内容紹介
Summary
A laparoscopy-assisted right hemicolectomy and D3 lymph node dissection were performed to treat a 60-year-old woman with ascending colon cancer. Microscopically, the resected specimen was diagnosed as adenocarcinoma(tub1>tub2, pSS, pN1, M0). Adjuvant chemotherapy using UFT/UZEL was administered for 6 months. Enlarged para-aortic lymph nodes were identified by follow-up CT 2 years post operation, and a para-aortic lymph node dissection was performed. Microscopic examination revealed that the #216 b1 int lymph node contained poorly differentiated metastatic adenocarcinoma. After 36 courses of FOLFOX as adjuvant chemotherapy, the chemotherapy was discontinued because of an adverse event. She has remained well without recurrence for 5 years after the second surgery. There have been reports of survival improvements by surgical resections in patients with solitary para-aorta lymph node metastases of colorectal cancer. These observations suggest that the surgical therapy may have contributed to the improved prognosis in the present case.
要旨
症例は60歳,女性。2011年2月上行結腸癌に対して腹腔鏡補助下結腸右半切除,D3リンパ節郭清術を施行した。病理組織診断はadenocarcinoma(tub1>tub2),pT3(SS),N1(1/40: #212),M0,Stage Ⅲaで,術後補助化学療法としてUFT/UZEL療法を6か月間施行した。術後2年のCTで大動脈周囲リンパ節の腫大を認めた。PET-CTで異常集積を認め再発が疑われたため,2013年3月大動脈周囲リンパ節郭清術を行った。#216 b1 intに低分化腺癌を認め結腸癌の転移と考えられた。その後,術後補助化学療法としてFOLFOX療法を開始し有害事象により中止するまで36コース施行した。2回目の手術後5年経過したが,無再発生存中である。孤発性の大動脈周囲リンパ節転移の切除については生存率改善の報告があることから切除も検討の余地があると考えられた。
目次
A laparoscopy-assisted right hemicolectomy and D3 lymph node dissection were performed to treat a 60-year-old woman with ascending colon cancer. Microscopically, the resected specimen was diagnosed as adenocarcinoma(tub1>tub2, pSS, pN1, M0). Adjuvant chemotherapy using UFT/UZEL was administered for 6 months. Enlarged para-aortic lymph nodes were identified by follow-up CT 2 years post operation, and a para-aortic lymph node dissection was performed. Microscopic examination revealed that the #216 b1 int lymph node contained poorly differentiated metastatic adenocarcinoma. After 36 courses of FOLFOX as adjuvant chemotherapy, the chemotherapy was discontinued because of an adverse event. She has remained well without recurrence for 5 years after the second surgery. There have been reports of survival improvements by surgical resections in patients with solitary para-aorta lymph node metastases of colorectal cancer. These observations suggest that the surgical therapy may have contributed to the improved prognosis in the present case.
要旨
症例は60歳,女性。2011年2月上行結腸癌に対して腹腔鏡補助下結腸右半切除,D3リンパ節郭清術を施行した。病理組織診断はadenocarcinoma(tub1>tub2),pT3(SS),N1(1/40: #212),M0,Stage Ⅲaで,術後補助化学療法としてUFT/UZEL療法を6か月間施行した。術後2年のCTで大動脈周囲リンパ節の腫大を認めた。PET-CTで異常集積を認め再発が疑われたため,2013年3月大動脈周囲リンパ節郭清術を行った。#216 b1 intに低分化腺癌を認め結腸癌の転移と考えられた。その後,術後補助化学療法としてFOLFOX療法を開始し有害事象により中止するまで36コース施行した。2回目の手術後5年経過したが,無再発生存中である。孤発性の大動脈周囲リンパ節転移の切除については生存率改善の報告があることから切除も検討の余地があると考えられた。