胃癌治療の現況と将来―外科治療

Present Status and Future of Surgical Treatment of Gastric Cancer

要旨　従来の胃癌イコールD2の広範囲胃切除術という時代から，胃癌治療も内視鏡治療を含めた縮小手術，そして個別化の時代に入ってきた．この非侵襲的治療は，大きな変貌を遂げ，術後のQOLの改善にも大きく貢献しつつある．2001年には日本胃癌学会は胃癌治療ガイドラインを発行し，その中には胃癌の進行度に合わせた治療のいくつかのオプションが示された．特に早期胃癌の治療に対しては，EMR（endoscopic mucosal resection）や縮小手術（D1＋α，D1＋β），神経保存胃切除術，定型手術の適応が示された．最近早期胃癌に対して腹腔鏡下胃局所切除や腹腔鏡補助下幽門側胃切除術の手技が導入され，良好な成績を示している．現段階ではこれらの内視鏡下手術は，ガイドラインでは臨床研究に位置づけされているが，今後腹腔鏡手術と開腹手術の比較対照試験で安全性，メリット，根治性が確認されれば近い将来内視鏡下手術が広く受け入れられるものと期待される．

　Recent advances for minimally invasive treatment for early gastric cancer have led to considerable changes in the modality of treatment with fairly good results for quality of life after surgery. In 2001, the Japanese Research Society for Gastric Cancer established “Gastric Cancer Treatment Guidelines” in which several treatment options for gastric cancer were described according to the stage of the primary tumor to be treated. In particular, in patients with early gastric cancer, EMR, limited gastrectomy (D1＋α, D1＋β) or nerve-preserving gastrectomy are indicated and recommended. Recently laparoscopic surgery such as laparoscopic wedge resection, or laparoscopy-assisted distal gastrectomy has been applied in the treatment of early gastric cancer. In the guideline, laparoscopic gastrectomy is still considered as investigational treatment. Laparoscopic surgery will be accepted widely as a routine treatment for early gastric cancer in the near future if objective evidence for safety, merit and curability can be obtained in large scaled randomized controlled trials comparing laparoscopic and conventional open gastrectomy.