内容紹介
Summary
A 68-year-old man presented with malaise and abdominal swelling. Lower gastrointestinal endoscopy revealed a type 2 circumferential sigmoid colon cancer. Computed tomography suggested the cancer infiltrating bladder and abdominal wall with abscess. Because of locally advanced infiltration, the patient was treated with capecitabine plus oxaliplatin(CapeOX)plus bevacizumab therapy after loop-colostomy. After 2 courses of chemotherapy, a CT revealed tumor reduction and increased abscess, which was punctured drainage. After 4 courses of chemotherapy, a CT revealed abscess reduction, we tried to operation. Sigmoidectomy with combined resection of abdominal wall and bladder total hysterectomy and fascia lata grafting were performed. The pathological diagnosis was tub1, T4b, ly2, v2, PN0, N0, M0, StageⅡ, pR0, GradeⅠa. We reported a case of curative resection of locally advanced sigmoid colon cancer treated with combined resection of bladder and abdominal wall after CapeOX therapy.
要旨
症例は68歳,男性。倦怠感と下腹部膨隆を主訴に受診した。S状結腸に全周性type 2病変を認め,CT検査にてS状結腸に長径約11 cmの腫瘤と膀胱内浸潤と腹壁浸潤による腹壁膿瘍も認めた。現時点での切除は局所浸潤が高度で剝離面の癌遺残が危惧されるため,人工肛門を造設後,capecitabine+oxaliplatin(CapeOX)+bevacizumab(Bmab)療法を開始した。2コース施行後,腹壁膿瘍の増悪のため穿刺ドレナージを施行し,4コース施行後,腹壁膿瘍は縮小したため根治切除の方針とした。手術はS状結腸切除・膀胱全摘・腹壁切除・人工肛門閉鎖・回腸導管造設・大腿筋膜皮弁を施行した。最終診断はtub1,T4b,ly2,v2,PN0,N0,M0,StageⅡ,切離断端は陰性で治療効果判定はGradeⅠaであった。今回,CapeOX療法により治癒切除し得た膀胱・腹壁浸潤を伴う高度局所進行S状結腸癌の1例を経験したので,若干の文献的考察を加え報告する。
目次
A 68-year-old man presented with malaise and abdominal swelling. Lower gastrointestinal endoscopy revealed a type 2 circumferential sigmoid colon cancer. Computed tomography suggested the cancer infiltrating bladder and abdominal wall with abscess. Because of locally advanced infiltration, the patient was treated with capecitabine plus oxaliplatin(CapeOX)plus bevacizumab therapy after loop-colostomy. After 2 courses of chemotherapy, a CT revealed tumor reduction and increased abscess, which was punctured drainage. After 4 courses of chemotherapy, a CT revealed abscess reduction, we tried to operation. Sigmoidectomy with combined resection of abdominal wall and bladder total hysterectomy and fascia lata grafting were performed. The pathological diagnosis was tub1, T4b, ly2, v2, PN0, N0, M0, StageⅡ, pR0, GradeⅠa. We reported a case of curative resection of locally advanced sigmoid colon cancer treated with combined resection of bladder and abdominal wall after CapeOX therapy.
要旨
症例は68歳,男性。倦怠感と下腹部膨隆を主訴に受診した。S状結腸に全周性type 2病変を認め,CT検査にてS状結腸に長径約11 cmの腫瘤と膀胱内浸潤と腹壁浸潤による腹壁膿瘍も認めた。現時点での切除は局所浸潤が高度で剝離面の癌遺残が危惧されるため,人工肛門を造設後,capecitabine+oxaliplatin(CapeOX)+bevacizumab(Bmab)療法を開始した。2コース施行後,腹壁膿瘍の増悪のため穿刺ドレナージを施行し,4コース施行後,腹壁膿瘍は縮小したため根治切除の方針とした。手術はS状結腸切除・膀胱全摘・腹壁切除・人工肛門閉鎖・回腸導管造設・大腿筋膜皮弁を施行した。最終診断はtub1,T4b,ly2,v2,PN0,N0,M0,StageⅡ,切離断端は陰性で治療効果判定はGradeⅠaであった。今回,CapeOX療法により治癒切除し得た膀胱・腹壁浸潤を伴う高度局所進行S状結腸癌の1例を経験したので,若干の文献的考察を加え報告する。