虫垂腫瘍に対する腹腔鏡・内視鏡合同手術（LECS）の有用性—当院での7例の経験

Availability of laparoscopy and endoscopy cooperative surgery（LECS） for appendiceal tumor : Seven cases experienced at our hospital

◆要旨：腹腔鏡・内視鏡合同手術（laparoscopy and endoscopy cooperative surgery：LECS）は内視鏡的粘膜下層剝離術（endoscopic submucosal dissection：ESD）の手技と腹腔鏡下手術を組み合わせることで，過不足なく局所全層切除を行う手技である．現在，主に胃病変に対して行われ，大腸病変に対するLECSの報告は少ない．今回われわれは，2017年から2024年1月までに，7例の虫垂腫瘍に対しLECSを施行した．年齢中央値56歳（43〜77歳），手術時間中央値145分（101〜209分），腫瘍は虫垂粘液性腫瘍2例，虫垂開口部病変は管状腺腫2例，鋸歯状腺腫・腺癌・amputation neuromaは1例ずつで，すべて断端陰性であった．合併症は認めず，術後在院日数中央値は4日（3〜7日）であった．本手技は低侵襲であり，必要十分な切除範囲での腫瘍切除が可能であり，適応症例と手術手技に関して報告する．

　Laparoscopy and endoscopy cooperative surgery（LECS） is a technique that combines endoscopic submucosal dissection（ESD） and laparoscopy to enable en bloc full-thickness resection. Although LECS is mainly performed for gastric lesions, there are several reports of LECS for colorectal lesions. We performed colorectal LECS for seven patients with appendiceal tumors from 2017 to January 2024. The median age was 56 years, with 4 males and 3 females. The median operating time was 145 minutes. LECS was successfully performed in all patients, and the R0 resection rate was 100％. No postoperative complications occurred, and the median hospital stay was 4（3-7） days. The pathological diagnoses were as follows : appendiceal mucinous tumor（n＝2）, tubular adenoma（n＝2）, sessile serrated adenoma/polyp（n＝1）, adenocarcinoma（n＝1）, and neuroendocrine tumor（n＝1）. LECS is a minimally invasive technique and allows resection of the tumors with a secure margin. We present the indications for LECS and describe the surgical procedure.