―治療面からみた実態と問題点―早期胃癌の治療法の変遷

Changes in the Methods of Treatment for Early Gastric Cancer

要旨　早期胃癌治療は標準的手術の時代を経て，1980年代から多様化の時代に入った．その方法論は内視鏡的治療と，手術療法に大別できる．内視鏡的治療は，内視鏡的粘膜切除(EMR)の出現により本幹が形成された．1990年代からは適応が拡大され，診断的EMRという概念が形成されつつある．手術療法は，1980年代にリンパ節郭清の縮小が提唱されたことに続いて機能温存手術が導入された．1990年代には腹腔鏡手術が移入され，より低侵襲の治療が模索されている．今後は，施設間の適応をできるだけ均質化することが望まれる．

　Treatment for gastric cancer started in earnest in the 1960s in Japan. At the beginning, standard D2 gastrectomy was applied as the treatment for early gastric cancer. Since the 1980s, we have been able to choose from a variety of treatments which were classified into two large groups,“endoscopic” and “surgical” therapy. In endoscopic therapy, endoscopic mucosal resection (EMR) has been the main method and the strip biopsy method has become widely used. Since the 1990s, indication for EMR has been extended due to the various devices that have been invented. In surgical therapy, limited lymph node dissection and function-preserving surgery were advocated in the 1980s. Since the 1990s, laparoscopic surgery has been adopted. Results of treatment for early gastric cancer have been satisfactory. For the future, application of this variety of treatments should be standardized.