大腸sm癌の治療

Treatment of Submucosal Invasive Carcinoma of the Colon and Rectum

要旨　教室で経験した大腸sm癌90例（結腸49例，直腸41例）の治療につき検討した．初回治療としては結腸sm癌49例中22例（44.9％），直腸sm癌41例中20例（48.8％）に局所的切除（内視鏡的ポリペクトミー，局所切除術）が行われ，残りの48例は腸管切除術が当初より行われた．局所的切除例42例中19例には追加根治術が行われた．腸管切除例67例中3例（4.5％）にリンパ節転移を認め，また，2例に再発を認めた．今回のsm癌リンパ節転移予測因子の検討より，高分化腺癌で粘膜下浸潤が軽度であり，かつ脈管侵襲（特にly-factor）がなければ，形態的，占居部位的に可能であれば，治療は局所的切除で十分であると考えられた．

　In order to establish the principles of treatment of invasive carcinoma which is limited within the mucosa and submucosa, we analysed clinicopathological findings in 90 patients with colorectal invasive carcinoma (49: colon, 41: rectum) treated at Keio University Hospital from 1970 to 1990.

　Forty-two patients (22: colon, 20: rectum) were initially treated by endoscopic polypectomy or local excision. Nineteen of them (10: colon, 9: rectum) subsequently underwent radical operation with lymph node dissection. The remaining 48 underwent bowel resection as initial treatment. Finally, 37 patients with colonic invasive cancer underwent bowel resection and 30 patients with rectal invasive cancer rectal resection (25: sphincter saving operation, 5: abdomino-perineal resection).

　Among these 67 patients finally treated by bowel resection, lymph node metastases were present in three patients (4.5%). Such pathological findings as moderately differentiated adenocarcinoma, submucosal massive invasion and lymphatic involvement were found in these patients.

　Only 2 of these patients treated by bowel resection developed reccurrent diseases (1: liver metastasis, 1: intrapelvic local reccurrence).

　We conclude that as treatment of submucosal invasive carcinoma with such characteristics as well differentiated adenocarcinoma without lymphatic vessel invasion and massive invasion to submucosal layer, endoscopic polypectomy or local excision is justified.