Bridge to surgeryとしてステント留置術を行った胃内分泌細胞癌の1例
症例は53歳，女性．心窩部痛の精査で施行した上部消化管内視鏡で，幽門から十二指腸球部に全周性3型腫瘍を認め，生検でneuroendocrine carcinoma （NEC），small cell typeと診断された．腹部CTでは幽門周囲と肝門部に多発リンパ節転移を認め，術前化学療法irinotecan + cisplatin （IP）療法を開始したが，1コース後に幽門狭窄をきたしたため，内視鏡的ステント留置を行った．2コース後の評価でリンパ節は49％縮小し，幽門側胃切除術，D2+17リンパ節郭清，Roux-en Y再建を施行した．病理組織学的診断はNEC，small cell type，y...
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| Published in | 日本臨床外科学会雑誌 Vol. 82; no. 3; pp. 534 - 541 |
|---|---|
| Main Authors | , , , , , |
| Format | Journal Article |
| Language | Japanese |
| Published |
日本臨床外科学会
2021
|
| Subjects | |
| Online Access | Get full text |
| ISSN | 1345-2843 1882-5133 |
| DOI | 10.3919/jjsa.82.534 |
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| Abstract | 症例は53歳，女性．心窩部痛の精査で施行した上部消化管内視鏡で，幽門から十二指腸球部に全周性3型腫瘍を認め，生検でneuroendocrine carcinoma （NEC），small cell typeと診断された．腹部CTでは幽門周囲と肝門部に多発リンパ節転移を認め，術前化学療法irinotecan + cisplatin （IP）療法を開始したが，1コース後に幽門狭窄をきたしたため，内視鏡的ステント留置を行った．2コース後の評価でリンパ節は49％縮小し，幽門側胃切除術，D2+17リンパ節郭清，Roux-en Y再建を施行した．病理組織学的診断はNEC，small cell type，ypT3 （SS），ypN2，ypM0，ypStage IIIA，化学療法の効果判定はGrade 1bであった．術後補助化学療法としてIP療法を5コース追加し，術後20カ月無再発生存中である． |
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| AbstractList | 症例は53歳，女性．心窩部痛の精査で施行した上部消化管内視鏡で，幽門から十二指腸球部に全周性3型腫瘍を認め，生検でneuroendocrine carcinoma （NEC），small cell typeと診断された．腹部CTでは幽門周囲と肝門部に多発リンパ節転移を認め，術前化学療法irinotecan + cisplatin （IP）療法を開始したが，1コース後に幽門狭窄をきたしたため，内視鏡的ステント留置を行った．2コース後の評価でリンパ節は49％縮小し，幽門側胃切除術，D2+17リンパ節郭清，Roux-en Y再建を施行した．病理組織学的診断はNEC，small cell type，ypT3 （SS），ypN2，ypM0，ypStage IIIA，化学療法の効果判定はGrade 1bであった．術後補助化学療法としてIP療法を5コース追加し，術後20カ月無再発生存中である． |
| Author | 今井, 寿 田中, 秀治 東, 敏弥 酒々井, 夏子 吉田, 和弘 村瀬, 勝俊 |
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| ContentType | Journal Article |
| Copyright | 2021 日本臨床外科学会 |
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| DOI | 10.3919/jjsa.82.534 |
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| References | 22) Tringali A, Didden P, Repici A, et al : Endoscopic treatment of malignant gastric and duodenal strictures : a prospective, multicenter study. Gastrointest Endosc 2014 ; 79 : 66-75 8) 植松 清，市原隆夫，裏川公章:胃内分泌細胞癌．別冊日本臨牀領域別症候群シリーズ，消化管症候群（上巻），日本臨牀社，大阪，1994，p491-493 24) Maetani I, Akatsuka S, Ikeda M, et al : Self-expandable metallic stent placement for palliation in gastric outlet obstructions caused by gastric cancer : a comparison with surgical gastrojejunostomy. J Gastroenterol 2005 ; 40 : 932-937 11) Okita NT, Kato K, Takahari D, et al : Neuroendocrine tumors of the stomach : chemotherapy with cisplatin plus irinotecan is effective for gastric poorly-differentiated neuroendocrine carcinoma. Gastric Cancer 2011 ; 14 : 161-165 16) Sasaki T, Isayama H, Maetani I, et al : Japanese multicenter estimation of Wallflex duodenal stent for unresectable malignant gastric outlet obstruction. Dig Endosc 2013 ; 25 : 1-6 2) 西倉 健，味岡洋一，渡邉 玄:【神経内分泌細胞腫瘍】胃内分泌細胞癌の病態・診断・治療．臨消内科 2006;21:1399-1408 5) 矢野佳子，前浦義市，山崎惠司他:胃内分泌細胞癌の1例．日臨外会誌 2003;64:352-355 4) 日比知志，寺崎正起，岡本恭和他:腺癌と共存した胃内分泌細胞癌の1例とわが国の報告71例の検討．