5）開腹手術

Surgical Treatment for Early Gastric Cancer

要旨　早期胃癌手術は，D2リンパ節郭清が標準術式とされてきた．しかし，リンパ節転移を来す早期胃癌の臨床病理学的特徴が明らかとなり，近年内視鏡的治療を含めた縮小手術が導入されてきている．縮小手術とは，胃切除範囲・リンパ節郭清範囲の縮小・機能温存が挙げられるが，根治性を保つには原発巣の完全切除とリンパ節転移のコントロールが重要である．当院でのガイドラインにおける縮小手術の導入状況とその根拠を示した．ESD導入後，手術症例の母集団はリンパ節転移陽性率の高い症例が多く占める傾向が示されたが，その治療成績は，ESD導入前と比較し同様であった．以上より，現在行われている早期胃癌に対する治療法は妥当であると考えている．

　D2 gastrectomy had been the standard treatment for early gastric cancer. Recently, the clinico-pathological feature of early gastric cancer with lymph node metastasis has been clarified, consequently, endoscopic resection and limited surgery have been introduced. Limited surgery for early gastric cancer includes surgery with a reduced area of resection in the stomach and in lymphadenectomy, aiming at preservation of gastric function. However, complete resection of the primary lesion and removal of the metastatic lymph node are both always important for curative therapy of early gastric cancer. We analyzed the trend in limited surgery and the outcome at the National Cancer Center Hospital. After ESD was introduced, the characteristics of surgically treated patients have changed, and patients with lymph node metastasis have increased. However, there is no significant difference in survival after surgery between the patients treated before and after the introduction of ESD. Endoscopic resection, limited gastrectomy or nerve-preserving gastrectomy are so far accepted as suitable treatments for early gastric cancer.