Kitano Taku, Aisu Yuki, Yasukawa Daiki, Hori Tomohide
Department of Digestive Surgery, Tenri Hospital, Tenri, Nara, Japan.
Am J Case Rep. 2019 Apr 6;20:465-473. doi: 10.12659/AJCR.913960.
BACKGROUND Three patients with stage IV esophagogastric junction cancer (EGJC) underwent extended resection to achieve a graphic/surgical R0 status (no visible remnant of viable tumor in imaging/surgical findings) and adjuvant chemotherapy from the early postoperative period. We also introduced use of our digestive reconstruction technique in these patients. CASE REPORT We used jejunal interposition for digestive reconstruction, which involved end-to-end jejunojejunostomy with a biofragmentable anastomosis ring. The mesojejunal autonomic nerves of the lifted jejunum were preserved. The first adenocarcinoma involved the perilesional lymph nodes (LNs). Graphic/surgical R0 resection was completed by para-aortic LN dissection. The diagnosis (Japanese Classification of Gastric Carcinoma) was stage IV [pM1(LYM)]. Adjuvant chemotherapy began on postoperative day (POD) 11. The second adenocarcinoma was accompanied by a solitary lung metastasis. Intraoperative cytology of ascitic fluid was positive, and cisplatin was intraperitoneally administered. Adjuvant chemotherapy began on POD 10. The solitary lung metastasis was then resected, and graphic/surgical R0 resection was achieved. The diagnosis was stage IV [pM1(PUL) and CY1]. The third adenocarcinoma was accompanied by multiple liver metastases and metastatic regional LNs. The diagnosis was stage IV [H1]. Systemic chemotherapy was repeated. Only a solitary liver metastasis remained and was treated by radiofrequency ablation. Conversion surgery was conducted, achieving graphic/surgical R0 resection. Systemic chemotherapy was continued from POD 10. CONCLUSIONS For patients with stage IV EGJC, extended resection to achieve a graphic/surgical R0 status is still controversial, and systemic chemotherapy is important. The results of the present study suggest that our physiological reconstruction technique does not affect the efficacy of other therapies, such as adjuvant chemotherapy.
三名IV期食管胃交界癌（EGJC）患者接受了扩大切除术，以达到影像学/手术R0状态（影像学/手术检查中无可见存活肿瘤残留），并在术后早期接受辅助化疗。我们还在这些患者中引入了我们的消化重建技术。
我们采用空肠间置术进行消化重建，其中包括使用生物可降解吻合环进行端端空肠吻合术。保留提起空肠的肠系膜自主神经。首例腺癌累及病变周围淋巴结（LNs）。通过主动脉旁淋巴结清扫完成影像学/手术R0切除。诊断（日本胃癌分类）为IV期[pM1(LYM)]。辅助化疗于术后第11天开始。第二例腺癌伴有孤立性肺转移。腹水术中细胞学检查呈阳性，腹腔内给予顺铂。辅助化疗于术后第10天开始。然后切除孤立性肺转移灶，实现影像学/手术R0切除。诊断为IV期[pM1(PUL)和CY1]。第三例腺癌伴有多发肝转移和转移性区域淋巴结。诊断为IV期[H1]。重复进行全身化疗。仅残留一个孤立性肝转移灶，采用射频消融治疗。进行了转化手术，实现了影像学/手术R0切除。从术后第10天开始继续进行全身化疗。
对于IV期EGJC患者，扩大切除术以达到影像学/手术R0状态仍存在争议，全身化疗很重要。本研究结果表明，我们的生理性重建技术不影响辅助化疗等其他治疗的疗效。
