胃と腸39巻1号

2004年01月発行

今月の主題 最新の早期胃癌EMR―切開・剥離法 主題研究

早期胃癌のリンパ節微小転移とEMR適応拡大

著者： 夏越祥次¹ 石神純也¹ 東泰志¹ 上之園芳一¹ 松本正隆¹ 奥村浩¹ 中条哲浩¹ 徳田浩喜¹ 中島三郎¹ 帆北修一¹ 高尾尊身¹ 愛甲孝¹

所属機関： ¹鹿児島大学大学院腫瘍制御学・消化器外科学

ページ範囲：P.57 - P.63

要旨　早期胃癌に対して，内視鏡的粘膜切除術(EMR)，縮小手術，定型手術を選択する上でリンパ節転移の有無は最も重要な因子である．近年の分子生物学的，遺伝子学的解析でリンパ節微小転移の存在が明らかとなってきた．粘膜癌では2cm以上から微小転移がみられ，粘膜下層癌ではその頻度はさらに高くなる．微小転移の観点からみると，現時点でEMRの適応拡大に関しては注意が必要である．今後，基礎的にはリンパ節微小転移の着床，増殖機序の解明，主病巣の転移能の評価の確立が必要である．臨床的にはsentinel node navigation surgeryの確立と微小転移の術中診断に関する各方法の評価が必要である．早期癌では根治は絶対条件であり，微小転移診断に基づくsentinel node生検を併用したEMRの適応拡大は機能温存と根治性を兼備した治療になりえると考えられる．

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