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Stomach and Intestine(Tokyo) Volume 32, Issue 1 （January 1997）

胃と腸 32巻1号（1997年1月発行）

Japanese English

今月の主題胃sm癌の細分類―治療法選択の指標として

主題

胃sm癌の細分類とリンパ節転移に関する検討―根治的内視鏡的切除術の適応拡大の可能性 Degree of Submucosal Invasion of Early Gastric Carcinomas and Risk for Lymph Node Metastasis: Consideration Limiting of Applicability for Endoscopic Resection 表和彦 ¹ , 磨伊正義 ¹ , 溝口雅之 ¹ , 高橋豊 ¹ , 川島篤弘 ² Kazuhiko Omote ¹ , Masayoshi Mai ¹ , Masayuki Mizoguchi ¹ , Yutaka Takahashi ¹ , Atsuhiro Kawashima ² ¹金沢大学がん研究所外科 ²金沢大学がん研究所病理 ¹Department of Surgery, Cancer Research Institute, Kanazawa University ²Department of Surgical Pathology, Cancer Research Institute, Kanazawa University キーワード：胃sm癌 , sm細分類 , リンパ節転移 , 内視鏡的切除 Keyword: 胃sm癌 , sm細分類 , リンパ節転移 , 内視鏡的切除 pp.49-55

発行日 1997年1月25日 Published Date 1997/1/25

DOI https://doi.org/10.11477/mf.1403104951

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要旨　当教室で経験した胃粘膜下層浸潤癌（sm癌）切除症例235例を，その粘膜下層への浸潤度によって細分類し，内視鏡的切除の適応を左右するリンパ節転移に関して検討を加えるとともに，sm癌に対する根治的内視鏡的切除術の適応について考察した．浸潤度sm_1-α（粘膜下層への浸潤が300μmまで）で腫瘍径30mm以下のもの，sm_1-β（300μm～1/3まで），sm₂（1/3～2/3まで）の10mm以下のもの，および30mm以下のsm_1-βで腫瘍先進部の組織型が高分化型ly（－）Ul（－）のものにリンパ節転移を認めず，この範囲のsm癌に対して根治的内視鏡的切除術の適応拡大の可能性が示唆された．

　Classifying 235 cases of submucosal (sm) carcinoma of the stomach according to the degree of sm invasion, we considered their applicability for endoscopic resection. The degree of sm invasion was designated as follows: sm_1-α; depth of the invasion was limited within the first 300 μm of the sm layer, sm_1-β; the invasion was limited within 300 μm ～ 1/3 of the sm layer, sm₂; the invasion reached from 1/3 to 2/3 of the sm layer, sm₃; carcinoma invaded close to the proper muscle layer. Histopathologically, all the specimens were examined to evaluate the risk for lymph node metastasis. On analysis of the degree of carcinomatous invasion into the sm layer, the positive rate of lymph node metastasis in sm_1-α was 6.3％, and rates in sm_1-β, sm₂ and sm₃ were 16.7％, 15.1％ and 22.7％ respectively. Histopathologic correlations with the risk for lymph node metastasis were observed in degree of sm invasion, tumor size, histologic type of the invasive front, lymphatic permeation and coexistance of ulceration. However, there were no lymph node metastases with the lesions of sm_1-α measuring 30 mm or less in size, sm_1-β and sm₂ measuring 10 mm or less in size. In addition, if the sm_1-β lesions measuring 30 mm or less in size were accompanied with well differentiated adenocarcinoma at the invasive front or without lymphatic permeation or ulceration, they also had no lymph node metastasis. Consideration of the risk for lymph node metastasis indicated that only the sm invasive carcinomas of the stomach without lymph node metastasis should be treated by endoscopic resection or laparoscopic local excision. It was thus suggested in this study that the lesions which seem to have no lymph node metastasis as described above can be cured with endoscopic therapy.