胃癌―外科的治療の最先端：標準（的）治療（欧米との比較）

New Wave in Japanese Surgery―Search for Standard Treatment

　「胃癌治療ガイドライン」

初版では，早期胃癌に対する治療として，EMR，縮小治療A，B，が定型手術以外に標準とされた．また，従来行われることが多かった大網切除，網囊切除も早期胃癌では省略可能とされた．T2/3の進行胃癌の標準手術は胃の2/3以上の切除とD2郭清と明確化されている．T4に関する浸潤臓器の合併切除は標準とされるが，郭清のための臓器の合併切除やD3郭清は標準から外れた．脾摘については標準との明記がない．一方欧米のガイドラインでは治癒切除可能症例に対する術式は一律であり，早期胃癌に対するoptionの記載はない．手術に関してはRCTの結果にかかわらずD2を望ましい手術としているところが興味深い．

　In the first edition of the Guidelines of the Japanese Gastric Cancer Association, EMR, limited surgery A and B are, for the first time, officially recognized as standard treatment options for early gastric cancers. Omentectomy and bursectomy, which used to be a part of standard D2 dissection, may be omitted for early lesions. The standard procedure for T2/3 lesions is clearly described as gastrectomy of two thirds or more of the stomach combined with D2 lymphadenectomy. Combined resection of adjacent organs for T4 is a part of the standard procedure, but that for lymphadenectomy is not included. D3 dissection remains as an experimental treatment. In the West, on the other hand, the “standard” procedure for curable tumors is uniformly decided irrespective of tumor stage and there is no option described for early lesions. It is interesting that D2 dissection is still the preferred procedure despite the results of the two major RCTs in the West.