術前補助療法後に腹腔鏡下ISRを施行した直腸GISTの1例 Laparoscopic Inter-sphincteric Resection following Neoadjuvant Imatinib Mesylate Therapy for the Treatment of Rectal GIST with Anal Preservation—A Case Report—

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症例は63歳,男性.排便困難を主訴に近医を受診し,下部直腸に巨大腫瘤を指摘され当院に紹介となった.最大径60mm大の直腸GISTの診断で切除を検討したが,肛門温存の希望が強く,術前療法としてメシル酸イマチニブ(以下IM)400mg/日の投与を開始した.治療開始6カ月で45mmまで縮小(縮小率33%)し,腹腔鏡下内肛門括約筋切除術(Laparoscopic intersphincteric resection:Lap-ISR)を施行した.Lap-ISRは下部直腸癌等で,肛門温存を可能にし,短期予後にも影響しない<SUP>1)</SUP>として,徐々に広がっている.完全切除が重要となるGISTの手術において,本術式は明確な視野のもとで施行可能であり,有用と考えられた.GISTに対する術前治療に関しては現時点で明確な基準がない.直腸GISTに対する術前治療の報告をまとめ,至適な投与期間と術式について検討した.

A 63-year-old man was admitted to our hospital with the chief complaint of constipation. A rectal digital examination revealed an elastic hard mass located in the posterior wall of the rectum. Colonoscopy showed a submucosal tumor measuring 60 mm in diameter in the lower rectum above the dentate line, near the anal canal. Dynamic CT revealed a rectal tumor measuring 61×59mm in size displacing the lower rectum forward. There was no evidence of either lymph node or distant metastasis. MRI showed the membrane-covered tumor extending to the levator ani muscle bilaterally. A biopsy specimen was positive for CD34 and c-kit (CD117). The Ki-67/MIB-1 index of the tumor cells was 10.7%. Based on the findings, the tumor was diagnosed as a rectal GIST. The patient desired anal preservation, therefore, preoperative imatinib mesylate (IM) therapy was selected. IM was administered at the dose of 400 mg once daily. After 6 months of IM therapy, CT and MRI revealed a decrease of the maximal diameter of the tumor to 45 mm (33% reduction). Seven months after the initial diagnosis, laparoscopic inter-sphincteric resection (ISR) was performed, including partial external sphincter resection and temporary ileostomy, and the anal sphincter muscle was successfully preserved.

収録刊行物

  • 日本臨床外科学会雑誌

    日本臨床外科学会雑誌 76(2), 338-343, 2015

    日本臨床外科学会

各種コード

  • NII論文ID(NAID)
    130005095221
  • 本文言語コード
    JPN
  • ISSN
    1345-2843
  • データ提供元
    J-STAGE 
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