深達度による十二指腸癌の治療方針

Treatment Strategy for Duodenal Cancer Based on the Depth of Invasion

要旨●十二指腸癌は希少癌であるが，その中でも粘膜下層浸潤癌は非常に少ない．粘膜下層浸潤癌はリンパ節転移の確率が高く，治療前の深達度診断は重要である．深達度診断は主に通常観察（白色光）で行われるが，画像強調内視鏡や超音波内視鏡なども併用し総合的に行われるべきである．粘膜下層浸潤と診断した際にはリンパ節郭清を含めた外科的治療が第一選択になりうる．粘膜内癌までと診断した際には内視鏡治療が検討されるが，CSP，EMR，ESD，LECSなどさまざまな治療法が選択肢になりうる．安全性と一括切除の両立を目指して，病変の大きさ，部位，線維化，操作性，術者の技量などを総合的に判断し治療するべきであるが，診療科を横断した集学的治療が望まれる．

　Duodenal cancer is rare, with submucosal invasive cancer being particularly uncommon. Because Submucosal invasive cancer has a high risk of lymph node metastasis ; therefore, accurately diagnosing the depth of invasion before treatment is crucial. This assessment is primarily conducted using a white light endoscope but should be conducted comprehensively using image-enhanced endoscopy and endoscopic ultrasonography. When the submucosal invasion is detected, surgical operation with lymph node dissection is often the preferred treatment.

　In cases of intramucosal cancer, endoscopic treatment may be an option ; however, various treatment options such as CSP, EMR, ESD, and LECS may be available. To ensure both safety and en bloc resection, treatment should be selected after comprehensively assessing the size, location, fibrosis, operability, and skill of the endoscopists. However, a multidisciplinary approach involving all treatment across all medical departments is ideal.