早期胃癌に対するESDの適応拡大の可能性

Can Indication for ESD for Early Gastric Cancer be Expanded?

要旨　2000年1月から2003年5月までにフックナイフを用いてESDを施行した早期胃癌のうち適応内群：82例84病変，適応拡大群（分化型）：51例53病変，適応拡大群（未分化型）：3例3病変を対象とした．偶発症の発生に差はなかった．一括完全切除率は，それぞれ95.2％，86.8％，66.7％で3群間に有意差はなかった．局所再発率は3群ともに0％であった．3年生存率は3群ともに100％であった．以上より早期胃癌に対する内視鏡治療の適応拡大は可能と考えられた．ただし適応拡大群（未分化型）については症例が少ないため，今後，症例を重ね検討が必要である．

　The indication for EMR decided by the Japanese Gastric Cancer Association is differentiated intramucosal adenocarcinoma less than 20mm in diameter and without ulceration. However, recently the indication has been expanding.

　Materials and methods: Early gastric cancers treated with endoscopic submucosal dissection (ESD) from January, 2000 to May, 2003, were divided into three groups : an indication group (82 patients with 84 lesions), an extended indication group (differentiated adenocarcinoma, 51 patients with 53 lesions) and a further extended indication group (undifferentiated adenocarcinoma, 3 patients with 3 lesions). There was no significant difference in background among the three groups.

　Results : There was no significant difference among the three groups in complications. The complete en-bloc resection rate was 95.2％, 86.8％, 66.7％, respectively. The local recurrence rate was 0％ in all three groups. The three-year survival rate was 95.9％, 91.5％, 66.7％, respectively. In addition, the cause-specific survival rate was 100％ in all three groups.

　Conclusion : The extended indication for ESD for early gastric cancer is based on sufficient reasons. The indication for ESD for undifferentiated adenocarcinoma needs to be investigated further, because the cases that have undergone ESD are few in number.