内容紹介
Summary
A 67-year-old man was referred to our hospital with a diagnosis of type 3 gastric cancer in lower third of the stomach. Computed tomography(CT)scan showed no distant metastasis, but peritoneal dissemination from gastric cancer. A laparoscopic exploration diagnosed pStage Ⅳ gastric cancer with peritoneal dissemination. Trastuzumab, capecitabine and cisplatin therapy was administered for initially unresectable gastric cancer. After 6 courses of chemotherapy, primary lesion and lymph node metastasis shrank, and the peritoneal dissemination did not worsen by CT scan. The second laparoscopic exploration showed no apparent dissemination or metastatic cancer cells. Total gastrectomy with D2 lymph node dissection, partial colectomy and cholecystectomy were performed with curative intent. The pathological diagnosis was ypT3N1P0CY0, Stage ⅡB, and the histological response of primary tumor after chemotherapy was categorized as Grade 1a. The patients is alive during 24 months after surgery with no evidence of recurrence.
要旨
症例は67歳,男性。健診異常の精査で行った上部消化管内視鏡検査で胃前庭部の3型胃癌(tub2)と診断され,加療目的に紹介となった。CTでは腫瘍周囲のリンパ節は腫大し,腹膜転移も疑われた。審査腹腔鏡で広範囲の腹膜転移と腹腔洗浄細胞診陽性を認め, 切除不能胃癌 (cT4aN3M1pP1CY1H0,pStage Ⅳ) と診断した。 HER2 score 3+のためtrastuzumab+capecitabine+cisplatin療法を6コース施行した。原発巣とリンパ節転移巣はともに縮小し腹膜転移の増悪もなかったため,再度審査腹腔鏡を施行した。腹膜転移巣の消失と腹腔洗浄細胞診陰性を確認したため,根治手術可能と判断し胃切除術を施行した。病理組織診断はypT3N1P0CY0,Stage ⅡB,R0切除で治療効果判定はGrade 1aであった。術後,S-1+trastuzumab療法を11コース施行し,2年経過した現在無再発生存中である。
目次
A 67-year-old man was referred to our hospital with a diagnosis of type 3 gastric cancer in lower third of the stomach. Computed tomography(CT)scan showed no distant metastasis, but peritoneal dissemination from gastric cancer. A laparoscopic exploration diagnosed pStage Ⅳ gastric cancer with peritoneal dissemination. Trastuzumab, capecitabine and cisplatin therapy was administered for initially unresectable gastric cancer. After 6 courses of chemotherapy, primary lesion and lymph node metastasis shrank, and the peritoneal dissemination did not worsen by CT scan. The second laparoscopic exploration showed no apparent dissemination or metastatic cancer cells. Total gastrectomy with D2 lymph node dissection, partial colectomy and cholecystectomy were performed with curative intent. The pathological diagnosis was ypT3N1P0CY0, Stage ⅡB, and the histological response of primary tumor after chemotherapy was categorized as Grade 1a. The patients is alive during 24 months after surgery with no evidence of recurrence.
要旨
症例は67歳,男性。健診異常の精査で行った上部消化管内視鏡検査で胃前庭部の3型胃癌(tub2)と診断され,加療目的に紹介となった。CTでは腫瘍周囲のリンパ節は腫大し,腹膜転移も疑われた。審査腹腔鏡で広範囲の腹膜転移と腹腔洗浄細胞診陽性を認め, 切除不能胃癌 (cT4aN3M1pP1CY1H0,pStage Ⅳ) と診断した。 HER2 score 3+のためtrastuzumab+capecitabine+cisplatin療法を6コース施行した。原発巣とリンパ節転移巣はともに縮小し腹膜転移の増悪もなかったため,再度審査腹腔鏡を施行した。腹膜転移巣の消失と腹腔洗浄細胞診陰性を確認したため,根治手術可能と判断し胃切除術を施行した。病理組織診断はypT3N1P0CY0,Stage ⅡB,R0切除で治療効果判定はGrade 1aであった。術後,S-1+trastuzumab療法を11コース施行し,2年経過した現在無再発生存中である。