開腹胃全摘後，食道腺扁平上皮癌内視鏡治療後肝門部リンパ節再発に対する腹腔鏡下リンパ節生検：1例報告

Laparoscopic lymph node biopsy in the hepatic hilum following endoscopic submucosal dissection for esophageal adenosquamous cell cancer and open total gastrectomy for gastric cancer ：Report of a case

◆要旨：患者は74歳，男性．41歳時，進行胃癌に対し開腹胃全摘を行った．経過観察中に表在型食道癌を認め，内視鏡的切除を施行した．病理診断はpT1b（SM2），ly0，v0であったが，本人希望で追加治療なしで経過観察した．術後3か月のCT検査で肝門部に18mmのリンパ節を認め，PET-CT検査で同部だけにFDG集積を認めた．治療方針を決めるうえで病理学的診断が必要と判断し，手術を施行した．初回手術時に剝離操作が及んでいない部位を辿り，比較的容易に腹腔鏡下にリンパ節を切除し，食道癌リンパ節再発と診断した．これまで開腹既往例で腹腔鏡下に肝門部リンパ節生検を行った報告はなく，若干の文献的考察を加えて報告する．

　We herein report a rare case of solitary hepatic hilar lymph node metastasis after endoscopic submucosal dissection for superficial esophageal adenosquamous cell cancer which was successfully diagnosed on laparoscopic lymph node biopsy. A seventy-four-year-old male, who underwent open total gastrectomy for advanced gastric cancer at the age of 41, underwent endoscopic submucosal dissection for superficial esophageal cancer （pT1b, ly0, v0）. Any additional treatment was not performed according to the patient's request. Three months after ESD, CT scan showed an enlarged hepatic hilar lymph node measuring 18mm in size, in which FDG-PET demonstrated abnormal uptake. Laparoscopic lymph node biopsy was performed for the mass. Histological examination suggested recurrence of esophageal cancer. The postoperative course was uneventful. Based on the pathological diagnosis, this patient has been undergoing chemotherapy and surviving for 14 months after laparoscopic biopsy. Even in a patient with a history of open gastrectomy for advanced gastric cancer, hepatic hilar lymph node could be safely excised by tracing the virgin dissectable layer using laparoscopic magnified horizontal image in combination with mediolateral and/or caudocranial approach.