内容紹介
Summary
An 82-year-old man with StageⅣ advanced gastric cancer and multiple liver metastases was referred to our hospital. Chemotherapy using S-1 was administered, resulting in withdrawal from the usual course because of an adverse event of grade 4 anorexia. GIS and EOB-MRI showed a prominent tumor reduction in both lesions; however, despite this, distal gastrectomy, D2 lymph node dissection, liver biopsy for S3 lesion, partial liver resection for S6 lesion, and cholecystectomy were performed to obtain a therapeutic diagnosis. Pathology revealed that the tumor cells remained in the main liver metastatic lesions. Therapeutic effect was assessed as Grade 2. Although weekly paclitaxel followed by reduced S-1 dosage was introduced after surgery, the recurrent mass was observed in the para-aortic region after 2 years. Subsequently, para-aortic lymph node dissection was performed because no new lesion was detected. More than 10 years have passed without any recurrence since the first surgery. As part of a multidisciplinary treatment for far advanced gastric cancer with multiple liver metastases(StageⅣ), conversion surgery might be considered effective.
要旨
症例は82歳,男性。多発肝転移を伴う胃癌StageⅣと診断された。S-1を開始したが,食思不振grade 4の有害事象を認め1コース途中で中止となり,その後当科紹介となった。GISでは主病変は著明に縮小し,EOB-MRI検査でも肝転移を同定できなかった。治療診断目的に幽門側胃切除術,D2リンパ節郭清,S3肝生検,S6部分切除,胆囊摘出術を施行した。病理組織学的結果では主病変,肝転移には癌遺残を認め,Grade 2の治療効果と診断された。術後にS-1を減量し再開した。2年後に大動脈周囲リンパ節に再発を認め,化学療法により病巣コントロールを行った。化学療法継続で新規病変の出現を認めなかったため,大動脈周囲リンパ節郭清を施行した。術後10年を超え再発なく経過している。胃癌StageⅣの多発肝転移症例に対する集学的治療の一環として,conversion surgeryも有効であると考えられた。
目次
An 82-year-old man with StageⅣ advanced gastric cancer and multiple liver metastases was referred to our hospital. Chemotherapy using S-1 was administered, resulting in withdrawal from the usual course because of an adverse event of grade 4 anorexia. GIS and EOB-MRI showed a prominent tumor reduction in both lesions; however, despite this, distal gastrectomy, D2 lymph node dissection, liver biopsy for S3 lesion, partial liver resection for S6 lesion, and cholecystectomy were performed to obtain a therapeutic diagnosis. Pathology revealed that the tumor cells remained in the main liver metastatic lesions. Therapeutic effect was assessed as Grade 2. Although weekly paclitaxel followed by reduced S-1 dosage was introduced after surgery, the recurrent mass was observed in the para-aortic region after 2 years. Subsequently, para-aortic lymph node dissection was performed because no new lesion was detected. More than 10 years have passed without any recurrence since the first surgery. As part of a multidisciplinary treatment for far advanced gastric cancer with multiple liver metastases(StageⅣ), conversion surgery might be considered effective.
要旨
症例は82歳,男性。多発肝転移を伴う胃癌StageⅣと診断された。S-1を開始したが,食思不振grade 4の有害事象を認め1コース途中で中止となり,その後当科紹介となった。GISでは主病変は著明に縮小し,EOB-MRI検査でも肝転移を同定できなかった。治療診断目的に幽門側胃切除術,D2リンパ節郭清,S3肝生検,S6部分切除,胆囊摘出術を施行した。病理組織学的結果では主病変,肝転移には癌遺残を認め,Grade 2の治療効果と診断された。術後にS-1を減量し再開した。2年後に大動脈周囲リンパ節に再発を認め,化学療法により病巣コントロールを行った。化学療法継続で新規病変の出現を認めなかったため,大動脈周囲リンパ節郭清を施行した。術後10年を超え再発なく経過している。胃癌StageⅣの多発肝転移症例に対する集学的治療の一環として,conversion surgeryも有効であると考えられた。