早期胃癌に対するESD切除成績と切除困難例の特徴

Treatment Outcome of Endoscopic Submucosal Dissection

要旨　当院開院以来の3年間にESDが施行された早期胃癌513例557病変のうち，多発胃癌および再発胃癌を除いた，単発早期胃癌353例を対象とし，術前適応別治療成績と切除困難例の特徴を検討した．適応病変，適応拡大病変，適応外病変における一括断端陰性切除率は，それぞれ，98％，94％，76％，治癒切除率は87％，68％，12％であり，適応および適応拡大病変に対するESDの成績は選択可能な治療の1つと考えられた．切除困難例を施行時間が120分を超える病変と120分以内の病変に分けて検討した結果，切除片が大きい，ULがある，部位がU＋M領域にある，ことが切除困難予測因子となりうると思われた．またデバイス，治療用スコープ，高周波装置の開発により，明らかに手技が改善されており，種々の機器開発がESDをより簡便化・普遍化させてゆくと思われた．

　We analyzed 353 cases of early gastric cancer in which ESD (endoscopic submucosal dissection) was carried out in the 3 years since the Shizuoka Cancer Center opening. The treatment outcome according to preoperative indication was devided into 3 groups : “indication”,“expanded indication” and “beyond indication”, and characteristics of difficult cases were evaluated.

　The rate of one-piece and cut margin free resection was 98％, 94％, 76％ and the rate of curative resection was 87％, 68％ and 12％, respectively. From these results, it seems that ESD might become accepted as a treatment option of early gastric cancer for “indication” and “expanded indication” cases. We defined the difficult cases as lesions whose procedure time exceeds 120 minutes. Cases that were large, were located on U and M areas and had ulcerative changes were difficult to remove by ESD. Recently, because devices such as gastroscope and electrosurgical unit have been improved, ESD is becoming easier technically and is in general use.