咽頭癌に対する内視鏡的切除の治療成績

Long-term Outcomes of ESD for Treating Superficial Pharyngeal Cancer

要旨●咽頭表在癌へのESDは，臓器温存やQOLの維持の観点から，他の治療方法と比較してより低侵襲な治療である．ESDは下咽頭や中咽頭後壁では経口挿管，喉頭蓋や舌根部では経鼻挿管を行うなど，病変部位ごとに治療方法をアレンジして行う．剝離中はトラクションをかけることで，治療時間の短縮や喉頭浮腫を最小限にすることができる．治療の安全性は高く合併症は少ないが，致命的になる場合もあり，マネージメントに精通する必要がある．277例435病変を対象とした自験例では，局所再発が1例，リンパ節転移再発が13例，原病死はなく5年の全生存率は85.5%であった．

　ESD（endoscopic submucosal dissection）is a minimally invasive method for treating superficial hypopharyngeal carcinoma, and it helps in organ preservation and maintenance of quality of life. ESD is performed with some ingenuity according to the site of a lesion, such as oral intubation is performed for a lesion located in the hypopharynx and posterior wall of the oropharynx, whereas nasal intubation is performed for a lesion located in the epiglottis and root of tongue. During dissection, traction is applied to reduce procedure duration and minimize laryngeal edema. Although this treatment is believed to be safe and has few complications, it can be fatal in some cases ; therefore, it is important to be familiar with various management approaches. In our study, 435 lesions from 277 patients were analyzed. Local recurrence, lymph node recurrence, and death from primary disease were detected in 1, 13, and 0 patients, respectively. The overall survival rate was 85.5% at 5 years.