食道表在癌に対するESDの治療成績

Clinical Course or Superficial Esophageal Cancer Treated by Endoscopic Submucosal Dissection

要旨　初回治療としてESDを施行した早期食道癌249症例を対象とし，組織深達度別にT1a-EP，LPM/T1a-MM，T1b-SM1/T1b-SM2の3群に分類して治療成績（一括切除率，R0切除率，偶発症，局所再発，リンパ節・遠隔再発，予後）を検討した．各群の治療成績は，一括切除率が99.4％/100％/92.3％，穿孔率が0.6％/3.3％/3.8％，治療後食道狭窄率が25％/37％/46％であった．中央値38か月の観察期間において，3年の疾患特異的生存率は100％/97.4％/100％と良好であったが，リンパ節・遠隔再発を0％/10.7％/7.7％に認めた．MM・脈管侵襲なしの症例や追加治療施行例にもリンパ節再発例を認めており，治療後の慎重な経過観察が重要と考えられた．

　Two hundred forty nine patients were observed in this study and treated from March 2005 to December 2011 in our cancer referral center. We classified them into 3 groups according to histological tumor depth（pT1a-EP and LPM, pT1a-MM and T1b-SM1, pT1b-SM2）and compared the treatment outcome（en bloc resection rate, R0 resection rate, complication, local recurrence, lymph-node metastasis, distant metastasis, and long term outcome）. En bloc resection rates were 99.4％/100％/96.2％, perforation rates were 0.6％/3.3％/3.8％, and post-ESD stricture rates were 25％/37％/46％, respectively. With a median follow up period of 38 months, three-year cause specific survival rates were 100％/97.4％/100％. However, lymph-node metastasis rates were 0％/10.7％/7.7％, respectively. There were a few patients with lymph-node metastasis even after the curative resection such as pT1a-MM without lymhovasular invasion. Careful observation even after curative ESD is needed.