Nakamura Naohiko, Kinami Shinichi, Fujita Jun, Kaida Daisuke, Tomita Yasuto, Miyata Takashi, Fujita Hideto, Ueda Nobuhiko, Takamura Hiroyuki
Department of Surgical Oncology, Kanazawa Medical University, 1-1 Daigaku, Uchinada, Kahoku, Ishikawa, 920-0293, Japan.
J Med Case Rep. 2021 May 9;15(1):230. doi: 10.1186/s13256-021-02820-7.
In patients with gastric cancer, 6-27% of patients are diagnosed with T4b disease that invades adjacent organs, and curative resection can improve the prognosis of these patients.
A 70-year-old Japanese man presented with an abdominal tumor and was diagnosed with advanced gastric cancer (L-Circ type 3 T4b N2 M0 H0 stage IVA, based on the 15th edition of the Japanese Classification of Gastric Carcinoma) with extensive abdominal wall invasion. We performed open gastrojejunal bypass for gastric obstruction and initiated a chemotherapeutic regimen comprising S-1 (120 mg/day) and oxaliplatin (100 mg/m). Upper gastrointestinal endoscopy performed after the administration of six courses of the S-1 and oxaliplatin regimen revealed a persistent primary lower gastric wall lesion; however, the diameter of the abdominal wall invasion and metastatic lymph nodes was significantly reduced, in addition to decreased serum carcinoembryonic antigen and carbohydrate antigen 19-9 levels. Subsequently, the patient underwent distal gastrectomy with D2 lymphadenectomy combined with transverse colon and abdominal wall resection. We performed radical en bloc resection and achieved a tumor-free resection margin. Simple abdominal wall closure was performed without mesh or musculocutaneous flap placement. Histopathological examination of the resected tumor specimen showed direct invasion of the mesocolon and rectus abdominis muscle. The patient was postoperatively diagnosed with L Gre-Ant type5 T4b (SI: rectus abdominis muscle) N2 PM0 DM0 Stage IIIA R0 Grade 2a gastric cancer based on histopathological findings and received S-1 as adjuvant chemotherapy, 2 months postoperatively. No recurrence was detected 6 months postoperatively.
We report a case of advanced gastric cancer with extensive abdominal wall invasion that was successfully treated with gastrectomy combined with resection of adjacent organs showing tumor invasion after effective systemic chemotherapy. A therapeutic approach comprising curative surgery combined with perioperative chemotherapy is useful in patients with T4b gastric cancer.
在胃癌患者中，6%至27%的患者被诊断为侵犯相邻器官的T4b期疾病，根治性切除可改善这些患者的预后。
一名70岁的日本男性因腹部肿瘤就诊，被诊断为晚期胃癌（根据日本胃癌分类第15版，为L-Circ型3 T4b N2 M0 H0 ⅣA期），伴有广泛的腹壁侵犯。我们对胃梗阻患者进行了开放式胃肠吻合术，并启动了由S-1（120毫克/天）和奥沙利铂（100毫克/平方米）组成的化疗方案。在给予六个疗程的S-1和奥沙利铂方案后进行的上消化道内镜检查显示，胃下壁原发性病变持续存在；然而，腹壁侵犯和转移性淋巴结的直径显著减小，血清癌胚抗原和糖类抗原19-9水平也有所下降。随后，患者接受了远端胃切除术加D2淋巴结清扫术，同时进行了横结肠和腹壁切除术。我们进行了根治性整块切除，切缘无肿瘤残留。未放置补片或肌皮瓣，直接进行了简单的腹壁缝合。切除的肿瘤标本的组织病理学检查显示中结肠和腹直肌有直接侵犯。根据组织病理学结果，患者术后被诊断为L Gre-Ant型5 T4b（SI：腹直肌）N2 PM0 DM0 ⅢA期R0 2a级胃癌，并在术后2个月接受S-1辅助化疗。术后6个月未检测到复发。
我们报告了一例伴有广泛腹壁侵犯的晚期胃癌病例，在有效的全身化疗后，通过胃切除术联合切除显示有肿瘤侵犯的相邻器官成功治愈。对于T4b期胃癌患者，采用根治性手术联合围手术期化疗的治疗方法是有效的。
