早期胃癌に対する局所切除 Local Excision for Early Gastric Cancers

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リンパ節転移の無い早期胃癌を特定化し局所切除をすればリンパ節郭清をともなった手術と同等の治療成績を挙げることが期待される.1962年から1985年までに国立がんセンター病院で切除された単発早期胃癌1,440例のリンパ節転移についての検討より,リンパ節転移を否定しうる病変は,IIb,2.0cm以下の潰瘍性変化の無いIIc,2.0cm以下のIIa,腺腫内癌であった.そこで安全誤差をいれて,(1)1.5cm以下のIIa,(2)1.5cm以下の胃炎類似型IIcまたはIIb,(3)腺腫内癌の3つを局所治療の適応とした.切除標本の組織学的検索結果により完全切除は厳重な経過観察,粘膜内断端陽性は外科的局所切除,粘膜下層浸潤もしくは脈管浸潤例はR1以上の胃切除を行うという治療体系を作った.現在までの11例中8例は局所切除のみで,3例では外科的切除が追加された.この治療体系は癌が根治する可能性を下げることなく局所切除を行える優れた治療体系である.

Complete local excision of early gastric cancers is expected to give as good results as radical surgery if we can determine the lesions having no lymph node metastases. 1440 cases of single early gastric cancer resected in National Cancer Center Hospital (NCCH) from 1962 to 1985 were analysed : IIb cancers of any size, IIc less than 2.1 cm in diameter without ulcerative change, and IIa less than 2.1 cm in diameter had no lymph node metastases. Based on this data, a prospective trial of local excision was started in NCCH in April 1988. Considering errors for safety, IIa cancers less than 1.6 cm, gastritis type lesions less than 1.6 cm and focal cancers in adenoma were consiedered indications for local excision. Endoscopic local excision is prefered so far as it is possible. The resected specimens are to be examined histologically. If a lesion limited to the mucosallayer is resected completely and has no vessel involvement, the patient will be folowed up intensively. If the cut margin is involved by cancer in the mucosal layer, additional interventional wider local excision is made. In cases where submucosdl invasion or vessel involvement is seen, radical gastrectomy is added. Eleven patients were eligible for this treatment system. Eight of them were treated successfully by local excision, and the rest underwent additional intervention. All patients are now disease free and are being followed up intensively. This treatment system enables us to perform local therapy as a curative treatment without reducing the possibility of a cure.

収録刊行物

  • 日本消化器外科学会雑誌

    日本消化器外科学会雑誌 23(9), 2191-2195, 1990-09-01

    一般社団法人日本消化器外科学会

被引用文献:  8件中 1-8件 を表示

各種コード

  • NII論文ID(NAID)
    110001310265
  • NII書誌ID(NCID)
    AN00192066
  • 本文言語コード
    JPN
  • 資料種別
    雑誌論文
  • ISSN
    03869768
  • データ提供元
    CJP引用  NII-ELS 
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