内容紹介
Summary
A 69—year—old woman presented with persistent nauseous, underwent upper gastrointestinal endoscopy, and was diagnosed with type 2 advanced gastric cancer at the antrum. Abdominal contrast CT image data revealed that there was a large, swollen, pancreatic superior lymph node invading the common hepatic artery. We determined that the tumor was unresectable and systemic chemotherapy was performed using S—1 plus oxaliplatin(SOX)therapy. After 5 courses of chemotherapy, the abdominal contrast CT image data indicated reduction of both the primary lesion and lymph node metastasis. A laparotomy was performed. As the No. 8a lymph node was forming hard scar tissue, we could not dissected clearly it from the common hepatic artery wall. We strongly suspected that cancer tissue remained at the artery wall. A distal gastrectomy and Roux—en—Y reconstruction were performed. Histologically, the resected specimen was determined to be Grade 3, with a pathological complete response(pCR). The patient was administered S—1 for 6 months after the operation and has enjoyed 2.5 years of recurrence—free survival. SOX therapy for unresectable gastric cancer and surgical intervention as conversion surgery were effective. This case demonstrated the possibility of life prolongation using these therapies.
要旨
症例は69歳,女性。嘔気が持続するため当院内科を受診した。上部消化管内視鏡を施行され,胃前庭部小弯の2型進行胃癌と診断された。腹部造影CT検査では総肝動脈前上縁リンパ節No. 8aの腫大があり,総肝動脈へ浸潤していると判断した。切除不能胃癌と判断してS—1+oxaliplatin(SOX)療法による全身化学療法を行った。5コース施行後の造影CTで,原発巣・リンパ節転移ともに縮小を認め,開腹胃切除術を行った。No. 8aリンパ節は硬く瘢痕化し,総肝動脈壁からきれいに剝離,切離できずR2が強く疑われたが,開腹幽門側胃切除,Roux—en—Y再建を行った。切除標本の組織学的効果判定がGrade 3,病理学的完全奏効(pCR)であった。術後補助化学療法としてS—1内服6か月間施行し,術後2年6か月無再発生存中である。切除不能胃癌に対してSOX療法が奏効し,conversion surgeryとして手術介入がなされ生存期間が延長する可能性が示された。
目次
A 69—year—old woman presented with persistent nauseous, underwent upper gastrointestinal endoscopy, and was diagnosed with type 2 advanced gastric cancer at the antrum. Abdominal contrast CT image data revealed that there was a large, swollen, pancreatic superior lymph node invading the common hepatic artery. We determined that the tumor was unresectable and systemic chemotherapy was performed using S—1 plus oxaliplatin(SOX)therapy. After 5 courses of chemotherapy, the abdominal contrast CT image data indicated reduction of both the primary lesion and lymph node metastasis. A laparotomy was performed. As the No. 8a lymph node was forming hard scar tissue, we could not dissected clearly it from the common hepatic artery wall. We strongly suspected that cancer tissue remained at the artery wall. A distal gastrectomy and Roux—en—Y reconstruction were performed. Histologically, the resected specimen was determined to be Grade 3, with a pathological complete response(pCR). The patient was administered S—1 for 6 months after the operation and has enjoyed 2.5 years of recurrence—free survival. SOX therapy for unresectable gastric cancer and surgical intervention as conversion surgery were effective. This case demonstrated the possibility of life prolongation using these therapies.
要旨
症例は69歳,女性。嘔気が持続するため当院内科を受診した。上部消化管内視鏡を施行され,胃前庭部小弯の2型進行胃癌と診断された。腹部造影CT検査では総肝動脈前上縁リンパ節No. 8aの腫大があり,総肝動脈へ浸潤していると判断した。切除不能胃癌と判断してS—1+oxaliplatin(SOX)療法による全身化学療法を行った。5コース施行後の造影CTで,原発巣・リンパ節転移ともに縮小を認め,開腹胃切除術を行った。No. 8aリンパ節は硬く瘢痕化し,総肝動脈壁からきれいに剝離,切離できずR2が強く疑われたが,開腹幽門側胃切除,Roux—en—Y再建を行った。切除標本の組織学的効果判定がGrade 3,病理学的完全奏効(pCR)であった。術後補助化学療法としてS—1内服6か月間施行し,術後2年6か月無再発生存中である。切除不能胃癌に対してSOX療法が奏効し,conversion surgeryとして手術介入がなされ生存期間が延長する可能性が示された。