内視鏡的粘膜切除後に外科手術が行われた早期胃癌症例の検討―胃癌研究会内視鏡治療委員会報告

Clinical Study of Early Gastric Cancer Patients who Underwent Surgical Operation after Endoscopic Mucosal Resection (EMR): A Report by the Committee of Endoscopic Surgery Associated with Gastric Cancer Research

要旨　胃癌研究会の内視鏡治療委員会では，内視鏡的粘膜切除（EMR）後に外科的切除を受けた早期胃癌106例を集計し，EMR標本と外科標本との評価の関連性を検討した．EMR標本のm癌のうち，粘膜断端癌陰性では外科標本に癌の遺残はなく，断端陽性例では75％に癌遺残がみられ，25％には癌遺残はみられなかった．また，sm癌の粘膜下層断面癌陽性例でも遺残のない症例もみられたが，56％に癌遺残がみられることから完全切除の目的で焼灼効果に期待することはできない．また，分割切除あるいは追加切除例においても遺残が認められた．m癌ではいずれもn₀，ly₀，v₀であったのに対し，sm癌ではly(＋)またはv(＋)がみられた．したがって，単回の一括完全切除が得られるm癌で，断端陰性と判定できる症例は完全治癒と考えられる．

　One hundred and six cases of patients with early gastric cancer who had undergone surgical operation after endoscopic mucosal resection (EMR) were collected by the committee of endoscopic surgery associated with gastric cancer research. mainly, the difference between assessment of EMR specimens and surgical specimens was examined. With regard to mucosal cancer, cancer cells weren't found in surgical specimens in cases of negative mucosal cutting edge. In cases of positive mucosal cutting edge, cancer cells were found in 75% 0f them, but were not seen in 25% of them because of the burning effect of high-frequency waves. On the one hand, with regard to submucosal cancer, cancer cells were not found in surgical specimens in some case of positive submucosal cutting edge because of the burning effect. On the other hand, this burning effect couldn't be expected to cure the cancers completely because cancer cells remain after positive mucosal cutting edge. Remains of cancer cells were found in cases of piecemeal resection or re-resection. Invasion of lymphatic vessels and blood vessels was found in some cases of submucosal cancers when lymph node metastasis and invasion of lymphatic vessels and blood vessels were negative in cases of mucosal cancer.

　In conclusion through resected specimens, we were able to judge single EMR as curative in cases of mucosal cancer and negative cutting edge.