幽門側胃切除以外の術後胃における癌―噴切後の残胃の癌

Clinicopathological Features of Gastric Remnant Cancer after Corpofundectomy for Gastric Cancer

要旨　胃癌幽門側胃切除術後以外の残胃の癌ということで，文献検索された噴門側胃切除後の残胃の癌26例について臨床病理学的検討を行い，当教室で経験した胃癌幽門側胃切除後の残胃の癌22例と比較した．その結果，噴門側胃切除後の残胃の癌は，術後比較的早期に手術操作と無関係な部位に発生し，その多くが分化型癌であるという特徴を示した．また，再建術式により食道残胃吻合群と空腸間置群とに分け，比較・検討したところ，空腸間置群では有意に介在期間が長く，進行癌が多かった．噴門側胃切除により残された胃は高発癌状態にあり，そのことを念頭に置いた術式の選択と定期的なフォローアップが重要である．

　We investigated the clinicopathological features of the reported 26 cases of gastric remnant cancer after corpofundectomy for gastric cancer and compared the results with our 22 cases of gastric remnant cancer after distal gastrectomy for gastric cancer. Remnant cancer after corpofundectomy developed at the non-surgical site of the stomach earlier than that after distal gastrectomy. The majority of the developed cancers were differentiated type. In addition, patients with jejunal interposition showed a longer interval between the previous operation and diagnosis of the remnant cancer and a higher incidenc of advanced stage cancer compared with patients with esophago-gastric anastomosis. The remnant stomach after corpofundectomy seems to be highly susceptible to gastric carcinogenesis. Based on the results, we conclude that pertinent reconstruction method and follow-up study after corpofundectomy is required.

　1) Department of Gastrointestinal Surgery, Graduate School of Medicine, The University of Tokyo, Tokyo