演題

早期胃癌に対する内視鏡的粘膜下層剥離術後の追加外科切除の経験

[演者] 天道 正成:1
[著者] 仲田 文造:1, 堀 武治:1, 増田 剛:1, 李 友浩:1, 黒田 顕慈:1, 中尾 重富:1, 三浦 光太郎:1, 石川 哲郎:1
1:市立柏原病院 外科

(Purpose) Majority of early gastric cancer has been treated with endoscopic submucosal resection (ESD) in Japan. A patient with non-curative lesion by ESD is recommended to undergo additional surgical resection (ASR) by the guidelines of Japan Gastroenterological Endoscopy Society (JGES) and Japanese Gastric Cancer Association (JGCA). However many studies have demonstrated that the rate of residual cancer and lymph node metastasis in ASR specimens is about 10%. We analyzed the conditions that could enable the avoidance of unnecessary ASR.
(Method)Data of 140 ESD lesions were analyzed retrospectively. The indication and the curability were evaluated according to JGES/JGCA guidelines.
(Result) The rate of non-curative resection and ASR were significantly higher in expanded indication group than those of absolute indication group(26.9% and 19.2% versus 7.9% and 0.9%, respectively).ASR was performed for six patients. The specimens of three ARS contained neither residual cancer nor lymph node metastasis. The pathological findings of proceeding ESD for these three specimens deviated faintly from curative criteria defined by the guidelines. The condition in each lesion which deviated from criteria was as follows: ① sm1 invasion of undifferentiated-type <10mm in diameter ② 21-25 mm in diameter of mucosal undifferentiated type ③ piecemeal resection with horizontal margin positive for mucosal differentiated-type.
(Conclusions) These data suggested closed follow-up without ASR might be allowed for the above mentioned category ①-③ after non-curative ESD.
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