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Stomach and Intestine(Tokyo) Volume 15, Issue 4 （April 1980）

胃と腸 15巻4号（1980年4月発行）

Japanese English

今月の主題大腸の早期癌―胃早期癌と比較して

主題

大腸早期癌の治療方針 A Policy of Treatment for Early Cancer of the Colon 伊藤英明 ¹ , 古賀淳 ¹ , 下田悠一郎 ² , 飯田三雄 ³ H. Itoh ¹ ¹九州大学医学部第1外科 ²九州大学医学部放射線科 ³九州大学医学部第2内科 ¹The First Department of Surgery, Faculty of Medicine Kyusyu University pp.409-416

発行日 1980年4月25日 Published Date 1980/4/25

DOI https://doi.org/10.11477/mf.1403106814

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Abstract 文献概要
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　近年の消化管診断技術の進歩，殊に内視鏡的ポリペクトミーの普及とともに大腸早期癌の報告は急速に増加している．しかしその治療方針については，リンパ節転移のリスクを有するinvasive cancer（sm癌）の問題など未解決な点が多い．今回著者らは自験例34例の分析を基にして，大腸早期癌の治療方針を検討したので報告する．

　A study of 34 cases (40 lesions) of early cancer of the colon gave us the following results. These cases consisted of 20 surgically excised ones (25 lesions) and 18 treated with endoscopic polypectomy.

　Macroscopically 18 lesions were pedunculated, 10 semipedunculated, 10 sessile and 2 sessile lesions with ulcer formation. The depth of infiltration varied from 27 intrarnucosal cancer to 13 cancers infiltrated into the submucosal layer (sm). Sm cancer was seen in 2 of 18 pedunculated lesions, 9 out of 20 semi-pedurculated and sessile lesions, and in 2 out of 2 sessile lesion with ulcer. Semi-pedunculated and sessile lesions showed to develop sm cancerincreasingly when they reached more than 1.5crn in the greatest diameter. Lymph node invasion was recognized in 2 cases of sessile lesions with ulcer.

　From these results along with reported cases in the literature we have attempted to study a policy of treatment for early cancer of the colon. Lymph node involvement in sm cancer was seen in 18.5 per cent of sessile lesions with ulcer formation and in only 1.6 per cent in sessile lesions without ulcer. Pedunculated polyp is an indication for endoscopic polypectomy. When it is considered to harbor lymph node involvement as described by Shatney et al., surgical resection must be done in addition. For semi-pedunculated and sessile polyps without ulcer formation, endoscopic polypectomy should be done when they are less than in diameter. Additional surgical excisement should be done when the endoscopic resection was considered insuflicient or sm infiltration was found out. Lesions more than 1.5 cm in diameter harbors a greater possibility of sm invasion, so that they are indicated for surgical resection. Sessile lesions with ulcer formation should be treated with surgical operation with suificient clearing out of the regional lymph nodes.