Katsube Takao, Murayama Minoru, Yamaguchi Kentaro, Usuda Atsuko, Shimazaki Asako, Asaka Shinichi, Konnno Soich, Miyaki Akira, Usui Takebumi, Yokomizo Hazime, Shiozawa Schunichi, Yoshimatsu Kazuhiko, Shimakawa Takeshi, Naritaka Yoshihiko
Department of Surgery, Tokyo Women's Medical University Medical Center East, Tokyo, Japan
Department of Surgery, Tokyo Women's Medical University Medical Center East, Tokyo, Japan.
Anticancer Res. 2015 May;35(5):2969-74.
The appropriate additional surgery after non-curative resection of Endoscopic Mucosal Resection (ESD) for early gastric cancer is herein discussed.
Data on 54 patients after non-curative resection of ESD were evaluated. These patients were broadly classified according to the risk of lymph node metastasis with lesions into group A (without risk) (n=26) and group B (with risk) (n=28). Their treatment results were evaluated.
The incidence of residual lesion was 7.7% in group A and 14.3% in group B. Risk factors were piecemeal resection, involvement of the horizontal margin (HM1) or unclear involvement of the horizontal margin (HMX) and with ulceration. Lymph node metastasis was detected in one patient with lymphatic invasion, total diameter of 3 cm or more and submucosal invasion over 0.5 mm (SM2). The 5-year survival rate was 93% and none of the patients died of gastric cancer.
Follow-up observation was reasonable in group A. Patients who are judged as having undergone piecemeal resection, HM1 or HMX and with ulceration, should be treated by additional surgery and patients judged with SM2 or total diameter of 3 cm or more or lymphatic invasion should be treated by additional surgery with lymphadectomy in group B.
本文讨论早期胃癌内镜黏膜下剥离术（ESD）非根治性切除术后的适当追加手术。
评估54例ESD非根治性切除术后患者的数据。根据病变的淋巴结转移风险将这些患者大致分为A组（无风险）（n = 26）和B组（有风险）（n = 28）。评估他们的治疗结果。
A组残留病变发生率为7.7%，B组为14.3%。危险因素为分块切除、水平切缘受累（HM1）或水平切缘受累情况不明（HMX）以及伴有溃疡。在1例伴有淋巴管浸润、总直径3 cm或以上且黏膜下浸润超过0.5 mm（SM2）的患者中检测到淋巴结转移。5年生存率为93%，无患者死于胃癌。
A组进行随访观察是合理的。对于判定为分块切除、HM1或HMX且伴有溃疡的患者，应进行追加手术治疗；对于判定为SM2或总直径3 cm或以上或伴有淋巴管浸润的B组患者，应进行追加手术并清扫淋巴结。
