ESD穿孔後に腹腔鏡補助下胃切除を施行しポート再発を発症した胃癌の1例

Port site recurrence of gastric cancer after laparoscopic surgery for perforation during endoscopic submucosal dissection : A case report

◆要旨：患者は58歳，女性．4年前に胃体中部大彎の早期胃癌に対してESDを施行した際，穿孔をきたした．保存的治療にて軽快したが，病理検査にて水平断端陽性であり，穿孔から2か月後に腹腔鏡補助下幽門保存胃切除術を施行した．病理組織検査では，M，Gre，0-Ⅱa，tub1，pT1a，ly0，v0，pN0，pPM0，pDM0，StageIAであった．胃切除から4年後に右下腹部のポート挿入部に腫瘤を認め，デスモイド腫瘍を疑い腫瘍摘出術を施行したが，病理にて先の胃癌と同様の組織と診断され，ポート再発と診断した．術後化学療法を施行したが，約4か月後にCT検査にて多発する腹膜播種を認め，再発後2年1か月で死亡した．

　We report a patient with port site recurrence of gastric cancer after laparoscopic surgery for perforation that was caused during endoscopic submucosal dissection （ESD）. A 58-year-old woman underwent ESD for early gastric cancer 4 years ago. Gastric wall perforation was detected during ESD and was treated endoscopically, followed by curative laparoscopic gastrectomy two months later. Four years after gastrectomy, a tumor was found in the port site of the right lower quadrant and was removed. Pathological examination revealed the tumor to be recurrent gastric cancer at the port site. The patient received chemotherapy after surgery, but approximately four months later, CT scan showed multiple peritoneal dissemination. She died of peritonitis carcinomatosis, 25 months after port site recurrence.