胃癌―5年以後の再発症例に対する再切除後生存例―残胃再発と再切除に関する考察

Long-term Survivals after the Second Operation for Carcinoma in the Gastric Remnant Recurring more than Five Years after Operation: Report of two cases

　早期胃癌症例の増加と，胃癌に対する広範リンパ節廓清や化学療法の併用によって，胃癌治癒切除後の5年生存率は60％を越えるようになったが，反面，術後5年を経ても再発をみる症例が少なくない．

　われわれは，胃癌で胃切除後7年6月と7年目に残胃再発を発見し，治癒再切除を行ない得て，再手術後10年と3年7月（初回手術後17年6月と13年2月）生存した2症例を経験しているので，この2症例を中心に，胃癌切除後5年以後の残胃再発と再切除とについて2，3の考察を加える．

　Case reports: Case 1. The patient was a woman, 47 year-old at the time of the first operation. Recurrent carcinoma in the gastric remnant was noted seven years and six months later. She has been alive for ten years after the second operation. Pathological examination revealed that primary lesion was located in the lesser curvature of the corpus around a linear ulcer for an area of 7.0×8.0 cm, Ⅱa in gross type. Histological examination revealed papillary adenocarcinoma, INFα, m, no metastases, and positive cancer cell at the oral stump. Histologically recurrent carcinoma was well-differentiated tubular adenocarcinoma, INFβ, and se. She has been alive for 17 years and six months after the first operation.

　Case 2. The patient was a man, 58 year-old at the time of the first operation. Recurrence in the gastric remnant was noted seven years later. The second operation was performed nine years and seven months after the first. The primary lesion, Borrmann type Ⅱ, was located in the greater curvature of the antrum for an area of 5.5×4.0 cm. Pathological examination revealed papillary adenocarcinoma, INFα, sm, no metastases, and no cancer cell within 6.0 cm of the oral stump. Recurrent carcinoma was histologically muconodular adenocarcinoma, INFβ, and se. He has been alive for 13 years and two months after the first operation.

　We have come across 15 patients with carcinoma in the gastric remnant recurring more than five years after operation. In the first operation,8 of 15 cases was early or early-like advanced stomach carcinoma. In the pathological examination of the first operation, five cases revealed positive cancer cell at the oral stump of the resected specimen. In these cases, carcinoma at the orae stump of the specimen was confined to the mucosa. In 11 of 15 cases (73.3%), the second operation was possible. In only two cases (13.3%) curative surgery was successfully performed. Average survival term for the second non-curative operation was 7.1 months.