| 特集名 | 消化器診療 ― 30年と今後の展望 | |
|---|---|---|
| 題名 | 食道領域の変遷と展望 (1) 癌 | |
| 発刊年月 | 2015年 01月 | |
| 著者 | 幕内 博康 | 東海大学外科 |
| 【 要旨 】 | 食道癌の診断・治療は最近30年間に著しい進歩を示し，“治る癌”の仲間入りを果たした． 診断面ではX線造影から直視のファイバースコープ，電子内視鏡，ハイビジョン内視鏡へと進み，ヨード染色からNBI，拡大内視鏡へと開発が進んだ．EUS，経鼻内視鏡も登場した． 治療面では術前照射，術後照射，三領域リンパ節郭清，術前化学療法と進行した．CRT，EMRからESDなども普及してきた． 今後は，リンパ節転移診断能の向上，『食道癌取扱い規約』での分化度や浸潤形式の記載法の改訂が望まれる．また，内視鏡下外科手術のさらなる進歩，術前化学療法の無効例の鑑別，ESD適応拡大の是非，CRTの照射野と線量，S-1の保険収載などの問題解決が望まれる． |
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| Theme | Clinical Gastroenterology -- Past 30 Years and Future Vision | |
|---|---|---|
| Title | Esophageal Cancer -- Progress over the Past 30 Years and Future Aims | |
| Author | Hiroyasu Makuuchi | Department of Digestive Surgery, Tokai University School of Medicine |
| [ Summary ] | There has been considerable progress in the diagnosis and treatment of esophageal cancer over the past 30 years, and now, it is a curable disease. Developments in diagnostic techniques have led to the replacement of X‒ray esophagography with direct visualization using slender fiberscopes, video endoscopy, high vision endoscopy. Other new diagnostic techniques include NBI, magnifying endoscopy, EUS and transnasal endoscopy. Advancements in the treatment of esophageal cancer include post‒surgical rather than pre‒surgical irradiation, three field lymphadenectomy, and neoadjuvant chemotherapy. Chemo‒radiotherapy (CRT), endoscopic mucosal resection (EMR) and endoscopic submucosal dissection (ESD) are widely used in Japan. Future targets for the management of esophageal cancer include improved diagnosis of lymphnode matastasis and revision of the guidelines for differentiation type and infiltrative growth pattern (INF). Efforts should also focus on progress in endoscopic surgery, improved neoadjuvant chemotherapy, expanded application of ESD, refinement of radiation fields and the dose of CRT, and the inclusion of S‒1 under health insurance cover. |
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