多発早期胃癌の再発例の1例―早期胃癌の再発に関する小考察

A Recurrent Case of Multiple Early Gastric Cancer

はじめに

　早期胃癌の手術例が増加し，その術後経過年数の長い例が多くなるにっれ，早期胃癌手術例にも再発例がみられるようになった．先に，筆者らは早期胃癌の再発例から，その発育を論じて来たが^1)～3)，今日までに教室では早期胃癌手術後の再発例を10例経験するにいたったので，第11回日本内視鏡学会夜の研究会および第13回胃癌研究会でその概要を報告した．因みに，教室で昭和43年の末までに手術を行なった早期胃癌は106例で，そのうち消息の明らかなものは105例（消息判明率99.1％），術後死亡例は12例（事故・他病死4例，再発死8例）で，再発例は10例（再発後再手術による生存例2例を含む）であった．再発例の再発様式は胃切除断端癌遺残例3例，肝転移例3例，胃壁内転移と推定されるもの2例，多発癌の残胃遺残と推定されるもの1例，不明1例であった．このうち，胃切除断端癌遺残例，胃壁内転移と推定される例，肝転移例についてはその詳細をすでに別誌^1)～4)に報告したので，今回は紙面の関係から，多発癌の残胃遺残と推定された1例について報告する．

　Information has been obtained of all but one of 106 cases of early gastric cancer operated on in the authors' department. Of these, recurrence has been confirmed in 10. This paper deals with one of such cases, which was multiple early gastric cancer already at the time of the first operation.

　The patient, a 34-year-old male, underwent gastrectomy (R2) in Feb., 1967. In the resected specimen there were on the anterior wall of the corpus a Ⅱc type mucosal cancer (less differentiated tubular adenocarcinoma), measuring 3.0 by 1.7 cm, and on the greater curvature of the body a I type mucosal cancer (papillary adenocarcinoma), measuring 3.0 by 3.0 cm. This was confirmed as multiple early gastric cancer with normal gastric wall in between. The distances from these lesions to the oral stump measured 2.5 and 6cm, respectively (OW). Resected lymph nodes were free from cancer. The postoperative course was favorable. Then at an x-ray examination done 1 year and 11 months after the operation, recurrence of cancer was recognized on the lesser curvature of the remnant stomach, so that the patient underwent re-operation in May, 1969 (2 years and 3 months after the initial surgery). Cancer existed in an area surrounding the lesser curvature of the gastric remnant, being less differentiated tubular adenocarcinoma invading the subserosal layer. No metastasis was found in the lymph nodes excised for cleaning. He has been having favorable progress toward recovery. As of the third year after the first operation, he is enjoying good health.

　The facts that this case was of multiple cancer from the outset, and that neither lymphatic nor vascular invasion was recognized within the two lesions led the authors to overlook the possible existence of another cancer lesion in the gastric remnant, probably because it was too slight to attract attention. The lesion found at the second operation was considered to have developed from this minute one.

　As incidence of multiple early gastric cancer is not too infrequent, it is especially stressed that strict care must paid not to miss any lesion in the cardia, fornix and oral part of the corpus so as not to overlook any possible cancer lesion in the remnant stomach. A few comments have been made on recurrent cases of early gastric cancer encountered in the authors' department.