胸部食道癌治療の現況

One thousand, six hundred and twenty-seven cases of the esophageal cancer have been admitted to our hospital for these fourteen years. The resection of the esophagus was performed in 846 cases (52%). Another surgical procedures were performed in 490 cases and no surgical treatment was carried out in the remaining cases. Considering the long-term-survival rate, 5-year-survival rate of the resected cases was 22%, otherwise, that of the non-resected cases was 1% even if the radical irradiation was performed. Till the end of last year, the thoracic esophageal cancers have been resected in 868 cases in our hospital. The operative mortality rate was 4.5%.<br>The operation of the thoracic esophageal cancer is usually constituted of the subtotal resection of the thoracic esophagus with the systemic cleaning of the lymphnodes and the reconstruction of the esophagus using stomach, colon and small intestine. As the reconstruction of the esophagus, ante-thoracic esophagogastrostomy (Nakayama's method) was performed most frequently in our hospital. This had many advantages, otherwise to improve the sole disadvantage, high incidence of suture insufficiency, some modified operative techniques have been applied.<br>The 10-year-survival rate after operation was 13%. From the analysis of the 10-year-survival rate, the patients with cancers less than 6cm in size on X-ray film, of which invasion revealed within the muscular layer, with no lymphnode involvement, being resected curatively and of histologically well differentiated type, had superiority in long-term survival.<br>To obtain better results in the long-term survival, it is important to find out early cancer of the esophagus. The early esophageal cancer was defined as the cancer of which infiltration was limited in the submucosa without any metastasis. Twenty-eight cases of early esophageal cancer was operated in our hospital for these fourteen years. These were 3.5% of the cancer cases of total esophageal resections. The 5-year-survival rate of the early esophageal cancer was 64%. As for the diagnostic procedures, esophagoscopy was more advisable for discovery of the erosive type of cancer. Mucosal cancer was seen in 3 of 28 cases. All mucosal cancers revealed endoscopically erosive types. So X-ray examination and esophagoscopy are necessary to find out tiny and erosive lesions of the esophagus in screening examination. The endoscopic dye method using 2% toluidine blue solution and 3% Lugol solution, was advisable to detect the mucosal and intraepithelial cancer. The extent of the intraepithelial invasion of cancer and the tiny accessory lesions could be clearly demarcated by this method.<br>In this report the present state of surgical treatment of the thoracic esophageal cancer and the diagnosis of early cancer are presented. The purpose of the surgery of thoracic esophageal cancer is placed not only for decrease of the mortality rate, but also for improvement of the long-term-survival rate after operation.