大腸SM癌の内視鏡切除後のfollow up―サーベイランスに向けて（局所再発，転移再発）

Surveillance, after Endoscopic Resection, of Patients with Submucosal Invasive Colorectal Carcinoma

要旨　内視鏡的摘除術を行い，追加腸切除を1年以内に行わず，経過観察した大腸SM癌107病変と進行癌術後5年以上経過観察をした結腸癌916例および直腸癌750例を検討し，再発病変の早期発見のための効率良いサーベイランスを検討した．内視鏡的摘除例では8例に転移再発を認め，「大腸癌治療ガイドライン」内視鏡治療根治例での再発は認めなかったが，再発後に病理診断の再検討が必要であった．再発の時期は切除後3年以内が多いが5年以上でも再発例を認めた．再発例はCEA高値やCT検査を契機に診断された．内視鏡治療根治例でも切除後3年以内は血清CEA/CA19-9は年2回，PET，CT，胸部X線検査，大腸内視鏡検査は年1回，3年以降は，CEA/CA19-9，PET，CT，胸部X線検査，大腸内視鏡検査は年1回のサーベイランスが必要である．

　The aim of this study was to determine a surveillance program after endoscopic resection for patients with SM invasive colorectal carcinoma. We investigated 107 patients who were treated with endoscopic resection for SM invasive colorectal carcinoma and 1,666 patients who were checked for recurrence for over five years after curative resection for colorectal cancer. In endoscopic resection, 8 cases showed recurrence. Recurrence within 3 years after endoscopic resection was common. In surgical resection, most local recurrence occurred within less than 3 years. CEA and CT were most effective modalities for the detection of local recurrence. It is concluded that surveillance for patients of sm cancer who have been treated by endoscopic resection should be performed by colonoscopy and other modalities such as CEA/CA19-9, CT, MRI and PET until more than 5 years have passed.