早期胃癌に対する粘膜切除法とレーザー照射との併用療法の長期成績からみた有用性

抄録

We performed endoscopic treatment for 210 early gastric cancer lesions with 186 cases for the last fourteen years. We studied the efficacy of combination therapy of endoscopic mucosal resection (EMR) followed by Nd: YAG laser irradiation for early gastric cancer from the view point of long-term prognosis. The objects of this study are 157 lesions after endoscopic treatment. They are divided into 3 groups: the first group is 78 lesions with absolute indication (0-I, IIa, IIb, IIc without ulcerative change whose depth of invation was limited mucosaal layer and size was less than 20mm in diameter with differentiated type of adenocarcinoma), the second group is 22 lesions with relative indication (the same type of macroscopic and histological findings as absolute indication except with more than 21mm in diameter) and the third group is 33 lesions which have no indication for endoscopic treatment and can not be operated. The recurrent rate was 10% in absolute indication group and 32% in relative indication group. However, additional treatment diminished the recurrent cancer in all cases and the effective rate was 100% in both groups. Among 100 lesions which passed more than three years after endoscopic treatment. 32 lesions treated with only EMR and 38 lesions treated with EMR followed by Nd: YAG laser irradiation. The recurrent rate was 0% in the group treated with only EMR and 21% in the group treated with EMR followed by Nd: YAG laser irradiation. However, additional treatment diminished the recurrent cancer in the group treated with EMR followed by Nd: YAG laser irradiation and the effective rate was 100% in both groups. Therefore, we concluded that EMR followed by Nd: YAG laser irradiation can cure early gastric cancer lesions with relative indication as well as the lesions with absolute indication.