早期胃癌内視鏡的切除の評価―外科の立場から

Evaluation of Endoscopic Resection of Early Gastric Cancer: Surgical Standpoint of View

要旨　早期胃癌内視鏡的切除の評価に関して検討した．切除早期胃癌の分析から，リンパ節転移非危険群として挙げられた内視鏡的切除の適応は，大きさ1cm前後，m，UⅠ（－）の早期胃癌であった．かかる症例に対する内視鏡的切除は安全かつ予後も良好で，根治的局所療法としてその重要性を増し，症例の増加と共に，今後早期胃癌の臨床病理学的検討に当たって，切除例のみでなく内視鏡的切除例をも加えた検討が必須になるであろう．内視鏡的切除適応外の2～3cm，mの早期胃癌に対しては，病変部の内視鏡的切除による組織学的深達度診断のうえに立つ，近傍リンパ節郭清を伴う胃局所切除の術式および症例を提示した．更に内視鏡的切除の癌遺残例も胃局所切除の適応となろう．早期胃癌の内視鏡的切除は，単に根治的治療のみでなく，早期胃癌の組織学的深達度診断にも発展すべきで，早期胃癌の縮小手術にも重要な役割を果たすであろう．

　Based on the results of studies using the resected stomach of early gastric cancer, endoscopic resection is considered to be indicated for the cases without lymph node metastasis, m, Ul (-) early cancer, measuring about 1.0 cm Endoscopic resection in these cases is safe and yields good prognosis, thus rendering it important as a curative local therapy. As the number of cases increases, clinico-pathological discussion of early gastric cancer will have to include not only surgically treated cases but also endoscopically resected cases. For cases of early gastric cancer larger than 2-3 cm, i.e., not considered to be an indication of endoscopic resection, endoscopically resected specimen should be histologically examined regarding the depth of invasion, followed by partial gastrectomy with regional lymph node dissection. Partial gastrectomy is also indicated for the cases with residual cancer after endoscopic resection.

　Thus, endoscopic resection of early gastric cancer should play an important role not only as a curative local treatment but also as a histological examination on the depth of invasion and as a limited gastrectomy.