内容紹介
Summary
Perforated gastric cancer reported to be relatively rare and to have a poor prognosis. This study examined 9 patients with perforated gastric cancer. Two-thirds of the patients were male and the median age was 69 years. The timing of the diagnosis of gastric cancer was preoperative clinical findings in 4 cases, intraoperative surgical findings in 3 cases, and postoperative examination in 2 cases. The depths of tumor invasion were T3 in 3 cases, T4a in 4 cases, and T4b in 2 cases and 5 patients were Stage Ⅳ. Four patients underwent palliative gastrectomy and only 1 patient underwent curative(R0)gastrectomy. Four patients underwent repair surgery, 2 of which underwent omental patch repair during the initial surgery. One of patients with omental patch repair received 2-stage curative gastrectomy; the other patient received chemotherapy after recovering from acute peritonitis. The median overall survival was 17.9 months and the prognosis was favorable in cases with curative resection or chemotherapy. For patients with perforated gastric cancer, if curative resection cannot be expected, the initial surgery should be directed toward the treatment of peritonitis and radical oncological surgery or systemic chemotherapy should be planned following patient recovery.
要旨
胃癌穿孔は比較的まれな病態であり,進行癌が多く予後不良とされている。今回,当院で経験した9例について検討した。性別は男性6例,女性3例,年齢中央値69歳。胃癌診断時期は術前4例,術中3例,術後2例であった。深達度はT3 3例,T4a 4例,T4b 2例,Stage Ⅳが5例であった。初回手術は5例に胃切除が行われ,4例は非切除であった。胃切除を施行した5例中4例は姑息的胃切除となり,R0切除は1例のみであった。一方,非切除の4例中大網充塡のみを施行した2例では,全身状態回復後にそれぞれ二期的根治切除,化学療法を施行した。全生存期間の中央値は17.9か月で,根治切除および化学療法施行例で予後良好な傾向を認めた。胃癌穿孔例に対しては,根治切除が困難な場合には全身状態の回復をめざした術式を選択し,その後に二期的切除や積極的な化学療法を行うことが有効と思われた。
目次
Perforated gastric cancer reported to be relatively rare and to have a poor prognosis. This study examined 9 patients with perforated gastric cancer. Two-thirds of the patients were male and the median age was 69 years. The timing of the diagnosis of gastric cancer was preoperative clinical findings in 4 cases, intraoperative surgical findings in 3 cases, and postoperative examination in 2 cases. The depths of tumor invasion were T3 in 3 cases, T4a in 4 cases, and T4b in 2 cases and 5 patients were Stage Ⅳ. Four patients underwent palliative gastrectomy and only 1 patient underwent curative(R0)gastrectomy. Four patients underwent repair surgery, 2 of which underwent omental patch repair during the initial surgery. One of patients with omental patch repair received 2-stage curative gastrectomy; the other patient received chemotherapy after recovering from acute peritonitis. The median overall survival was 17.9 months and the prognosis was favorable in cases with curative resection or chemotherapy. For patients with perforated gastric cancer, if curative resection cannot be expected, the initial surgery should be directed toward the treatment of peritonitis and radical oncological surgery or systemic chemotherapy should be planned following patient recovery.
要旨
胃癌穿孔は比較的まれな病態であり,進行癌が多く予後不良とされている。今回,当院で経験した9例について検討した。性別は男性6例,女性3例,年齢中央値69歳。胃癌診断時期は術前4例,術中3例,術後2例であった。深達度はT3 3例,T4a 4例,T4b 2例,Stage Ⅳが5例であった。初回手術は5例に胃切除が行われ,4例は非切除であった。胃切除を施行した5例中4例は姑息的胃切除となり,R0切除は1例のみであった。一方,非切除の4例中大網充塡のみを施行した2例では,全身状態回復後にそれぞれ二期的根治切除,化学療法を施行した。全生存期間の中央値は17.9か月で,根治切除および化学療法施行例で予後良好な傾向を認めた。胃癌穿孔例に対しては,根治切除が困難な場合には全身状態の回復をめざした術式を選択し,その後に二期的切除や積極的な化学療法を行うことが有効と思われた。