EMRか？ 外科手術か？（高齢者早期胃癌）―外科手術後の予後からみて

Treatment Strategy for Early Gastric Cancer in the Elderly

要旨　平均余命が約7年となる，80歳以上の患者の治療は根治性，安全性，QOL維持の3つの観点からの治療が必要となる．80歳以上の患者の胃切除は，一般には安全に行えるが，併存症のある患者においてはhigh riskであった．また，QOLの悪化は必須である．当院ではリンパ節転移率の低い，早期胃癌患者にEMRの相対的適応を拡大して治療を行い，胃切除と同等の生存成績が得られた．また，EMRで局所コントロール不良例の予後は不良であり，胃切除の積極的追加が必要とされた．

　Elderly patients have a limited life expectancy, more preoperative risk factors, and poor quality of life often associated with the operation. The operative procedure used for such patients must be chosen with care, considering radicality, predicted hospital mortality, and postoperative quality of life. Since there is a low incidence of lymph node metastasis from early gastric cancer, we expanded the indication for endoscopic mucosal resection (EMR) with meticulous prediction of nodal metastasis and evaluation of operative risks. Survival was identical to that of gastrectomy. Further evaluation with EMR as an effective tool for early gastric cancer in the elderly is feasible. Failure of local control by EMR was associated with a high incidence of recurrence. Gastrectomy should be carried out in such cases, since it is able to be carried out safely.

　1) Gastric Division, Department of Surgical Oncology, National Cancer Center Hospital, Tokyo