胃癌の切除範囲をどう決めるのか―切除する立場から

Extent of Resection of the Stomach in Gastric Cancer, Viewed from a Surgical Standpoint

要旨　限局型発育を示す胃癌では肉眼的癌浸潤部より3cm以上，浸潤型発育を示すものでは5cm以上離して胃切離線を設定するという従来の考え方を変える必要はないが，これはあくまでも進行癌を対象としたものであり，早期癌ではこの限りではない．早期癌に対していたずらに広範胃切除に固執することは得策ではない．このような意味から，上部胃癌に対する噴門側胃切除は，むしろ積極的になされるべきであると思われる．噴切後は高ガストリン血症の状態になるが，この意義についてはいまだ解明されていない．噴切後は十二指腸，上部空腸，膵組織におけるDNA合成の亢進が示されており，ガストリンはこれら臓器に対して何らかのtrophic actionを示しているのではないかと思われる．

　It is widely accepted by surgeons that in surgery of gastric cancer, distance from the edge of the tumor to the resection margins should be more than 3 cm in cases of carcinoma of the localized type, and more than 5 cm in carcinoma of the infiltrative type. However, this treatment policy is not always carried out. In cases of early gastric cancer, total gastrectomy is not the surgical procedure of choice. The results of proximal gastrectomy in these cases have obviously been satisfactory. To assess the efficacy of proximal gastrectomy in the treatment of upper gastric carcinoma, we analyzed clinical data from patients with lesions confined to the upper third of the stomach, and from patients with lesions which, while primarily located in the upper portion of the stomach, had spread to the body of the stomach. None of the patients in the former group demonstrated metastasis to the infrapyloric lymph nodes. The postoperative 5-year survival rates in curatively operated patients with lesions confined to the upper third of the stomach didn't differ in those treated by proximal gastrectomy from those subjected to total gastrectomy. We conclude that proximal gastrectomy is indicated as definitely the best procedure in patients with upper gastric carcinoma, when it is in the early stage of advancement.