EMRを施行した食道sm2癌の1例

Esophageal Submucosal Cancer Treated by Endoscopic Mucosectomy, Report of a Case

要旨　患者は57歳，男性．食道症状なし．健康診断の上部消化管造影検査で食道に異常を発見され，内視鏡検査により食道癌との診断を受けた．精密検査により胸部下部食道癌（Lt 0-Ⅱa＋0-Ⅱc，深達度m3，転移なし）と判断して，informed consent下に内視鏡的粘膜切除術を施行した．切除組織の病理学的検索で明らかな脈管侵襲は認めなかったものの，固有食道腺直下まで癌巣は拡がり，深達度sm2と診断した。また，腫瘍は上皮下粘膜固有層内を伸展しており，口側に癌遺残が疑われた．十分な診断情報を提供するとともに追加治療を勧めたが，患者本人の意志により厳重に経過観察することとなった．内視鏡，CT，EUS，腫瘍マーカーなどによる検索を続けているが，術後約3年半の現在まで再発を認めていない．

　A 57-year-old male without symptoms was referred to our hospital because of superficial esophageal cancer detected at a health check-up examination. The tumor was located on the lower esophagus, showing a type of 0-Ⅱa+0-Ⅱc cancer invading the muscularis mucosae, but with no metastasis clinically. We performed endoscopic mucosectomy, using a np-EEM technique, after obtaining informed consent. Histopathological examination revealed that the tumor had invaded the mid-submucosal layer just below the proper esophageal glands without obvious vascular involvement and it extended subepithelially. According to the histopathological data of the resected specimen, we recommended that the patient should undergo radical esophagectomy because of the possibility of metastasis. However, the patient preferred to be observed with an intensive follow-up schedule using endoscopy, CT, EUS and tumor markers. He has been in good health for three and a half years without recurrence of esophageal cancer.