早期胃癌術後死亡原因の分析

Cause of Death after Surgery for Early Gastric Cancer

要旨　過去34年間にわれわれの施設で切除された早期胃癌452例のうち，現在までに107例の死亡が確認された．その内訳は手術直接死亡6例，癌による死亡38例，癌以外の原因による死亡63例であった．癌以外の死因として最も多いのは脳血管障害，次いで心疾患，老衰，肝硬変症，肺炎などであった．癌による死亡38例のうち15例は他臓器癌の進展によるものであり，異時性肺癌，肝癌などが多かった．残胃の癌は3例にみられた．早期胃癌の再発は20例にみられ，このうち5例は相対非治癒切除後の広義の再発であり，治癒切除後の狭義の再発は15例にみられた．術後1年以上経過例を対象とした早期胃癌の再発率は，m癌では1.0％（2/196），sm癌では5.6％（13/231）であった．

　During the 34-year period from 1948 to 1981, a total of 452 patients with early gastric cancer underwent gastrectomy in our clinic. Among these patients, there were six operative deaths and 101 were late deaths. The cause of death in these patients was studied in this communication.

　Of 101 late deaths, 63 died of non-cancerous diseases such as cerebrovascular disorders, heart diseases, senile decay, liver cirrhosis and so forth, and the other 38 died of cancer. Among the latter, 15 were due to cancer recurrence after curative surgery, five to recurrence after non-curative surgery, 15 to primary cancer in another organ and three to cancer in the residual stomach.

　As to the pathological findings on the primary cancer lesions in patients who manifested recurrence after curative surgery, the macroscopically protruded (Ⅰ-type) or elevated type (Ⅱa-type) and lesions combining the depressed (Ⅱc-type) or excavated type (Ⅲ-type) were found more frequently in their lesions. Differentiated adenocarcinoma with submucosal invasion was a characteristic histological finding for these lesions. Regarding the recurrence patterns, hematogenous metastasis such as liver or bone metastasis was most frequent.