食道胃接合部癌の術後再発に対する根治的手術が成功している

Successful curative surgery for postoperative oesophageal recurrence of oesophagogastric junction cancer.

• Masahiko Ikebe
• Nobuhide Kubo
• Seiichi Fukuyama
• Tokujiro Yano

抄録

70歳代の男性が食道胃接合部癌で胃全摘術を受けた。3年11ヵ月後、食後に嘔吐するようになり、食道胃接合部癌の縦隔再発と診断された。CTスキャンの結果、腫瘍は大動脈と肺への浸潤が疑われた。S-1とシスプラチンによる2サイクルの化学療法を受け、腫瘍は縮小した。この患者は左胸腹部切開による腫瘍、左肺下葉および心膜を含む下部食道の切除を受けた。これは、食道胃接合部癌の術後再発に対して外科的に切除した患者の最初の報告である。食道胃接合部癌の術後再発の多くは診断時にはかなり進行しており予後不良であるが，局所再発の患者では化学療法に続いて手術を行うことで予後が改善する可能性がある。

A man in his 70s had undergone total gastrectomy for oesophagogastric junction cancer. Three years and 11 months later, he began to vomit after meals and was diagnosed with mediastinal recurrence of oesophagogastric junction cancer. A CT scan showed that the tumour was suspected of infiltrating the aorta and lung. He received two cycles of chemotherapy with S-1 plus cisplatin, resulting in tumour reduction. The patient underwent resection of the lower oesophagus, including the tumour, the left lower lobe of the lung and the pericardium through a left thoracoabdominal incision. This is the first report of a patient surgically resected for postoperative oesophageal recurrence of oesophagogastric junction cancer. Although most postoperative recurrences of oesophagogastric junction cancer are far advanced at the time of diagnosis and prognosis is poor, chemotherapy followed by surgery may improve the prognosis of patients with locoregional recurrence.

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