臨床外科73巻5号

2018年05月発行

特集 縦隔を覗き，さらにくり抜く—これからの食道・胃外科手術 総論

「食道胃接合部癌手術」および「非胸腔アプローチによる食道癌手術」の現状

著者： 瀬戸泰之¹ 山下裕玄¹ 愛甲丞² 八木浩一¹ 西田正人¹ 奥村康弘¹ 山形幸徳³ 森和彦⁴ 野村幸世¹

所属機関： ¹東京大学消化管外科 ²東京大学肥満メタボリックケア ³国立がん研究センター中央病院胃外科 ⁴三井記念病院消化器外科

ページ範囲：P.526 - P.530

【ポイント】
◆食道腺癌が世界的に増加しているとの報告が多い．Siewert type Ⅱに関しては一定の報告はないが，わが国における手術件数は増加傾向にあると思われる．
◆EGJ扁平上皮癌は食道癌として治療されるが，EGJ腺癌，特にSiewert type Ⅱに対する術式はcontroversialである．ただし，わが国における調査では，胃下部リンパ節の郭清意義は乏しく，郭清目的での胃全摘は不要と結論づけられた．下縦隔郭清の効果については，現在進行中の前向き調査の結果を待つ必要がある．
◆非胸腔アプローチによる食道手術は，術後呼吸器合併症の抑制目的で開発された．標準的に行われている術式ではないが，胸腔アプローチと同等の郭清ができることや，術後肺炎防止効果，術後QOLなどに関する報告が出始めている．2018年4月に保険収載されることもあり，今後普及していく術式と考えられる．

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