| 特集名 | 大腸LST（側方発育型腫瘍）の新展開 | |
|---|---|---|
| 題名 | 発生部位別に見たLSTの特徴 | |
| 発刊年月 | 2015年 08月 | |
| 著者 | 千野 晶子 | がん研有明病院消化器内科/内視鏡診療部 |
| 著者 | 森重 健二郎 | がん研有明病院消化器内科/内視鏡診療部 |
| 著者 | 石川 寛高 | がん研有明病院消化器内科/内視鏡診療部 |
| 著者 | 岸原 輝仁 | がん研有明病院消化器内科/内視鏡診療部 |
| 著者 | 為我井 芳朗 | がん研有明病院消化器内科/内視鏡診療部 |
| 著者 | 五十嵐 正広 | がん研有明病院消化器内科/内視鏡診療部 |
| 【 要旨 】 | 早期大腸癌の治療方針には部位別の検討が必要であり，下部直腸においては，機能温存の点からも完治可能な病変に対する内視鏡的摘除は低侵襲治療であり意義が高い．当院のLST 848病変を直腸142病変，結腸706病変に分け両群の部位別特徴について検討した．直腸は30mm以上の大きなLST‒G（M）を高頻度に認め，腫瘍径に相関して担癌率とSM 癌率は高い．直腸のLST‒NGは20mm未満でも担癌率59％と高率で，腫瘍径にかかわらずT1b または脈管侵襲陽性の頻度が高い．内視鏡診断正診率は結腸95％，直腸89％であった．直腸には診断的治療目的も含め，内視鏡治療が優先される病変が多いが，正確な深達度や脈管侵襲の評価は予後に重要な因子であり，一括切除（ESD）が重要である． | |
| Theme | New Development of Laterally Spreading Tumor | |
|---|---|---|
| Title | The Characteristics of Rectal LSTs Compared to Colonic LSTs | |
| Author | Akiko Chino | Department of Gastroenterology and Endoscopy, Japanese Foundation for Cancer Research Cancer Institute Hospital |
| Author | Kenjiro Morishige | Department of Gastroenterology and Endoscopy, Japanese Foundation for Cancer Research Cancer Institute Hospital |
| Author | Hirotaka Ishikawa | Department of Gastroenterology and Endoscopy, Japanese Foundation for Cancer Research Cancer Institute Hospital |
| Author | Teruhito Kishihara | Department of Gastroenterology and Endoscopy, Japanese Foundation for Cancer Research Cancer Institute Hospital |
| Author | Yoshiro Tamegai | Department of Gastroenterology and Endoscopy, Japanese Foundation for Cancer Research Cancer Institute Hospital |
| Author | Masahiro Igarashi | Department of Gastroenterology and Endoscopy, Japanese Foundation for Cancer Research Cancer Institute Hospital |
| [ Summary ] | Our presentation compared rectal laterally spreading tumors (LSTs) to colonic LSTs. Because endoscopic resection of early rectal cancer can result in a complete cure, treatment has a very beneficial effect on quality of life. The treatment strategy for early colorectal cancer should be divided into categories by site of tumor, rectum, or colon. The total number of LSTs was 848 lesions, including 142 rectal LSTs and 706 colonic LSTs. In the group of rectal LSTs, there were several granular LSTs (nodular mixed type) tumors larger than 30 mm. The malignant potential of granular LST (recurrence or invasive cancer) has a correlation with increasing tumor size. There were only a few rectal non‒granular LST type tumors, but the potential for malignancy of non‒granular LST (T1b or lymphovascular invasion) is high even when the tumor is smaller than 20 mm. In rectal LSTs, endoscopic diagnostic accuracy is 89 %, lower than the 95% accuracy for colonic LSTs. There is a variety of rectal LST lesions detected on endoscopy that are indicated for diagnostic treatment such as a total biopsy. |
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