Katsuyama Shinsuke, Masuzawa Toru, Sugimura Keijiro, Yanagisawa Kiminori, Shinke Go, Kinoshita Mitsuru, Ikeshima Ryo, Hiraki Masayuki, Ohmura Yoshiaki, Hata Taishi, Takeda Yutaka, Murata Kohei
Dept. of Surgery, Kansai Rosai Hospital.
Gan To Kagaku Ryoho. 2022 Dec;49(13):1905-1907.
A 78-year-old man was diagnosed with a liver tumor on follow-up CT after thoracic aortic aneurysm surgery. Esophagogastroduodenoscopy revealed a type 2 tumor in the gastric antrum, a biopsy showed poorly differentiated adenocarcinoma, and CT revealed multiple liver metastases, resulting in a diagnosis of clinical Stage ⅣB(cT4aN0M1[HEP]). S-1/oxaliplatin (SOX)chemotherapy was started. However, after 9 courses of chemotherapy, the primary tumor continued to increase in size. Ramucirumab/paclitaxel(RAM/PTX)was started; after 3 courses, CT revealed shrinkage of the primary tumor and disappearance of multiple liver metastases. PET-CT showed no abnormal FDG accumulation in the stomach, surrounding lymph nodes, and liver. Therefore, the patient was considered to have a PR in efficacy, and a decision to perform conversion surgery was made based on the assumption that curative resection was possible. The patient underwent laparoscopic distal gastrectomy D2 lymph node dissection and Billroth Ⅰ reconstruction. The pathological result was M, Ant, type 2, por, ypT2N0M0, ypStage ⅠB, while the histological effect of the chemotherapy was Grade 0. The patient was treated with paclitaxel as adjuvant chemotherapy, which was discontinued 1 year after surgery owing to no recurrence. No recurrence has been noted during 2 years of follow-up.
一名78岁男性在胸主动脉瘤手术后的随访CT检查中被诊断出患有肝肿瘤。食管胃十二指肠镜检查发现胃窦有2型肿瘤，活检显示为低分化腺癌，CT显示有多处肝转移，因此诊断为临床ⅣB期（cT4aN0M1[HEP]）。开始使用S-1/奥沙利铂（SOX）化疗。然而，在9个疗程的化疗后，原发肿瘤持续增大。于是开始使用雷莫西尤单抗/紫杉醇（RAM/PTX）；3个疗程后，CT显示原发肿瘤缩小，多处肝转移消失。PET-CT显示胃、周围淋巴结和肝脏无异常FDG聚集。因此，该患者被认为疗效达到部分缓解（PR），并基于可能进行根治性切除的假设决定进行转化手术。患者接受了腹腔镜远端胃切除术、D2淋巴结清扫和毕Ⅰ式重建。病理结果为M，Ant，2型，por，ypT2N0M0，ypⅠB期，化疗的组织学效果为0级。患者接受紫杉醇辅助化疗，术后1年因无复发而停药。在2年的随访中未发现复发。
