最近の残胃癌の頻度の動向―術式別・部位別等

Clinicopathological Features of Cancer in the Gastric Stump (CGS)

要旨　良性疾患術後の残胃の癌（良性群）は減少しつつあるが，胃癌術後の残胃の癌（悪性群）は増加している．当院で経験した“幽門側胃切除術後の残胃の癌”211例を対象として，良悪性群の臨床病理学的特徴を比較検討した．良性群に比べて悪性群では，患者の年齢がやや高く，初回手術から残胃の癌診断までの介在期間は短く，早期癌が多かった．また，Billroth II法再建後の良性群では吻合部癌が多かったのに対し，悪性群およびBillroth I法再建後の良性群ではいずれも非吻合部癌が多かった．発生時期や部位などの特徴を理解しつつ，残胃の癌の早期診断に努めることが大切である．

　The number of patients with cancer in the gastric stump (CGS) after gastrectomy for primary gastric cancer (PGC) is steadily increasing due to the improved prognosis for PGC. On the other hand, the number of patients with CGS after benign disease is decreasing as a result of the low frequency of gastrectomies for benign ulcer in recent decades. The patients with CGS after distal gastrectomy for PGC (malignant group, n＝111) and for benign disease (benign group, n＝100) were reviewed for comparison of the characteristics. The average age was slightly higher in the malignant group than in the benign group. CGS in the malignant group was generally detected at an early stage and after a short interval from previous gastrectomy as compared with CGS in the benign group. Furthermore, CGS in the benign group after Billroth II reconstruction frequently developed near the gastrojejunostomy, whereas CGS in the malignant group commonly developed in the non-anastomotic site regardless of previous reconstruction. Accurate knowledge of the characteristics of CGS in each group, such as the time interval and the tumor site, is helpful for its earlier detection.

　1) Gastric Surgery Division, The National Cancer Center, Tokyo