食道胃接合部早期癌の治療―縮小手術

Minimally Invasive Surgery for the Treatment of Early Gastric Cardia Cancer

要旨　過去24年間で切除された噴門部早期胃癌20例を検討した．臨床病理学的には，噴門部早期癌は早期胃癌全体と比較して，男性，隆起型，分化型，sm癌の割合が多かった．リンパ節転移はm癌ではみられず，sm癌で1群転移が1例（7％）に認められた．2群転移は認められなかった．噴門部早期胃癌の低いリンパ節転移率を考慮すると，m癌の場合には癌近傍リンパ節を郭清して癌転移陰性が確認された場合には，噴門側局所切除を施行し残胃を大きく残した食道胃吻合の可能性が考えられた．sm癌の場合には術中sentinel node navigationを応用することで，sm癌でもリンパ節郭清を縮小する可能性が期待された．

　We have investigated the 20 early gastric cardia cancer patients who have undergone resection during the past 24 years. Early cardia cancer showed male preponderance, higher incidences of macroscopically elevated type, of histologically differentiated type, and of submucosal cancer as compared with the overall data concerning early gastric cancer. Nodal involvement was not observed in mucosal cancer, whereas, in submucosal cancer, it was confined to the first-tier with low frequency (7%). Therefore, local resection with adjacent lymphadenectomy and gastroesophageal anastomosis is feasible for mucosal cancer. The majority of submucosal cancer patients are potentially candidates for local resection, but sentinel node navigation may enable physicians to discriminate patients who should undergo systematic lymphadenectomy from those who need not.