多発食道癌と粘膜切除

Endoscopic Mucosal Resection and Multiple Esophageal Cancer

要旨　粘膜切除後1年以上経過観察を行った185例227病巣（m癌165，sm癌20）を検討対象とした．同時多発食道癌は31例73病巣（2病巣22，3病巣7，4病巣2）であった．主病巣の病型はⅡcが47.6％と多く，副病巣の病型はⅡbが61.9％を占めていた．副病巣の大きさは10mm以下が57.1％であった．副病巣の40.5％は，主病巣の口側に存在した．副病巣にも粘膜切除を行い，すべて粘膜癌であった．多発食道癌と単発の食道癌における他臓器癌の合併頻度の比較では，癌の既往，同時性および異時性他臓器癌合併のいずれにおいても，多発食道癌のほうが高率であった．異時性食道癌は23例27病巣（12.5％）であった．異時性食道癌の病型はⅡcが59.3％と多く，大きさは20mm以内が92.6％を占めていた．23例中17例（73.9％）は3年以内に発見され，初回治療病巣の肛門側に存在する症例が，15病巣（55.6％）を占めていた．25病巣（92.6％）に粘膜切除を行い，深達度はすべて粘膜癌であった．異時性食道癌例における他臓器癌合併頻度は高く，特に異時性他臓器癌を8例（34.8％）に認め，23例中4例（17.4％）は，3重複癌症例であった．異時性食道癌発生の背景として，初回治療病巣が多発であり，食道粘膜に多数のヨード不染部を認める症例に，高率に異時性食道癌を認めた．

　One hundred and eighty five patients was included in this study. They underwent endoscopic mucosal resection (EMR) for treatment of superficial esophageal cancer more than one year before at our hospital. Synchronous multiple esophageal cancer was identified in 31 patients (22 patients had two lesions, 7 three lesions and 2 four lesions). Type 0-Ⅱc lesion (superficial and slightly depressed type) was frequent and occupied of all primary lesions (47.6％). At the same time, type 0-Ⅱb lesion was most frequent among second esophageal cancers (61.9％). The size of lesions was less than 10 mm in 57％ of all secondary lesions. Multiple primary cancers in other organs were frequent among patients with multiple esophageal cancer than patients who had only one cancer in the esophagus. Metachronous multiple esophageal cancer was identified in 23 patients (12.5％ of all cases with EMR). Type 0-Ⅱc lesions occupied 59.3％ of all lesions. 92.6％ of all metachronous multiple esophageal cancer was less than 20 mm in size. 73.9％ of all cases was detected within three years after EMR and 55.6％ of all cases was existed at distal side to the primary lesions EMR was carried out on 92.6％ of all metachronous multiple esophageal cancer lesions and confirmed as mucosal cancer. Malignant lesions in other organs were frequent among patients with metachronous multiple esophageal cancer (34.8％). Metachronous esophageal cancer was significantly frequent among patients with multiple cancer lesion in the esophagus and who had many unstained areas in the esophagus. They were noted at proximal side of the primary lesion (40.5％). All syn-chronous multiple cancer lesion was treated by EMR and they remained within the mucosa.