直腸癌側方リンパ節郭清術後の閉鎖リンパ節転移に対して腹腔鏡下に切除した1例
症例は64歳女性．60歳時，左閉鎖リンパ節腫大を伴う直腸癌に対して腹腔鏡下括約筋間直腸切除術，左側側方郭清を施行した．側方郭清は鏡視下に直腸切除後，小開腹下に施行した．切除した側方リンパ節に転移は認めなかった．術後早期からCT検査で腫大した左閉鎖リンパ節残存を認めた．術後3年4ヵ月のFDG-PET検査で同リンパ節への集積を認め，3年7ヵ月で腹腔鏡下に左閉鎖リンパ節を再度郭清した．手術時間3時間18分，術中出血2g，合併症なく術後6日目に退院した．14ヵ月経過した時点で再発を認めていない．本症例は初回手術の小開腹下側方郭清が不十分であった可能性が高く，一方，再手術で行った腹腔鏡下側方郭清は良好な...
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| Published in | 日本大腸肛門病学会雑誌 Vol. 72; no. 8; pp. 509 - 515 |
|---|---|
| Main Authors | , , , , , |
| Format | Journal Article |
| Language | Japanese |
| Published |
日本大腸肛門病学会
2019
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| Subjects | |
| Online Access | Get full text |
| ISSN | 0047-1801 1882-9619 |
| DOI | 10.3862/jcoloproctology.72.509 |
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| Abstract | 症例は64歳女性．60歳時，左閉鎖リンパ節腫大を伴う直腸癌に対して腹腔鏡下括約筋間直腸切除術，左側側方郭清を施行した．側方郭清は鏡視下に直腸切除後，小開腹下に施行した．切除した側方リンパ節に転移は認めなかった．術後早期からCT検査で腫大した左閉鎖リンパ節残存を認めた．術後3年4ヵ月のFDG-PET検査で同リンパ節への集積を認め，3年7ヵ月で腹腔鏡下に左閉鎖リンパ節を再度郭清した．手術時間3時間18分，術中出血2g，合併症なく術後6日目に退院した．14ヵ月経過した時点で再発を認めていない．本症例は初回手術の小開腹下側方郭清が不十分であった可能性が高く，一方，再手術で行った腹腔鏡下側方郭清は良好な視野のもと確実な郭清操作が可能と考えられ，文献的考察を加えて報告する． |
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| AbstractList | 症例は64歳女性．60歳時，左閉鎖リンパ節腫大を伴う直腸癌に対して腹腔鏡下括約筋間直腸切除術，左側側方郭清を施行した．側方郭清は鏡視下に直腸切除後，小開腹下に施行した．切除した側方リンパ節に転移は認めなかった．術後早期からCT検査で腫大した左閉鎖リンパ節残存を認めた．術後3年4ヵ月のFDG-PET検査で同リンパ節への集積を認め，3年7ヵ月で腹腔鏡下に左閉鎖リンパ節を再度郭清した．手術時間3時間18分，術中出血2g，合併症なく術後6日目に退院した．14ヵ月経過した時点で再発を認めていない．本症例は初回手術の小開腹下側方郭清が不十分であった可能性が高く，一方，再手術で行った腹腔鏡下側方郭清は良好な視野のもと確実な郭清操作が可能と考えられ，文献的考察を加えて報告する． |
| Author | 大矢, 雅敏 藤本, 佳也 竹下, 惠美子 大井, 悠 奥山, 隆 鮫島, 伸一 |
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| References | 9) 大腸癌研究会／編:大腸癌治療ガイドライン. 医師用, 2016年版, 金原出版, 東京, 2016 13) Ueda T, Koyama F, Nakagawa T, et al: Prophylactic laparoscopic lateral pelvic lymph node dissection for lower rectal cancer: Remarking on the vesicohypogastric fascia. Gan To Kagaku Ryoho 41:1488-1490, 2014 12) Obara S, Koyama F, Nakagawa T, et al: Laparoscopic lateral pelvic lymph node dissection for lower rectal cancer: Initial clinical experiences with prophylactic dissection. Gan To Kagaku Ryoho 39:2173-2175, 2012 19) Kim HJ, Choi GS, Park JS, et al: Selective lateral pelvic lymph node dissection: A comparative study of the robotic versus lateral approach. Surg Endosc 32:2466-2473, 2018 11) Liang JT: Technical feasibility of laparoscopic lateral pelvic lymph node dissection for partients with low rectal cancer after concurrent chemoradiation therapy. Ann Surg oncol 18:153-159, 2011 5) Willett CG, Czito BG, Bendell JC: Radiation therapy in Stage II and III rectal cancer. Clin Cancer Res 13:6903s-6908s, 2007 16) Ogura A, Akiyoshi T, Nagasaki T, et al: Feasibility of laparoscopic total mesorectal excision with extended lateral pelvic lymph node dissection for advanced lower rectal cancer after preoperative chemoradiotherapy. World J Surg 41:868-875, 2017 20) Horie H, Koinuma, Ito H, et al: Utility of preoperative 3-D simulation of laparoscopic lateral pelvic lymph node dissection for advanced rectal cancer: Surgical outcomes of 10 initial cases. Asian J Endosc Surg 2018. [Epub ahead of print] 8) 大矢雅敏, 鮫島伸一, 奥山 隆ほか:直腸癌側方郭清の治療成績. 