直腸GISTに対して術前化学療法後に腹腔鏡下超低位前方切除・膣後壁合併切除を施行した1例
患者は43歳女性．直腸前壁に4cm大のGISTを認めた．画像上，腫瘍は膣と近接しており，膣後壁への浸潤を否定しきれなかった．肛門温存は可能であったが，腫瘍を縮小させ，より確実な温存を行うため，メシル酸イマチニブを術前に投与．44日目で副作用により投与中止となったが，投与後の画像では腫瘍の縮小（45mm→38mm）を認めた．膣後壁への明らかな浸潤もなく，肛門温存もより確実と判断し，手術の方針となった．腹腔鏡下に直腸を骨盤底まで充分に剥離．肛門管内は内肛門括約筋を温存しつつ剥離を行った．肛門側より内肛門括約筋を温存しつつ，腹腔内からの剥離と交通させた．直腸前壁の腫瘍を露出しないように膣後壁の一部を...
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| Published in | 日本大腸肛門病学会雑誌 Vol. 69; no. 3; pp. 164 - 169 |
|---|---|
| Main Authors | , , , , , |
| Format | Journal Article |
| Language | Japanese |
| Published |
日本大腸肛門病学会
2016
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| Subjects | |
| Online Access | Get full text |
| ISSN | 0047-1801 1882-9619 |
| DOI | 10.3862/jcoloproctology.69.164 |
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| Abstract | 患者は43歳女性．直腸前壁に4cm大のGISTを認めた．画像上，腫瘍は膣と近接しており，膣後壁への浸潤を否定しきれなかった．肛門温存は可能であったが，腫瘍を縮小させ，より確実な温存を行うため，メシル酸イマチニブを術前に投与．44日目で副作用により投与中止となったが，投与後の画像では腫瘍の縮小（45mm→38mm）を認めた．膣後壁への明らかな浸潤もなく，肛門温存もより確実と判断し，手術の方針となった．腹腔鏡下に直腸を骨盤底まで充分に剥離．肛門管内は内肛門括約筋を温存しつつ剥離を行った．肛門側より内肛門括約筋を温存しつつ，腹腔内からの剥離と交通させた．直腸前壁の腫瘍を露出しないように膣後壁の一部を合併切除した．膣後壁は経膣的に縫合閉鎖．再建は経肛門的に結腸肛門吻合を行った．直腸GISTに対して術前のメシル酸イマチニブ投与と腹腔鏡の手術は，肛門温存をより安全で正確に行えると考えられた． |
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| AbstractList | 患者は43歳女性．直腸前壁に4cm大のGISTを認めた．画像上，腫瘍は膣と近接しており，膣後壁への浸潤を否定しきれなかった．肛門温存は可能であったが，腫瘍を縮小させ，より確実な温存を行うため，メシル酸イマチニブを術前に投与．44日目で副作用により投与中止となったが，投与後の画像では腫瘍の縮小（45mm→38mm）を認めた．膣後壁への明らかな浸潤もなく，肛門温存もより確実と判断し，手術の方針となった．腹腔鏡下に直腸を骨盤底まで充分に剥離．肛門管内は内肛門括約筋を温存しつつ剥離を行った．肛門側より内肛門括約筋を温存しつつ，腹腔内からの剥離と交通させた．直腸前壁の腫瘍を露出しないように膣後壁の一部を合併切除した．膣後壁は経膣的に縫合閉鎖．再建は経肛門的に結腸肛門吻合を行った．直腸GISTに対して術前のメシル酸イマチニブ投与と腹腔鏡の手術は，肛門温存をより安全で正確に行えると考えられた． |
| Author | 的場, 周一郎 建, 智博 富沢, 賢治 花岡, 裕 黒柳, 洋弥 戸田, 重夫 |
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| References | 9) Heinrich MC, Corless CL, Demetri GD, et al: Kinase Mutations and Imatinib Response in Patients With Metastatic Gastrointestinal Stromal Tumor. J Clin Oncol 21:4342-4349, 2003 13) Nishimura J, Nakajima K, Omori T, et al: Surgical strategy for gastric gastrointestinal stromal tumors: laparoscopic vs. open resection. Surg Endosc 21:875-878, 2007 7) Demetri GD, von Mehren M, Blanke CD, et al: Efficacy and safety of imatinib mesylate in advanced gastrointestinal stromal tumors. N Engl J Med 347:472-480, 2002 1) Yamashita K, Kubozoe T, Yamamura M, et al: Usefulness of Neoadjuvant Imatinib mesylate for a Huge Rectal Gastrointestinal Stromal Tumor: A case Report. J coloproct 59:24-30, 2006 5) Kato K, Otsuka K, Itabashi T, et al: A case of Rectal GIST with Imatinib Mesylate Neoadjuvant Therapy to Preserve the Anus and Curative Resection. J coloproct 65:239-244, 2012 8) Hirota S, Isozaki K, Moriyama Y, et al: Gain-of-function