Ishii Yasushi, Iwasaki Yoshiki, Ohashi Manabu, Iwanaga Tomohiro, Ohinata Ryouki, Takahashi Keiichi, Matsumoto Hiroshi, Yamaguchi Tatsurou, Nakano Daisuke
Dept. of Surgery, Tokyo Metropolitan Cancer and Infectious Diseases Center Komagome Hospital.
Gan To Kagaku Ryoho. 2011 Nov;38(12):2084-6.
A male patient in his 50s underwent distal gastrectomy for gastric cancer. In operation, there was no peritoneal dissemination. But peritoneal lavage cytology revealed positive peritoneal dissemination. Thus, we set an intraperitoneal infuser port to this patient. On specimen, a type-3 tumor was located in the gastric lesser of antrum to angle. Microscopic examination of specimens revealed a signet ring cell carcinoma and poorly differentiated adenocarcinoma under serosa, and positive of lymph node metastasis. The diagnosis was pT4N2M1P0CY1H0, Stage IV( Japanese classification of gastric carcinoma The 14 Edition). CDDP was administered through the infuser port (on day 7, a first dose of 60 mg/m2 and 30 mg/m2 for second) combined with oral administration of S-1 (100 mg/body) for two weeks, with one week of drug withdrawal. This chemotherapy was repeated for 11 courses. After that, peritoneal lavage cytology became negative. S-1 oral administration was continued for four years, and this patient has been well for five years and six months after the surgery. Therefore, it is suggested that intraperitoneal chemotherapy with cisplatin is an effective treatment for microscopical peritoneal dissemination.
一名50多岁的男性患者因胃癌接受了远端胃切除术。手术中未发现腹膜播散,但腹腔灌洗细胞学检查显示腹膜播散呈阳性。因此,我们为该患者置入了腹腔灌注导管。标本上,一个3型肿瘤位于胃窦小弯至角部。标本显微镜检查显示为印戒细胞癌和浆膜下低分化腺癌,且有淋巴结转移。诊断为pT4N2M1P0CY1H0,IV期(日本胃癌分类第14版)。通过灌注导管给予顺铂(第7天,首剂60mg/m²,第2剂30mg/m²),并联合口服S-1(100mg/体)两周,停药一周。这种化疗重复进行了11个疗程。之后,腹腔灌洗细胞学检查转为阴性。继续口服S-1四年,该患者术后已健康存活五年零六个月。因此,提示顺铂腹腔化疗是治疗显微镜下腹膜播散的有效方法。