下行結腸癌同時性多発肝転移に対して腹腔鏡補助下肝前区域切除，S3部分切除および下行結腸切除術を上腹部正中切開アプローチで施行した1例

Simultaneous right anterior segmentectomy and partial liver resection and colectomy for synchronous descending colon cancer and multiple liver metastases by laparoscopic assisted surgery with short upper midline approach

◆要旨：腹腔鏡補助下に肝右葉の授動・脱転後，上腹部正中切開創より肝前区域切除，肝部分切除，結腸切除を施行した症例を報告する．患者は74歳，女性．下行結腸癌と同時性肝転移（S8横隔膜直下，S3）を認めた．糖尿病のコントロールが悪く，強化インスリン療法を導入し，同時に術前化学療法を行った．腫瘍が縮小した後に，上腹部正中切開アプローチによる腹腔鏡補助下肝前区域切除，部分切除および下行結腸切除術にて治癒切除を施行可能であった．上腹部正中切開アプローチによる肝・結腸同時切除は，複数部位の肝切除も可能で低侵襲であるため，有用な術式である．

　We reported a case which simultaneous right anterior segmentectomy and partial resection and colectomy were performed by hybrid laparoscopic surgery with short upper midline approach. A 74 year old woman had a descending colon cancer and two metastatic liver tumors synchronously. Because she needed insulin therapy for severe diabetes mellitus, she underwent 6 courses of neo-adjuvant chemotherapy （mFOLFOX6＋Cetuximab） before surgery. After chemotherapy and insulin therapy the liver tumors were reduced in size and her diabetes mellitus was improved. After colectomy through the upper median incision （9cm）, the liver mobilization was done by hand assisted laparoscopic approach. Thereafter right anterior segmentectomy and partial resection was performed through the same incision up to 12cm. The patient experienced no major operative complication after surgery. The liver resection and colectomy by hybrid laparoscopic surgery with short upper midline incision is thought to be effective and less invasive for a case with simultaneous liver resection and colectomy.