胃・直腸重複癌に対して一期的に腹腔鏡補助下根治手術を施行した3例の検討

Laparoscopy assisted curative resection for synchronous gastric and rectal cancer : report of three cases

◆要旨：胃・直腸重複癌に対する手術は従来大切開が必要であったが，内視鏡外科手術ではより小さな創で施行可能である．筆者らは腹腔鏡下根治手術を3例に施行したので報告する．［症例1］は腹腔鏡下に幽門側胃切除術（以下，LADG）と直腸切断術，［症例2］はLADGと直腸高位前方切除術，［症例3］は胃全摘術と直腸低位前方切除術を施行した．全例で5ポートによる胃切除術を先行し，骨盤操作のため1あるいは2ポートを追加した．標本の摘出，吻合のために［症例1，2］は臍部創を延長し，［症例3］は心窩部に小切開を置いた．全例重篤な合併症はなく，軽快退院した．上下腹部重複癌に対する腹腔鏡下手術はより小さな創で安全に施行することができ，整容上の利点からも有用である．

　The operation for synchronous gastric and rectal cancer conventionally requires a large incision. On the other hand, laparoscopic surgery allows it with small cosmetic incisions. We performed laparoscopic radical operation for synchronous gastric and rectal cancer in three patients and report their details. Patient 1 received laparoscopic distal gastrectomy（LADG）and abdominoperineal resection of the rectum. Patient 2 received LADG and laparoscopic high anterior resection of the rectum. Patient 3 received laparoscopic total gastrectomy and low anterior resection of the rectum. In all patients, laparoscopic gastrectomy was performed first, followed by rectal resection. We used 5 ports for gastrectomies and added one or two ports for pelvic operation. We extended the umbilical wound in case 1 and 2 for the retrieval of surgical specimens and gastro-duodenal anastomosis while patient 3 had small vertical incision on the epigastric region for retrieval of the surgical specimens and esophago-jejunostomy. All patients had no remarkable complications. Laparoscopic approach for synchronous gastric and rectal cancer is feasible as minimally invasive surgery with better cosmetic results.