深達度m3で，EMR施行4年後にリンパ節転移を来した1症例

A Superficial Esophageal Cancer with a Depth of m3 Followed by Lymph Node Metastasis Four Years after EMR Procedure

要旨　患者は79歳，男性．検診で食道病変を指摘され，他院を受診．手術を勧められたが，EMR希望で当院を受診．術前診断は深達度m3であったが，陳旧性肺結核による肺機能障害と本人の希望でEMRを施行した．組織所見にて0-Ⅱc，深達度m3，ly（＋），v（＋）のため，補助療法として，化学療法を行った．6～12か月ごとの超音波，CT，内視鏡検査による経過観察を行っていたが，3年目に相当する1年間は，来院しなかった．EMR後4年目に嗄声が出現し，リンパ節再発が発見された．リンパ節再発に対し，放射線・化学療法を行うも，リンパ節は縮小せず，EMR後4年10か月，再発後11か月で死亡した．深達度m3・sm1にてEMRを行った症例では，少なくとも6か月ごとに検査を行い，5年以上の長期にわたる経過観察が必要と考えられた．

　An annual examination of a 79-year-old male patient revealed an esophageal lesion. He went to a university hospital where he was recommended for surgery. He wanted to take EMR (endoscopic mucosal resection) however, so he visited our hospital. In pre EMR diagnosis, the depth of the cancer was m3. He had a history of lung tuberculosis and he strongly wanted EMR procedure instead of the operation. Pathological diagnosis of the EMR specimen was 0-Ⅱc, m3 and 1y (+), v (+). He also agreed to additional treatment using chemotherapy. Every 6 to 12 months, he was examined by ultrasonography, CT and endoscopy. However, he did not visit the hospital for follow-up examinations in the third year after EMR. The fourth year after EMR, he came to the hospital with hoarsness and lymph node metastasis. He received chemotherapy and irradiation for the lymph node metastasis, but the size of the lymph nodes didn't change. He died four years and eleven months after EMR, which was eleven months after recurrence. EMR cases in which the depth of cancers are m3 or sm1 should be examined every 6 months and also need over five years of follow up study.