多発早期胃癌で残胃再発を来し残胃再切除後更に肝転移して9年6ヵ月で死亡した1例

Liver Metastasis after Re-operation for Recurrence of Multiple Early Gastric Cancer, Report of a Case

要旨　患者は初回胃切除時34歳の男性．病変は胃体部前壁にⅡc（3.0×1.7cm，pap，m，ly₀，v₀，ow(－)）と胃体部大彎にⅠ（3.0×3.0×1.2cm，tub₂，m，ly₀，v₀，ow(－)）とがあった．1967年2月12日に胃切除{R₂，n_1～2(－)〔0/15〕}．術後2年3カ月目に残胃再発のため残胃全摘に膵脾合併切除（R₂）が行われた．再発癌は残胃小彎からやや後壁にかけ胃腸吻合部に接して存在し，病巣内にⅡa様隆起を有するⅡc，5.7×4.5cm，tub₂，ssγ，ly(＋)，v(＋)，n_1～2(－)〔0/12〕であった．再手術後5年4カ月ごろから腰痛を来すようになり，1975年3月に肝転移と腰椎への転移と診断された．肝転移に対してはMMC（10mg/週）とtegafur（1,200mg/日），腰椎に対してはテレコバルト照射（1回量200cGy）で治療したところ，一時，肝腫は縮小し症状は軽減し，社会へ復帰することができた．しかし，肝再発後1年5カ月，初回胃切除後9年6カ月で死亡した．剖検で肝転移が確認されたが（tub₂～por），腰椎への転移は認められず，再発形式は血行性転移であった．

　The patient, a 34 year-old man, underwent gastrectomy (R₂) in February 1967. In the resected speci-men, there were two lesions. One was a Ⅱc-type mucosal cancer (moderately differentiated tubular adenocarcinoma, ly₀, v₀, ow (-)), measuring 3.0×1.7 cm on the anterior wall of the corpus, and the other was a I-type mucosal cancer (papillary adenocarcinoma, ly₀, v₀, ow (-)), measuring 3.0×3.0×1.2 cm on the greater curvature of the body. Resected lymph nodes were free from cancer (0/15). After that, he underwent re-operation, in which total gastrectomy, splenectomy and removal of the tail of pancreas were performed for recurrence of cancer on the remnant stomach in May,1969 (two years and three months after the first operation). Cancer existed in an area surrounding the lesser curvature of the gastric remnant, being moderately differentiated tubular adenocarcinoma invading the submucosal layer (ly (+), v (+)), measuring 5.7×4.5 cm. In the second operation, resected lymph nodes were free from metastasis, too (0/12).

　He returned on September 1974, five years and four months after the second surgery, complaining of pain in the loin. Re-recurrence of cancer was recognized in his liver and lumbar vertebrae on March, 1975. He was treated by anti-cancer drug chemotherapy with mitomycin C and tegafur for metastatic cancer of the liver, and treated by irradiation with telecobalt for the lumbar vertebrae. For one time, his complaint and tumor size of the liver decreased markedly (Karnofsky's classification : Ⅰ-B) but he died in August, 1976 (nine years and six months after the initial operation). Findings at autopsy showed positive metastasis in the liver but negative metastasis in the lumbar vertebrae. The form of re-recurrence seemed to be haematogenous.