mutations of c-kit in human gastrointestinal stromal tumors. Science 279:577-580, 1998 12) 日本癌治療学会, 日本胃癌学会, GIST研究会:GIST診療ガイドライン2014年4月改訂【第3版】 15) Schiessel R, Karner-Hanusch J, Herbst F, et al: Intersphincteric resection for low rectal tumors. Br J Surg 81:1376-1378, 1994 6) Miettinen M, Lasota J: Gastrointestinal stromal tumors: definition, occurrence, pathology, differential diagnosis and molecular genetics. Pol J Pathol 54:3-24, 2003 10) Heinrich MC, Owzar K, Corless CL, et al: Correlation of Kinase Genotype and Clinical Outcome in the North American Intergroup Phase III Trial of Imatinib Mesylate for Treatment of Advanced Gastrointestinal Stromal Tumors. J Clin Oncol 26:5360-5367, 2008 14) Sasaki A, Koeda K, Obuchi T, et al: Tailored laparoscopic resection for suspected gastric gastrointestinal stromal tumors. Surgery 147:516-520, 2010 2) Ebihara Y, Okushiba S, Kawarada Y, et al: Neoadjuvant Imatinib in a Gastrointestinal Stromal Tumor of the Rectum: Report of a Case. Surg Today 38:174-177, 2008 4) Mashita N, Yokoyama H, Taniguchi K, et al: A CASE OF SURGICAL RESECTION OF RECTAL GASTROINTESTINAL STROMAL TUMOR AFTER NEOADJUVANT THERAPY WITH IMATINIB MESYLATE. J Jpn Surg Assoc 72:2877-2881, 2011 3) Yamakawa K, Akiyoshi T, Kuroyanagi H, et al: A case of rectal GIST successfully treated by transanal local resection and recto-anal anastomosis following laparoscopic rectal dissection. J Jpn Endosc Surg 16:343-348, 2011 16) Shirouzu K, Ogata Y, Araki Y, et al: A new ultimate anus-preserving operation for extremely low rectal cancer and for anal canal cancer. Tech Coloproctol 7:203-206, 2003 11) Demetri GD, Vbenjamin R, Blanke CD, et al: NCCN Task Force Report: Optimal management of patients with gastrointestinal stromal tumor (GIST)-Expansion and Update of NCCN Clinical Practice Guidelines. JCCN 2:S1-S26, 2004 17) Fujimoto Y, Akiyoshi T, Kuroyanagi H, et al: Safety and feasibility of laparoscopic intersphincteric resection for very low rectal cancer. J Gastrointest Surg 14:645-650, 2010 |
| References_xml | – reference: 5) Kato K, Otsuka K, Itabashi T, et al: A case of Rectal GIST with Imatinib Mesylate Neoadjuvant Therapy to Preserve the Anus and Curative Resection. J coloproct 65:239-244, 2012 – reference: 2) Ebihara Y, Okushiba S, Kawarada Y, et al: Neoadjuvant Imatinib in a Gastrointestinal Stromal Tumor of the Rectum: Report of a Case. Surg Today 38:174-177, 2008 – reference: 8) Hirota S, Isozaki K, Moriyama Y, et al: Gain-of-function mutations of c-kit in human gastrointestinal stromal tumors. Science 279:577-580, 1998 – reference: 9) Heinrich MC, Corless CL, Demetri GD, et al: Kinase Mutations and Imatinib Response in Patients With Metastatic Gastrointestinal Stromal Tumor. J Clin Oncol 