内容紹介
Summary
A 74-year-old man with bloody vomit was diagnosed as having clinical Stage Ⅳ advanced gastric cancer with lymph node metastasis around the abdominal aorta. Initially, for curative surgery, he was administered neoadjuvant chemotherapy. On day 32, in the second course of chemotherapy containing S-1 after 12 courses of chemotherapy containing S-1 and cisplatin, he developed pan-peritonitis owing to the perforation of gastric cancer caused by chemotherapy, and thus, we performed emergency omental implantation and peritoneal drainage. He was discharged from the hospital after 14 days with no trouble. His gastric cancer was judged to be resectable without retaining metastatic lymph nodes based on intraoperative findings and abdominal computed tomography. Therefore, 3 months after the emergency surgery, he underwent total gastrectomy with D1+(+No. 11d)lymphadenectomy. The postoperative course was uneventful. He rejected adjuvant chemotherapy despite our recommendation. Regrettably, intraabdominal dissemination was observed 15 months after total gastrectomy, and he then received chemotherapy again. He has remained alive for 57 months after the first visit to our hospital.
要旨
症例は74歳,男性。血性嘔吐を主訴に精査を施行し,大動脈周囲リンパ節転移を伴うcStage Ⅳの進行胃癌と診断され,治癒切除をめざして術前化学療法を導入した。SP療法を12コース,その後S-1療法に移行して2コース目施行中に胃穿孔による急性汎発性腹膜炎を発症し,緊急で大網充塡術,ドレナージ術を施行し,術後14日目に退院した。退院後の評価で治癒切除が可能と判断し,緊急手術より3か月後に胃全摘術D1+(+No. 11d)を施行した。術後経過は良好であった。本人が希望されず術後補助化学療法は施行しなかった。胃全摘後15か月で腹部CTにて腹膜播種再発を認め化学療法を再導入しているが,現在,初発より57か月生存中である。
目次
A 74-year-old man with bloody vomit was diagnosed as having clinical Stage Ⅳ advanced gastric cancer with lymph node metastasis around the abdominal aorta. Initially, for curative surgery, he was administered neoadjuvant chemotherapy. On day 32, in the second course of chemotherapy containing S-1 after 12 courses of chemotherapy containing S-1 and cisplatin, he developed pan-peritonitis owing to the perforation of gastric cancer caused by chemotherapy, and thus, we performed emergency omental implantation and peritoneal drainage. He was discharged from the hospital after 14 days with no trouble. His gastric cancer was judged to be resectable without retaining metastatic lymph nodes based on intraoperative findings and abdominal computed tomography. Therefore, 3 months after the emergency surgery, he underwent total gastrectomy with D1+(+No. 11d)lymphadenectomy. The postoperative course was uneventful. He rejected adjuvant chemotherapy despite our recommendation. Regrettably, intraabdominal dissemination was observed 15 months after total gastrectomy, and he then received chemotherapy again. He has remained alive for 57 months after the first visit to our hospital.
要旨
症例は74歳,男性。血性嘔吐を主訴に精査を施行し,大動脈周囲リンパ節転移を伴うcStage Ⅳの進行胃癌と診断され,治癒切除をめざして術前化学療法を導入した。SP療法を12コース,その後S-1療法に移行して2コース目施行中に胃穿孔による急性汎発性腹膜炎を発症し,緊急で大網充塡術,ドレナージ術を施行し,術後14日目に退院した。退院後の評価で治癒切除が可能と判断し,緊急手術より3か月後に胃全摘術D1+(+No. 11d)を施行した。術後経過は良好であった。本人が希望されず術後補助化学療法は施行しなかった。胃全摘後15か月で腹部CTにて腹膜播種再発を認め化学療法を再導入しているが,現在,初発より57か月生存中である。