外科 79:517-524, 2017 6) Homma Y, Hamano T, Otsuki Y, et al: Total number of lymph node metastasis is a more significant risk factor for poor prognosis than positive lateral lymph node metastasis. Surg Today 45:168-174, 2015 3) Georgiou P, Tan E, Gouvas N, et al: Extened lymphadenectomy versus conventional surgery for rectal cancer: a meta-analysis. Lancet Oncol 10:1053-1062, 2009 4) Sugihara K, Kobayashi H, Kato T, et al: Indication and benefit of pelvic sidewall dissection for rectal cancer. Dis Colon Rectum 49:1663-1672, 2006 7) Ueno M, Oya M, Azekura T, et al: Incidence and prognostic significance of lateral lymph node metastasis in patients with advanced low rectal cancer. Br J Surg 92:756-763, 2005 14) Furuhata T, Okita K, Nishidate T, et al: Clinical feasibility of laparoscopic lateral pelvic lymph node dissection following total mesorectal excision for advanced rectal cancer. Surg Today 45:310-314, 2015 1) Konishi T, Kuroyanagi H, Oya M, et al: Multimedia article. Lateral Lymph node dissection with preoperative chemoradiation for locally advanced lower rectal cancer through a laparoscopic approach. Surg Endosc 25:2358-2359, 2011 18) Yamaguchi T, Konishi T, Kinugasa Y, et al: Laparoscopic versus open lateral lymph node dissection for locally advanced low rectal cancer: A subgroup analysis of a large multicenter cohort study in Japan. Dis Colon Rectum 60:954-964, 2017 2) Grinnell RS: The lymphatic and venous spread of carcinoma of the rectum. Ann Surg 116:200-216, 1942 10) 上原圭介, 有元淳記, 加藤健宏ほか:直腸癌局所再発に対する外科的アプローチの要点. 臨外 69:1180-1186, 2014 17) Matsumoto A, Arita K: A technique of laparoscopic lateral pelvic lymph node dissection based on vesicohypogastric fascia and ureterohypogastric nerve fascia for advanced low rectal cancer. Surg Endosc 31:945-948, 2017 15) Nagayoshi K, Ueki T, Manabe T, et al: Laparoscopic lateral pelvic lymph node dissection is achievable and offers advantages as a minimally invasive surgery over the open approach. Surg Endosc 30:1938-1947, 2016 |
| References_xml | – reference: 14) Furuhata T, Okita K, Nishidate T, et al: Clinical feasibility of laparoscopic lateral pelvic lymph node dissection following total mesorectal excision for advanced rectal cancer. Surg Today 45:310-314, 2015 – reference: 1) Konishi T, Kuroyanagi H, Oya M, et al: Multimedia article. Lateral Lymph node dissection with preoperative chemoradiation for locally advanced lower rectal cancer through a laparoscopic approach. Surg Endosc 25:2358-2359, 2011 – reference: 15) Nagayoshi K, Ueki T, Manabe T, et al: Laparoscopic lateral pelvic lymph node dissection is achievable and offers advantages as a minimally invasive surgery over the open approach. Surg Endosc 30:1938-1947, 2016 – reference: 2) Grinnell RS: The lymphatic and venous spread of carcinoma of the rectum. Ann Surg 116:200-216, 1942 – reference: 3) Georgiou P, Tan E, Gouvas N, et al: Extened lymphadenectomy versus conventional surgery for rectal cancer: a meta-analysis. Lancet Oncol 10:1053-1062, 2009 – reference: 10) 上原圭介, 有元淳記, 加藤健宏ほか:直腸癌局所再発に対する外科的アプローチの要点. 