―治療面からみた早期胃癌の実態と問題点―EMR後遺残再発病変の治療

Treatment of Recurrence or Residual Lesions after EMR for Early Gastric Cancer

要旨　早期胃癌EMR後遺残再発病変に対する治療方針と治療法およびその成績について述べた．EMRは235例266病巣に行い，完全切除率は64.7％である．不完全切除94病巣(“遺残癌”)に対する治療方法は追加内視鏡的治療69病巣，外科的切除15病巣，未治療10病巣である．追加内視鏡的治療の有効率は92.8％であった．追加内視鏡的治療は深達度Mで，比較的遺残範囲の狭い病巣に対し行った．外科的切除は広範なMの遺残とSM_1-β以深の病巣に対し行った．遺残再発癌は5病巣(5.3％，5/94)認めたが，4病巣は再EMRで切除した．他部位再発癌のうち外科的切除の適応となったものが2例あった．早期胃癌に対するEMR治療では，EMR前の慎重な診断，不完全切除病巣に対する積極的追加治療および厳重な経過観察が重要である．

　This paper deals with therapeutic policy for recurrence or residual lesions after EMR for early gastric cancers, as well as the treatment methods and therapeutic outcome. EMR was conducted for 266 lesions in 235 patients. The complete resection rate was 64.7％. Additional endoscopic treatment and surgical resection were conducted for 69 and 15, respectively, of the 94 residual lesions. Ten residual lesions were left untreated. The efficacy rate for additional endoscopic treatment was 92.8％. This treatment was conducted for residual lesions present in a relatively narrow area if the depth of invasion was M. Surgical treatment was undertaken for SM_1-β or deeper residual lesions present in a wide area. Five of the 94 (5.3％) retreated lesions recurred, but 4 of them were resected by EMR. Surgical treatment was undertaken for cancers which recurred at other sites in 2 patients. Our experience stresses the importance of careful diagnosis prior to EMR, aggressive additional treatment for residual lesions, and close post-treatment monitoring after EMR for early gastric cancer.