手術成績からみた食道粘膜切除術の評価

Endoscopic Mucosectomy of Superficial Esophageal Carcinoma Evaluated by Surgical Results

要旨　表在癌の粘膜切除可能病巣を知り，その治療効果をみるために，当教室で切除した食道表在癌症例190例の遠隔成績と病理所見および自験粘膜切除13例を検討した．overallの累積生存率Aと明らかな他病死例を除いた累積生存率Bとを比較し，AはBより約10％低い予後を呈した．この累積生存率Aの低下はmm癌，76歳以上の高齢者群で顕著にみられた．内視鏡的粘膜切除の適応病変を切除標本から検討したが，脈管侵襲がなく絶対安全な病変はep癌，それも0-Ⅱbか平らな0-Ⅱc癌，比較的適応としては肉眼型0-Ⅱ型で深達度1pmまで，大きさ2cm前後の病変が挙げられた．sm癌でも大きさが1.Ocm前後のものは脈管侵襲率が低頻度でone pieceで切除可能なことから，このような病変をもつ高齢者やリスク症例には今後慎重に適応を拡大し，摘出標本の病理所見をみて更なる治療の必要性に関し検討していきたいと考える．

　To evaluate resectability of superficial esophageal carcinoma by endoscopic mucosectomy, we analyzed the late results and the pathological findings of 190 patients with superficial esophageal carcinoma who underwent esophagectomy and showed the results of 13 patients who underwent endoscopic mucosectomy. The gross cumulative survival rate (A) was about 10% lower than the corrected one (B) excluding non-cancerous deaths. The decrease in the gross cumulative survival rate was prominent in the group of mm carcinoma and the elderly who was older than 76 years old.

　Intra-epithelial carcinoma, especially a type 0-Ⅱb or a flat type 0-Ⅱc lesion was regarded as an absolute indication for endoscopic mucosectomy. A type 0-Ⅱ carcinoma within the lamina propria mucosae invasion and a lesion less than 2 cm in size were relative indications. Because sm carcinomas less than 1 cm in size had low possibility of vessel invasion and high resectability by single mucosectomy, we would like to extend indications for mucosectomy to the elderly and the high risk patients and evaluate the necessity of additional treatments by histopathological findings.