早期胃癌に対する内視鏡的胃粘膜切除（EMR）後の胃切除症例の検討

Abstract

Sixteen cases were treated with salvage gastrectomy after endoscoplc mucosal resection (EMR) for early gastric cancer in Nara Prefectural Nara Hospital from 1996 to 2002. The residual cancer cells and lymph node metastases were pathologlcally evaluated in comparing the findings of EMR-specimens. The reasons for salvage gastrectomy are described below. Twelve cases were treated for 'positive surgical margin'. Two cases that were not proved 'negative surglcal margin' in the EMR-specimens were underwent salvage gastrectomy for remnant cancer at 4 and 9 months after EMR. Although one case was 'negative surglcal margin', salvage gastrectomy was performed because of the patient's choice. One case was a recurrent case after curative EMR. In resected specimens, remnant cancer cells were observed in 12 of all 16 cases (75.0％), 11 of 14 cases that were not proved 'negative surgical margin' (78.6％) in the EMR specimens. Lymph node metastasis was not found in all cases. Although one case was mucosal cancer with 'positive surgical margin' in EMR-specimens, salvage gastrectomy was not performed because no cancer cells were observed by follow-up gastrofiberscopy in the EMR-scar and the patient's choice. In this case, the follow-up gastrofiberscopy at 9 months after EMR proved cancer cells and laparoscopy assisted distal gastrectomy was perfomed. The surgical specimen pathlogically showed submucosal invasion. Laparoscoplc gastrectomy as minimally invasive surgery was performed in 6 of 16 cases. In conclusion, surgical operation should be performed as soon as possible for remnant and recurrent gastric cancer after EMR and if possible, laparoscoplc operations would be a good choice.