Tsujimoto Tomoyuki, Gakuhara Atsushi, Tomihara Hideo, Fukuda Shuichi, Ohta Katsuya, Kitani Kotaro, Hashimoto Kazuhiko, Ishikawa Hajime, Hida Jinichi, Wakasa Tomoko, Ohta Yoshio, Yukawa Masao
Dept. of Gastroenterological Surgery, Kindai University Nara Hospital.
Gan To Kagaku Ryoho. 2020 Dec;47(13):1936-1938.
A 74-year-old woman visited her local doctor with stomach ache and weight loss. Abdominal ultrasonography showed a mass in the hepatic flexure of the transverse colon. She was referred to our hospital. Colonoscopy revealed transverse colon cancer in the hepatic flexure. Upper endoscopy showed redness of the mucosa and stenosis in the descending portion of the duodenum. Therefore, duodenal invasion was suspected. The CT scan showed a regional lymph node metastasis, but there were no obvious signs of distant metastases. From the aforementioned findings, we diagnosed the patient with duodenal invasion of transverse colon cancer(cT4b, N1, M0, cStage Ⅲ). There was no intraoperative peritoneal dissemination or liver metastasis, and we performed right hemicolectomy and pancreatoduodenectomy for transverse colon cancer. On histopathological examination, we diagnosed pT4b(Duo, Pan), N1b(3/35), M0, pStage Ⅲb. The patient had delayed gastric emptying after surgery. She recovered conservatively and was discharged on POD 37. She underwent adjuvant chemotherapy( capecitabine therapy)and has been alive without recurrence 8 months after surgery. In some cases of colon cancer invasion of other organs, long-term survival can be achieved if R0 resection is possible, and we should consider extended resection.
一名74岁女性因腹痛和体重减轻前往当地医生处就诊。腹部超声检查显示横结肠肝曲处有一个肿块。她被转诊至我院。结肠镜检查显示横结肠肝曲处患有结肠癌。上消化道内镜检查显示十二指肠降部黏膜发红且狭窄。因此，怀疑有十二指肠侵犯。CT扫描显示有区域淋巴结转移，但无明显远处转移迹象。根据上述检查结果，我们诊断该患者为横结肠癌侵犯十二指肠（cT4b，N1，M0，cⅢ期）。术中未发现腹膜播散或肝转移，我们对横结肠癌实施了右半结肠切除术和胰十二指肠切除术。组织病理学检查显示，我们诊断为pT4b（十二指肠、胰腺），N1b（3/35），M0，pⅢb期。患者术后出现胃排空延迟。经保守治疗后康复，术后第37天出院。她接受了辅助化疗（卡培他滨治疗），术后8个月一直存活且无复发。在某些结肠癌侵犯其他器官的病例中，如果能够进行R0切除，则可实现长期生存，我们应考虑扩大切除范围。
