As long as you treat gastric cancer, you should study the indications of chemotherapy and the side effects of anticancer drugs.

 Postoperative pathological test results: Type IIc + III early cancer (m cancer) that remains in the mucosa, no metastatic findings in lymph nodes, peritoneum, liver, etc., and stage I early cancer

(In the gross diagnosis during this operation, the cancer tissue is clearly shown on the serous surface in the serous surface infiltration, and the lymph node metastasis is found in the second group lymph node, and it is judged to be advanced cancer in stage III. However, in the judgment, it is recognized as a misidentification as an ulcerative scar, etc., and the pathological test results, etc. performed several times should be prioritized over the gross diagnosis, and the patient should be diagnosed. X was found not to have advanced cancer)

Progress of anticancer drug administration after surgery discharge

May 20: Visited the clinic as an outpatient, prescribed UFT in 6 capsules a day for 1 week, white blood cell count 3800 / cubic millimeter

The same amount of the drug was prescribed on May 27, June 4, June 11, June 18, and June 25.

June 4 Mitomycin C was first administered by intravenous drip, and the white blood cell count was 3900 / cubic millimeter.

The drug was administered on June 11th, 18th (3400 / cubic millimeter for leukocyte teaching) and 25th.

June 21st I had 4 severe diarrhea

Re-hospitalized on June 29, infusion of 5FU 1250 mg, no white blood cell count test

June 30: 5FU 1250 mg infusion, no white blood cell count test, diarrhea

July 1 White blood cell count decreased to 2900 / cubic millimeter

July 3 White blood cell count decreased to 2400 / cubic millimeter, diarrhea and fever continued

July 4 White blood cell count 2200 / cubic millimeter

July 6 White blood cell count 1000 / cubic millimeter

July 7: The white blood cell count decreased sharply to 600 / cubic millimeter, and fever and diarrhea continued (during this period, CRP test, no confirmation of fungal or sepsis, no bacterial culture test).

July 7 Transferred to A Medical University Hospital, leukocyte count 500 / cubic millimeter, granulocytopenia and sepsis due to myelosuppression, decreased consciousness level in DIC (disseminated intravascular coagulation)

July 8 Chest X-ray findings of pneumonia, white blood cell count 300 / cubic millimeter

July 9 Transfer to 1CU with respiratory arrest

July 18 Died of respiratory failure

It was

"(About Dr. Y's negligence)

… As mentioned above, patient X's gastric cancer is early gastric cancer, and while the possibility of recurrence is extremely low even with excision surgery alone, the effect of anticancer drugs is not clear, and there is a risk of adjuvant chemotherapy. Was not in a situation to do.

Furthermore, according to <evidence omitted>, the size of the cancer lesion of patient X is 4 to 5 centimeters in size, and for surface-enlarged gastric cancer (<evidence omitted>), it is defined as surface-enlarged gastric cancer. It is described as "50 mm x 50 mm = having a spread of 2500 or more". ) Was recognized.

Based on the above facts, the prognosis is determined by the depth of cancer and the presence or absence of metastasis, not the size, histological type or nuclear atypia of the cancer. Therefore, the cancer of patient X is signet ring cell carcinoma (tissue). It cannot be considered that the possibility of recurrence is high because it was (by type classification), but rather, signet ring cell carcinoma at the time of early gastric cancer has a better prognosis than other gastric cancers. According to the National Cancer Center's May 1962-December 1990 survey of lymph node metastasis rates by histology and depth of invasion, signet ring cell carcinoma has a lymph node metastasis rate of 44.1%. According to the histological prognosis of all cases of gastric resection surgery for gastric cancer from 1962 to 1990 at the National Cancer Center, signet ring cell carcinoma is poorly differentiated adenocarcinoma, glue-like (mucous) adenocarcinoma, and papillary gland. Statistics show that the prognosis is better than other cancers such as cancer, and the prognosis is better than all cases. ), Patient X had superficial enlarged gastric cancer, but the size of the cancer lesion is 4 to 5 centimeters in size, which is not a rare case for early gastric cancer, but rather an average size. It is acknowledged that the risk of metastasis can be considered as normal early gastric cancer.

