食道とS状結腸の同時性重複癌に対し内視鏡下に一期的切除再建を施行した1例

A case of esophagus and sigmoid colon cancer treated with simultaneous endoscopic surgery

◆要旨：患者は62歳，男性．嚥下困難の精査で胸部下部食道癌と診断され，CTでS状結腸にも腫瘍性病変を認めた．食道癌はcT3，N2，M0，StageⅢ，S状結腸癌はcT3，N1，M0，Stage Ⅲaと診断し，Ⅲ期食道癌に対する術前化学療法としてDCS療法（docetaxel, cisplatin，S-1の3剤併用療法）を2コース施行した．両病変の縮小を認め根治切除可能であると判断し，内視鏡下に一期的に切除する方針とした．まず腹臥位でD2郭清を伴う胸腔鏡下食道切除を行い，次に砕石位で腹腔鏡下に大彎側胃管を作製し後縦隔径路にて再建した．引き続いてD3郭清を伴うS状結腸切除再建を行った．術後経過は良好で，現在も無再発生存中である．

The case is 62-year-old man. He complained of dysphagia and was diagnosed with lower thoracic esophageal cancer. Further, systemic CT pointed out sigmoid colon cancer. We diagnosed esophageal cancer as cT3 N2 M0 Stage Ⅲ, Sigmoid colon cancer as cT3 N1M0 Stage Ⅲa. We administered neo-adjuvant-chemotherapy with DCS therapy（docetaxel, cisplatin, S-1）. After 2 courses of treatment, the primary lesion and lymph nodes were significantly decreased in size. We judged they were resectable under thoracoscope and laparoscope. At first, we treated thoracoscopic esophagectomy in the prone position, secondly, we constructed a gastric tube and treated sigmoid colectomy under laparoscopy. The postoperative course is satisfactory and he is surviving without recurrence.