内容紹介
Summary
Introduction: Endoscopic submucosal dissection(ESD)for colorectal tumors has been covered by the national health insurance system in Japan since April 2012, and is widely used. We analyzed colorectal ESD cases we performed. Patients and methods: We investigated 515 patients with colorectal lesions(580 lesions)for whom ESD was performed between November 2005 and April 2017. Clinicopathological data, technical methods, complications, and outcomes were analyzed. Results: Most tumors were found in the transverse colon(134 lesions). The average diameter was about 26 mm. The largest lesion was 120 mm. The en bloc resection rate was high(96.2%). The average operative time was 51 minutes. Among complications, the number of delayed major bleeding cases was 7(1.2%). Minor perforations occurred in 3 cases(0.5%). The perforation could be closed with endoscopic clips. About 70% of the cases were adenomas, and the remainder were carcinomas. One patient with carcinoma in situ showed a mucosal recurrence 4 months later and received repeat endoscopic treatment. The cure rate was 99.8%. Among 29 deep submucosal invasion cases, additional colectomy was performed in 21; 3 patients had persistent carcinoma in the colonic wall and another patient had lymph node metastasis. Conclusions: Colorectal ESD can be performed for all sites in the large intestine, and en bloc resection was possible for a large lesion. A good outcome was observed for“Loco-Regional Cancer Therapy”in early colorectal carcinoma.
要旨
大腸癌に対する内視鏡的粘膜下層剝離術(ESD)は,近年普及してきている。今回,当院での大腸腫瘍ESD治療成績を検討した。2005年11月～2017年4月までにESDを施行した515例(580病変)を対象とした。治療経過,臨床病理学的因子,予後を検討した。病変占拠部位は,横行結腸が134病変と最多であり,肉眼形態は表面隆起型が347病変と多かった。平均腫瘍径は26 mm,最大腫瘍径は120 mmであった。完遂率は99%と高率で,一括切除率96.2%,平均所要時間は51分であった。合併症は,内視鏡的止血術を要した後出血が7例(1.2%)あった。微小穿孔3例(0.5%)は全例保存的に軽快した。SM軽度浸潤までの治癒率は99.8%であり,粘膜内再発を認めたM癌の1例は再度内視鏡的切除をし得た。大腸ESDは一括切除率および治癒率が高く良好な治療成績が得られ,SM軽度浸潤までの癌局所療法として根治性および安全性において有効な治療法と考えられた。
目次
Introduction: Endoscopic submucosal dissection(ESD)for colorectal tumors has been covered by the national health insurance system in Japan since April 2012, and is widely used. We analyzed colorectal ESD cases we performed. Patients and methods: We investigated 515 patients with colorectal lesions(580 lesions)for whom ESD was performed between November 2005 and April 2017. Clinicopathological data, technical methods, complications, and outcomes were analyzed. Results: Most tumors were found in the transverse colon(134 lesions). The average diameter was about 26 mm. The largest lesion was 120 mm. The en bloc resection rate was high(96.2%). The average operative time was 51 minutes. Among complications, the number of delayed major bleeding cases was 7(1.2%). Minor perforations occurred in 3 cases(0.5%). The perforation could be closed with endoscopic clips. About 70% of the cases were adenomas, and the remainder were carcinomas. One patient with carcinoma in situ showed a mucosal recurrence 4 months later and received repeat endoscopic treatment. The cure rate was 99.8%. Among 29 deep submucosal invasion cases, additional colectomy was performed in 21; 3 patients had persistent carcinoma in the colonic wall and another patient had lymph node metastasis. Conclusions: Colorectal ESD can be performed for all sites in the large intestine, and en bloc resection was possible for a large lesion. A good outcome was observed for“Loco-Regional Cancer Therapy”in early colorectal carcinoma.
要旨
大腸癌に対する内視鏡的粘膜下層剝離術(ESD)は,近年普及してきている。今回,当院での大腸腫瘍ESD治療成績を検討した。2005年11月～2017年4月までにESDを施行した515例(580病変)を対象とした。治療経過,臨床病理学的因子,予後を検討した。病変占拠部位は,横行結腸が134病変と最多であり,肉眼形態は表面隆起型が347病変と多かった。平均腫瘍径は26 mm,最大腫瘍径は120 mmであった。完遂率は99%と高率で,一括切除率96.2%,平均所要時間は51分であった。合併症は,内視鏡的止血術を要した後出血が7例(1.2%)あった。微小穿孔3例(0.5%)は全例保存的に軽快した。SM軽度浸潤までの治癒率は99.8%であり,粘膜内再発を認めたM癌の1例は再度内視鏡的切除をし得た。大腸ESDは一括切除率および治癒率が高く良好な治療成績が得られ,SM軽度浸潤までの癌局所療法として根治性および安全性において有効な治療法と考えられた。