Therefore, based on the fact of the defendant's allegation, it cannot be recognized that the cancer of patient X has a poor prognosis and that adjuvant chemotherapy with an anticancer drug was necessary to prevent recurrence.

3 Defendant also claims that chemotherapy was necessary because Patient X had cancerous peritonitis or purulent peritonitis.

However, according to the whole point of the argument, cancerous peritonitis is peritoneal dissemination (peritoneal dissemination) in which cancer cells break the serosa, are dispersed in the abdominal cavity, and engraft on the organ-side and wall-side peritoneum to form nodules. Dr. Y said that he suspected right cancerous peritonitis when he developed metastasis) and eventually developed nausea, vomiting, severe abdominal pain and other various symptoms. Later, it is confirmed that CT scan, peritoneal puncture, enema imaging, and measurement of tumor markers have not been performed for confirmation.

In addition, according to <Omitted Evidence>, there is no evidence that there was any problem with cancerous peritonitis in the medical care of A Medical University Hospital, and according to the testimony of Witness B, it was confirmed that there are no cancer cells in the ascites. It is admitted that it is.

Therefore, it cannot be confirmed that patient X had cancerous peritonitis or had any findings suggestive of cancerous peritonitis.

In addition, there is no evidence that Patient X had purulent peritonitis by <Omitted Evidence>.

As described above, the gastric cancer of patient X is an early gastric cancer, and although he is not indicated for chemotherapy, he continued to receive an anticancer drug having side effects as described below.

Therefore, it can be said that there was already a fundamental negligence in the treatment of Dr. Y.

(Duty of care when administering anticancer drugs)

1 As mentioned above, it is a clear mistake that Dr. Y administered the anticancer drug to patient X, which is a serious treatment mistake, but the duty of care that should be observed when administering the anticancer drug is also significantly neglected. Is.

…… Based on the above facts, when Dr. Y administers the anticancer drug to patient X (although the administration itself is wrong), he thinks of the serious side effects of the anticancer drug, and the characteristics of each anticancer drug are sufficient. After understanding this, observe the number of leukocytes and the presence or absence of diarrhea by conducting frequent clinical tests, and if any abnormalities are observed, discontinue administration and take necessary measures such as infection prevention measures. It is natural that there is an obligation to take.

As mentioned above, Dr. Y administered an anticancer drug that is unnecessary and harmful to early-stage cancer, and the administration itself is about the same as that of the anticancer drug, which inevitably has side effects. As a doctor who administers while carefully observing the physical condition of the patient, he did not take the duty of care, but simply took the anti-cancer drug in combination, and considered the side effects of the anti-cancer drug. There is no attitude.

It is easy to see that the symptoms of diarrhea and leukopenia after administration of the anticancer drug in patient X on the right are typical side effects, and Dr. Y immediately discontinued the administration of the anticancer drug in patient X. It was obligatory to carefully inspect the condition, investigate the presence of infectious diseases, and take necessary measures against infection.

However, Dr. Y has a tendency to leukopenia after the administration of the anticancer drug UFT, and despite the fact that it is contraindicated in the book, he also has a large amount of 5FU, which is unthinkable in common sense. It was administered, and the act clearly lacked the duty of care as a doctor.

…… In contrast to the above, the defendant judges that the duty of care of doctors is based on the fact that the medical standard that was accepted and formed at the academic level has become widespread and universalized in the medical practice and has become the medical standard as a practice. What should be done, Dr. Y did not know that there was a sudden case of side effects of anticancer drugs like this case, and did not know that he would not give adjuvant chemotherapy to cancer patients with a low recurrence rate, but that was Heisei. It is not the medical standard of general practitioners at the time of 4 years, and it is insisted that Dr. Y does not violate the duty of care.

…… According to Dr. Y himself, it is recognized that he had been treated with anti-cancer drugs for some time.

