Stage IV 直腸癌術後に生じた孤立性小腸転移の1切除例  [in Japanese] A Case of Isolated Metastasis to Small Bowel after Resection of Stage IV Rectal Cancer  [in Japanese]

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Abstract

大腸癌の孤立性小腸転移はまれである.直腸癌術後3年半を経過して発症した小腸転移の1例を報告する.症例は73歳の男性で,直腸癌,同時性多発肝転移にて低位前方切除術,肝部分切除術を施行した(Rs,3型,tub2,se,ly1,v1,n1,P0,H3,M0,Stage IV).術後化学療法を行うも2年4か月後に左肺下葉転移を生じ胸腔鏡下左肺部分切除術を施行した.経過観察中のCTにて下腹部正中の小腸腫瘍と右肺野に微小結節を指摘された.その後,下血あり小腸転移の診断にて回腸部分切除術を施行した.腫瘍は回腸粘膜に深い潰瘍を有し,病理検査では腸型の中分化型腺癌を認め直腸癌の小腸転移と診断した.現在,初回手術後6年2か月を経過し,多発肺転移,残肝再発を来し担癌状態ではあるが外来化学療法を継続している.大腸癌からの孤立性小腸転移は,効果の高い全身化学療法を背景に,適切な時期に外科治療を施行し,良好なquality of life(QOL)を維持しうる症例が存在すると考える.

We report a rare case of rectal cancer with small-bowel metastasis. A 73-year-old man who had undergone low anterior resection combined with partial liver resection in June 2003 was found 3.5 years later to have elevated CA19-9. Abdominal computed tomography showed a small-bowel lesion in the pelvis. Positron-emission-tomography-CT showed an abdominal concentration in the small bowel in the pelvis, necessitating laparotomy in January 2007 based on a diagnosis of tumor metastasis from rectal cancer. A tumor infiltrating to the ileal serosal surface necessitated partial ileal resection. Pathological findings for the resected specimen showed a histological similarity to primary rectal cancer. Now, over 6 years after rectal cancer surgery, the patient lives with multiple lung metastases and residual liver metastases and visits the outpatient clinic for chemotherapy, maintaining a good quality of life (QOL). Surgical resection thus occasionally bring a good prognosis and QOL to a patient with isolated small-bowel metastasis from colorectal cancer, despite other metastasis.

Journal

  • The Japanese Journal of Gastroenterological Surgery

    The Japanese Journal of Gastroenterological Surgery 43(8), 850-856, 2010-08-01

    The Japanese Society of Gastroenterological Surgery

References:  18

Cited by:  2

Codes

  • NII Article ID (NAID)
    110007703365
  • NII NACSIS-CAT ID (NCID)
    AN00192066
  • Text Lang
    JPN
  • Article Type
    Journal Article
  • ISSN
    03869768
  • Data Source
    CJP  CJPref  NII-ELS  J-STAGE 
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