食道SM癌の治療選択—外科治療の立場から

Treatment Options for Esophageal Submucosal Cancer, from the Viewpoint of Surgery

要旨●3領域リンパ節郭清を伴う食道癌手術は，内視鏡手術が広く取り入れられ，低侵襲な治療として確立している．癌腫を身体から取り除くことの確実性の他，詳細な病理診断が可能であるなどのメリットは大きい．食道SM癌においては，手術，dCRTとも治療選択となるが，リンパ節転移を認めるcStage IIは術前化学療法後の手術が推奨される．一方，cStage Iは食道温存の観点から，サルベージ治療をセカンドラインとしてdCRTを選択することを考慮する．治療成績の差があり，経験の多い専門施設での手術が勧められる．

　Thoracoscopic esophagectomy with three-field lymphadenectomy is a minimally invasive treatment that has been widely adopted, and it has a great advantage of not only removing carcinoma with a high level of certainty but also providing detailed pathological diagnosis. Although both surgery and dCRT（definitive chemoradiotherapy）are treatment options for submucosal esophageal cancer, if there is lymph node metastasis, that is, cStage II, surgery is recommended after neoadjuvant chemotherapy. Conversely, dCRT followed by an optional salvage treatment should be considered for cStage I cancer, from the viewpoint of esophageal preservation. Esophageal surgery in a specialized institute with experience is recommended because of the good prognosis.