特集名 | 食道癌治療 -- 最近の話題 | |
---|---|---|
題名 | m3・sm1食道癌に対するEMR | |
発刊年月 | 2003年 10月 | |
著者 | 幕内 博康 | 東海大学医学部消化器外科 |
著者 | 島田 英雄 | 東海大学医学部消化器外科 |
著者 | 千野 修 | 東海大学医学部消化器外科 |
著者 | 田仲 曜 | 東海大学医学部消化器外科 |
著者 | 西 隆之 | 東海大学医学部消化器外科 |
著者 | 木勢 佳史 | 東海大学医学部消化器外科 |
【 要旨 】 | m3・sm1食道癌のリンパ節転移は15%にすぎないので,技術的に可能であれば内視鏡的粘膜切除術 (EMR) の適応を拡大するべきである. 0-I,0-III型様のもの,0-IIc+IIa,0-IIa+IIcで隆起陥凹の著しいもの,4cm以上に及ぶ腫瘍径の大きいものは外科的根治術を適応する.これらではリンパ節転移率が33.3%となる. EMRが可能なものはまずEMRを施行し,病理組織学的にly (+),infγ様,poorly diffのものは外科的根治術を行う. EMR施行例79例中,EMRのみで治療された症例73例ではリンパ節再発3例4.1%,臓器再発2例2.7%であり,m3・sm1癌79例の5年生存率は88.0%であった.なおこのうち6例が外科的根治術へ移行し,うち3例にリンパ節転移を認めた. リンパ節転移診断能のさらなる向上が望まれる. |
Theme | Current Topics on The Treatment for Esophageal Cancer | |
---|---|---|
Title | Endoscopic Mucosal Resection for m3•sm1 Esophageal Cancer | |
Author | Hiroyasu Makuuchi | Department of Digestive Surgery, Tokai University, School of Medicine |
Author | Hideo Shimada | Department of Digestive Surgery, Tokai University, School of Medicine |
Author | Osamu Chino | Department of Digestive Surgery, Tokai University, School of Medicine |
Author | Hikaru Tanaka | Department of Digestive Surgery, Tokai University, School of Medicine |
Author | Tkayuki Nishi | Department of Digestive Surgery, Tokai University, School of Medicine |
Author | Takashi Kise | Department of Digestive Surgery, Tokai University, School of Medicine |
[ Summary ] | Superficial esophageal cancer, of which depth of invasion is limited to the muscularis mucosa (m3) or shallow layer of the sub mucosa (sm1) has lymph node metastasis rate of only 15%. For this reason we should extend the indications for EMR to these cases. In cases of m3, sm1 esophageal cancer, radical surgical treatment is indicated for those where clinical classifications are of the 0-I or 0-III type, the 0-IIc+0-IIa or the 0-IIa+0-IIc type, and where the diameter is over 4cm. Lymph node metastasis should be included, due to an involvement rate of 33.3%. Endoscopic mucosal resection is indicated for m3, sm1 cancer cases where technically possible. Patients with ly (+), infγ or poorly differentiated types should be receive radical surgery. Seventy nine cases of m3, sm1 cancer, which received EMR, had lymph node recurrence rates of 4.1% and distant organ recurrence rates of 2.7%. The five year survival rate was 88.0%. As we can determine from this information, accurate preoperative diagnoses of lymph node metastasis is essential. |