臨外 69:1180-1186, 2014 – reference: 17) Matsumoto A, Arita K: A technique of laparoscopic lateral pelvic lymph node dissection based on vesicohypogastric fascia and ureterohypogastric nerve fascia for advanced low rectal cancer. Surg Endosc 31:945-948, 2017 – reference: 18) Yamaguchi T, Konishi T, Kinugasa Y, et al: Laparoscopic versus open lateral lymph node dissection for locally advanced low rectal cancer: A subgroup analysis of a large multicenter cohort study in Japan. Dis Colon Rectum 60:954-964, 2017 – reference: 5) Willett CG, Czito BG, Bendell JC: Radiation therapy in Stage II and III rectal cancer. Clin Cancer Res 13:6903s-6908s, 2007 – reference: 8) 大矢雅敏, 鮫島伸一, 奥山 隆ほか:直腸癌側方郭清の治療成績. 外科 79:517-524, 2017 – reference: 12) Obara S, Koyama F, Nakagawa T, et al: Laparoscopic lateral pelvic lymph node dissection for lower rectal cancer: Initial clinical experiences with prophylactic dissection. Gan To Kagaku Ryoho 39:2173-2175, 2012 – reference: 9) 大腸癌研究会／編:大腸癌治療ガイドライン. 医師用, 2016年版, 金原出版, 東京, 2016 – reference: 16) Ogura A, Akiyoshi T, Nagasaki T, et al: Feasibility of laparoscopic total mesorectal excision with extended lateral pelvic lymph node dissection for advanced lower rectal cancer after preoperative chemoradiotherapy. World J Surg 41:868-875, 2017 – reference: 19) Kim HJ, Choi GS, Park JS, et al: Selective lateral pelvic lymph node dissection: A comparative study of the robotic versus lateral approach. Surg Endosc 32:2466-2473, 2018 – reference: 4) Sugihara K, Kobayashi H, Kato T, et al: Indication and benefit of pelvic sidewall dissection for rectal cancer. Dis Colon Rectum 49:1663-1672, 2006 – reference: 6) Homma Y, Hamano T, Otsuki Y, et al: Total number of lymph node metastasis is a more significant risk factor for poor prognosis than positive lateral lymph node metastasis. Surg Today 45:168-174, 2015 – reference: 13) Ueda T, Koyama F, Nakagawa T, et al: Prophylactic laparoscopic lateral pelvic lymph node dissection for lower rectal cancer: Remarking on the vesicohypogastric fascia. Gan To Kagaku Ryoho 41:1488-1490, 2014 – reference: 20) Horie H, Koinuma, Ito H, et al: Utility of preoperative 3-D simulation of laparoscopic lateral pelvic lymph node dissection for advanced rectal cancer: Surgical outcomes of 10 initial cases. Asian J Endosc Surg 2018. [Epub ahead of print] – reference: 11) Liang JT: Technical feasibility of laparoscopic lateral pelvic lymph node dissection for partients with low rectal cancer after concurrent chemoradiation therapy. Ann Surg oncol 18:153-159, 2011 – reference: 7) Ueno M, Oya M, Azekura T, et al: Incidence and prognostic significance of lateral lymph node metastasis in patients with advanced low rectal cancer. Br J Surg 92:756-763, 2005 |
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| Title | 直腸癌側方リンパ節郭清術後の閉鎖リンパ節転移に対して腹腔鏡下に切除した1例 |
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