92 183 188 2016 1 1,2) 1) 1) 1) 1) 1) 3) 1) 2016 2 1 2016 3 11 84 S 2011 10 S 30 40 2 tub1 muc SS ly0 v0 PM0 DM0 N0 0/27 S 30 30 2 tub1 tub2 SS ly0 v0 PM0 DM0 N0 0/19 stage tub1 M ly0 v0 HM0 VM0 stage 0 3 4 CT Key words: Ⅰ 1,2 1) 2) 3) Yoshiharu Sato 1,2), Takeshi Ogasawara 1), Takashi Shida 1), Satoru Nomura 1), Yoshihiro Takahara 1), Hidehiko Uno 1), Teisuke Komatsu 3) and Makoto Takahashi 1). A case of primary small intestinal cancer after laparoscopic resection for three synchronous colorectal cancers. 1) Department of Surgery, JCHO Funabashi Central Hospital, Funabashi 273-8556. 2) Department of Pediatric Surgery, JCHO Funabashi Central Hospital, Funabashi 273-8556. 3) Department of Diagnostic Pathology, JCHO Funabashi Central Hospital, Funabashi 273-8556. Phone: 047-433-2111. Fax: 047-435-2655. E-mail: yoshiharuster@gmail.com Received February 1, 2016, Accepted March 11, 2016.
184 2012 3 4 1 Ⅱ 84 2011 9 Hb 4.1g/dl S 3 2 5 LST G S ESD 10 S S 4 4 S D2 3 34 68mL 30 40 2 tub1 muc SS ly0 v0 PM0 DM0 N0 0/27 S 30 30 2 tub1 tub2 SS ly0 v0 PM0 DM0 N0 0/19 stage LST-G ESD LST 4 5 2 pit pattern tub1 M ly0 v0 HM0 VM0 3 1 3 6 2 2015 10 4 2 10 149 42 37.4 140/80 Hg 80 / a b d e f 1 S 30 30 2 a 30 40 2 b 50 45 c 2 S d: HE 100 e: HE 100 f: HE 100 c
1 185 Hb 8.6g/dl CEA 3ng/ CA19-9 4U/ X Niveau 2 CT 2.4 3 4 CT 50 a b c 3 CT a a b 2.4 c 2 X Niveau 4 CT
186 a b 5 50 5 2 25 2 6 a tub2 tub1 pap 6 b PET-CT 2 6 2 a Ⅲ 1 5 % 3 1,2,4 2 3.49% 1.8% 80 90% 2
1 187 5 6 2 ESD 5 10 2 2 7,8 3 25 9 1 2 1 1999 10 2004 11 2 12 1/4 13 2 2 14 2 SUMMARY An 84-year-old man with severe anemia was diagnosed with ascending colon cancer, sigmoid colon cancer, and rectal lateral spreading tumor, and simultaneously underwent laparoscopic surgery for double colon cancer. Rectal tumor was resected with ESD after 6 months of the initial surgery. Histopathological examination revealed that all lesions were adenocarcinoma and were resected completely. Three synchronous primary colorectal cancers were followed up as per the Japanese Society for Cancer of the Colon and Rectum Guidelines. After 4 years of the initial surgery, he presented with intermitted abdominal pain, vomiting, and weight loss. Abdominal compute tomography indicated an obstruction in the ileum adjacent to the staple and clip in the initial surgery. Following decompression with a long tube, laparotomy was performed and adhesion was found on the small intestine, which stuck to the staple that was used for closing the end of the ileum during the initial surgery. Inside the small intestine, we palpated a small tumor and resected it. The tumor was diagnosed as a primary small
188 intestinal cancer. Complete endoscopic evaluation of the colon before operation and routine surveillance after resection of colorectal cancer is very important because the risk of synchronous and metachronous colon cancer is relatively high. Postoperative surveillance is more important for people who are at the risk of hereditary colon cancer. 1 Rex DK, Kahi CJ, Levin B. American Cancer Society; US Multi-Society Task Force on Colorectal Cancer: Guidelines for colonoscopy surveillance after cancer resection: a consensus update by the American Cancer Society and the US Multi-Society Task Force on Colorectal Cancer. Gastroenterology 2006; 130; 1865-71. 2 2006; 59: 863-8. 3 2012 4 Noura S, Ohue M, Seki Y. Second primary cancer in patients with colorectal cancer after a curative resection. Dig Surg 2009; 26: 400-5. 5 4 1 2005; 66; 442-7. 6 Chu DZJ, Giacco G, Martin RG. The significance of synchronous carcinoma and polyps in the colon and rectum. Cancer 1986; 57; 445-50. 7 4 1 2009; 34: 883-8. 8 2001; 34: 1718-26. 9 Watson P, Lynch HT. Extracolonic cancer in hereditary nonpolyposis colorectal cancer. Cancer 1993; 71: 677-85. 10 Vasen HF. Clinical diagnosis and management of hereditary colorectal cancer syndromes. J Clin Oncol 2000; 18: 81S-92S. 11 Umar A, Boland CR, Terdiman JP. Revised Bethesda guidelines for hereditary nonpolyposis colorectal cancer Lynch syndrome and microsatellite instability. J Natl Cancer Inst 2004; 96: 261-8. 12 1 pitfall 2013; 38: 944-9. 13 Pinol V, Castells A, Andreu M. Accuracy of revised Bethesda guidelines, microsatellite instability, and immunohistochemistry for the identification of patients with hereditary nonpolyposis colorectal cancer. JAMA 2005; 293: 1986-94. 14 Lynch 1 2014; 111: 2140-48.