Tatsuhiko Nogawa

Preoperative UFT administration for patients with advanced colorectal cancer--increased uptake of 5-fluorouracil by tumor tissue is a prognostic factor.

The aim of this study was to clarify whether increased 5-fluorouracil (5-FU) uptake by tumor tissue following preoperative UFT administration is a prognostic factor after surgery in colorectal cancer patients. We examined the concentrations of 5-FU in tumor or normal tissue of 96 colorectal cancer patients who received UFT (400 mg/day) orally for 7 days prior to surgery. Patients were divided into two groups with high or low 5-FU concentrations in tumor tissue (defined as higher or lower than the cut-off value, respectively). The cut-off value of 5-FU was established based on the upper limit of the 95% confidence interval of the median of the concentration found in normal tissue (0.106 μg/g). Of the 96 patients, 62 (64.6%) were in the low-5-FU group and 34 (35.4%) in the high-5-FU group. The latter had a more favorable clinical outcome (p=0.0465). Cox regression analysis revealed that two independent variables, stage and 5-FU status in tumor tissue, were significant for prediction of survival. These findings suggest that increased uptake of 5-FU by tumor tissue following preoperative oral administration of UFT is an independent prognostic factor in colorectal cancer patients. This variable needs to be considered in the design of future therapeutic trials.

A CASE OF ILIOPSOAS ABSCESS AND PANPERITONITIS CAUSED BY RENOCOLIC FISTULA

症例は79歳，女性．10日ほど前より左腰痛，2日前より下腹部痛，嘔吐出現，増強するため当院に救急搬送された．16年前に直腸癌にて腹会陰式直腸切断術の既往があった．左下腹部に筋性防御を認め，血液検査では著明な炎症所見を認めた．腹部CTでは，腹膜炎の所見とともに巨大な左腎結石と左腸腰筋の腫大が認められた．同日，緊急手術を行った．開腹すると乳白色の膿性腹水を認め，汎発性腹膜炎の状態であったが，腸管に絞扼や穿孔は認められず，腎盂腎炎に伴う急性汎発性腹膜炎と判断．洗浄・ドレナージのみを行った．翌日，経皮的に左腎瘻を造設し造影すると，左尿管からDouglas窩が造影され，少し遅れて腎から結腸が直接造影された．尿管の穿孔と腎結腸瘻が考えられた．その後の再手術にて，左尿管は総腸骨動脈と交叉する付近で閉塞，その中枢側にて穿孔していたことが判明した．病理学的検索にて腎結腸瘻は結腸憩室が原因と考えられた．