巨大子宮筋腫を伴う直腸癌に対しレルゴリクスによる偽閉経療法後に腹腔鏡補助下超低位前方切除術を施行し得た1例

Laparoscopy-assisted super-low anterior resection after pseudomenopausal therapy for rectal cancer with giant uterine myoma : A case report

◆要旨：症例は37歳，女性．狭窄を伴う局所進行下部直腸癌に対し，腹腔鏡下横行結腸人工肛門造設術を施行した．その際に巨大子宮筋腫による視野確保困難が著明であり，腹腔鏡下での低位前方切除は困難と判断した．婦人科との協議の結果，直腸癌に対する術前化学放射線療法と並行して，子宮筋腫縮小を期待して巨大子宮筋腫に対してゴナドトロピンアンタゴニストであるレルゴリクスによる偽閉経療法を行った．31.4％の筋腫の縮小を得て，腹腔鏡補助下超低位前方切除術，D3，LD0を施行した．術後は合併症なく13病日で退院した．術後補助化学療法を行い，現在無再発で経過観察中である．巨大子宮筋腫を伴う直腸癌に対する術前レルゴリクス投与は，有害事象もなく有意義な治療戦略であった．

　A 37-year-old woman underwent laparoscopic transverse colostomy for locally advanced low rectal cancer with stenosis. At that time, it was markedly difficult to create a sufficient operative field because of a giant uterine myoma, and we therefore judged that laparoscopic low anterior resection was impossible. As a result of discussions with the gynecologist, pseudomenopausal therapy with relugolix was performed for the giant uterine myoma in parallel with preoperative chemoradiotherapy for the rectal cancer. A 31.4% reduction in the myoma was achieved, and the patient underwent laparoscopy-assisted super-low anterior resection, D3, LD0. The postoperative course was uneventful, and she was discharged at 13 days after surgery. She received adjuvant chemotherapy and survived with no signs of recurrence. Preoperative pseudomenopausal therapy with relugolix for this patient with rectal cancer and a giant uterine myoma was an effective treatment strategy without any adverse events.