癌の臨 2002;48:807-812 21) Costamagna G, Tringali A, Spicak J, et al : Treatment of malignant gastroduodenal obstruction with a nitinol self-expanding metal stent : an international prospective multicentre registry. Dig Liver Dis 2012 ; 44 : 37-43 9) 診療ガイドライン作成委員会，日本神経内分泌腫瘍研究会（JNETS），膵・消化管神経内分泌腫瘍/編:膵・消化管神経内分泌腫瘍（NEN）診療ガイドライン．2019年第2版，金原出版，東京，2019 19) Kim CG, Choi IJ, Lee JY, et al : Covered versus uncovered self-expandable metallic stents for palliation of malignant pyloric obstruction in gastric cancer patients : a randomized, prospective study. Gastrointest Endosc 2010 ; 72 : 25-32 26) 中川 朋，遠藤俊治，池永雅一:ステント留置後に行った術前補助化学療法により組織学的完全奏効が得られた胃流出路障害を伴う進行胃癌の1例．日外科系連会誌 2018;43:1033-1041 20) Moura EG, Ferreira FC, Cheng S, et al : Duodenal stenting for malignant gastric outlet obstruction : prospective study. World J Gastroenterol 2012 ; 18 : 938-943 6) Organization World Health : WHO Classificatlon of Tumours. Dlgestive System Tumours, 5th ed., World Health Organization, Geneva, 2019 10) Noda K, Nishiwaki Y, Kawahara M, et al : Irinotecan plus cisplatin compared with etoposide plus cisplatin for extensive small-cell lung cancer. N Engl J Med 2002 ; 346 : 85-91 3) 柴田 裕，中川康彦，小玉雅志他:術前診断した胃原発小細胞癌の1例．日臨外会誌 2006;67:2074-2078 15) Isayama H, Sasaki T, Nakai Y, et al : Management of malignant gastric outlet obstruction with a modified triple-layer covered metal stent. Gastrointest Endosc 2012 ; 75 : 757-763 1) 日本胃癌学会/編:胃癌取扱い規約．第15版，金原出版，東京，2017 12) Ramage JK, De Herder WW, Delle Fave G, et al : Enets Consensus Guidelines Update for Colorectal Neuroendocrine Neoplasms. Neuroendocrinology 2016 ; 103 : 139-143 25) 松本謙一，遠藤俊治，中島慎介他:胃十二指腸ステント留置後に幽門側胃切除術を施行した胃癌の6例．日消外会誌 2016;49:1053-1058 31) Matsuzawa T, Ishida H, Yoshida S, et al : A Japanese prospective multicenter study of self-expandable metal stent placement for malignant colorectal obstruction : short-term safety and efficacy within 7 days of stent procedure in 513 cases. Gastrointest Endosc 2015 ; 82 : 697-707.e691 30) Sabbagh C, Browet F, Diouf M, et al : Is stenting as “a bridge to surgery” an oncologically safe strategy for the management of acute, left-sided, malignant, colonic obstruction? A comparative study with a propensity score analysis. Ann Surg 2013 ; 258 : 107-115 7) 笹野公伸:【神経内分泌腫瘍update】神経内分泌腫瘍の病理診断．日消誌 2010;107:374-379 17) Maetani I, Mizumoto Y, Shigoka H, et al : Placement of a triple-layered covered versus uncovered metallic stent for palliation of malignant gastric outlet obstruction : a multicenter randomized trial. Dig Endosc 2014 ; 26 : 192-199 29) Sabbagh C, Chatelain D, Trouillet N, et al : Does use of a metallic colon stent as a bridge to surgery modify the pathology data in patients with colonic obstruction? A case-matched study. Surg Endosc 2013 ; 27 : 3622-3631 14) Strosberg JR, Coppola D, Klimstra DS, et al : The NANETS consensus guidelines for the diagnosis and management of poorly differentiated (high-grade) extrapulmonary neuroendocrine carcinomas. Pancreas 2010 ; 39 : 799-800 28) 前平博充，清水智治，目片英治他:左側閉塞性大腸癌症例の臨床経過の検討．