─早期胃癌の治療と予後─外科治療

Current Status and Future Perspectives of Minimally Invasive Surgery for Early Gastric Cancer

要旨●内視鏡的切除適応外の早期胃癌の外科治療として腹腔鏡下胃切除術が急速に普及しつつある．腹腔鏡下手術は開腹手術と比べて創縮小，術後疼痛軽減，出血軽減，早期回復など複数の利点を有する一方，技術的困難性，手術時間延長，長期予後に関するエビデンスの不足などの欠点も指摘されている．cStageI遠位側胃癌を対象とした多施設共同前向き非対照第II相試験（JCOG0703）で熟練者による腹腔鏡下幽門側胃切除術，D1＋郭清の安全性が示され，「胃癌治療ガイドライン第4版」で日常診療の選択肢の一つとされた．また，低侵襲性向上，機能温存の試みとして，ロボット支援手術や腹腔鏡下センチネルリンパ節生検が行われ，先進医療Bとしてその臨床的有用性が検証されている．

　Although LG has several advantages, including better cosmetic outcomes, less pain, reduced blood loss, and faster recovery compared with open laparotomy, it has not demonstrated significant improvement in long-term outcomes owing to its disadvantages such as longer operation time, technical complexity, and an extended learning curve. The JCOG0703 trial confirmed the safety of laparoscopic distal gastrectomy for cStageI gastric cancer performed by credentialed surgeons, which the Japanese Gastric Cancer Treatment Guidelines（ver.4）has recognized as a standard treatment option. Recently, experiments seeking to improve minimally invasive techniques and preserve function have investigated the clinical efficacy of robotic surgery and sentinel node navigation surgery, which participate in the Japanese Advanced Medical Technology B program.