胃癌同時性肝転移に対して化学療法後に腹腔鏡下切除を施行した1例

症例は75歳の男性で，食思不振を主訴に近医受診され，上部消化管内視鏡検検査にて胃体中部大彎後壁に進行胃癌を認め当院に紹介となった．造影CTにて肝S2に単発の転移（20 mm）を認め，cT4aN0M1HEP cStage IVの診断となった．生検結果にてHER2陽性であったため，カペシタビン+シスプラチン+トラスツズマブ療法を計2コース施行した．2コース施行後転移巣の縮小を認め，PRの効果判定となった．審査腹腔鏡検査にて腹膜播種がないことを確認した後，腹腔鏡下幽門側胃切除および腹腔鏡下肝S2部分切除を施行した．術後経過良好で，術後9日目に退院となった．病理結果はypT4aN0M1HEP ypSt...

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Published in日本消化器外科学会雑誌 Vol. 52; no. 5; pp. 257 - 262
Main Authors 益澤, 徹, 大村, 仁昭, 村田, 幸平, 村上, 剛平, 賀川, 義規, 武田, 裕, 永野, 輝明, 竹野, 淳, 遠矢, 圭介, 桂, 宜輝
Format Journal Article
LanguageJapanese
Published 一般社団法人 日本消化器外科学会 01.05.2019
Subjects
同時切除
胃癌同時性肝転移
腹腔鏡手術
Online AccessGet full text
ISSN0386-9768
1348-9372
DOI10.5833/jjgs.2018.0095

