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要旨●目的:大腸内視鏡切除標本においては種々の問題点が指摘されている.本研究では大腸内視鏡切除材料において,1)側方断端における腫瘍組織の残存と残存腸管の遺残・再発との関連性と,2)深部断端と癌組織における断端距離と遺残・再発との関連性について検討を行った.加えて内視鏡切除後再発例の再発までの期間についても検討した.対象と方法:内視鏡的に切除された肉眼型Is,IIa型およびLST型腫瘍を対象とした.1)側方断端:内視鏡切除後に6か月以上の転帰が確認可能で,側方断端が陽性であった腺腫および粘膜内癌81例を対象とした.側方断端の臨床病理学的所見と遺残・再発の有無との関連性について検討した.2)深部断端:内視鏡切除後に追加治療が施行された,もしくは6か月以上の転帰が確認可能な粘膜下層浸潤癌194例を対象とした.対象症例の癌浸潤の先進部から深部断端までの距離を測定し,遺残・再発の有無との関連性について検討を加えた.結果:側方断端陽性例においては,再発を認めた症例は5例(6.2%)であった.深部断端陽性例は22例(11.3%)であったが,再発を来した症例はなかった.深部断端対象症例においては再発を認めた症例は1例(0.6%)のみで,深部断端までの距離は350μmであった.考察:側方断端陽性症例では,断端成分における腫瘍組織の組織学的差異にかかわらず,一定の頻度で遺残・再発が生じることが明らかとなった.粘膜下層浸潤癌において,深部断端までの距離が500μmを超える症例では再発の危険性が低く,安全な断端距離であることが示唆された.
Aims : Several problems have been pointed out for pathological diagnosis of surgical margins in microscopically resected colorectal specimens. In present study, we examined the relationship between(1)lateral margin,(2)vertical margin, and residual tumor tissue/local recurrence in microscopically resected colorectal specimens. Furthermore, we investigated the relationship between surgical margin and the interval of recurrence after microscopically resection.
Materials and methods : Microscopically resected colorectal tumor showing Is, IIa and LST type macroscopically were enrolled.(1)Lateral margin : A total 81 cases of colorectal adenoma and intramucosal cancer with positive for lateral margin comprised those with follow-up intervals >6 months were examined. The relationship between histological differences of lateral margin and residual tumor tissue/local recurrence were investigated.(2)Vertical margin : A total 194 cases of microscopically resected colorectal carcinoma invading to the submucosa comprised those with follow-up intervals >6 months and those with colorectal resection after microscopic resection were enrolled. The relationship between residual cancer tissue/local recurrence and both clinicopathological features and distance to the vertical margin were investigated.
Results : In cases with positive for lateral margin, 5 cases of local recurrence were found(5/81, 6.2%). In cases for examination of vertical margin, only 1 case of local recurrence was found(1/194, 0.6%), whereas no cases were found with residual cancer tissue in the surgically resected large intestine after microscopic resection. The recurrent case showed a negative vertical margin(pVM(−)). Among 22 cases with positive vertical margins(pVM(+)), no cases with local recurrence were found. Furthermore, the recurrent case showed distance to the vertical margin was 350μm, and no recurrence was found in cases with distance to the vertical margin >500μm.
Conclusion :(1)In cases with positive for lateral margin, the recurrence will be occurred at a certain frequency, regardless of the histological differences in tumor component on margin.(2)The recurrence is less frequent in cases with distance from invasive front to vertical margin >500μm after microscopic resection ; therefore, this should be defined as the safety margin.
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