早期胃癌に対するESDの治療成績―適応拡大の可能性

Long-term Outcome of ESD for Early Gastric Cancer

要旨　2000年から2003年までに，当センターにおいて根治目的にESDが施行された1,033病変945症例の長期成績より適応拡大の可能性を検討した．治癒切除は857病変（83％）で得られ，そのうち649病変は半年以上当センターにおいて経過観察が行われていた（観察期間中央値：3.1年）．ガイドライン治癒切除360病変では，現在まで遺残再発は認めていない．適応拡大治癒切除289病変では，分割切除であった1例でESD後9.2か月に局所のみの再発を認めたが，他の症例は遺残再発を認めていない．適応拡大病変を含め，一括切除され治癒切除と病理組織学的に証明された症例では，高い根治性があると考えられた．

　Endoscopic submucosal dissection (ESD) is a new technique developed to obtain one-piece resection in cases of early gastric cancer (EGC). To clarify the long-term outcome of this treatment, 1,033 lesions in a consecutive 945 EGC patients were selected. They had been treated with ESD with curative intent from 2000 to 2003 at the National Cancer Center Hospital and were investigated concerning their clinical course. Patients who were followed up at other hospitals after ESD were excluded from the analysis.

　Histologically, curative resection was found in 857 (83％) lesions including 485 evaluated according to the general criteria and 372 evaluated according to expanded criteria. With 3-year median follow-up periods, except for one patient who had local recurrence after piecemeal resection, no recurrence or metastasis was evident in the curative resection group.

　ESD showed an excellent long-term outcome in patients who belonged to the one-piece and curative resection group, and it might be a possible treatment even in an expanded criteria group.