Sano Takayuki, Ichikawa Tatsuo, Iai Akira, Osa Kiyoshi, Inoue Takeshi, Ono Satoshi, Asanuma Kouzo, Kaneko Shiori, Kuribara Tadao, Shigeyoshi Itaru, Matsubara Kouta, Irie Naoko, Ishizu Hideki
Dept. of Surgery, Saitama Cooperative Hospital.
Gan To Kagaku Ryoho. 2021 Jun;48(6):825-827.
Chemotherapy is the standard treatment for unresectable gastric cancer, but there is no clear evidence of therapeutic lymphadenectomy in conversion surgery after the tumor shrinks or the combined effect of perioperative chemotherapy. A 63-year-old man was diagnosed with advanced gastric cancer by upper gastrointestinal endoscopy; computed tomography (CT)showed swelling of the gastric regional lymph nodes, abdominal para-aortic lymph nodes, and left supraclavicular lymph node. After 4 courses of combination therapy with S-1 and cisplatin(SP therapy), CT showed that the left supraclavicular lymph node disappeared and the para-aortic lymph node was reduced. Distal gastrectomy and D2 plus para-aortic lymph node dissection were performed as conversion surgery. Two courses of postoperative SP therapy were administered, and S-1 monotherapy was continued for 2 years and 6 months. After 5 years and 1 month since the operation, the patient is alive without recurrence. This case shows that SP therapy can be effective as chemotherapy for unresectable gastric cancer. In addition, that conversion surgery after chemotherapy may contribute to recurrence-free survival.
化疗是不可切除胃癌的标准治疗方法，但对于肿瘤缩小后的转化手术中治疗性淋巴结清扫或围手术期化疗的联合效果，尚无明确证据。一名63岁男性经上消化道内镜检查诊断为晚期胃癌；计算机断层扫描（CT）显示胃区域淋巴结、腹主动脉旁淋巴结和左锁骨上淋巴结肿大。在接受4个疗程的S-1和顺铂联合治疗（SP疗法）后，CT显示左锁骨上淋巴结消失，腹主动脉旁淋巴结缩小。行远端胃切除术及D2加腹主动脉旁淋巴结清扫作为转化手术。术后给予2个疗程的SP治疗，并继续S-1单药治疗2年6个月。术后5年1个月，患者存活且无复发。该病例表明，SP疗法作为不可切除胃癌的化疗可能有效。此外，化疗后进行转化手术可能有助于无复发生存。
