| 特集名 | 胃癌に対するESD/EMRガイドライン―正しい理解・運用のために | |
|---|---|---|
| 題名 | ガイドラインの考え方と日常臨床での用い方 (2) 適応・根治性の評価 | |
| 発刊年月 | 2015年 06月 | |
| 著者 | 山口 太輔 | 東京大学医学部附属病院光学医療診療部 |
| 著者 | 藤城 光弘 | 東京大学医学部附属病院光学医療診療部／東京大学消化器内科 |
| 著者 | 辻 陽介 | 東京大学医学部附属病院光学医療診療部 |
| 著者 | 吉田 俊太郎 | 東京大学医学部附属病院光学医療診療部 |
| 著者 | 藤本 一眞 | 佐賀大学医学部内科学 |
| 著者 | 小池 和彦 | 東京大学消化器内科 |
| 【 要旨 】 | 胃癌に対するESD/EMRの絶対適応病変は，「2cm以下の肉眼的粘膜内癌（cT1a）と診断される分化型癌．肉眼型は問わないが，UL（－）に限る」であり，適応拡大病変は，「(1) 2cmを超えるUL（－）のcT1a，分化型癌 (2) 3cm以下のUL（＋）のcT1a，分化型癌 (3) 2cm以下のUL（－）のcT1a，未分化型癌」である．根治性は，局所因子とリンパ節転移リスクの因子で評価される．日常診療においては「胃癌に対するESD/EMRガイドライン」による絶対適応病変，適応拡大病変，適応外病変を正しく理解したうえで，患者背景や病変因子を踏まえた個々に応じた治療方針を決定することが重要である． | |
| Theme | The Guidelines of ESD/EMR for Early Gastric Cancer | |
|---|---|---|
| Title | Explanation of Guidelines for ESD and EMR for Early Gastric Cancer : Evaluation of Diagnostic Criteria and Curative Excision | |
| Author | Daisuke Yamaguchi | Department of Endoscopy and Endoscopic Surgery, Graduate School of Medicine, The University of Tokyo |
| Author | Mitsuhiro Fujishiro | Department of Endoscopy and Endoscopic Surgery, Graduate School of Medicine, The University of Tokyo / Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo |
| Author | Yosuke Tsuji | Department of Endoscopy and Endoscopic Surgery, Graduate School of Medicine, The University of Tokyo |
| Author | Shuntaro Yoshida | Department of Endoscopy and Endoscopic Surgery, Graduate School of Medicine, The University of Tokyo |
| Author | Kazuma Fujimoto | Department of Internal Medicine and Gastrointestinal Endoscopy, Saga Medical School |
| Author | Kazuhiko Koike | Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo |
| [ Summary ] | Early detection and early treatment are vital, as these improve the prognosis of patients with gastric cancer. The most important indications for endoscopic treatment of early gastric cancer are determined by considering the risk of lymph node (LN) metastasis and technical problems and by considering whether to resect the tumor en bloc. The absolute criteria for endoscopic submucosal dissection/endoscopic mucosal resection (ESD/EMR) are papillary or tubular (differentiated) adenocarcinoma, less than 2 cm in diameter, and without ulceration within the tumor. The extended criteria for ESD/EMR are therefore : 1) no size limitation for intramucosal differentiated cancers without ulceration ; 2) less than 3 cm in diameter for differentiated cancers with ulceration ; or 3) less than 2 cm in diameter for undifferentiated intramucosal cancers without ulceration. These lesions have no or minimal risk of LN metastasis. When curative excision is achieved for an indicated lesion, the risks of local recurrence and LN metastasis are extremely low. However, when the pathological examination indicates noncurative resection, additional surgery, including LN dissection, is strongly recommended. After having understood these guidelines correctly, the treatment strategy for patients with early gastric cancer should be determined on an individual basis, considering patient background and the tumor characteristics. |
|