| 特集名 | 残胃の癌 | |
|---|---|---|
| 題名 | 概念・定義・分類 | |
| 発刊年月 | 1997年 12月 | |
| 著者 | 曽和 融生 | 大阪市立大学医学部第一外科学教室 |
| 【 要旨 】 | 残胃癌の定義ならびに分類については，まだ一定したものはない．一般に，初回胃良性疾患で胃切除を受け，一定期問（多くは10年以上）経過したのち残胃に癌がみられるものを狭義の残胃癌と定義できる．一方，初回悪性疾患で胃切後にみられる残胃癌については複雑である．したがって，残胃にみられる癌を「残胃の癌」と総括して論じられている．かかる観点から，残胃の癌の定義・分類について概説し，その問題点について述べた．とくに初回悪性疾患の場合，再発であるのか，残された残胃の遺残癌，すなわち同時性多発癌なのかである．さらには異時性多発癌と残胃に初発した癌とをどのように区別するか，などである．これには，初回手術時の癌の特性とその癌化につながる背景粘膜の性状の検討が重要であろう．近年の早期胃癌の増加とその治療の縮小化に伴い，二次発癌につながる残胃新生癌発生機序のさらなる解明を期待したい． | |
| Theme | Carcinoma in Remnant Stomach | |
|---|---|---|
| Title | Aspect, Definition, and Classification of Car-cinoma in Remnant Stomach | |
| Author | Michio Sowa | First Department of Surgery, Osaka City University Medical School |
| [ Summary ] | There is no established definition or classification of carcinoma in the remnant stomach. In a narrow sense, it is a tumor that has developed in the remnant stomach following surgery (usually more than ten years), after an initial gastrectomy for a benign lesion. In the meantime, tumors that have developed in the gastric remnant after resection for malignant lesions are complex. At present, all tumors involving the gastric remnant are classified under the category of cancer of the remnant stomach. In this article, we have related the conventional definitions and classifications, in general, as well as pointing out problems confronting us. For example, in the case of a patient who was gastrectomized for malignant lesions, how can we dis-tinguish between a recurrence of the primary malignant gastric tumor and a lesion that has developed in the remnant stomach as one of concomitant multiple gastric lesions? Furthermore, it is difficult to differentiate a tumor that is one of chronologically different multiple lesions and a primary tumor that has newly developed in the gastric remnant. It is important to characterize a gastric lesion at the first operation. Simultaneously, it is necessary to examine the gastric mucosa to ascertain whether these are risk factors responsible for recurrence. Recently, clinical surgeons have been attempted minimal surgery for early gastric cancer. Under these circumstances, we would like to stress the importance of elucidating, more precisely, carcinogenesis in the gastric remnant. |
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