早期胃癌に対する外科的治療の最前線―機能温存，QOL向上を目指した手術の工夫

Early Gastric Cancer―Update Practice of Surgical Treatment

　近年，早期胃癌症例の全胃癌手術に占める割合が増加し，同時に胃癌術後長期生存例も増加したことから，術後の生活の質を考慮した治療法が選択される機会が多い．胃切除後障害への対応としてリンパ節郭清範囲の縮小，幽門保存胃切除術，迷走神経温存手術などが多くの施設で行われている．1990年代初頭に導入された腹腔鏡下手術は，今日では胃部分切除のみならず，リンパ節郭清を伴う胃切除術も可能となった．今後sentinel node navigation surgeryによる理論的なリンパ節転移診断の確立が，QOLを重視した縮小手術，殊にSM癌への縮小手術の応用に大きな役割を持つと思われる．「胃癌治療ガイドライン2001年3月版」を念頭に置いて早期胃癌手術の現状と将来展望を概説した．

　Postoperative quality of life of patients with gastric cancer is becoming more important because of the increasing number of patients with early gastric cancer and the increase in numbers of long term survivors. Limited lymph node dissection (D 1, D 1＋α, D 1＋β), pylorus preserving distal gastrectomy, and vagus nerve preserving gastrectomy have been introduced in many institutes. Laparoscopic surgery which was started in the early nineteen-nineties is now widely performed in Japan. Not only wedge resection of the stomach but also gastrectomies with lymph node dissection are able to be performed laparoscopically. Establishing the proper indication and techniques of sentinel node navigation surgery for early gastric cancer has an important role for the limited surgery for gastric cancer and in improving quality of life of the patients. Present clinical status and future perspectives of treatment of early cancer was described along with the “gastric cancer treatment guideline” published in 2001.