粘膜切除法の遺残に対する追加レーザー照射の成績からみた早期胃癌に対する内視鏡治療の治療方針

抄録

We performed endoscopic treatment on 182 cases (184 lesions) of early gastric cancer during a period between 1980 and June 1993. Of them 104 cases (106 lesions) were treated by endoscopic mucosal resection (EMR) and 108 cases were by laser irradiation.
On 30 cases of 108 laser irradiation were treated as a additional laser therapies for residual tumors after EMR. We compared the result of additional laser therapy with the result of EMR single therapy and Laser single therapy from the viewpoint of selection of endoscopic methods. Complete resection was possible in 55.7% of all EMR cases, 69.7% for absolute indication group and 20.0% for relative indication group. On 108 cases of laser irradiationi, 41 cases could be folloed-up more than one year after the end of laser single therapy. No residual cancer cell was detected on 31 cases (75.7%).
When these 41 cases were analysed to a indication group, the effectiveness rate was 100% (12/12) for absolute indiaction group, and 65.5% (19/29) for relative indication group. On 30 cases of additional laser therapy 22 cases could be followed-up more than one year. The effectiveness rate was 81.8% (18/22) for all cases, 91.7% (11/12) for absolute indication group and 70.0% (7/10) for relative indication group.
The effectiveness was separately assessed for EMR, which allows histological examination of resected tissue, and for laser irradiation, which dose not allow collection of tissue. Assessment of the effectiveness of laser irradiation requires accumulation of endoscopic and biopsy's data for long period. For the reason of this advantages of EMR, our view as to indications of endoscopic treatment for early gastric cancer is as follows: lesions which belong to absolute indication group are indicated for EMR. In cases where EMR has been incomplete or difficult, additional laser irradiation is given. Lesions which belong to relative indication group are principlly treated by surgical procedures. These group are likely to have lymph node metastasis which cannot be endoscopically treated. For these group endoscopic treatment is limitted to inoperable cases. For these inoperable cases lesions are treated by laser irradiation.