表在型食道癌の内視鏡治療適応診断と治療前リスク評価

Determination of indications for endoscopic treatment and pretreatment risk assessment in superficial esophageal cancer

要旨

食道癌の治療にはその進行状況に応じて内視鏡治療，外科手術，化学放射線療法などがある。表在型食道癌の内視鏡治療の適応としては，扁平上皮癌であれば「深達度」「周在性」「長径」をもとに判断し，術前深達度診断T1a-EP/LPMで非全周性のもの，全周性ならば長径5cm以下のもの，術前深達度診断T1a-MMで非全周性のものが，腺癌ならば術前深達度診断T1aで未分化成分が含まれないものが推奨される。治療のリスクには心臓，肺，肝臓，腎臓などの内臓の機能，糖尿病，心疾患などの併存症，食道癌，肺癌，咽頭癌などの既往歴，アルコール依存などの精神状態など複数の要因が複雑に関与しており，追加治療なども念頭におき術前に十分な評価が必要である。

　Esophageal cancer can be treated by endoscopic treatment, surgery, or chemoradiotherapy, depending on its progression. The indications for endoscopic treatment of superficial esophageal cancer are determined based on “depth”, “circumferentiality” and “longitudinal diameter” for squamous cell carcinoma; treatment is recommended when lesions are non-circumferential with the preoperative depth diagnosis T1a-EP/LPM, or, if totally circumferential, with a long diameter of 5cm or less, or, when non-circumferential, with the preoperative depth diagnosis T1a-MM. Adenocarcinomas with the preoperative depth diagnosis T1a-M without any undifferentiated component are also recommended for treatment. The risk of treatment is complicated by multiple factors, including the functioning of organs such as the heart, lungs, liver, and kidneys; comorbidities such as diabetes and heart disease; history of esophageal cancer, lung cancer, or pharyngeal cancer; and mental status such as alcohol dependence. A thorough preoperative evaluation is necessary with additional treatment in mind.