早期胃癌ESD適応拡大病変に対する不完全切除の要因と対策

Incomplete Resection of ESD in Patients with Early Gastric Cancer Meets Expanded Criteria

要旨　ESDは従来の内視鏡的粘膜切除術に比べて高率に一括完全切除が得られ，切除後の詳細な組織学的検索が可能なため，適応拡大の妥当性が検討されている．当院で2002年7月から2007年6月までにESDが施行された適応拡大病変300病巣において，一括切除率は93.3％，一括完全切除率は84.0％，穿孔率は5.3％であった．不完全切除の要因として，病巣内のUL，ESD導入後の経験症例数が挙げられた．一括完全切除例では経過観察期間中，遺残再発を認めなかったが，不完全切除例では経過中に14.6％で局所再発を認め，一括完全切除の重要性が再認識された．

　The endoscopic submucosal dissection (ESD) technique yields a higher complete resection rate in comparison with that of conventional methods of endoscopic mucosal resection. With completely resected specimens, detailed histological evaluation for assessment of risk of lymph node metastasis is possible. We investigated the outcomes of ESD for early gastric cancers that met the expanded criteria. From July, 2002 to June, 2007, 300 lesions were resected by ESD in our center. En bloc resection rate was 93.3％, the complete resection rate was 84.0％, and the perforation rate was 5.3％. The ulcer scar in the lesion and the timing of ESD were significantly associated with the rate of incomplete resection. No local recurrence was observed after complete resection, whereas it was noted in 14.6％ after incomplete resection.