内視鏡的食道粘膜切除術後長期経過例の検討―異時性多発癌を中心に

Analysis of Long-term Follow-up Patients after Endoscopic Mucosal Resection for Early Esophageal Cancer: With Special Reference to Metachronous Multiple Cancers

要旨　食道癌に対する内視鏡的粘膜切除術を1988年10月から開始したが，東海大学で施行した126例154病巣について検討した．術後早期の合併症は穿孔2例，皮下気腫1例，動脈性出血7例，狭窄4例，静脈瘤出血1例であった．全例保存的に治癒され外科的切除術を受けたものはない．術後局所再発は3例（全病巣数の1.9％）に，平均9．3か月で出現したが全例治療された．異時性多発癌の発生は6例（全症例の4.8％）に平均26か月で認められたが，多発病巣7病巣すべてがm癌であった．全例EEMRで治療されていた．食道癌による再発死亡は5年6か月後にリンパ節再発死亡が1例あるのみで，他癌死・他病死12例を除くと5年生存率は100％であった．

　We started endoscopic mucosal resection for early esophageal cancer (EEMR) in October 1988. Analysis of results for EEMR on 154 lesions in 126 cases conducted in Tokai University was performed.

　Early postoperative complications included two cases of esophageal perforation, one case of subcuntaneous emphysema, seven cases of arterial bleeding and four cases of esophageal stenosis. All these cases were treated conservationaly without any surgical resection.

　Local recurrence was found in three cases (1.9% of all lesions) at a median time of 9.3 months after EEMR.

　Metachronous multiple cancers were detected in six cases (4.7% of all cases) at a median time of 26 months after EEMR, though all these lesions were limited to the mucosal layer and had already been treated by reEEMR.

　One patient is dead due to lymph node metastasis at 5.5 years after EEMR. Five year survival rate was 100% excluding 12 deaths unrelated to the primary lesions.