内視鏡的粘膜切除術で不完全切除となった例に対するレーザー照射の効果と評価方法に対する検討

Effectiveness of Additional Laser Therapy for Residual Tumor after Endoscopic Mucosal Resection for Early Gastric Cancer

要旨　粘膜切除術の追加治療としてレーザー照射を施行した30例中，評価可能22例のうち遺残率は4.5％（1/22）で，再発率は14.3％（3/21）であった．適応別にみると，遺残率は絶対的適応群0％（0/11），相対的適応群9.1％（1/11），また再発率は絶対群で9.1％（1/ll），相対群で20.0％（2/10）であった．肉眼型別では遺残率は隆起，陥凹ともなく，混合50.0％（2/4）で，再発率は隆起13.3％（2/15），陥凹20.0％（1/5），混合0％（0/1）であった．深達度別では遺残率はmO％，sm20％，再発率はm5.9％，sm50.0％，組織型では遺残率，再発率は分化型5.6％，5.9％，未分化型0％，50.0％であった．今後の長期にわたる詳細な経過観察と，より多数の症例の集積が必要である．

　Endoscopic laser therapy as an additional treatment was performed on 30 cases with a residual tumor after endoscopic mucosal resection (EMR) for early gastric cancer. Twenty two cases could be followed for more than one year after the procedure. Residual rate was 4.5% and recurrence rate was 14.3% for all 22 cases. Residual and recurrence rates were evaluated by the following factors: 1) absolute indication (protruded type being smaller than 20 mm in size, and depressed type without ulcer or ulcer scar being smaller than 10 mm in size, without submucosal invasion and microscopically differentiated type) and relative indication, 2) macroscopic classification, 3) depth of invasion, and 4) histological classification.

　Residual and recurrence rates for each classified groups were as follows respectively: 1) absolute indication; 0% and 9.1%, relative indication; 9.1% and 20%, 2) macroscopic classification: protruded type; 0% and 13.3% (2/15), depressed type; 0% and 20.0% (1/5), and combined type; 50.0% (2/4) and 0%(0/1), 3) depth of invasion: m cancer; 0% and 5.9%, sm cancer; 20% and 50%, 4) histological classification: differentiated type; 5.6% and 5.9%, undifferentiated type; 0% and 50.0%.

　In this study, we followed patients at least one year, however, a final effectiveness should be assessed by 5-year or 10-year survival rate.