胃癌ESD適応外病変の経過と予後

Outcomes of Endoscopic Submucosal Dissection for Early Gastric Cancer in Cases Preoperatively Contraindicated for Endoscopic Resection

要旨　術前に内視鏡治療適応外と判断した早期胃癌に対し，何らかの理由で初期治療として内視鏡的粘膜下層剝離術（ESD）を選択した104症例の治療成績および予後を検討した．一括断端陰性切除率は71％と低く，また出血・穿孔などの偶発症発生率は高かった．ESD後の病理学的評価により治癒切除と判断されたのは16％であった．全体の5年生存率は72％であったが，疾患特異的5年生存率は93％と良好であった．年齢や併存疾患などで外科手術が困難な早期胃癌症例では，偶発症のリスクを考慮のうえで，ESDは治療法の選択肢のひとつとなりうる．

　Treatment outcomes of ESD（endoscopic submucosal dissection）for 104 patients with EGC（early gastric cancer）who were preoperatively contraindicated for endoscopic resection were evaluated. The en bloc with R0 resection rate was as low as 71％, and the complication rate of perforation and postoperative bleeding was high. Curative resection was achieved in 16％ cases. The overall 5-year survival rate was 72％, but the disease-specific 5-year survival rate of 93％was favorable. Although the risk of complication should be considered, ESD may be a treatment option for EGC patients who are not suitable for radical surgery.