Nishi Masaaki, Miyamoto Ryosuke, Shima Kasane, Miki Hirokazu, Terasawa Hideo, Takasu Chie, Yoshikawa Kozo, Oyama Takuro, Tanaka Katsuya, Izumi Yuishin, Shimada Mitsuo
Department of Surgery, Institute of Biomedical Sciences, Tokushima University Graduate School, Tokushima University, Tokushima, 770-8503 Japan.
Department of Neurology, Institute of Biomedical Sciences, Tokushima University Graduate School, 3-18-15 Kuramoto-cho, Tokushima, 770-8503 Japan.
Int Cancer Conf J. 2021 Jul 12;10(4):318-323. doi: 10.1007/s13691-021-00499-7. eCollection 2021 Oct.
Amyotrophic lateral sclerosis (ALS) is a fatal neurodegenerative disease. Although affected patients may develop cancers, major surgical intervention has been hampered by its questionable overall benefit due to limited prognosis and risk of postoperative respiratory collapse. A recent study, however, showed that tracheostomy invasive ventilation (TIV) prolonged median survival to 11.3 years; thus, patients with ALS receiving TIV might benefit from major surgery. A 66-year-old man with ALS, who had received TIV and enteral tube feeding for 8 years, presented with bloody stool. The patient also had type 2 diabetes mellitus, stage 4 chronic kidney disease, abdominal aortic aneurysm, and anti-phospholipid syndrome, as well as multiple episodes of pneumonia and catheter-related urinary tract infection treated by antibiotics. Medical examination and esophagogastroduodenoscopy revealed a type 3 tumor in the middle part of the stomach. The patient's preoperative diagnosis was gastric cancer (GC), MU, type3, Less-Post, T3(SS), N1, H0, P0, M0, cStage III. The estimated mortality rate was 30.5%, according to the Japanese National Clinical Database. The patient and his family were fully informed of the risk of surgery; the patient clearly requested curative surgery by eye movement. Thus, robot-assisted total gastrectomy (RATG) was performed. The tissues were extremely fragile and hemorrhagic. The surgical time was 7 h 0 min; intraoperative blood loss was 324 ml. Pathological examination revealed GC, MU, type3, T4a(SE), N2, H0, CY0, P0, M0 fStage IIIB. The postoperative course was uneventful. He has remained in stable condition for 3 months. Our findings suggest that patients with ALS who achieve longer survival with TIV can undergo major cancer surgery, including robot-assisted surgery, which may facilitate a better mid-long-term prognosis.
The online version contains supplementary material available at 10.1007/s13691-021-00499-7.
肌萎缩侧索硬化症（ALS）是一种致命的神经退行性疾病。尽管患病患者可能会患癌症，但由于预后有限和术后呼吸衰竭风险，重大手术干预因其总体益处存疑而受到阻碍。然而，最近一项研究表明，气管切开侵入性通气（TIV）可将中位生存期延长至11.3年；因此，接受TIV的ALS患者可能会从重大手术中获益。一名66岁的ALS男性患者，已接受TIV和肠内管饲8年，出现便血。该患者还患有2型糖尿病、4期慢性肾脏病、腹主动脉瘤和抗磷脂综合征，以及多次肺炎和经抗生素治疗的导管相关尿路感染。医学检查和食管胃十二指肠镜检查发现胃中部有一个3型肿瘤。患者术前诊断为胃癌（GC），MU，3型，少后型，T3（SS），N1，H0，P0，M0，c期III。根据日本国家临床数据库，估计死亡率为30.5%。患者及其家属充分了解了手术风险；患者通过眼球运动明确要求进行根治性手术。因此，实施了机器人辅助全胃切除术（RATG）。组织极其脆弱且出血。手术时间为7小时0分钟；术中失血324毫升。病理检查显示为GC，MU，3型，T4a（SE），N2，H0，CY0，P0，M0，f期IIIB。术后病程平稳。他已稳定状态3个月。我们的研究结果表明，通过TIV实现更长生存期的ALS患者可以接受重大癌症手术，包括机器人辅助手术，这可能有助于获得更好的中长期预后。
在线版本包含可在10.1007/s13691-021-00499-7获取的补充材料。
