内容紹介
Summary
A man in the 60s visited our hospital with the complaints of epigastralgia and weight loss. Following an investigation, he was diagnosed with human epidermal growth factor receptor 2(HER2)-positive gastric cancer with invasion to the pancreas(T4b[pancreas], N2, M0, Stage ⅣA[Union for International Cancer Control 8th edition]). Preoperatively, he was administered a chemotherapeutic regimen of S-1 and cisplatin plus trastuzumab. After 2 courses of chemotherapy, computed tomography revealed invasion to the abdominal wall and pyloric stenosis; however, invasion to the pancreas was obscured, and the lymph node metastases had shrunk. He underwent laparoscopic gastro-jejunostomy. After 4 courses of chemotherapy, his condition was considered stable. A laparoscopic distal gastrectomy was performed together with resection of the abdominal wall invasion. The pathological stage was pT4b(abdominal wall), pN0, M0, Stage ⅢA, and R0 resection was achieved. The patient was administered 4 courses of adjuvant capecitabine plus oxaliplatin therapy and 4 courses of capecitabine monotherapy. He has been followed-up for 1.5 years since the curative resection and has not developed recurrences. This case suggests the usefulness of multimodal therapy for locally advanced gastric cancer.
要旨
症例は60歳台,男性。心窩部痛,体重減少を主訴に当院を受診した。精査の結果,胃癌,T4b(pancreas),N2,M0,Stage ⅣA(UICC第8版)と診断され,術前化学療法としてS-1+cisplatin+trastuzumab療法を施行した。2コース後に腹壁浸潤や幽門狭窄の所見が認められたが膵浸潤は不明瞭化し,リンパ節転移は縮小が認められた。腹腔鏡下胃空腸吻合術を施行した。4コース後の効果判定はSDであった。腹腔鏡下幽門側胃切除術,腹壁浸潤合併切除を行った。病理組織学的検査は,pT4b(abdominal wall),pN0,M0,Stage ⅢAで,R0切除を施行し得た。術後補助化学療法として,capecitabine+oxaliplatin療法4コースおよびcapecitabine療法4コースを施行した。術後1年6か月現在,無再発生存中である。局所進行胃癌に対して集学的治療は有用な治療になり得ると考えられた。
目次
A man in the 60s visited our hospital with the complaints of epigastralgia and weight loss. Following an investigation, he was diagnosed with human epidermal growth factor receptor 2(HER2)-positive gastric cancer with invasion to the pancreas(T4b[pancreas], N2, M0, Stage ⅣA[Union for International Cancer Control 8th edition]). Preoperatively, he was administered a chemotherapeutic regimen of S-1 and cisplatin plus trastuzumab. After 2 courses of chemotherapy, computed tomography revealed invasion to the abdominal wall and pyloric stenosis; however, invasion to the pancreas was obscured, and the lymph node metastases had shrunk. He underwent laparoscopic gastro-jejunostomy. After 4 courses of chemotherapy, his condition was considered stable. A laparoscopic distal gastrectomy was performed together with resection of the abdominal wall invasion. The pathological stage was pT4b(abdominal wall), pN0, M0, Stage ⅢA, and R0 resection was achieved. The patient was administered 4 courses of adjuvant capecitabine plus oxaliplatin therapy and 4 courses of capecitabine monotherapy. He has been followed-up for 1.5 years since the curative resection and has not developed recurrences. This case suggests the usefulness of multimodal therapy for locally advanced gastric cancer.
要旨
症例は60歳台,男性。心窩部痛,体重減少を主訴に当院を受診した。精査の結果,胃癌,T4b(pancreas),N2,M0,Stage ⅣA(UICC第8版)と診断され,術前化学療法としてS-1+cisplatin+trastuzumab療法を施行した。2コース後に腹壁浸潤や幽門狭窄の所見が認められたが膵浸潤は不明瞭化し,リンパ節転移は縮小が認められた。腹腔鏡下胃空腸吻合術を施行した。4コース後の効果判定はSDであった。腹腔鏡下幽門側胃切除術,腹壁浸潤合併切除を行った。病理組織学的検査は,pT4b(abdominal wall),pN0,M0,Stage ⅢAで,R0切除を施行し得た。術後補助化学療法として,capecitabine+oxaliplatin療法4コースおよびcapecitabine療法4コースを施行した。術後1年6か月現在,無再発生存中である。局所進行胃癌に対して集学的治療は有用な治療になり得ると考えられた。