日臨外会誌 2012;73:2745-2751 18) van Hooft JE, Uitdehaag MJ, Bruno MJ, et al : Efficacy and safety of the new Wallflex enteral stent in palliative treatment of malignant gastric outlet obstruction (DUOFLEX study) : a prospective multicenter study. Gastrointest Endosc 2009 ; 69 : 1059-1066 13) Arvold ND, Willett CG, Fernandez-del Castillo C, et al : Pancreatic neuroendocrine tumors with involved surgical margins : prognostic factors and the role of adjuvant radiotherapy. Int J Radiat Oncol Biol Phys 2012 ; 83 : e337-343 27) 中村祐介，唐木洋一，福田啓之他:内視鏡的胃十二指腸用ステント留置術後に胃切除術を施行した幽門狭窄を伴う進行胃癌の1例．Gastroenterol Endosc 2019;61:49-54 23) 松本俊彦，日野佳織，寺澤裕之他:悪性腫瘍による胃十二指腸狭窄に対する内視鏡的ステント留置術の検討 胃空腸吻合術との比較を通して．Palliat Care Res 2016;11:166-173 32) 斉田芳久:大腸の悪性狭窄に対するステント留置．日臨外会誌 2016;77:2123-2137 |
| References_xml | – reference: 25) 松本謙一，遠藤俊治，中島慎介他:胃十二指腸ステント留置後に幽門側胃切除術を施行した胃癌の6例．日消外会誌 2016;49:1053-1058 – reference: 15) Isayama H, Sasaki T, Nakai Y, et al : Management of malignant gastric outlet obstruction with a modified triple-layer covered metal stent. Gastrointest Endosc 2012 ; 75 : 757-763 – reference: 2) 西倉 健，味岡洋一，渡邉 玄:【神経内分泌細胞腫瘍】胃内分泌細胞癌の病態・診断・治療．臨消内科 2006;21:1399-1408 – reference: 17) Maetani I, Mizumoto Y, Shigoka H, et al : Placement of a triple-layered covered versus uncovered metallic stent for palliation of malignant gastric outlet obstruction : a multicenter randomized trial. Dig Endosc 2014 ; 26 : 192-199 – reference: 1) 日本胃癌学会/編:胃癌取扱い規約．第15版，金原出版，東京，2017 – reference: 32) 斉田芳久:大腸の悪性狭窄に対するステント留置．日臨外会誌 2016;77:2123-2137 – reference: 10) Noda K, Nishiwaki Y, Kawahara M, et al : Irinotecan plus cisplatin compared with etoposide plus cisplatin for extensive small-cell lung cancer. N Engl J Med 2002 ; 346 : 85-91 – reference: 21) Costamagna G, Tringali A, Spicak J, et al : Treatment of malignant gastroduodenal obstruction with a nitinol self-expanding metal stent : an international prospective multicentre registry. Dig Liver Dis 2012 ; 44 : 37-43 – reference: 30) Sabbagh C, Browet F, Diouf M, et al : Is stenting as “a bridge to surgery” an oncologically safe strategy for the management of acute, left-sided, malignant, colonic obstruction? A comparative study with a propensity score analysis. Ann Surg 2013 ; 258 : 107-115 – reference: 24) Maetani I, Akatsuka S, Ikeda M, et al : Self-expandable metallic stent placement for palliation in gastric outlet obstructions caused by gastric cancer : a comparison with surgical gastrojejunostomy. J Gastroenterol 2005 ; 40 : 932-937 – reference: 28) 前平博充，清水智治，目片英治他:左側閉塞性大腸癌症例の臨床経過の検討．日臨外会誌 2012;73:2745-2751 – reference: 7) 笹野公伸:【神経内分泌腫瘍update】神経内分泌腫瘍の病理診断．日消誌 2010;107:374-379 – reference: 29) Sabbagh C, Chatelain D, Trouillet N, et al : Does use of a metallic colon stent as a bridge to surgery modify the pathology data in patients with colonic obstruction? A case-matched study. Surg Endosc 2013 ; 27 : 3622-3631 – reference: 14) Strosberg JR, Coppola D, Klimstra DS, et al : The NANETS consensus guidelines for the diagnosis and management of poorly differentiated (high-grade) extrapulmonary neuroendocrine carcinomas. Pancreas 2010 ; 39 : 799-800 – reference: 23) 松本俊彦，日野佳織，寺澤裕之他:悪性腫瘍による胃十二指腸狭窄に対する内視鏡的ステント留置術の検討 胃空腸吻合術との比較を通して．Palliat Care Res 2016;11:166-173 – reference: 16) Sasaki T, Isayama H, Maetani I, et al : Japanese multicenter estimation of Wallflex duodenal stent for unresectable malignant gastric outlet obstruction. Dig Endosc 2013 ; 25 : 1-6 – reference: 27) 中村祐介，唐木洋一，福田啓之他:内視鏡的胃十二指腸用ステント留置術後に胃切除術を施行した幽門狭窄を伴う進行胃癌の1例．