21:4342-4349, 2003 – reference: 3) Yamakawa K, Akiyoshi T, Kuroyanagi H, et al: A case of rectal GIST successfully treated by transanal local resection and recto-anal anastomosis following laparoscopic rectal dissection. J Jpn Endosc Surg 16:343-348, 2011 – reference: 15) Schiessel R, Karner-Hanusch J, Herbst F, et al: Intersphincteric resection for low rectal tumors. Br J Surg 81:1376-1378, 1994 – reference: 11) Demetri GD, Vbenjamin R, Blanke CD, et al: NCCN Task Force Report: Optimal management of patients with gastrointestinal stromal tumor (GIST)-Expansion and Update of NCCN Clinical Practice Guidelines. JCCN 2:S1-S26, 2004 – reference: 13) Nishimura J, Nakajima K, Omori T, et al: Surgical strategy for gastric gastrointestinal stromal tumors: laparoscopic vs. open resection. Surg Endosc 21:875-878, 2007 – reference: 16) Shirouzu K, Ogata Y, Araki Y, et al: A new ultimate anus-preserving operation for extremely low rectal cancer and for anal canal cancer. Tech Coloproctol 7:203-206, 2003 – reference: 1) Yamashita K, Kubozoe T, Yamamura M, et al: Usefulness of Neoadjuvant Imatinib mesylate for a Huge Rectal Gastrointestinal Stromal Tumor: A case Report. J coloproct 59:24-30, 2006 – reference: 4) Mashita N, Yokoyama H, Taniguchi K, et al: A CASE OF SURGICAL RESECTION OF RECTAL GASTROINTESTINAL STROMAL TUMOR AFTER NEOADJUVANT THERAPY WITH IMATINIB MESYLATE. J Jpn Surg Assoc 72:2877-2881, 2011 – reference: 10) Heinrich MC, Owzar K, Corless CL, et al: Correlation of Kinase Genotype and Clinical Outcome in the North American Intergroup Phase III Trial of Imatinib Mesylate for Treatment of Advanced Gastrointestinal Stromal Tumors. J Clin Oncol 26:5360-5367, 2008 – reference: 14) Sasaki A, Koeda K, Obuchi T, et al: Tailored laparoscopic resection for suspected gastric gastrointestinal stromal tumors. Surgery 147:516-520, 2010 – reference: 7) Demetri GD, von Mehren M, Blanke CD, et al: Efficacy and safety of imatinib mesylate in advanced gastrointestinal stromal tumors. N Engl J Med 347:472-480, 2002 – reference: 17) Fujimoto Y, Akiyoshi T, Kuroyanagi H, et al: Safety and feasibility of laparoscopic intersphincteric resection for very low rectal cancer. J Gastrointest Surg 14:645-650, 2010 – reference: 6) Miettinen M, Lasota J: Gastrointestinal stromal tumors: definition, occurrence, pathology, differential diagnosis and molecular genetics. Pol J Pathol 54:3-24, 2003 – reference: 12) 日本癌治療学会, 日本胃癌学会, GIST研究会:GIST診療ガイドライン2014年4月改訂【第3版】 |
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| Title | 直腸GISTに対して術前化学療法後に腹腔鏡下超低位前方切除・膣後壁合併切除を施行した1例 |
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| ispartofPNX | 日本大腸肛門病学会雑誌, 2016, Vol.69(3), pp.164-169 |
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