外科臨床の立場からみた早期胃癌再発死

Recurrence and Mortality in Early Gastric Carcinoma

要旨　早期胃癌再発死亡例について検討した．早期胃癌手術1,000例中の再発死亡例は35例（再発死亡率3.5％）であった．m癌の再発率は1.4％，sm癌は5.5％であった．隆起型の再発死亡率は4.3％（7/164），混合型は10％（9/90），陥凹型では2.4％（18/730）であり，混合型に高率であった．再発死亡の多い肉眼型は，混合型sm，n(＋)＞隆起型sm，n(＋)＞陥凹型sm，n(＋)＞陥凹型m，n(＋)の順であった．再発形式としては肝転移を主に血行性転移が22/35（62.8％）と多く，進行癌に腹膜播種が多いのに比べて著しい対照を示した．隆起型，混合型では血行性転移が多いので十分なリンパ節郭清，血行遮断など，また，陥凹型でリンパ節転移がある例は腹膜播種，局所再発の可能性があるので，術後の化学療法が必要であろう．

　Recurrence and mortality in early gastric carcinoma were studied. Among 1,000 cases of operated early gastric carcinoma the cases which expired due to recurrence were 35 (a recurrence and mortality rate of 3.5%). The recurrence rate for mucosal carcinoma (m) was 1.4%, and for submucosal carcinoma (sm) was 5.5%. The recurrence and mortality rate in the elevated type was 7/164 (4.3%), in the mixed type, 9/90 (10%), and in the depressed type, 18/730 (2.4 %). Thus, the rate was high in the mixed type. In macroscopic types of early gastric carcinoma, the order of high recurrence and mortality rate was as follows: i) mixed type, sm, n (+), ii) elevated type, sm, n (+), iii) depressed type, sm, n (+), iv) depressed type, m, n (+). Hematogenous metastasis, mainly in the liver, was common (occuring in 22/35 or 62.8% of cases) in such cases and had considerable contrast to the cases of advanced carcinoma, in which peritoneal dissemination is common. In the elevated and mixed types with differentiated histological type, the rate of lymph node metastasis was high and so as the recurrence rate. Therefore, sufficient lymph node removal and circulation blockade are necessary. In cases of depressed type sm carcinomas with the lymph node metastasis, there is a possibility of peritoneal dissemination or local recurrence, so postoperative adjuvant chemotherapy is likely to become necessary as well. There were also 25 cases which died of carcinoma in other organs, occupying 22.3% of the nonrecurrent death cases. In order to decrease carcinoma mortality, long-term postoperative local and systemic control are necessary.