胃癌切除例の術後10年以後の再発例

Four Cases of Gastric Cancer Recurrence with Free Interval of more than 10 Years After Gastrectomy

　胃癌の術後再発は主として術後5年以内にみとめられるが，術後5年以上経過した症例の中にも，再発が時にみとめられる．しかし，この晩期再発の中でも，胃癌の根治手術後10年以上も経過して再発する例が稀であるが経験されている¹⁾²⁾．

　われわれは，胃癌術後10年以上経過した症例について，術後5年以後の再発例を検討したが，特に術後10年以後の再発例をとりあげて報告すると共に，特に残胃に癌がみとめられた際には，残胃再発か異時性重複癌かについても検討する．

　A study has been made of four cases with gastric cancer recurred more than 10 years after the surgical correction. Case 1 is a patient with AM infiltrative cancer for which gastrectomy had been done. The results of the operation were: Po, Ho, n1, ss, Stage Ⅱ. Histologically the cancer was adenocarcinoyna scirrhosum. Thirteen years later ovariectomy was performed. The patient eventually died of lung metastasis 15 years and 1 month after the first operation. Case 2 is also a patient with AM infiltrative cancer of the stomach for which total gastrectomy had been done with the results: P₀, H₀, n₁, s₂, Stage Ⅲ. Histologic picture showed likewise adenocarcinoma scirrhosum. The patient died from peritoneal dissemination 10 years and 8 months later. Case 3 is a patient for whom gastrectomy had been done in another hospital reportedly for gastric ulcer. After 12 years and 3 months the remnant stomach was excised because of cancer found there. The patient died of lung metastasis 6 years and 2 monthes after the second operation. Histological re-examination of the initially resected stomach showed early cancer of Ⅱa+Ⅱc (sm) type. Cancer infiltration was ow (+), or cancer cells were seen in the cardiac end of the resected stomach. Recurrence of cancer in the remaining stomach was thus confirmed. Case 4 is a patient gastrectomized previously in another hospital on account of gastric ulcer. Re-resection was done 13 years and 5 months later for a cancer detected in the remnant stomach. Four months later the patient died from peritoneal dissemination. This case was similar to case 3: the initial ulcer lesion was Ⅱc+Ⅲ (m) with ow (+). Likewise it was a recurrence of cancer in the gastric stump.

　In case recurrence of gastric cancer with more than five years of free interval, cancer in relatively early stage was often detected. In those with more than 10 years of free interval were seen peritoneal dissemination and recurrence of cancer in the remaining stomach. Detection of cancer in the remnant stomach would invariably bring forth the question whether it is really recurrence of cancer or it is non-synchronous multiple cancers. We would like to emphasize the importance of histologic examination for the cardiac end of the initially resected stomach. Also discussed here is the differentiation between recurrence of cancer in the gastric remnant and nonsynchronous multiple cancers.