Distal gastrectomy for early gastric tube cancer : a case report

幽門側胃管部分切除を施行した食道癌術後早期胃管癌の1例

Distal gastrectomy for early gastric tube cancer : a case report

Creators Shigeta Masatoshi

Creators Yamamoto Naohiro

Creators Fukamitsu Gaku

Creators Amasaki Youtarou

Creators Oka Kazuhito

Creators Sudou Manabu

Creators Minami Yoshihide

Creators Ueki Kouichi

症例は75歳男性.3年前に食道癌に対して食道亜全摘,後縦隔胃管再建が行われていた.今回,経過観察目的に上部消化管内視鏡検査を行ったところ幽門部の小弯側に早期胃癌0-IIbを発見し深達度は粘膜内癌と判断した.また生検標本で低分化型腺癌と診断した.内視鏡的粘膜下層剥離術は困難であり外科的切除の方針とした.幽門側胃管部分切除を行った.またインドシアニングリーン蛍光法を用いて右胃動脈に沿ったリンパ節の生検を行い転移は認めなかった.術後肺炎の合併があったが速やかに軽快して術後29日に軽快退院した.病理診断においても低分化腺癌ではあるが粘膜内癌であり術後3年間であるが再発を認めていない.後縦隔再建の胃管癌の外科的切除は困難とされている.しかし本症例では病変が幽門近傍の早期胃管癌でありその結果も良好であった.胃管癌に対する治療は様々な方法が行われていると思われるが幽門側胃管部分切除およびリンパ節生検は幽門部の早期の胃管癌に考慮されると思われるので報告した.

A 75-year-old man who had undergone an esophagectomy and posterior mediastinal gastric tube reconstruction for esophageal cancer 3 years previously was diagnosed with mucosal gastric cancer type 0-IIb proximal to the pyloric ring on follow-up endoscopy. Biopsy revealed a poorly differentiated adenocarcinoma. Submucosal dissection was not indicated by endoscopy. Surgical resection of the distal gastric tube and indocyanine green fluorescence-guided biopsies of the lymph nodes along the right gastric artery were performed. Intraoperative pathological examination of the lymph nodes revealed no metastases. The patient developed postoperative pneumonia, but his condition improved rapidly and he was discharged on postoperative day 29. Pathological evaluation confirmed a poorly differentiated adenocarcinoma limited to the mucosa. The patient remains free of gastric cancer 3 years after resection. In such patients, resection and reconstruction of the gastric tube by the posterior mediastinal route can be a complicated procedure. It was successful in this patient because the lesion was located near the pylorus and was detected at an early stage. A standard surgical procedure for gastric tube cancer has not been established, but distal gastric tube resection with lymph node biopsy may be preferred in patients with tumors detected at an early stage.

[ISSN]0513-1731

[NCID]AN00243156