Hata Tatsuo, Tsuruta Yoshihiko, Takamori Shigeru, Shishikura Yuri
Dept. of Surgery, Chiba Tokushukai Hospital.
Gan To Kagaku Ryoho. 2012 Sep;39(9):1431-3.
A 78-year-old man had undergone abdominoperineal resection for rectal cancer in 2003. After 7 years, he visited our hospital with complaints of turbid discharge from the stoma. A tumor 11 cm in diameter was shown at the site of the stoma. A partial resected biopsy revealed moderately-differentiated adenocarcinoma. We diagnosed metachronous multiple carcinoma or recurrent cancer at the colostomy site. After loop colostomy of the ascending colon was performed, systemic chemotherapy with mFOLFOX6 was performed. After 5 courses, the tumor revealed a significant reduction in its size. Afterwards, the stoma including the tumor and remaining left-side colon with adjacent abdominal wall was resected, keeping the surgical margin free. In the resected specimen, histological evaluation of the treatment with chemotherapy was assessed to be Grade 1a. As a result of preoperative chemotherapy, we finally were able to resect the minimal area of the adjacent skin and abdominal wall, and succeed in primary closure of the surgical wound. This case suggests that preoperative chemotherapy is a good option for treating cancer occurring at a colostomy site.
一名78岁男性于2003年接受了直肠癌腹会阴联合切除术。7年后,他因造口处有浑浊分泌物而前来我院就诊。造口部位显示有一个直径11厘米的肿瘤。部分切除活检显示为中分化腺癌。我们诊断为造口部位的异时性多发癌或复发性癌。在进行升结肠袢式造口术后,采用mFOLFOX6方案进行全身化疗。5个疗程后,肿瘤大小显著缩小。之后,切除包括肿瘤在内的造口以及剩余的左侧结肠和相邻腹壁,确保手术切缘无肿瘤残留。在切除标本中,化疗治疗的组织学评估为1a级。由于术前化疗,我们最终能够切除最小面积的相邻皮肤和腹壁,并成功实现手术切口的一期缝合。该病例表明,术前化疗是治疗造口部位癌症的一个良好选择。