異時性大腸癌に対する腹腔鏡補助下結腸切除術

Second laparoscopic assisted colectomy for metachronous colon cancer : a case report

◆要旨：患者は74歳，男性で，上行結腸癌に対して腹腔鏡補助下右半結腸切除術（D3）を施行した．病理組織診断はadenocarcinoma（mod）, ss, ly2, v1, n1, StageⅢaだった．外来にて補助化学療法を行い経過観察していた．初回術後10か月で下行結腸癌が見つかり，腹腔鏡補助下下行結腸切除術（D2）を施行した．病理組織診断はadenocarcinoma（well, mod）, sm（1.6mm）, ly0, v1, n0, StageⅠだった．初回手術の癒着はほとんどみられず再手術に支障はなかった．腹腔鏡下手術は低侵襲で癒着も少ないと考えられている．郭清を伴う腹腔鏡補助下結腸悪性腫瘍手術後でも異時性多発結腸癌に対して再度の内視鏡下手術を選択できる場合があると考えられた．

　The patient was a 74 year-old man who underwent laparoscopic assisted right hemicolectomy with D 3 lymphnode dissection for ascending colon cancer in October 2008. The pathological diagnosis was adenocarcinoma（mod）, ss, ly 2, v 1, n 1, StageⅢ. Adjuvant chemotherapy was administered for 6 months. At 10 months after the first operation, descending colon cancer, i.e., another new lesion, was detected. A second laparoscopic surgery, a descending colectomy with D 2 lymphnode dissection, was performed in September 2009. There were no adhesions in the peritoneal cavity, and the second laparoscopic surgery went smoothly. The pathological diagnosis was adenocarcinoma（wel, mod）, sm（1.6 mm）, ly 0, v 1, n 0, StageⅠ. Laparoscopic surgery is thought to have low invasiveness and to be associated with few adhesions. Laparoscopic surgery may thus be useful for metachronous colon cancers.