噴門部領域の癌に対する最近の治療法

Current Treatment for Gastric Cancer of the Cardiac Region

要旨　噴門部癌55例を対象に適切な治療法につき検討した．その結果，リンパ節転移率は深達度がss以深の症例で著明に上昇しており，mp症例では10例中3例（30％）と転移率こそ低かったものの，脾動脈幹リンパ節への転移率は66.7％と高かったことから，mp以深の症例に対しては胃全摘術および膵脾合併切除を行うべきと考えられた．一方，噴門部早期胃癌8症例では第2群リンパ節転移を来した症例はみられず，C領域のsm癌症例32例においても，大彎リンパ節右側，幽門上・下リンパ節への転移陽性症例は認めなかったことから，内視鏡的治療が困難，あるいは適応外の早期胃癌に対してはQOLを考慮した噴門側胃切除術が最適と思われた．リンパ節転移を来さないと判断される早期胃癌に対してはEMRを第一選択とすべきであるが，完全切除率は噴門部においては70％前後とされるため切除後の厳重なる経過観察が肝要であり，完全切除が困難な症例に対しては侵襲の少ない腹腔鏡下粘膜切除が有用と考えられた．

　Last two decades, we experienced 55 cases of gastric cancer of the cardiac region. We have studied suitableness of treatment for the gastric cancer of the cardiac region. As a results, incident of nodal involvement was very high in the cases with subserosal invasion. Although the incidence of nodal metastasis of the cases with muscularis propria invasion was not so high, most of the cases with nodal involvement had metastasis to the lymph nodes around the splenic artery. Therefore, the cases with invasion deeper than the muscularis propria should be treated by total gastrectomy combined with pancreatosplenectomy. By the way, resection of the cardiac region should be recommended for the early gastric cancer of the cardiac region, because only one out of eight cases of early cancer had regional lymph node metastasis. Endoscopic mucosal resection (EMR) was an appropriate treatment for the cases without nodal involvement by preoperative assessment. However precise postoperative inspection was important because complete mucosal resection rate was reported to be about 70%. Consequently less invasive laparoscopic surgery may be considered for the cases to which EMR may not be applicable.