1. 食道癌術後局所再発に対する手術

Surgery for Local Recurrence after Esophagectomy

食道癌に対する根治手術後の再発は30％程度の症例に起こるとされている1～3）．これら再発例に対してさまざまな治療が試みられているが，再発後生存は3～10ヵ月程度と予後は不良である．一般的に根治術後再発は全身病（systemic disease）と考えられ，延命治療として全身治療を行われることが多いが，リンパ節や肺の単独再発などでは，局所治療を加えることにより長期生存が得られることも経験する．本稿では，食道癌根治術後のリンパ節再発に対する局所治療としての外科治療について，それらのポイントおよび注意点を概説する．

Lymph node （LN） recurrence is frequently encountered in esophageal cancer. The prognosis of patients with LN recurrence is usually very poor due to systemic disease, but there are some patients with relatively favorable prognosis by multidisciplinary treatment including surgery.

It would be a good indication for surgical treatment that number of LN recurrence is the just one, and the region of LN recurrence is the just one as cervical, upper mediastinal or abdomen. However, recurrence of LN is likely to be part of a systemic disease and should be operated on as one of the multidisciplinary treatments.

It is very important to carefully perform the procedures in the surgical treatment for LN recurrence, because the anatomical shift due to the previous surgery and the tissue fibrosis after surgery and irradiation make it difficult to grasp the positional relationship and boundaries with recurrence tumor as well as normal tissues such as nerves and vessels. Even if recurrence is found after radical resection, it is important to always consider what the surgeon can do to cure it.