1)中・下咽頭

Endoscopic Mucosal Resection for Superficial Neoplasia at the Oropharyngeal and Hypopharyngeal Mucosal Sites

要旨　内視鏡診断技術の進歩により，これまで発見が困難であった中・下咽頭の上皮内癌が発見されるようになった．これまで，中・下咽頭癌のほとんどは自覚症状を伴って進行癌で発見されていたため，侵襲の大きな外科的切除が行われていたが，上皮内癌の発見が可能になったことより消化管同様のEMRが応用されつつある．しかし，この分野はまだ産声を上げたばかりで，予後を考慮したいわゆる“早期の癌”の定義や治療方針もなく，長期予後も不明である．一方，低侵襲治療の観点からは臓器温存と機能温存が可能であり極めて画期的な進歩であることに異論はないだろう．今後，耳鼻咽喉科医や放射線治療医などの様々な分野との協調をはかり，様々な課題を解決しながら成熟させていく必要がある．

　Advance in endoscopic imaging technology makes it possible to detect a superficial neoplasia such as carcinoma in situ at the oropharyngeal and hypopharyngeal mucosal sites, though these neoplasia have been considered difficult to identify clinically. As most cancers in the oropharynx and the hypopharynx are diagnosed at the advanced stage and accompanied with several other complaints, extensive surgical resection is required. We can now use endoscopic mucosal resection for the treatment of superficial neoplasia at the oropharyngeal and hypopharyngeal mucosal sites as a minimum invasive treatment method as it is also in the gastrointestinal tract. However, this strategy is not yet perfected and there is no evidence for a definition of “so-called early cancer” or a definitive treatment strategy. In addition, there is no data concerning long-term survival after treatment. However, the fact remains that endoscopic treatment in this region is quite helpful for the patients because they do not lose the important organs for the functions of speech, swallowing and eating. Our conclusion is that we should continue research for the scientific evidence necessary to back up our use of endoscopic mucosal resection in this area.