2015.6.12 EGJ Ca at NCC [互換モード]...Sato T, Kato Y. Hepatogastroenterology 2008;55:305-7...
Transcript of 2015.6.12 EGJ Ca at NCC [互換モード]...Sato T, Kato Y. Hepatogastroenterology 2008;55:305-7...
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食道胃接合部癌ー最近の知見ー
東京大学消化管外科
瀬戸 泰之
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Pohl H. Cancer Epi Biom Prev 2010;19:1468-70
Esophageal Adenocarcinoma Incidence
米国 NCI database
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Buas MF. Semin Radiat Oncol 2013;23:3-9
EGJ Ca
Stomach Ca
Eso Ca
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EGJ Ca:肥満とともに増加する
男性 女性
Hoyo C. Int J Epide 2012;41:1706-18
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EGJ Ca in PubMed by year
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我が国におけるEGJ Ca 手術件数推移
273施設 日本胃癌学会・食道学会共同全国調査結果より
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食道胃接合部 EGJ ?
食道胃接合部癌 EGJ Ca?
食道胃接合部領域?
食道胃接合部 EGJ ?
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食道筋層と胃筋層の境界
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消化器の局所解剖学 食道・胃 佐藤 達夫 金原出版 1993
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消化器の局所解剖学 食道・胃 佐藤 達夫 金原出版 1993
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ネッター解剖学アトラス 第5版、 図230 南江堂 2011
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食道筋層と胃筋層の境界
LES下端
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幕内博康 臨床外科 2013;68:388-94
Sphincter
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Sato T, Kato Y. Hepatogastroenterology 2008;55:305-7
Sato T, Kato Y, et al. Dig Dis Sci 2010;55:3095-101
Aida J, Takubo K, et al. Am J Surg Pathol 2011;35:1140-5
Kumagai Y, Takubo K, et al. Dig Esophagus 2012;25:484-90
Palisading longitudinal vesselsPalisade vessels
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正常:柵状血管、縦走ひだ ヘルニア:柵状血管、縦走ひだ
柵状血管、縦走ひだ 柵状血管、縦走ひだ
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自験例
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自験例
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食道胃接合部 EGJ ?
食道胃接合部癌 EGJ Ca?
食道胃接合部領域?食道胃接合部領域?
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噴門部癌ー食道胃境界部癌の提唱ー
EGJ の上下 2cm
西満正. 外科診療 1973:1328-38
EGJ の上下 2cm
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消化器の局所解剖学 食道・胃 佐藤 達夫 金原出版 より
横隔膜脚?
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陰圧 -2~-7mmHg
陽圧 0~5mmHg
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陰圧 -2~-7mmHg
陽圧 0~5mmHg
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鈴木 剛. Therapeutic Research 2009:30;1357-60
胃内圧
基礎内圧 閾値圧
12mmHg 26mmHg
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呼気:2mmHg
吸気:10mmHg
食道胃内圧格差LES圧:10-25mmHg
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消化器の局所解剖学 食道・胃 佐藤 達夫 金原出版 より
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食道
横隔膜脚
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噴門部癌ー食道胃境界部癌の提唱ー
EGJ の上下 2cm
西満正. 外科診療 1973:1328-38
解剖学的、機能的
EGJ の上下 2cm
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食道胃接合部 EGJ ?
食道胃接合部癌 EGJ Ca?
食道胃接合部領域?
食道胃接合部癌 EGJ Ca?
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食道癌取扱い規約
第2版(1972) 食道噴門接合部癌
第5版(1976) 食道胃接合部癌
胃癌取扱い規約
第12版(1993) 食道胃境界部領域癌
第14版(2010) 食道胃接合部癌
西満正 1973
噴門部癌、食道胃境界部癌
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Siewert JR. Chirurg 1987;58:25-37
Adenocarcinoma
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扁平上皮
食道腺
バレット
噴門腺
胃底腺
噴門腺
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三隅厚信, 他. 胃と腸 1982;17:573-9
噴門癌の定義に関するわれわれの見解
2 cm 1 cm
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三隅厚信, 他. 胃と腸 1982;17:573-9
噴門癌の定義に関するわれわれの見解
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三隅厚信, 他. 消化器内視鏡 1990;2:255-9
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小川正純, 他. 胃と腸 2001;36:625-33
日本人における食道胃接合部の臨床病理学的検討
5.2 mm
11.5 mm
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Siewert JR. Chirurug 1987 ;58:25-37
噴門腺由来
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何が問題か?
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Mariette C. Lancet Oncol 2011;12:296-305
type I type II type II type III
開胸・非開胸 全く異なる術式が世界で許容されている
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J Am Coll Surg 2015;220:510-20
These patients are often reffered to thoracic surgeons for EGJ cancers rather than to abdominal surgeons forproximal gastric cancers
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J Am Coll Surg 2015;220:510-20
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J Am Coll Surg 2015;220:510-20
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J Am Coll Surg 2015;220:510-20
Surgical approach is not an independent factor
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Gastric Cancer 2015 Jan 28, Epub
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胃癌学会・食道学会合同ワーキンググループ
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食道胃接合部癌の至適リンパ節郭清範囲を検討するための全国調査
(多施設共同研究)
報告集 2013年11月20日
273 施設
3177 例
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PALN
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Frequency of LNs metastasis
Rate of LNs dissection
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ワーキンググループ報告集より
M,SM; No.1,2,3,7;
MP以深; No.1,2,3,7,8a,9,11p,19,20;
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2014.8.25
食道胃接合部癌
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T3,LN: 1/31No. 3a
33*25 mm
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T3, LN: 4/65No. 1,2,3a
30*23mm
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集学的治療?
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J Natl Compr Canc Netw 2015;13:194-227
Targeted therapies with trastuzumab andramucirumab have produced encouragingresults in treatment of EGJ adenocarcinoma.
Multidisciplinary team management is essential.
Prof. Ajani
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Ann Surg Oncol 2015 May 22, Epub
A:CDDP+5-FUB:Oxaliplatin+5-FU
C:Epirubicin+Platin+5-FU
D:Taxane+Platin+5-FU
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Ann Surg Oncol 2015 May 22, Epub
Taxane-containing regimens should be furtherinvestigated in RCT, especially in EGJ cancers.
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Katai H. World J Surg 2014;38:426-30
HER2 in true cardia cancer
Liver recurrence
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扁平上皮
食道腺
バレット
噴門腺
胃底腺
発生母地は?
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AJ Bass et al. Nature 000, 1-8 (2014) doi:10.1038/nature13480
Gastric cancer subtypes
超高メチル化超高メチル化
高メチル化高メチル化
低メチル化低メチル化