食道癌の治療 : 最近の進歩

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Treatment of superficial esophageal carcinoma: The prognostic factors after esophagectomy for superficial esophageal carcinoma were reviewed. An age of over 75 years and high risk factors were poor prognostic indicators. The most important pathological prognostic factors for esophagectomy of superficial esophageal carcinoma were the grade of lymph node metastasis and the presence of residual tumor. T1b carcinoma was associated with lymph node metastasis in about 50%, which is similar to the rate for advanced carcinoma. Extended lymphadenectomy during esophagectomy contributed the improvement of late results, but surgical invasiveness was high and strict management was required. Therefore, we have started a clinical trial of mini-thoracolaparotomy for improvement of the postoperative QOL without loss of radicality since 1996. Our mini-thoracolaparotomy method reduces the invasiveness of esophagectomy and improves postoperative QOL with early recovery of plumonary function. Based on clinicopathological studies, metastatic mucosal carcinoma (Tis-T1a) is uncommon, so endoscopic mucosal resection (EMR+α) of mucosal carcinoma has been done widely since 1990. Multidisciplinary treatment (EMR+α) can preserve the esophagus and we can use noninvasive treatment to obtain good late results even in high risk cases. Effectiveness of microvascular surgery for esophageal reconstruction: The introduction of microvascular surgery has made esophageal reconstruction safer by prevention of anastomotic leakage. Especially in cervical esophagectomy, free jejunal transplantation has made possible ultra-high esophago-jejunostomy and laryngeal preservation. We have also tried reconstruction with free jejunal transplantation and a jejunal voice box to enable speaking after esophagolaryngectomy. Free jejunal transplantation with microvascular surgery is extremely useful for improving postoperative QOL. Adjuvant therapy for the far advanced esophageal carcinoma: Neoadjuvant chemo-radiotherapy was performed as the treatment of first choice for unresectable T4 carcinoma or patients with distant lymph node metastasis (M1LYM). The response rate of esophageal carcinoma to chemo-radiotherapy is about 66-88%, and there are many cases of long-term survival after a complete response (CR). Compared with a rate of 21.4% in the NC-PD group, the rate of 41.2% in the CR-PR group showed that preoperative chemo-radiotherapy was useful for cT4 carcinoma and significantly improved the 5-year survival. Furthermore, the 5-year survival rate of the esophagectomy without preoperative adjuvant therapy T4 group was only 16.2%, similar to that of the no-response neoadjuvant group. We should avoid esophagectomy for cT4 carcinoma without preoperative treatment since radical cure cannot be expected.
東京女子医科大学の論文

食道癌の治療 : 最近の進歩

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