多発胃癌，とくに多発性早期胃癌について

MULTIPLE SIMULTANEOUS EARLY GASTRIC CANCERS

1．はじめに

　多発胃癌の問題点としては，1）術前診断上の問題，2）治療上の問題，3）病理組織学的な問題の3点が考えられる．われわれは，術前診断を行なうものとしての立場から，術後，病理組織学的に多発胃癌と診断された症例のうち，特に多発早期胃癌例に重点をおいて考察を加えた．

　In the light of the definition of multiple gastric cancers established by Moertel et al., the authors define them as follows.

　1. Multiple cancers of the stomach must be proved as such pathologically as well as macroscopically on a resectecl specimen.

　2. These cancerous lesions should be pathologically separated by gastric wall without invasion of cancer cells in between. And the possibility that one of the lesions represents a local extension or metastatic tumor must be ruled out beyond any reasonable doubt.

　3. One macroscopic lesion is to becounted as of one entity, even if pathologically it may consist of more than one cancerous lesion.

　4. Mucosal cancers confirmed by the present level of pathological diagnostic method in Japan are included in this category.

　From 1960 through 1967, 412 cancerous lesions in 392 gastric cancer cases were examined by X-ray and endoscope in our department and resected accordingly. Out of these cases there were 18 cases (38 lesions) of multiple cancers, and of these 11 cases (24 lesions) belonged to multiple early cancers. By studying them we reached the following conclusions.

　Ⅰ. The incidence of multiple simultaneous early gastric cancers to all our early gastric cancer cases is 10.7%, whereas that of multiple simultaneous cancers including early ones to a total of 392 cases of gastric carcinoma is 4.6%.

　Ⅱ. Eighty percent of cancerous foci in multiple simultaneous early cancer is of superficial type, and usually they are smaller than those of single early cancers. The diagnosis of multiple simultaneous early cancers accordingly depends on the detection of minute early gastric cancer.

　Ⅲ. Diagnostic accuracy for lesions of multiple simultaneus early cancer both in X-ray and endoscopic studies is less satisfactory compared with that of single early cancer. The former is only 40%. This is due to the fact that the more common type of lesions in multiple simultaneous early cancers is of superficial one, and is hard to detect if it is a lesion of Type Ⅱc, superficial depressed type, less than 5mm in diameter.

　Ⅳ. The combined examinations by X-ray and endoscopy increase diagnostic accuracy.

　Ⅴ. Careful determination of resecting range of the stomach is essential in the surgery of mutiple cancers.

　Ⅵ. Several neighboring independent cancerous foci may coalesce and become one cancer in the process of development. It is only right and proper that the incidence of multiple simultaneous early cancers should be higher than that of multiple simultaneous advanecd cancers. After all, multiplicity of gastric cancer has to be studied in the early stage of pathological process.