腹腔鏡下腹会陰式直腸切断術・前立腺合併切除を施行し根治切除が得られた前立腺浸潤を伴う直腸癌の1例

Laparoscopic abdominoperineal resection combined with prostatectomy for rectal cancer invading the prostate : a case report

◆要旨：患者は80歳，男性．下血を主訴に受診し，大腸内視鏡検査で直腸Rb領域に2型の腫瘍を認め，画像検査にて前立腺への浸潤が疑われた．腹腔鏡下に結腸・直腸の周囲を剝離後，前立腺を合併切除し，腹会陰式直腸切断術・前立腺合併切除術を行った．尿道膀胱吻合による尿路再建も腹腔鏡下に施行した．術後は明らかな合併症を認めず，術後第14病日に退院した．術後半年の時点で明らかな排尿障害は認めず，無再発生存中である．病理学的診断は前立腺浸潤を伴う直腸癌と前立腺癌の重複癌であった．腹腔鏡が直腸癌手術に導入されて久しいが，本術式は前立腺への浸潤を疑う直腸癌や，直腸癌と前立腺癌の合併症例に対し有用な術式であると考えられた．

A 80-year-old man who was suffering from melena was diagnosed with type 2 rectal cancer by colonofiberscopy. Computed tomography and magnetic resonance imaging revealed tumor invasion of the prostate. We performed abdominoperineal resection, prostatectomy, and urethral reconstruction by laparoscopy alone. The patient was discharged from our hospital 14 days after surgery without any complications or urinary dysfunction. At the time of drafting this report, the patient has been alive for 6 months after surgery without cancer recurrence. Histopathological examination revealed prostatic invasion of rectal cancer as well as locally advanced prostate cancer. Our experience with this case suggests that laparoscopic abdominoperineal resection combined with prostatectomy is a useful surgical procedure for rectal cancer invading the prostate.