A case of early gastric cancer in the reconstructed gastric tube after radical resection for esophageal cancer

食道癌根治手術後に発見された再建胃管癌の1例を経験した.症例は73歳,男性.10年前より慢性腎不全にて血液透析を継続中であったが,3年前に食道癌にて右開胸開腹胸部食道亜全摘術,胸骨後経路による頚部食道吻合術が施行された.2012年9月定期的内視鏡検査で胃管の胃体中部後壁にIIc病変が認められた.生検では印環型細胞癌と診断されEndoscopic Mucosal Resection(以下EMR)の適応外病変と判断された.胃管切除手術を勧めたが本人が拒否したためテガクール・ウラシル配合剤(以下UFT)の内服を開始した.その後3ヵ月毎の内視鏡検査,6ヵ月毎のPET/CTを施行して経過を追った.2013年6月のPETで右肺門部リンパ節の異常集積を認めたためUFT内服に加えCPT-11を2コースのみ(2週毎点滴投与)投与した.UFT投与後約2年経過する現在,患者は健在であり,2014年7月の内視鏡ではIIc病変は縮小し生検で癌細胞は検出されなくなり化学療法が奏効している.胃管癌の予後は一般に不良とされているが早期発見による長期生存例の報告も多くみられる.食道切除後の6ヵ月毎の定期的な内視鏡検査が病変の早期発見に不可欠である.また,胃管内の早期胃癌に対してUFTの内服は安全性,有用性の点から選択肢の一つと成り得るものと考える.

We experienced a case of carcinoma arising in the reconstructed gastric tube after a radical operation for esophageal cancer. This patient, a 73-year-old man who had undergone haemodialysis for 10 years due to chronic renal failure, underwent subtotal esophagectomy and retrosternal reconstruction by a gastric tube for esophageal cancer 3years earlier. IIc type early cancer of the gastric tube was discovered in the middle part of the stomach by periodic endoscopy in September 2012. Endoscopic biopy showed signet ring cell carcinoma so endoscopic mucosal resection was unable to be indicated for the case. The patient rejected the operation of a resection of the gastric tube, and he was therefore adminis-tered oral UFT. We followed this case by gastroendoscopy every three months and by PET/CT every six months. PET in May 2013 demonstrated metastases of right bronchopulmonary lymph nodes, so we administered only 2 course of CPT-11(bi-weekly drip infusion)added to oral UFT. As of 2 years after the administration of UFT, the patient is still doing well. In July 2014, endoscopy revealed reduction of the IIc lesion and pathological findings of a specimen revealed no residual cancer cells, indicating a partial response to UFT therapy. The prognosis of cancer in the gastric tube is generally poor, but many suvivors have been reported due to early diagnosis. Regular endoscopy every 6 monthes after esophagectomy is necessary to detect the disease in an early stage. Oral uracil and tegafur therapy is considered to be one of treatment option for the patients with early cancer of gastric tube from a standpoint of clinical efficacy and safety.

食道癌

再建胃管癌

化学療法

慢性腎不全