─早期胃癌の治療と予後─高齢早期胃癌患者に対する治療の現状と今後の展望

Current Status and Future Perspectives of Treatment for Early Gastric Cancer in Elderly Patients

要旨●高齢早期胃癌患者に対しても，対象を適切に選択すれば内視鏡治療や外科治療を安全に施行できると報告されている．しかし，特に外科治療では，術関連死を含めた手術リスクをゼロにはできないことや，胃切除による術後食生活への影響といったQOLの問題を考慮する必要がある．その点を考えると，高齢早期胃癌患者の内視鏡治療適応については，転移リスクゼロを前提にした現行ガイドラインにおける絶対適応・適応拡大基準よりも，もう少しリスクを許容するような高齢者新規適応基準という考え方も成り立つかもしれない．早期胃癌の病変因子のみならず，高齢患者の身体的・社会的因子を含めたさまざまな要素を考慮のうえ，一人ひとりに最適な対応法を提供することが重要である．

　Endoscopic and surgical treatment has been reported feasible for early gastric cancer in elderly patients if patient selection is appropriate. However, the non-negligible risk associated with surgical treatment for elderly patients and its effect on the quality of life should be considered when deciding a treatment plan. Considering the invasiveness of the surgical treatment, it may be necessary to discuss the new indications of endoscopic treatment for elderly patients with early gastric cancer because the current indications, in which endoscopic treatment is only indicated for early gastric cancer with a nominal risk of lymph node metastasis, may be too strict for elderly patients. Therefore, not only lesion factors but also patient physical and social factors should be considered to achieve an optimal treatment strategy for each elderly patient with early gastric cancer.