内容紹介
Summary
A 46-year-old male patient with anorexia consulted our hospital. A scirrhous gastric cancer was found, and he was introduced to us. Laparoscopic examination was performed, and advanced peritoneal disseminated nodules were confirmed(CY1, P1). S-1 plus docetaxel therapy was introduced as first-line chemotherapy. Although the best effect judgment was PR, the primary lesion re-increased in size. We changed to the secondary weekly paclitaxel therapy. After 7 courses of the therapy, a second laparoscopic examination was performed, which confirmed the microscopic residual cancer cells(P1)in the reduced peritoneal nodules. Then, we performed 4 courses of intraperitoneal chemotherapy and a third laparoscopic examination. It showed CY0, P0, and we decided to perform conversion surgery. Total gastrectomy with D2 lymph node dissection was performed. The postoperative pathological diagnosis was ypT3N0M0, ypStageⅡA, and the histological effect judgment was Grade 2. S-1 oral administration was continued for 1 year as an adjuvant therapy, and recurrence was observed for 2 years.
要旨
症例は46歳,男性。食欲不振を主訴に近医を受診し,スキルス胃癌と診断され当科紹介となった。審査腹腔鏡を施行し,高度の腹膜播種結節が確認された(CY1,P1)。S-1+ドセタキセル療法を導入し,最良効果判定はPRであったものの主病巣の再増大を認め,weeklyパクリタキセルにレジメンを変更した。効果判定はSDであり,この時点で二度目の審査腹腔鏡を施行し,微小播種結節の残存が確認された(CY0,P1)。腹腔内化学療法(ドセタキセル+S-1+シスプラチン)を施行した後に三度目の審査腹腔鏡でCY0,P0を確認したため,conversion surgeryの方針となった。開腹胃全摘術,D2リンパ節郭清を施行した。病理診断はypT3N0M0,ypStageⅡA,組織学的効果判定はGrade 2であった。術後化学療法としてS-1を実施し,根治術後2年無再発生存中である。
目次
A 46-year-old male patient with anorexia consulted our hospital. A scirrhous gastric cancer was found, and he was introduced to us. Laparoscopic examination was performed, and advanced peritoneal disseminated nodules were confirmed(CY1, P1). S-1 plus docetaxel therapy was introduced as first-line chemotherapy. Although the best effect judgment was PR, the primary lesion re-increased in size. We changed to the secondary weekly paclitaxel therapy. After 7 courses of the therapy, a second laparoscopic examination was performed, which confirmed the microscopic residual cancer cells(P1)in the reduced peritoneal nodules. Then, we performed 4 courses of intraperitoneal chemotherapy and a third laparoscopic examination. It showed CY0, P0, and we decided to perform conversion surgery. Total gastrectomy with D2 lymph node dissection was performed. The postoperative pathological diagnosis was ypT3N0M0, ypStageⅡA, and the histological effect judgment was Grade 2. S-1 oral administration was continued for 1 year as an adjuvant therapy, and recurrence was observed for 2 years.
要旨
症例は46歳,男性。食欲不振を主訴に近医を受診し,スキルス胃癌と診断され当科紹介となった。審査腹腔鏡を施行し,高度の腹膜播種結節が確認された(CY1,P1)。S-1+ドセタキセル療法を導入し,最良効果判定はPRであったものの主病巣の再増大を認め,weeklyパクリタキセルにレジメンを変更した。効果判定はSDであり,この時点で二度目の審査腹腔鏡を施行し,微小播種結節の残存が確認された(CY0,P1)。腹腔内化学療法(ドセタキセル+S-1+シスプラチン)を施行した後に三度目の審査腹腔鏡でCY0,P0を確認したため,conversion surgeryの方針となった。開腹胃全摘術,D2リンパ節郭清を施行した。病理診断はypT3N0M0,ypStageⅡA,組織学的効果判定はGrade 2であった。術後化学療法としてS-1を実施し,根治術後2年無再発生存中である。