切除を繰り返した直腸癌異時性多臓器転移の1例 [in Japanese] A CASE OF RECTAL CANCER WITH METACHRONOUS METASTASES TO MULTIPLE ORGANS RESECTED REPEATEDLY [in Japanese]
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直腸癌の副腎,腎転移はそれぞれ稀であり,1症例に異時性に認め,切除された報告例はない.今回,直腸癌術後,肺,副腎,腎に異時性に転移をきたし切除を繰り返した症例を経験したので報告する.症例は69歳,女性.直腸癌 (Rs) にて高位前方切除, D3郭清を行った.病理所見は,高分化型腺癌, ss, INFβ, ly2, v1, n0, stage IIであった.初回手術2年6カ月後,左肺転移に対しS8区域切除術施行,同3年8カ月後,左副腎転移に対し副腎摘出術施行,同4年6カ月後,左腎転移に対し腎摘出術施行,同5年4カ月後,再度の左肺転移に対し舌区,上葉部分切除術を施行した.直腸癌の異時性の転移巣に対しては,原発巣がコントロールされており,他に転移巣がなければ積極的な切除がすすめられる.
Both the adrenal gland and kidney are uncommon sites for metastasis of rectal cancer. We report a case of rectal cancer with metachronous metastases to multiple organs involving the lung, adrenal gland and kidney which were repeatedly resected. No such cases have been reported in Japan. The patient was a 69-year-old woman. She underwent a high anterior resection for rectal cancer. Histopath-ological findings showed well-differentiated adenocarcinoma, ss, ly2, v1, n0, and stage II. Two years and 6 months after the operation, left S8 segmentectomy was performed for metastatic lung cancer. Three years and 8 months after the first operation, left adrenalectomy was performed for adrenal metastasis. Four years and 6 months after the first operation, left nephrectomy with lymph node dissection was performed for left renal metastasis. Five years and 4 months after the first operation, partial lung resection was performed for recurrent left pulmonary metastasis. All resected specimens showed metastatic adenocarcinoma of rectal cancer. Aggressive resection is recommended for metachronous metastasis of rectal cancer, if the primary lesion is well controlled and other metastatic foci are absent.
- The journal of the Japanese Practical Surgeon Society
The journal of the Japanese Practical Surgeon Society 67(9), 2238-2242, 2006-09-25
Japan Surgical Association