Nara Atsushi, Udagawa Masaru, Onishi Iichiro, Sueyoshi Kuniyo, Gokita Kentaro, Watanabe Yuichiro, Adikrisna Rama
Dept. of Surgery, JA Toride Medical Center.
Gan To Kagaku Ryoho. 2020 Jan;47(1):114-116.
A 68-year-old female with rectal cancer underwent low anterior resection with regional lymph node dissection. The final pathological diagnosis was Stage Ⅲa, and an adjuvant therapy(S-1)was provided for 6 months. One year after the surgery, an anastomotic recurrence was detected. Therefore, pelvic chemoradiotherapy with folinic acid and 5-fluorouracil(FL)was provided, and resection was performed with the Hartmann procedure. Following the second surgery, chemotherapy with bevacizumab(BV)and capecitabine plus oxaliplatin(CapeOX)was provided, and the patient showed no signs of recurrence for several years. However, lung metastasis appeared, which was resected. A year later, the patient underwent hepatectomy and radiofrequency ablation for liver metastasis. Another year later, she underwent lung resection again because of new lung metastasis. During the periods between the surgeries, various chemotherapy regimens were followed continuously, however, the patient died of progressive recurrence 8 years and 4 months after the initial surgery. Recurrences and distant metastases are poor prognostic factors for rectal cancers. However, combined effective chemotherapy and radiotherapy with surgery may improve the patient's chances of survival.
一名68岁的直肠癌女性患者接受了低位前切除术及区域淋巴结清扫术。最终病理诊断为Ⅲa期，并接受了6个月的辅助化疗（S-1）。术后一年，发现吻合口复发。因此，给予亚叶酸和5-氟尿嘧啶（FL）盆腔放化疗，并采用哈特曼手术进行切除。第二次手术后，给予贝伐单抗（BV）、卡培他滨加奥沙利铂（CapeOX）化疗，患者数年无复发迹象。然而，出现了肺转移并进行了切除。一年后，患者因肝转移接受了肝切除术和射频消融术。又过了一年，由于新的肺转移，她再次接受了肺切除术。在手术期间，持续采用了各种化疗方案，然而，患者在初次手术后8年4个月死于疾病进展复发。复发和远处转移是直肠癌预后不良的因素。然而，联合有效的化疗、放疗与手术可能会提高患者的生存几率。
