残胃癌の治療―外科的治療

Treatment for Cancer Newly Developed in the Remnant Stomach―Surgical Therapy

要旨　胃切除術後の残胃（新生）癌は発癌機序の解明モデルとして，また診断学的な意味でも注目されてきた．大阪医科大学一般・消化器外科では過去25年間に60例の同疾患の外科治療を経験してきたが，その臨床病理と手術治療成績を胃上部初発胃癌の成績と対比して，その特徴を検討した．結果と結論;①初回手術と残胃癌手術の間は初回悪性群が短い．②残胃早期癌は初回悪性群あるいはBillroth I法再建群に多い．③高分化型腺癌は初回悪性群に多い．④術後遠隔成績は胃上部初発癌と同等である．⑤下縦隔リンパ節ないし空腸間膜内リンパ節転移が残胃癌の特徴的転移経路である．

　Cancer in the remnant stomach after partial gastrectomy (CRS) attracts interests not only as a typical model in the study of carcinogenesis, but also under the aspect of cancer diagnosis. During the last 26 years we have had experience in treating 60 patients with CRS. Clinicopathological variables and postoperative survivals were reviewed to clarify whether there are any common characteristics of this disease. Results and Conclusion : 1)The mean time interval between the initial and second surgeries was shorter in patients with previous cancer. 2)An early stage of CRS is more frequent in patients with previous cancer or in those with reconstruction by the Billroth I method. 3)CRS with a differentiated histology developed more frequently in patients with previous cancer. 4)Long-term survivals of CRS were comparable to a certain extent with those of primary cancer in the upper stomach. 5)Prevalence of the development of lymph node metastasis in the lower mediastinum or the jejunal mesentery is one of the unique features of CRS.

　1) Department of General and Gastroenterological Surgery, Osaka Medical College, Takatsuki, Japan