sm massive以深に浸潤した10mm以下の大腸癌の治療

Management of Colorectal Carcinoma 10 mm or Less in Size Invading Massively into the Submucosal Layer or Deeper

要旨　sm massive以深に浸潤した10mm以下の大腸癌の臨床病理学的特徴と治療方針に関して検討した．外科的に切除した腫瘍径10mm以下のsm以深に浸潤を認める大腸癌55病変のうち，進行癌は4例(7.3％)であった．10mm以下のsm massive癌と11mm以上のsm massive癌の比較では前者でリンパ管侵襲陽性率が低値であった以外には臨床病理学的に悪性度に差は認めなかった．術前に10mm以下のSM massive'以深の大腸癌と診断した場合には11mm以上の病変と同様の治療法を選択すべきだと考える．また腹腔鏡手術は早期大腸癌の外科的治療に関しては第一選択であり，進行癌に対しても適応を広げつつある．

　This study was carried out to clarify the clinicopathologic features of small colorectal cancers 10 mm or less in size (CRC≦10 mm) invading massively into the submucosal layer or deeper, and to examine the usefulness of laparoscopic colorectal surgery for early carcinoma. A total of 55 cases of CRC≦10 mm invading massively into the submucosal layer or deeper were analyzed. The depth of invasion remained within the submucosal layer in 51 cases. There was no difference in terms of clinicopathologic characteristics between CRC≦10 mm and colorectal cancers 11 mm or larger (CRC≧11 mm) invading massively into the submucosal layer, except for lymphatic permeation of which the positive rate was higher in CRC≧11 mm. CRC≦10 mm invading massively into the submucosal layer or deeper may have the same malignant potential as CRC≧11 mm, so they should not be ignored.

　On the other hand, results of laparoscopic surgery in patients with early colorectal cancer were favorable. With improvements in technology and surgeon experience, laparoscopic surgery will eventually be extended to patients with advanced colorectal carcinoma.