内容紹介
Summary
There is a clear consensus regarding the combined resection of organs with cancer invasion, patients with colon cancer. However, there are very few reports to our knowledge regarding the use of pancreato-duodenectomy(PD)for colon cancer patients with cancer invasion in the duodenum. We here report a colon cancer patient in whom we performed PD and right hemicolectomy, who showed favorable results with no recurrence. The patient was a 69-year-old woman. Her chief complaint was hypogastric pain. Her previous doctor performed colonoscopy and a colonoscopic biopsy, and detected a type 2 lesion, throughout the entire circumference of the transverse colon near the liver, and she was diagnosed with adenocarcinoma. From further imaging analyses, she was diagnosed as having transverse colon cancer with invasion into the superior mesenteric vein(SMV), duodenum, and pancreatic head, and No. 223 lymph node metastasis. The patient's cancer was concluded to be unresectable, and she underwent chemotherapy, namely mFOLFOX6 with cetuxiumab(Cmab). One course of mFOLFOX with Cmab, the patient decided to consult our hospital for a second opinion. We concluded that her cancer was resectable, so we performed PD, right hemicolectomy, and resection and reconstruction of a part of the SMV. The operation time was 5 hours 17 minutes, and total blood loss was 190 mL. The histopathological diagnosis was tub2, T4b(duodenum and, tissue surrounding the SMV), int, INF b, ly1, v2, PN1b, EX(+)/ND(PN+, v+), PM0(25 cm), DM0(14.3 cm), N1(1/20), H0, P0, M0, pStage Ⅲa. She was discharged 15 days after surgery with no complications, and thereafter received ajduvant chemotherapy(capecitabine with oxaliplatin)as an outpatient. After 3 courses, capecitabine with oxaliplatin was changed to capecitabine because she developed a nervous system disorder, and she was further treated for approximately about 6 months. She is doing well at the time of writing, with no recurrences for 2 years. We suggest that PD should be performed on colon cancer patients in which the colon cancer has invaded other organs and has been evaluated as being unresectable.
要旨
他臓器浸潤のある結腸癌に対する他臓器合併切除術については一定のコンセンサスが得られている。しかし十二指腸への浸潤に対して膵頭十二指腸合併切除を行った報告は少ない。今回われわれは,横行結腸癌の十二指腸浸潤に対し膵頭十二指腸合併切除を伴う右半結腸切除術にてen blocな切除を行い,良好な経過を経た1例を経験したので報告する。症例は69歳,女性。前医で横行結腸肝弯曲部大腸癌,膵頭部および上腸間膜動静脈への浸潤,No. 223リンパ節転移と診断し,en bloc切除は困難と判断されcetuximab(Cmab)併用mFOLFOX6療法が1コース行われた。second opinion目的で当院を受診した。en bloc手術が可能と判断し,幽門輪温存膵頭十二指腸,上腸間膜静脈(SMV)合併切除を伴う右半結腸切除術,血行再建術を施行した。最終診断はtub2,T4b(十二指腸漿膜,SMV周囲組織),int,INF b,ly1,v2,PN1b,EX(+)/ND(PN+,v+),PM0(25 cm),DM0(14.3 cm),N1(1/20),H0,P0,M0,pStage Ⅲaであった。術後経過は良好で第15病日に退院した。外来で術後補助化学療法を約6か月間施行した。術後2年が経過したが,現在無再発生存中である。結腸癌の他臓器浸潤例ではR0切除可能と判断できれば,膵頭十二指腸切除術を含む積極的な他臓器合併切除を考慮すべきである。
目次
There is a clear consensus regarding the combined resection of organs with cancer invasion, patients with colon cancer. However, there are very few reports to our knowledge regarding the use of pancreato-duodenectomy(PD)for colon cancer patients with cancer invasion in the duodenum. We here report a colon cancer patient in whom we performed PD and right hemicolectomy, who showed favorable results with no recurrence. The patient was a 69-year-old woman. Her chief complaint was hypogastric pain. Her previous doctor performed colonoscopy and a colonoscopic biopsy, and detected a type 2 lesion, throughout the entire circumference of the transverse colon near the liver, and she was diagnosed with adenocarcinoma. From further imaging analyses, she was diagnosed as having transverse colon cancer with invasion into the superior mesenteric vein(SMV), duodenum, and pancreatic head, and No. 223 lymph node metastasis. The patient's cancer was concluded to be unresectable, and she underwent chemotherapy, namely mFOLFOX6 with cetuxiumab(Cmab). One course of mFOLFOX with Cmab, the patient decided to consult our hospital for a second opinion. We concluded that her cancer was resectable, so we performed PD, right hemicolectomy, and resection and reconstruction of a part of the SMV. The operation time was 5 hours 17 minutes, and total blood loss was 190 mL. The histopathological diagnosis was tub2, T4b(duodenum and, tissue surrounding the SMV), int, INF b, ly1, v2, PN1b, EX(+)/ND(PN+, v+), PM0(25 cm), DM0(14.3 cm), N1(1/20), H0, P0, M0, pStage Ⅲa. She was discharged 15 days after surgery with no complications, and thereafter received ajduvant chemotherapy(capecitabine with oxaliplatin)as an outpatient. After 3 courses, capecitabine with oxaliplatin was changed to capecitabine because she developed a nervous system disorder, and she was further treated for approximately about 6 months. She is doing well at the time of writing, with no recurrences for 2 years. We suggest that PD should be performed on colon cancer patients in which the colon cancer has invaded other organs and has been evaluated as being unresectable.
要旨
他臓器浸潤のある結腸癌に対する他臓器合併切除術については一定のコンセンサスが得られている。しかし十二指腸への浸潤に対して膵頭十二指腸合併切除を行った報告は少ない。今回われわれは,横行結腸癌の十二指腸浸潤に対し膵頭十二指腸合併切除を伴う右半結腸切除術にてen blocな切除を行い,良好な経過を経た1例を経験したので報告する。症例は69歳,女性。前医で横行結腸肝弯曲部大腸癌,膵頭部および上腸間膜動静脈への浸潤,No. 223リンパ節転移と診断し,en bloc切除は困難と判断されcetuximab(Cmab)併用mFOLFOX6療法が1コース行われた。second opinion目的で当院を受診した。en bloc手術が可能と判断し,幽門輪温存膵頭十二指腸,上腸間膜静脈(SMV)合併切除を伴う右半結腸切除術,血行再建術を施行した。最終診断はtub2,T4b(十二指腸漿膜,SMV周囲組織),int,INF b,ly1,v2,PN1b,EX(+)/ND(PN+,v+),PM0(25 cm),DM0(14.3 cm),N1(1/20),H0,P0,M0,pStage Ⅲaであった。術後経過は良好で第15病日に退院した。外来で術後補助化学療法を約6か月間施行した。術後2年が経過したが,現在無再発生存中である。結腸癌の他臓器浸潤例ではR0切除可能と判断できれば,膵頭十二指腸切除術を含む積極的な他臓器合併切除を考慮すべきである。