大腸sm癌の治療方針―内科の立場から

Treatment for Colorectal sm Cancer

要旨　大腸のsm早期癌の治療法について検討した．これまで当科で治療した進行癌との合併を除くsm癌67例73病変のうち，内視鏡的ポリペクトミーのみで経過を見たものは22例で，ポリペクトミー後追加腸切除されたものは19例，外科的切除26例である．これらの治療後の経過観察からsm癌の治療方針として以下の結論を得た．①有茎，亜有茎病変で脈管侵襲がなく断端陰性のものはポリペクトミーのみで根治しうる．②断端陽性，脈管侵襲陽性，低分化型癌の場合は外科的追加腸切除が原則である．しかし腺腫を併存するものはリンパ節転移や脈管侵襲の程度は低くポリペクトミーによる根治可能例が多い．③sm癌でsm深層へ浸潤しているものは脈管侵襲やリンパ節転移例が多くポリペクトミー後の追加切除が必要である．

　Study was carried out on the treatment for colorectal sm cancer. We have followed-up 22 cases by endoscopic polypectomy alone, 19 cases in which surgical resection was performed following polypectomy, and 24 cases surgically treated without polypectomy. Prospective analysis of these cases led to the following suggestions: 1) Pedunculated or subpedunculated lesions without cancer invasion into the vessels and/or extension to the resected margin after polypectomy can be treated completely by polypectomy alone. 2) The lesions with histopathological findings of vessel invasion, infiltration at the resected margin and poorly differentiated adenocarcinoma should be treated by curative resection following polypectomy. However, since the sm cancer associated with adenoma is considered to grow slowly, it seems feasible to resect completely by polypectomy alone. 3) Since sm cancer with deep infiltration into the submucosal layer is likely to have metastasized to the lymph node and/or invaded into the vessels or lymphoid canals, these lesions should be treated by curative resection after polypectomy.