大腸sm癌内視鏡的切除後の外科的追加切除の適応に関する検討

Characteristic Features of Submucosal Invasive Colon Cancer and Its Lymph Node Metastasis

要旨　内視鏡切除後の外科的追加切除の適応を検討するために，sm癌症例を検討した．n（＋）症例は13/120（11％）であった．n（＋）症例では，大多数がly（＋）であり，増殖様式がPG，NPGを問わずsm浸潤面積に相関していると思われた．n（＋）症例のsm深達値は1,075μm以上，sm浸潤面積は0.45mm²以上であった．更にly（＋）症例は37/120（31％）であった．ly（＋）症例のsm深達値とsm浸潤面積は，1例（sm深達値400μm，sm浸潤面積0.04mm²）を除いては全例n（＋）症例以上の値を示した．したがって，内視鏡切除材料でsm深達値1,000μm以上あるいはsm深達面積0.45mm²以上の症例には，追加外科手術が必要と思われた．

　One hundred and twenty Submucosal invasive colon carcinomas were examined to determinate characteristic features of the cases with lymph nodes metastasis.

　The rate of lymph node metastasis is 13/120 (11%), and the rate was related to cancer square in the submucosal layer. In cases with lymph node metastasis, the minimum cancer depth in the submucosal layer was 1,075μm, and the minimum cancer square in the submucosa was 0.45 mm². On the other hand, the rate of lymphatic invasion was 37/120 (31%). In all cases with lymphatic invasion, except one case, the cancer depth and the cancer square in the submucosal layer were more than that of the cases with lymph node metastasis.

　Consequently, when the submucosal cancer depth is more than 1,075μm and submucosal cancer square is more than 0.45 mm² surgical operation in addition to endoscopic resection is recommended.