下咽頭癌を重複した胸部食道表在癌の4例

Primary Superficial Carcinoma of the Esophagus with Concurrent Carcinoma of the Hypopharynx, Report of Four Cases

要旨　下咽頭癌を同時性に重複した胸部食道表在癌の4例を経験した．全例に共通する事項として，①50歳台の男性，②梨状陥凹部原発の進行癌（Stage Ⅳ），③胸部食道に長径3.5～10cmの深達度ep～smの表在癌の存在，である．〔症例1〕は胃の早期多発癌を，〔症例3〕は口腔底癌を更に重複した．現在まで，口腔・咽頭・喉頭領域腫瘍の3.7～57％に胸腹部食道癌の重複が報告されている．筆者らの施設においては，食道癌切除例の3.9％（5/128），下咽頭癌切除例の21.1％（4/19）にそれぞれの癌の合併を認めた．根治手術（頸部郭清，非開胸食道抜去，喉頭全摘，下咽頭胃あるいは結腸吻合術）および術前後の集学治療にもかかわらず全例2年以内に死亡し，食道癌あるいは下咽頭癌の単発例に比較し著しく予後不良であった．4例の診断過程および病理所見を検討し，口腔・咽頭・喉頭領域腫瘍の治療に当たっては多発癌の観点から食道病変の十分な精査を行い，予後の向上に努めるべきことを強調した．

　Four cases of concurrent cancers of the esophagus and hypopharynx that were surgically treated are reviewed with respect to their clinical and pathological features and therapy.

　The patients were men in the sixth decade of life, and all presented with superficial cancer (depth ep～sm) of the thoracic esophagus (3.5 cm to 10 cm in size) and advanced cancer of the piriform sinus (Stage Ⅳ).

　Furthermore, Case 1 was associated with early multiple gastric cancers, and Case 3 with oral floor carcinoma. Despite radical operations including cervical dissection, total esophagectomy without thoracotomy, total laryngectomy, and pharyngo-gastric or -colonic anastomosis and adjuvant therapy before and after surgery, three patients had recurrences within two years, and thus, the prognosis was far worse than that in case of single carcinoma of the hypopharynx. In the other reports published to date, double cancer accounts for 3.7 to 57% of cancer of the hypopharynx, but a high incidence of the esophageal cancer associated with cancer of the piriform sinus has not been reported.

　In conclusion, it is necessary to carefully examine the esophagus for possible cancer in patients with cancer of the hypopharynx, and further efforts are required to improve the prognosis in these patients.