虫垂病変の臨床―虫垂癌の臨床的特徴と治療方針

Clinical Features and Treatment Principles of Appendiceal Cancers

要旨　虫垂癌の特徴を明らかにすべく，当科で経験した虫垂癌を臨床病理学的に検討し，文献的考察を加えた．虫垂癌13例を盲腸癌138例と比較したところ，虫垂癌の特徴は，年齢が若い（62.7歳），分化型癌の頻度が低い（15％），Stage IVの割合が高い（38％），腹膜転移の割合が高い（38％），非治癒となる手術の頻度が高い（38％），であった．虫垂癌の術前正診率はいまだに14～22％と低く，急性虫垂炎の手術を行う際は，虫垂癌の可能性を患者や家族に説明しておく必要がある．虫垂切除後に癌が判明した場合には追加の結腸右半切除が推奨されているが，リンパ節転移が見つかる症例は多くない．追加手術の適応検討や化学療法の確立が今後の課題である．

　This study aimed to clarify the features of appendiceal cancer by conducting a clinicopathological review of patients with appendiceal cancer treated at our department alone with a review of the relevant literature. We evaluated 13 patients with appendiceal cancer and 138 patients with cecal cancer. The features of appendiceal cancer were as follows : younger age of onset（average 62.7 years）, low incidence of differentiated carcinoma（15％）, high rate of stage IV disease（38％）, high rate of peritoneal metastasis（38％）, and high rate of non-curative surgery（38％）. Because the preoperative diagnosis of appendiceal cancer is difficult, it is important to counsel the patients and their family of the risk of malignancy prior to surgery for acute appendicitis. An additional right hemicolectomy is recommended when adenocarcinoma of the appendix is confirmed after appendectomy. Furthermore, lymph node metastases from appendiceal cancer are rare. Further investigation of the optimal additional surgery and chemotherapy protocol would benefit patients with appendiceal cancer in the future.