治疗性手术后的新辅助化疗局部先进的Sigmoid结肠癌与广泛的腹壁入侵:一个案例报告
Hirofumi Suzumura1, Toshiaki Terauchi1, Seigo Yukisawa2
1Department of Surgery, Saiseikai Utsunomiya Hospital, Tochigi, JPN.
Cureus
|September 23, 2024
概括
使用FOLFOX的新辅助化疗 (NAC) 有效地减少了腹壁侵袭的局部晚期结肠癌 (LACC),使得治疗性手术和重建成为可能. 这种方法为复杂的LACC病例提供了一个有希望的治疗策略.
科学领域:
- 手术瘤学手术瘤学
- 胃肠道瘤学 胃肠道瘤学
- 化疗 化疗是一种化学疗法.
背景情况:
- 局部晚期结肠癌 (LACC) 需要量身定制的治疗策略以获得最佳的预后.
- 在LACC中,广泛的腹壁侵袭在实现足够的外科手术边缘和缺陷修复方面提出了挑战.
- 新辅助化疗 (NAC) 已成为LACC的有希望的选择,可能通过瘤缩改善切除能力和治愈率.
研究的目的:
- 报告一个在NAC治疗局部晚期西格结肠癌,腹壁侵袭严重的治愈性手术的病例.
- 为了突出NAC的成功应用和随后的手术重建在复杂的LACC病例中.
- 为LACC提供有效的治疗策略,涉及显著的腹壁干涉.
主要方法:
- 一名50岁的患者被诊断患有西格结肠的IIIc阶段LACC,腹壁有广泛的侵袭 (T4b[皮肤]N1bM0) 进行了初始结肠直肠术.
- 患者接受了十个周期的新辅助化疗,其中包括leucovorin,5-fluorouracil和oxaliplatin (FOLFOX).
- 在化疗后进行了治疗性sigmoidectomy与腹壁切除和重建使用左侧前侧大腿皮.
主要成果:
- 与FOLFOX一起的NAC导致瘤大小减少约39%,没有严重的不良事件.
- 手术切除取得了足够的边际,病理学检查证实了对NAC的部分反应.
- 腹壁缺陷成功地用一个自由的前侧大腿板重建,实现了负的外科边缘.
结论:
- 新辅助化疗后进行治愈性手术是一种可行且有效的治疗策略,用于局部晚期的西格结肠癌,具有广泛的腹壁侵袭.
- 在经过新辅助治疗后,使用自由片成功重建了广泛的腹壁缺陷.
- 这个案例证明了NAC和复杂的外科重建的成功整合,在具有挑战性的LACC病例中获得更好的结果.
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