INTESTINE Vol.11 No.4(1)

特集名 早期直腸癌の治療 -- 局所切除 vs. 内視鏡的治療
題名 [総論]早期直腸癌の治療
発刊年月 2007年 07月
著者 渡邊 聡明 帝京大学医学部外科
【 要旨 】 要旨はありません。
Theme Treatment of early rectal cancer -- Local excision vs. endoscopic resection
Title Treatment of early rectal cancer
Author Toshiaki Watanabe Department of Surgery, Teikyo University School of Medicine
[ Summary ] For local excision of early rectal cancer, surgical excision or endoscopic excision is performed. Surgical excision includes, transanal, trans-sphincteric and trans-sacral excision. The transanal surgical approach also includes MITAS (minimally invasive transanal surgery) and TEM (transanal endoscopic microsurgery). Endoscopic excision includes, the endoscopic mucosal resection (EMR) mode, the endoscopic submucosal dissection mode (ESD), as well as others. The most important point concerning local excision is to resect the lesion completely so that an accurate pathological diagnosis can be made. When lesions reveal invasion into the submucosal layer, there is appruximately a 10 % risk of lymph node metastasis. Risk factors are used to determine high risk lesions with lymph node metastasis. For lesions displaying positive risk factors, surgery with lymph node dissection should be considered. For the surgical treatment of rectal cancer, preservation of autonomic nerves is very important to preserve urinary and sexual function. When conducting surgical procedures, total mesorectal excision (TME) is recommended to avoid local recurrence. When lesions are located within 5 cms of the anal verge, abdomino-perineal excision (APR) with a permanent colostomy or intersphincteric excision (ISR) is indicated. The recurrence rate after surgical treatment of rectal submucosal cancer is 1.1 %.