胃と腸46巻10号

2011年09月発行

今月の主題 大腸SM癌に対する内視鏡治療の適応拡大 主題

大腸SM癌に対する内視鏡治療の適応拡大―現状と将来展望

著者： 金尾浩幸¹ 田中信治¹ 中土井鋼一² 中山奈那² 寺崎元美² 高田さやか² 岡志郎¹ 吉田成人¹ 茶山一彰²

所属機関： ¹広島大学内視鏡診療科 ²広島大学消化器･代謝内科

ページ範囲：P.1520 - P.1535

要旨　「大腸癌治療ガイドライン2009」において，内視鏡的摘除後の摘除標本の組織学的検索で，（1）SM浸潤度1,000μm以上，（2）脈管侵襲陽性，（3）低分化腺癌，印環細胞癌，粘液癌，（4）浸潤先進部の簇出（budding）Grade 2/3のうち一因子でも認めれば，追加治療としてリンパ節郭清を伴う腸切除を考慮するとされている．しかし，当科の検討では，（2）～（4）の条件のない大腸SM癌は，SM浸潤度にかかわらずリンパ節転移率は1.2％程度であった．大腸SM癌内視鏡治療後の根治度判定に際しては，種々のリンパ節転移危険因子の組み合わせによりリンパ節転移リスクを層別化し，患者背景に応じて運用することが重要である．

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