from CT and PET-CT, CapeOX plus Bmab therapy and IRIS plus Bmab therapy were performed. After that, repeated intestinal obstruction due to exacerbated stoma stenosis, metastatic lesion increased in CT examination, furthermore the patient had hope of stoma closure, we decided to resect the primacy tumor, performed subtotal colonectomy and stoma closure. Pathological diagnosis revealed RAS wild type. After surgery, Pmab plus CPT-11 therapy was performed and the metastatic lesion was temporarily shrunk but re-exacerbated, the patient died 2 years 2 months after the first treatment started, 7 months after the primary tumor resection. In the treatment of colorectal cancer, when metastatic lesion is unresectable, chemotherapy is often carried out except when the primary tumor is symptomatic. In our case, although the primary tumor was asymptomatic, an intestinal obstruction due to stoma stenosis was developed and it was necessary to examine whether to use anti-EGFR antibody drugs, therefore we performed operation.
要旨
症例は55歳,女性。S状結腸憩室穿孔でハルトマン手術を施行後であり,2年後,腹痛で当科を受診した。人工肛門狭窄で下部内視鏡,組織学的検査を施行できなかったが,CT,PET-CTで盲腸癌,肝転移,遠隔リンパ節転移と診断,CapeOX+Bmab療法,IRIS+Bmab療法を施行した。その後,増悪した人工肛門狭窄で腸閉塞を繰り返し,CTでは転移巣が増大,さらに人工肛門閉鎖の希望があることから原発巣切除の方針とし,結腸亜全摘術,人工肛門閉鎖術を施行した。病理検索でRAS野生型と判明し,術後Pmab+CPT-11療法を行い転移巣は一時縮小するも再増悪し,初回治療開始2年2か月,原発巣切除7か月後に死亡した。大腸癌では転移巣が切除不能の際は,原発巣が有症状の時を除き化学療法を行うことも多い。本症例は原発巣無症状も人工肛門狭窄による腸閉塞を発症し,抗EGFR抗体薬の使用可否検索が必要と考え,手術を施行した。
目次
Summary
The patient was 55-year-old woman, undergoing Hartmann operation by the sigmoid colon diverticulum perforation, 2 years later visited our hospital with abdominal pain. Although lower endoscopy and histological examination could not be performed due to stoma stenosis, we diagnosed cecal carcinoma, liver metastasis, distant lymph node metastasis from CT and PET-CT, CapeOX plus Bmab therapy and IRIS plus Bmab therapy were performed. After that, repeated intestinal obstruction due to exacerbated stoma stenosis, metastatic lesion increased in CT examination, furthermore the patient had hope of stoma closure, we decided to resect the primacy tumor, performed subtotal colonectomy and stoma closure. Pathological diagnosis revealed RAS wild type. After surgery, Pmab plus CPT-11 therapy was performed and the metastatic lesion was temporarily shrunk but re-exacerbated, the patient died 2 years 2 months after the first treatment started, 7 months after the primary tumor resection. In the treatment of colorectal cancer, when metastatic lesion is unresectable, chemotherapy is often carried out except when the primary tumor is symptomatic. In our case, although the primary tumor was asymptomatic, an intestinal obstruction due to stoma stenosis was developed and it was necessary to examine whether to use anti-EGFR antibody drugs, therefore we performed operation.
要旨
症例は55歳,女性。S状結腸憩室穿孔でハルトマン手術を施行後であり,2年後,腹痛で当科を受診した。人工肛門狭窄で下部内視鏡,組織学的検査を施行できなかったが,CT,PET-CTで盲腸癌,肝転移,遠隔リンパ節転移と診断,CapeOX+Bmab療法,IRIS+Bmab療法を施行した。その後,増悪した人工肛門狭窄で腸閉塞を繰り返し,CTでは転移巣が増大,さらに人工肛門閉鎖の希望があることから原発巣切除の方針とし,結腸亜全摘術,人工肛門閉鎖術を施行した。病理検索でRAS野生型と判明し,術後Pmab+CPT-11療法を行い転移巣は一時縮小するも再増悪し,初回治療開始2年2か月,原発巣切除7か月後に死亡した。大腸癌では転移巣が切除不能の際は,原発巣が有症状の時を除き化学療法を行うことも多い。本症例は原発巣無症状も人工肛門狭窄による腸閉塞を発症し,抗EGFR抗体薬の使用可否検索が必要と考え,手術を施行した。