Gastroenterol Endosc 2019;61:49-54 – reference: 12) Ramage JK, De Herder WW, Delle Fave G, et al : Enets Consensus Guidelines Update for Colorectal Neuroendocrine Neoplasms. Neuroendocrinology 2016 ; 103 : 139-143 – reference: 31) Matsuzawa T, Ishida H, Yoshida S, et al : A Japanese prospective multicenter study of self-expandable metal stent placement for malignant colorectal obstruction : short-term safety and efficacy within 7 days of stent procedure in 513 cases. Gastrointest Endosc 2015 ; 82 : 697-707.e691 – reference: 13) Arvold ND, Willett CG, Fernandez-del Castillo C, et al : Pancreatic neuroendocrine tumors with involved surgical margins : prognostic factors and the role of adjuvant radiotherapy. Int J Radiat Oncol Biol Phys 2012 ; 83 : e337-343 – reference: 19) Kim CG, Choi IJ, Lee JY, et al : Covered versus uncovered self-expandable metallic stents for palliation of malignant pyloric obstruction in gastric cancer patients : a randomized, prospective study. Gastrointest Endosc 2010 ; 72 : 25-32 – reference: 11) Okita NT, Kato K, Takahari D, et al : Neuroendocrine tumors of the stomach : chemotherapy with cisplatin plus irinotecan is effective for gastric poorly-differentiated neuroendocrine carcinoma. Gastric Cancer 2011 ; 14 : 161-165 – reference: 8) 植松 清，市原隆夫，裏川公章:胃内分泌細胞癌．別冊日本臨牀領域別症候群シリーズ，消化管症候群（上巻），日本臨牀社，大阪，1994，p491-493 – reference: 18) van Hooft JE, Uitdehaag MJ, Bruno MJ, et al : Efficacy and safety of the new Wallflex enteral stent in palliative treatment of malignant gastric outlet obstruction (DUOFLEX study) : a prospective multicenter study. Gastrointest Endosc 2009 ; 69 : 1059-1066 – reference: 26) 中川 朋，遠藤俊治，池永雅一:ステント留置後に行った術前補助化学療法により組織学的完全奏効が得られた胃流出路障害を伴う進行胃癌の1例．日外科系連会誌 2018;43:1033-1041 – reference: 9) 診療ガイドライン作成委員会，日本神経内分泌腫瘍研究会（JNETS），膵・消化管神経内分泌腫瘍/編:膵・消化管神経内分泌腫瘍（NEN）診療ガイドライン．2019年第2版，金原出版，東京，2019 – reference: 3) 柴田 裕，中川康彦，小玉雅志他:術前診断した胃原発小細胞癌の1例．日臨外会誌 2006;67:2074-2078 – reference: 20) Moura EG, Ferreira FC, Cheng S, et al : Duodenal stenting for malignant gastric outlet obstruction : prospective study. World J Gastroenterol 2012 ; 18 : 938-943 – reference: 22) Tringali A, Didden P, Repici A, et al : Endoscopic treatment of malignant gastric and duodenal strictures : a prospective, multicenter study. Gastrointest Endosc 2014 ; 79 : 66-75 – reference: 5) 矢野佳子，前浦義市，山崎惠司他:胃内分泌細胞癌の1例．日臨外会誌 2003;64:352-355 – reference: 4) 日比知志，寺崎正起，岡本恭和他:腺癌と共存した胃内分泌細胞癌の1例とわが国の報告71例の検討．癌の臨 2002;48:807-812 – reference: 6) Organization World Health : WHO Classificatlon of Tumours. Dlgestive System Tumours, 5th ed., World Health Organization, Geneva, 2019 |
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| Snippet | 症例は53歳，女性．心窩部痛の精査で施行した上部消化管内視鏡で，幽門から十二指腸球部に全周性3型腫瘍を認め，生検でneuroendocrine carcinoma （NEC），small cell... |
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| SubjectTerms | bridge to surgery 胃十二指腸ステント 胃神経内分泌細胞癌 |
| Title | Bridge to surgeryとしてステント留置術を行った胃内分泌細胞癌の1例 |
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| ispartofPNX | 日本臨床外科学会雑誌, 2021, Vol.82(3), pp.534-541 |
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