ESD＋追加CRT後に局所再発を来した表面型表層拡大型食道癌の1例

A Case with Superficial Spreading esophageal Carcinoma Which Recurred Locally after ESD and Additional Chemoradiation

要旨　患者は57歳，男性．早期胃癌EMR後の経過観察目的に上部消化管内視鏡検査を施行し，食道病変を指摘した．胸部中部食道の表層拡大型食道表在癌で，術前診断は深達度T1b-SM2だったが，患者希望により診断的治療を目的にESDを施行した．ESD標本の病理組織診断はsquamous cell carcinoma，pT1b-SM2（500μm），ly0，v0，INFa，HM0，VM0，Type 0-IIc，52×31mmであった．ESD後狭窄を生じ，バルーン拡張術を2回施行した後，追加治療としてESD後3か月に放射線化学療法を施行した．ESD後9か月の上部内視鏡検査で，粘膜下腫瘍様の立ち上がりを呈する局所再発を認めた．再発病変の壁深達度はSM深部浸潤と評価し，サルベージ手術を施行した．最終診断はsquamous cell carcinoma（por），pT1b-SM3，INFb，ly0，v1，N0であった．ESD後7年経過するが，これ以降は再発なく生存中である．

　A 57-year-old man underwent esophagogastroduodenoscopy as a follow-up examination after endoscopic treatment for early gastric cancer. Superficial spreading esophageal carcinoma was observed in the middle thoracic esophagus, and the invasion depth was determined to be the middle third of the submucosa. ESD（endoscopic submucosal dissection）was performed as a diagnostic therapy according to the patient decision. The pathological diagnosis was SCC（squamous cell carcinoma）pT1b-SM2（500μm）, ly0, v0, INFa, HM0, VM0, Type 0-IIc, 52×31mm. After balloon dilation for postprocedural stricture, chemoradiation therapy was added at 3months after ESD. A locally recurrent carcinoma with a shape similar to that of a submucosal tumor was detected 6 months after ESD. Because the carcinoma was diagnosed as having invaded the deep part of the submucosal layer preoperatively, a salvage operation was performed. The final diagnosis was SCC（por）, pT1b-SM3, INFb, ly0, v1, N0. Seven years after ESD, the patient has had no recurrence.