結腸癌に対する腹腔鏡補助下結腸切除術(1) : 進行結腸癌の適応について

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  • ケッチョウガン ニ タイスル フククウキョウ ホジョ カ ケッチョウ セツジョジュツ 1 シンコウ ケッチョウガン ノ テキオウ ニ ツイテ
  • Laparoscopic-Assisted Colectomy (LAC) for Colon Cancer (1) : Indications for the Advanced Colon Cancer

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Criteria for indications for laparoscopy-assisted colectomy (LAC) for advanced colon cancer vary according to each institution. We consider the histological findings of lymph node metastasis ≦n1, the depth of invasion ≦ss or al, and the absence of metastases associated with peritoneal dissemination as the criteria for absolute indication for LAC. However, since the status of lymph node metastasis and the depth of invasion, which have been determined preoperatively, are not always consistent with postoperative histological findings, we investigated preoperatively available macroscopic findings that meet the above criteria, i.e., the macroscopic findings for which advanced colon cancers are indicated for LAC. Two hundred seventy nine patients who underwent colectomy in the institution between January 1995 and December 2000 were retrospectively investigated for the association between the largest diameter and circumference of tumors and the criteria for absolute indication for LAC. According to evaluation of 80 cases that had the tumor largest diameter <4 cm, 3 cases (3.8%) were accompanied with the lymph node metastasis >n2, 6 cases (7.5%) were the depth of invasion >se or a2 and no peritoneal dissemination was seen. In 75 cases that had the tumor circumference ≦1/2 colon circumference, 2 cases (2.7%) were the lymph node metastasis >n2,4 cases (5.3%) were the depth of invasion >se or a2 and 1 case (1.3%) was peritoneal dissemination. In 62 cases those were fulfilled both of two criteria, 1 cases (1.6%) were the lymph node metastasis >n2, 3 cases (4.8%) were the depth of invasion >se or a2 and no peritoneal dissemination was seen. As a result, we discovered that if macroscopic findings were tumor diameter <4 cm and tumor circumference ≦1/2 colon circumference, the above criteria for absolute indication for LAC would almost be met. Therefore, we think that LAC can be indicated for colon cancers that fulfill the above two conditions. Although these results were obtained by retrospective investigation, we consider the two macroscopic findings as the criteria for LAC, and will use LAC for advanced colon cancers.

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