title: [Improved QOL in a case of remnant gastric cancer with common bile duct obstruction treated with weekly paclitaxel therapy and cholecystojejunostomy].
abstract: We report a patient with unresectable remnant gastric cancer with common bile duct stricture, whose quality of life(QOL) was improved by switching to cholecystojejunostomy from percutaneous transhepatic gallbladder drainage(PTGBD). He was a 69-year-old man who underwent distal gastrectomy(Billroth I reconstruction)3 years previously, and he vomited many times due to cancer at the anastomosis. It could not be resected because of its involvement with the hepatoduodenal ligament, and therefore, gastrojejunostomy was performed. Four days later, abdominal pain occurred and gallbladder swelling was observed, resulting from common bile duct obstruction. PTGBD relieved the pain, and four courses of S-1/cisplatin (CDDP)treatment were performed. The bile duct stenosis was still so severe that the chemotherapy regimen was changed to weekly paclitaxel(PTX). The bile amount of PTGBD decreased after its four courses and the tube, which was a great burden for the patient, was removed. Because abdominal pain recurred in 2 weeks, the tube needed to be reinserted. An endoscopic stent was not inserted successfully. We performed cholecystojejunostomy and he was finally free from the PTGBD tube. The spread of cancer to the cystic duct was controlled by continuing the PTX for more than 20 courses. Thus, this case highlights PTX's contribution toward improving the patient's QOL.
authors.affiliation: Dept. of Surgery, Kishiwada City Hospital.
authors.forename: Katsuyoshi
authors.initials: K
authors.lastname: Furumoto
authors.forename: Daisuke
authors.initials: D
authors.lastname: Nagashima
authors.forename: Masayuki
authors.initials: M
authors.lastname: Okuno
authors.forename: Hidenobu
authors.initials: H
authors.lastname: Kojima
authors.forename: Hiroaki
authors.initials: H
authors.lastname: Fuji
authors.forename: Tomohiko
authors.initials: T
authors.lastname: Mori
authors.forename: Daisuke
authors.initials: D
authors.lastname: Ito
authors.forename: Masafumi
authors.initials: M
authors.lastname: Kogire
mesh_terms: D000368:Aged; D000972:Antineoplastic Agents, Phytogenic / Q000008:administration & dosage / Q000627:therapeutic use*; D002767:Cholecystostomy; D002779:Cholestasis / Q000209:etiology*; D006801:Humans; D007582:Jejunostomy; D008297:Male; D017239:Paclitaxel / Q000008:administration & dosage / Q000627:therapeutic use*; D011788:Quality of Life; D016879:Salvage Therapy; D013274:Stomach Neoplasms / Q000150:complications / Q000188:drug therapy* / Q000601:surgery
chemical_list: D000972:Antineoplastic Agents, Phytogenic; D017239:Paclitaxel