内容紹介
Summary
A 79-year-old male presented with right inguinal mass and right leg pain. Laparoscopic right hemicolectomy was performed for transverse colon cancer(type 1, muc, pSS, pN1a, pStage Ⅲa)3 years and 6 months ago. We resected the mass located in the spermatic cord and reconstructed it using the Direct Kugel Patch. Histopathological examination revealed mucinous carcinoma and was diagnosed as a metastatic lesion. Local recurrence was detected in the spermatic cord 1 year after resection, and radical inguinal orchiectomy was performed. Six months after the surgery performed for local recurrence, repeated recurrence was detected in the mesh used for reconstruction. Because this recurrence time was short, the patient opted for chemotherapy; however, this resulted in tumor growth, and surgery had to be scheduled. We performed extended resection of the abdominal wall and reconstruction using the fascia lata tensor muscle flap. Although intestinal obstruction, aspiration pneumonia, and skin flap necrosis were observed, the patient was discharged on the 85th postoperative day and remained alive without recurrence for 17 months. Mucinous carcinoma tends to cause local recurrence and requires adequate surgical margin resection. Extended excision should be considered in such cases of repeated local recurrence without distant metastases.
要旨
症例は79歳,男性。横行結腸癌に対して,腹腔鏡下右半結腸切除術を施行した(type 1,muc,pSS,pN1a,Stage Ⅲa)。術後3年6か月で,右鼠径部腫瘤,右下肢痛を主訴に来院し,同部に腫瘤を認め,腫瘤摘出術,メッシュ再建を行った。病理組織学的検査にて粘液癌を認め,転移性病変と診断された。その1年後に局所再発を来し,高位精巣摘除術を施行するも,その6か月後にメッシュ再建部に局所再発を認めた。再発までの期間が短く全身化学療法を施行したが,増大を認めたため切除の方針となり,腹壁切除術,大腿筋膜張筋皮弁術を施行した。術後,腸閉塞,誤嚥性肺炎,皮弁壊死を認めたが,術後85日目に自宅退院となった。術後17か月間,無再発生存中である。粘液癌は局所再発を来しやすく確実な切除マージンが必要である。本症例のように局所再発を繰り返す場合には,積極的な切除を考慮してもよいと考えられた。
目次
A 79-year-old male presented with right inguinal mass and right leg pain. Laparoscopic right hemicolectomy was performed for transverse colon cancer(type 1, muc, pSS, pN1a, pStage Ⅲa)3 years and 6 months ago. We resected the mass located in the spermatic cord and reconstructed it using the Direct Kugel Patch. Histopathological examination revealed mucinous carcinoma and was diagnosed as a metastatic lesion. Local recurrence was detected in the spermatic cord 1 year after resection, and radical inguinal orchiectomy was performed. Six months after the surgery performed for local recurrence, repeated recurrence was detected in the mesh used for reconstruction. Because this recurrence time was short, the patient opted for chemotherapy; however, this resulted in tumor growth, and surgery had to be scheduled. We performed extended resection of the abdominal wall and reconstruction using the fascia lata tensor muscle flap. Although intestinal obstruction, aspiration pneumonia, and skin flap necrosis were observed, the patient was discharged on the 85th postoperative day and remained alive without recurrence for 17 months. Mucinous carcinoma tends to cause local recurrence and requires adequate surgical margin resection. Extended excision should be considered in such cases of repeated local recurrence without distant metastases.
要旨
症例は79歳,男性。横行結腸癌に対して,腹腔鏡下右半結腸切除術を施行した(type 1,muc,pSS,pN1a,Stage Ⅲa)。術後3年6か月で,右鼠径部腫瘤,右下肢痛を主訴に来院し,同部に腫瘤を認め,腫瘤摘出術,メッシュ再建を行った。病理組織学的検査にて粘液癌を認め,転移性病変と診断された。その1年後に局所再発を来し,高位精巣摘除術を施行するも,その6か月後にメッシュ再建部に局所再発を認めた。再発までの期間が短く全身化学療法を施行したが,増大を認めたため切除の方針となり,腹壁切除術,大腿筋膜張筋皮弁術を施行した。術後,腸閉塞,誤嚥性肺炎,皮弁壊死を認めたが,術後85日目に自宅退院となった。術後17か月間,無再発生存中である。粘液癌は局所再発を来しやすく確実な切除マージンが必要である。本症例のように局所再発を繰り返す場合には,積極的な切除を考慮してもよいと考えられた。