And, for patient X, he tried to treat patient X by chemotherapeutic treatment following the surgery to remove gastric cancer (this was operated by Dr. Z), so as Dr. Y, it is an auxiliary chemistry. Of course, it is necessary to study the general medical findings at that time, such as the indication of therapy and the side effects of anticancer drugs, which is specialized as long as it treats gastric cancer. There is no difference between being a professional doctor and not.

Moreover, the findings that are problematic in the treatment of patient X are that the recurrence rate of m cancer is extremely low, that anticancer drugs have a tumor shrinkage effect on gastric cancer but no curative effect, and that there is no curative effect on gastric cancer. Surface-enlarged gastric cancer / ulcer-type gastric cancer has nothing to do with the risk of recurrence, anticancer drugs have serious side effects, anticancer drugs reduce the number of leukocytes, and anticancer drugs cause diarrhea. Although it should not be administered to patients with cancer, all of the findings are the matters published in the above-mentioned general medical literature, etc., and there is no particular difficulty in obtaining the findings.

Dr. Y has been making excuses based on the findings from June 1973 to 1951 when he was working at a cancer specialty hospital, but the methods of cancer treatment are advancing day by day, and some findings are also available. It is natural that it may be denied as invalid in the subsequent research and medical practice, and Dr. Y should try to acquire the latest knowledge as much as possible as long as it treats gastric cancer. be.

Therefore, there is no reason for the defendant's allegation in this regard.

6. As described above, Dr. Y tried chemotherapy for early gastric cancer of patient X who is not indicated for chemotherapy, and did not think about the side effects of the anticancer drug, and even when it was contraindicated, he used the anticancer drug. It is clear that there is a fault in the fact that patient X was affected by DIC and died as a result of continued high doses.

The plaintiffs allege other reasons for liability, such as a breach of Dr. Y's accountability, but it is clear that Dr. Y had gross negligence in the course of treatment without mentioning them, and his use. It should be clear that the defendant, who is a person, is liable for damages to the plaintiffs. "

It was

In the case where a patient after gastric cancer removal surgery suffered from an infectious disease such as septicemia due to leukopenia due to the side effect of an anticancer drug and died, the right cancer is an early stage cancer and chemotherapy for this is unnecessary or harmful. This is a case in which a large amount of anti-cancer drug was administered indiscriminately, and even after the anti-cancer drug became contraindicated, the administration was continued, and there was a negligence without paying attention to its side effects.

The ruling says about the findings of early gastric cancer as follows. According to the definition of "Stomach Cancer Handling Regulations" edited by the Gastric Cancer Study Group, early gastric cancer is defined as early gastric cancer in which cancer infiltration remains intramucosal (m) or submucosal (sm) regardless of lymph node metastasis. Say something. The degree of gross gastric cancer progression is from low-grade I (peritoneal metastasis, liver metastasis, lymph node metastasis, no serous surface invasion) to high-grade IV (dissemination in the peritoneum close to gastric cancer) but distant. It is classified into each stage up to (no metastasis in the peritoneum, metastasis in only one lobe of the liver, metastasis of group 3 to 4 lymph nodes, and metastasis of cancer tissue to other organs).

As for the macroscopic classification of early gastric cancer, the basic types are the raised type (I) with marked uplift to the gastric lumen, the surface type (II) with relatively inconspicuous surface irregularities, and the conspicuously depressed type with mucosal depression (III). ) Is the third type. The surface type is a subtype of cancer that is slightly raised from the mucosal surface, and its height is about two to three times that of the surrounding mucosa (IIa), and the difference in unevenness from the normal mucosa is almost the same. It is divided into three types: flat surface type (IIb), which shows no flat spread, and surface recess type (IIc), which is a depression of the mucosa that is shallow enough not to exceed the depth of the muscularis mucosae. In cases where the lesion is large and the findings are partially different, it is recognized that the most prominent findings are to be judged, and if it is difficult, two or more kinds of findings are to be listed together.

Therefore, the judgment is that the gastric cancer of patient X, which is the problem in this case, is shallow enough not to exceed the depth of the muscularis mucosae.