大腸LECSの現状と展望

Current Status and Perspectives of Laparoscopy and Endoscopy Cooperative Surgery for Colorectal Tumors

要旨●大腸腹腔鏡・内視鏡合同手術（LECS）は，上皮下腫瘍の治療として発展した胃LECSとは異なり，内視鏡単独では切除困難な病変に対する低侵襲治療として開発された．本邦では虫垂・憩室進展例や高度線維化病変を主な適応とし，良好な成績が示されてきたが，症例数は少なく報告は限定的である．一方，欧米ではアクセス不良を理由に内視鏡切除困難とされた症例を対象に，腹腔鏡と内視鏡を併用する複数の治療法が1990年代より報告され，有用性が示されている．LECSは腸管開放に伴う腹腔内汚染の懸念など克服すべき課題もあり，今後は腸管を開放せずに行うLECS手技の発展が期待される．また，シングルポート腹腔鏡手術やロボット支援手術の応用も期待される．

　Colorectal laparoscopy and endoscopy cooperative surgery（LECS）differs from gastric LECS, which was originally developed as a minimally invasive therapeutic option for the treatment of subepithelial lesions that are difficult to resect by endoscopy alone. In Japan, the primary LECS indications include lesions extending into the appendiceal orifice or diverticula and those with severe fibrosis, and favorable outcomes have been reported. However, the number of patients undergoing LECS is limited, and few studies have explored this modality. In contrast, in Western countries, studies since the 1990s have demonstrated the clinical utility of multiple hybrid techniques combining laparoscopy and endoscopy for lesions deemed endoscopically unresectable due to poor accessibility. Nevertheless, LECS presents challenges, including concerns regarding intra-abdominal contamination associated with intentional bowel luminal opening. Therefore, future studies should develop nonexposed LECS techniques that avoid luminal opening. Furthermore, the application of single-port laparoscopic and robotic-assisted surgical options is expected to expand the potential of this approach.