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早期胃癌に対する内視鏡下手術は,リンパ節郭清を伴わない局所切除,胃内手術,さらに縮小リンパ節郭清(D1十α,β)を伴う胃切除は普及しつつある.しかし進行胃癌に対する内視鏡下手術の適応拡大については未だ議論の多いところである.われわれは内視鏡下en—bloc D2郭清を積極的に行い,Stage IIまでの進行胃癌に対し内視鏡下手術を施行している.現在までに計35例の内視鏡下D2郭清を施行し,重篤な合併症および癌再発症例は経験していない.内視鏡下en-bloc D2郭清は技術的に可能であり,進行胃癌に対する内視鏡下手術の適応拡大は可能と考えられる.
Endoscopic treatments for early gastric cancer-local resection, intragastric mucosal resection, and partial gastrectomy with limited lymph node dissection-are currently accepted practice. However, endoscopic gastrectomy for advanced gastric cancer is still controversial, including endoscopic en-bloc D2 lymph node dis-section. However, we successfully performed endoscopic en-bloc D2, lymph node dissection in 35 patients with gastric cancer without experiencing severe complications or carcinoma recurrence. Our results demonstrate that this surgical procedure is technically feasible and safe.
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