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Abstract 症例は75歳の男性で，食思不振を主訴に近医受診され，上部消化管内視鏡検検査にて胃体中部大彎後壁に進行胃癌を認め当院に紹介となった．造影CTにて肝S2に単発の転移（20 mm）を認め，cT4aN0M1HEP cStage IVの診断となった．生検結果にてHER2陽性であったため，カペシタビン+シスプラチン+トラスツズマブ療法を計2コース施行した．2コース施行後転移巣の縮小を認め，PRの効果判定となった．審査腹腔鏡検査にて腹膜播種がないことを確認した後，腹腔鏡下幽門側胃切除および腹腔鏡下肝S2部分切除を施行した．術後経過良好で，術後9日目に退院となった．病理結果はypT4aN0M1HEP ypStage IV，治療効果はGrade 1aであった．術後補助化学療法としてS-1を退院後約1か月より開始し，術後6か月無再発生存中である．
AbstractList 症例は75歳の男性で，食思不振を主訴に近医受診され，上部消化管内視鏡検検査にて胃体中部大彎後壁に進行胃癌を認め当院に紹介となった．造影CTにて肝S2に単発の転移（20 mm）を認め，cT4aN0M1HEP cStage IVの診断となった．生検結果にてHER2陽性であったため，カペシタビン+シスプラチン+トラスツズマブ療法を計2コース施行した．2コース施行後転移巣の縮小を認め，PRの効果判定となった．審査腹腔鏡検査にて腹膜播種がないことを確認した後，腹腔鏡下幽門側胃切除および腹腔鏡下肝S2部分切除を施行した．術後経過良好で，術後9日目に退院となった．病理結果はypT4aN0M1HEP ypStage IV，治療効果はGrade 1aであった．術後補助化学療法としてS-1を退院後約1か月より開始し，術後6か月無再発生存中である．
Author 村上, 剛平
武田, 裕
遠矢, 圭介
永野, 輝明
賀川, 義規
桂, 宜輝
竹野, 淳
村田, 幸平
益澤, 徹
大村, 仁昭
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References 6) Hu Y, Huang C, Sun Y, Su X, Cao H, Hu J, et al. Morbidity and mortality of laparoscopic versus open D2 distal gastrectomy for advanced gastric cancer: a randomized controlled trial. J Clin Oncol. 2016 Apr;34(12):1350–1357.
8) Beppu T, Wakabayashi G, Hasegawa K, Gotohda N, Mizuguchi T, Takahashi Y, et al. Long-term and perioperative outcomes of laparoscopic versus open liver resection for colorectal liver metastases with propensity score matching: a multi-institutional Japanese study. J Hepatobiliary Pancreat Sci. 2015 Oct;22(10):711–720.
5) Inaki N, Etoh T, Ohyama T, Uchiyama K, Katada N, Koeda K, et al. A multi-institutional, prospective, phase II feasibility study of laparoscopy-assisted distal gastrectomy with D2 lymph node dissection for locally advanced gastric cancer (JLSSG0901). World J Surg. 2015 Nov;39(11):2734–2741.
3) Kinoshita T, Kinoshita T, Saiura A, Esaki M, Sakamoto H, Yamanaka T. Multicentre analysis of long-term outcome after surgical resection for gastric cancer liver metastases. Br J Surg. 2015;102:102–107.
7) de’Angelis N, Eshkenazy R, Brunetti F, Valente R, Costa M, Disabato M, et al. Laparoscopic versus open resection for colorectal liver metastases: a single-center study with propensity score analysis. J Laparoendosc Adv Surg Tech A. 2015 Jan;25(1):12–20.
1) 日本胃癌学会編．胃癌治療ガイドライン医師用．2018年1月改訂第5版．東京：金原出版；2018.
2) Kodera Y, Fujitani K, Fukushima N, Ito S, Muro K, Ohashi N, et al. Surgical resection of hepatic metastasis from gatric cancer: a review and new recommendation in the Japanese gastric cancer treatment guidelines. Gastric Cancer. 2014;17:206–212.
10) Sakuramoto S, Sasako M, Yamaguchi T, Kinoshita T, Fujii M, Nashimoto A, et al. Adjuvant chemotherapy for gastric cancer with S-1, an oral fluropyrimidine. N Engl J Med. 2007;357:1810–1820.
4) Oki E, Tokunaga S, Emi Y, Kusumoto T, Yamamoto M, Fukuzawa K, et al. Surgical treatment of liver metastasis of gastric cancer: a retrospective multicenter cohort study (KSCC1302). Gastric Cancer. 2016;19:968–976.
9) Cipriani F, Rawashdeh M, Stanton L, Armstrong T, Takhar A, Pearce NW, et al. Propensity score-based analysis of outcomes of laparoscopic versus open liver resection for colorectal metastases. Br J Surg. 2016 Oct;103(11):1504–1512.
11) Noh SH, Park SR, Yang HK, Chung HC, Chung IJ, Kim HH, et al. Adjuvant capecitabine plus oxaliplatin for gastric cancer after D2 gastrectomy (CLASSIC): 5-year follow-up of an open-label, randomised phase 3 trial. Lancet Oncol. 2014 Nov;15(12):1389–1396.
References_xml – reference: 2) Kodera Y, Fujitani K, Fukushima N, Ito S, Muro K, Ohashi N, et al. Surgical resection of hepatic metastasis from gatric cancer: a review and new recommendation in the Japanese gastric cancer treatment guidelines. Gastric Cancer. 2014;17:206–212.
– reference: 9) Cipriani F, Rawashdeh M, Stanton L, Armstrong T, Takhar A, Pearce NW, et al. Propensity score-based analysis of outcomes of laparoscopic versus open liver resection for colorectal metastases. Br J Surg. 2016 Oct;103(11):1504–1512.
– reference: 7) de’Angelis N, Eshkenazy R, Brunetti F, Valente R, Costa M, Disabato M, et al. Laparoscopic versus open resection for colorectal liver metastases: a single-center study with propensity score analysis. J Laparoendosc Adv Surg Tech A. 2015 Jan;25(1):12–20.
– reference: 8) Beppu T, Wakabayashi G, Hasegawa K, Gotohda N, Mizuguchi T, Takahashi Y, et al. Long-term and perioperative outcomes of laparoscopic versus open liver resection for colorectal liver metastases with propensity score matching: a multi-institutional Japanese study. J Hepatobiliary Pancreat Sci. 2015 Oct;22(10):711–720.
– reference: 11) Noh SH, Park SR, Yang HK, Chung HC, Chung IJ, Kim HH, et al. Adjuvant capecitabine plus oxaliplatin for gastric cancer after D2 gastrectomy (CLASSIC): 5-year follow-up of an open-label, randomised phase 3 trial. Lancet Oncol. 2014 Nov;15(12):1389–1396.
– reference: 10) Sakuramoto S, Sasako M, Yamaguchi T, Kinoshita T, Fujii M, Nashimoto A, et al. Adjuvant chemotherapy for gastric cancer with S-1, an oral fluropyrimidine. N Engl J Med. 2007;357:1810–1820.
– reference: 1) 日本胃癌学会編．胃癌治療ガイドライン医師用．2018年1月改訂第5版．東京：金原出版；2018.
– reference: 3) Kinoshita T, Kinoshita T, Saiura A, Esaki M, Sakamoto H, Yamanaka T. Multicentre analysis of long-term outcome after surgical resection for gastric cancer liver metastases. Br J Surg. 2015;102:102–107.
– reference: 4) Oki E, Tokunaga S, Emi Y, Kusumoto T, Yamamoto M, Fukuzawa K, et al. Surgical treatment of liver metastasis of gastric cancer: a retrospective multicenter cohort study (KSCC1302). Gastric Cancer. 2016;19:968–976.
– reference: 6) Hu Y, Huang C, Sun Y, Su X, Cao H, Hu J, et al. Morbidity and mortality of laparoscopic versus open D2 distal gastrectomy for advanced gastric cancer: a randomized controlled trial. J Clin Oncol. 2016 Apr;34(12):1350–1357.
– reference: 5) Inaki N, Etoh T, Ohyama T, Uchiyama K, Katada N, Koeda K, et al. A multi-institutional, prospective, phase II feasibility study of laparoscopy-assisted distal gastrectomy with D2 lymph node dissection for locally advanced gastric cancer (JLSSG0901). World J Surg. 2015 Nov;39(11):2734–2741.
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Snippet 症例は75歳の男性で，食思不振を主訴に近医受診され，上部消化管内視鏡検検査にて胃体中部大彎後壁に進行胃癌を認め当院に紹介となった．造影CTにて肝S2に単発の転移（20 mm）を認め，cT4aN0M1HEP cStage...
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StartPage 257
SubjectTerms 同時切除
胃癌同時性肝転移
腹腔鏡手術
Title 胃癌同時性肝転移に対して化学療法後に腹腔鏡下切除を施行した1例
URI https://www.jstage.jst.go.jp/article/jjgs/52/5/52_2018.0095/_article/-char/ja
Volume 52
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