| 特集名 | 《解説》よくわかる大腸ESD/EMRガイドライン | |
|---|---|---|
| 題名 | 根治性判定 | |
| 発刊年月 | 2015年 09月 | |
| 著者 | 斎藤 彰一 | 東京慈恵会医科大学内視鏡科 |
| 著者 | 池上 雅博 | 東京慈恵会医科大学病理学講座 |
| 【 要旨 】 | 「大腸ESD/EMRガイドライン」における根治性判定につき詳述する．根治性については，病変部術後の局所再発と粘膜下層浸潤によるリンパ節・遠隔転移の二者に分けられる．前者は切除後断端の遺残再発で，ESDでは分割EMRと比較して再発率は低い傾向にあった．一方，後者では大腸癌研究会編「大腸癌治療ガイドライン医師用2014年版」の根治基準に則って治療した場合，重篤な再発に至る症例は文献検索をしたかぎりはみられなかった． | |
| Theme | <Comprehensible explanation> "JGES guidelines for colorectal endoscopic submucosal dissection/endoscopic mucosal resection" | |
|---|---|---|
| Title | Curability Assessment for colon cancer | |
| Author | Shoichi Saito | Department of Endoscopy, The Jikei University School of Medicine |
| Author | Masahiro Ikegami | Department of Pathology, The Jikei University School of Medicine |
| [ Summary ] | When pT1 SM cancer is detected in a pathological examination after endoscopic resection, the subsequent therapeutic course should be determined in accordance with the Guidelines 2014 for the Treatment of Colorectal Cancer edited by Japanese Society for Cancer of the Colon and Rectum. Additional surgical operation should be performed for deep stamp-positive lesions due to incomplete endoscopic resection. In the case of complete endoscopic resection, pT1 SM cancer can be judged to have been radically cured when the following items are satisfied in histopathological findings : (1) The vertical stump is negative (complete resection) (2) There is no evidence of papillary adenocarcinoma and tubular adenocarcinoma (tub 1) (3) SM invasion depth is<1000μm (4) Vascular invasion is negative (5) The budding grade is 1. These conditions are comprehensively evaluated, and then it is determined whether follow-up or additional resection is required. When a therapeutic course that satisfies the above five items is selected, the number of cases in which lymph node metastasis and residual/recurrence are found is extremely small (level of evidence：Ⅳb, grade of recommendation : B). |
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