術後サーベイランスと再発の早期発見

Surveillance after Endoscopic Resection and Early Diagnosis of Local Recurrence

要旨　早期胃癌に対して内視鏡的切除（ER）を施行した113例を対象として，術後経過における遺残・再発の問題と不完全切除例に対する追加治療について検討した．完全切除71例には遺残・再発は認めなかった．不完全切除42例のうち，遺残・再発が確認されたのは28例（67％）で，ほとんどが3か月以内に判明したが，切除断端（＋）および（±）であった2例は，それぞれ6か月後と18か月後に局所再発を認めた．遺残・再発例に対する追加治療として3例に再ER，23例にレーザー照射，3例にヒートプローブの併用を行った結果，レーザー追加照射例に局所再発2例と遺残4例を認めたが，そのほかは最長8年間にわたって癌陰性化が得られている．局所再発例に対しては，再ERおよびレーザー再照射で全例に癌陰性化が得られており，またER後に外科手術を追加した3例には遺残は認めなかった．以上の結果に基づき，再発の早期発見のための術後サーベイランスの方法について若干の考察を加えた．

　To evaluate problems associated with residual cancer and local recurrence after endoscopic resection (ER), and efficacy of additional treatments for incomplete resection, 113 patients with the endoscopically resected early gastric cancer over the last eight years were analyzed.

　In 71 patients with complete resection, there was no residual cancer and local recurrence. On the other hand, 28 out of 42 patients with incomplete resection (67%) had recurrence of cancer. In patients with resected margin (±) and (＋) for cancer, residual cancer or local recurrence were found in 17% (1/6) and 75% (27/36) respectively. Twenty six patients with residual cancer were detected within the three months, and two patients with local recurrence were diagnosed in the six and 18 months since ER. They were treated by repeated ER, Nd-YAG laser or heat probe coagulation method, and all but four patients were cured. Surgical operation was added to three paients, but there was no residual cancer. The final local cure rate was 96% (109/113). Two patients developed metachronous multiple cancers which were found in the two and five years since ER.

　These results suggest the following conclusions; 1) In cases with complete resection, regular surveillance after ER is necessary at least once a year to find metachronous multiple cancers, 2) In cases with imcomplete resection, careful follow-up endoscopic examination is required at least for three years or more to detect residual cancer or local recurrence. Moreover, it is recommended to perform additional treatment, such as Nd-YAG laser or heat probe coagulation method to prevent local recurrence, even if apparent residual cancer is not detected around the ulcerative lesion after ER.