食道扁平上皮癌に対する内視鏡的切除術の適応

Indications for Endoscopic Resection for Esophageal Squamous Cell Carcinoma

要旨　食道扁平上皮癌に対する内視鏡的切除術（ER）の適応は以前と特に変化はなく，また，EMRでもESDでも変わらない．T1a-EP，LPMがよい適応であるが，全周性に広範囲に存在するものは適応が難しい．T1a-MM，T1b-SM1ではER可能と診断されれば，まずERを行い，ly（＋），INFc，低分化型のものには外科的根治術あるいは化学・放射線療法を行う．長径5cm以上で全周性に及ぶものも，リンパ節転移を有する可能性が高いので注意する必要がある．高齢者が多いため，合併疾患を有することが多く，また，重複癌症例も少なくない．1例1例その患者に合った治療戦略を立てる必要がある．どうしたら患者の快適な時間が長くなるかを考えたい．

　The indications for endoscopic resection（ER） for esophageal squamous cell carcinoma（SCC） have been determined using the same criteria for EMR and ESD. ER is generally indicated for cases of T1a-EP-LPM. However, ER could be difficult in wide ranging lesions encompassing the whole esophageal circumference. If preoperative evaluation allows ER for T1a-MM and T1b-SM1, ER should be performed. If pathological examination reveals, ly（＋）, INFc, poorly differentiated carcinoma for the resected samples, radical operation or additional chemoradiotherapy should be applied. Lesions with major diameter of more than 5 cm should be treated with caution because of the high incidence of lymph node metastasis in such cases. Moreover, these lesions are more common in the elderly and are often accompanied by complications or multiple cancers. The best treatment should be considered on an individual basis to obtain the best prognosis in each case.