大腸sm癌の内視鏡治療後の再発・転移に対する早期発見のためのフォローアップ法

Follow-up Study of Recurrence and Metastasis After Endoscopic Resection for Submucosal Invasive Colorectal Cancer

要旨　内視鏡的治療を行った大腸sm癌133例のフォローアップの実際を明らかにし，より安全で有効なフォローアップ法の確立に向けて検討した．フォローアップ法は患者に予定検査時期の案内を郵送，sm癌の場合は3～6か月後に局所を観察，その後は1年目のTCSを行い，異常なければclean colonとして2～3年に1回のTCSあるいはSCSを伴った注腸X線検査を行う．遠隔転移に対しては腫瘍マーカー，腹部超音波検査を年2回，3年間施行する．初回に内視鏡的治療を行った133例のうち局所再発と遠隔転移は各々1例（0.75％）に認めた．この間のフォローアップで発見された異時性腫瘍性病変は44例（33.1％）で，このうち癌病変はm癌の2例（1.5％）であった．これらはすべて内視鏡的治療が可能な時期に発見できた．現フォローアップ法は概ね有効と考えている．

　One hundred and thirty-three submucosal invasive colorectal cancers after endoscopic resection were examined for the establishment of a more effective follow-up policy. The patients were supposed to be informed of their scheduled examination by mail. Cases of submucosal invasive colorectal cancer should be followed up by total colonoscopy within 3 to 6 months, and then once a year thereafter. If no neoplasms were found, it meant that the colon was clean, and total colonoscopy or barium enema study with sigmoid colonoscopy was recommended to be performed every 3 years. For distant metastasis, tumor marker and abdominal ultrasonography were examined twice a year for 3 years. The local recurrence rate was 0.75 ％ in 133 cases with endoscopic resection and the metastasis was 0.6 ％ in 162 cases with operation. There were 44 cases with metachronous neoplastic lesions and 2 cases with multiple cancers, but these cases were successfully treated with endoscopic resection. We emphasize that our follow-up schedule is generally adequate.

　1) Kenseikai Nara Coloproctology Center, Yamatotakada, Japan