残胃癌に対する腹腔鏡下残胃全摘術施行4例の検討

Laparoscopic total gastrectomy for remnant gastric cancer

◆要旨：近年，早期胃癌に対する腹腔鏡下幽門側胃切除術は，標準治療の1つとなりつつある．しかし，残胃癌に対する腹腔鏡下残胃全摘術はその手術手技の困難さから，その有効性や安全性は検討されていない．筆者らは初回手術において腹腔鏡下胃切除を受けた残胃癌に対し，腹腔鏡下残胃全摘術を施行した4例を経験したので，手術手技の要点とその治療成績を報告する．開腹移行例はなく，平均手術時間と出血量は343±37分，135±112gで術後合併症は認めず，平均術後在院日数は9.2±1.7日であった．初回手術時に血管周囲の神経叢を温存し，術前血管構築を行うなどの工夫により腹腔鏡下残胃全摘術は安全に施行可能で，残胃癌に対する治療戦略の1つとなりうると思われる．

　Laparoscopic gastrectomy has been one of the standard surgical treatment option for early gastric cancer. However, concerning remnant gastric cancer（RGC）, benefit and safety of laparoscopic surgery have not been fully investigated. Naturally, surgical techniques are much more difficult for RGC than that for primary gastric cancer due to adhesions to adjacent organs, and displacement of anatomical structure. We here report four cases of RGC undergoing laparoscopic remnant gastrectomy for the second primary gastric cancer. The previous laparoscopic surgeries of the four patients had been distal gastrectomy in three patients with first primary gastric cancer, and proximal gastrectomy in the other primary gastric cancer patient. The second laparoscopic total gastrectomies of the remnant stomach were performed between April 2012 and Octorber 2014 in our institusion, and these patients were successfully treated. The mean operative time was 343±37min and the mean blood loss was 135±112g. There were no postoperative complications and thus no conversions to open surgery. The mean postoperative hospital stay was 9.2 ± 1.7 days. The second laparoscopic total gastrectomy after the first laparoscopic gastrectomy may be feasible and safe procedure, and can become an option of therapeutic strategy.