Masataka Takebayashi

Possible role of lymph node dissection in the surgical treatment of gastric cancer with disseminating peritoneal metastasis

Pathological background factors of patients with gastric cancer and peritoneal metastasis were studied. In palliatively gastrectomized patients, there was a close relationship between the extent of cancer invasion to the gastric serosa and postoperative survival; the less extensive the serosal invasion, the longer was the survival time. The relationship between the extent of lymph node dissection and postoperative survival showed that, in the presence of metastasis to Group 1 and 2 lymph nodes, many of the long-term survivors had undergone dissection of these lymph nodes. Although a sweeping conclusion should be avoided since retrospective analysis forms the basis of this report, it is assumed that in patients with gastric cancer and peritoneal metatasis, surgery should not be confined to resection of the primary focus, but should include regional lymph node dissection.

PRIMARY CANCER OF THE SMALL INTESTINE ARISEN IN THE ELEVATED INTESTINE AFTER TOTAL GASTRECTOMY

胃全摘後挙上腸管に発生した原発性小腸癌の1例を経験したので報告する.症例は81歳,男性.平成14年5月10日,胃癌にて胃全摘術が施行された.以後再発症状はなかったが,平成15年5月27日,内視鏡検査にて再建挙上小腸に腫瘤性病変を認め,生検の結果group Vと診断された. CTおよびUSでは他には転移はないと判断し, 6月18日,手術を施行した.腹腔内には転移を疑う所見はなく,年齢を考慮して可及的に挙上腸管を剥離・切離し,再度Roux-Y吻合にて再建した.病理組織学的には中分化腺癌であった.自験例の発癌様式として, (1)胃癌の組織型は低分化腺癌であったこと, (2)初回手術時の腫瘍撒布にしては距離が離れすぎていること, (3)今回の腫瘍の位置が挙上前はTreitz靱帯より50cm以内の空腸であった,すなわち小腸癌の好発部位であることを考慮し,原発性小腸癌と考えた.