Shimonosono Masataka, Ishigami Sumiya, Arigami Takaaki, Uenosono Yoshikazu, Uchikado Yasuto, Kita Yoshiaki, Kijima Yuko, Kurahara Hiroshi, Mataki Yuko, Maemura Kosei, Natsugoe Shoji
Department of Surgical Oncology and Digestive Surgery, Graduate School of Medicine, Kagoshima University, Sakuragaoka 8-35-1, Kagoshima, 890-8520, Japan.
Surg Case Rep. 2016 Dec;2(1):131. doi: 10.1186/s40792-016-0259-x. Epub 2016 Nov 11.
Advanced gastric cancer in the lower third of the stomach often results in stricture of the gastric cavity and digestive symptoms. Gastrojejunostomy has been suggested to improve such symptoms, and the advent of new anticancer agents for gastric cancer has improved the response rate of the disease, which makes it possible to perform R0 gastrectomy in part of patients with stage IV gastric cancer. We experienced a rare case in which a patient with stage IV gastric cancer and cancerous pyloric stenosis was treated with R0 surgery after undergoing a gastrojejunal bypass procedure and multidisciplinary treatment. There have not been any previous reports about cases in which a previous gastrojejunostomy was utilized as a reconstruction route during distal gastrectomy in a patient with gastric cancer that had been treated with chemotherapy and/or CRT.
An 80-year-old female with advanced gastric cancer and pyloric stenosis was admitted to Kagoshima University Hospital. As peritoneal washing cytology produced a positive result, laparoscopic gastrojejunostomy (modified Devine procedure) was performed to improve food passage, and S-1 (100 mg/body, days 1-14) plus paclitaxel (120 mg/body, days 1 and 15) was administered. Although the tumor was temporarily reduced in size, an abdominal computed tomography scan obtained after four courses of chemotherapy showed progressive disease. Thus, chemoradiotherapy (56 Gy, S-1: 60 mg/body, CDDP: 5 mg/body, days 1-5) was indicated. Marked tumor shrinkage and negative peritoneal washing cytological results were achieved. Curative gastrectomy with D2 lymphadenectomy was performed. We carried out distal gastrectomy and lymph node dissection, and the gastrojejunostomy produced as a gastric bypass in the previous operation was preserved. The patient has not suffered a tumor relapse in 4 years since the surgery.
We surgeons increase a chance to perform R0 gastrectomy for stage IV gastric cancer following intensive chemotherapy and/or CRT. We should choose proper position of gastrojejunostomy in producing alimentary bypass for stage IV gastric cancer patients to facilitate curative surgery.
胃下三分之一的进展期胃癌常导致胃腔狭窄和消化症状。有人提出胃空肠吻合术可改善此类症状，并且新型胃癌抗癌药物的出现提高了该疾病的缓解率，这使得部分IV期胃癌患者能够进行R0胃切除术。我们遇到了一例罕见病例，一名IV期胃癌合并癌性幽门狭窄的患者在接受胃空肠吻合术和多学科治疗后接受了R0手术。此前尚无关于在接受过化疗和/或同步放化疗的胃癌患者中，将先前的胃空肠吻合术用作远端胃切除术中重建途径的病例报告。
一名患有进展期胃癌和幽门狭窄的80岁女性入住鹿儿岛大学医院。由于腹腔冲洗细胞学检查结果呈阳性，遂行腹腔镜胃空肠吻合术（改良迪瓦恩手术）以改善食物通过情况，并给予S-1（100mg/体，第1 - 14天）加紫杉醇（120mg/体，第1天和第15天）。尽管肿瘤大小暂时缩小，但化疗四个疗程后进行的腹部计算机断层扫描显示疾病进展。因此，进行了同步放化疗（56Gy，S-1：60mg/体，顺铂：5mg/体，第1 - 5天）。实现了肿瘤明显缩小且腹腔冲洗细胞学检查结果为阴性。进行了D2淋巴结清扫的根治性胃切除术。我们进行了远端胃切除术和淋巴结清扫，并保留了先前手术中作为胃旁路形成的胃空肠吻合术。自手术以来，该患者4年未出现肿瘤复发。
我们外科医生通过强化化疗和/或同步放化疗增加了IV期胃癌患者进行R0胃切除术的机会。我们应为IV期胃癌患者在构建消化道旁路时选择合适的胃空肠吻合术位置，以利于根治性手术。
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