食道sm癌に対する食道温存治療の可能性―外科の立場からの検討

Organ Preserving Treatment for Submucosal Cancer of the Esophagus-A Study from a Surgeon's Point of View

要旨　食道sm癌の90％近くの症例でly，v等の予後不良関連因子が陽性であるが，これに対するD2，3郭清術の5生率は72.6％，disease specific survivalが81.8％で，D0，1郭清術の40.2％，59.8％より明らかに良好であった．sm癌の中には非手術的な局所治療が根治的な症例もあり，リンパ節転移があっても化学・放射線同時併用療法等で根治できる症例もあるが，過去の成績にはselection biasがあり手術と直接比較できない．sentinel node navigation surgeryも注目されるが技術的にも理論的にも更なる検討を要する．食道sm癌に対する標準治療は現在もその確実性から定型郭清を伴う食道切除再建術であるが，QOL向上の観点から食道温存治療の成績向上と食道切除再建術との客観的比較が望まれる．

　Although nearly 90% of sm cancers of the esophagus show one or more factors related to poor prognosis such as ly (+), v(+), n(+), the five-year survival rate after D2, 3 esophagectomy is as high as 72.6% (disease specific survival: 81.8%), which is evidently higher than the figure of 40.2% (59.8%) after D0, 1 operation. However, there are surely some sm cancers to which local therapy such as EMR is curative and some in which chemo-radiotherapy can eradicate tumor cells in spite of lymph node involvement. Because the results of such organ preserving treatment available now inevitably have selection bias, it can not be compared directly to the results of surgical treatment. Sentinel node navigation surgery, a charming new concept, still involves many problems to be solved both technically and theoretically before its clinical application. The standard treatment for sm cancers of the esophagus at present is still esophagectomy with standard lymph node dissection. The effort to improve the outcome of esophagus preserving treatment and its objective comparison to the outcome of surgical treatment is necessary to improve the QOL of the patients.