1 ）Saitoh Y, Inaba Y, Sasaki T, Sugiyama R, Sukegawa R,
Fujiya M: Management of colorectal T 1 carcinoma
treated by endoscopic resection. Digestive Endoscopy, 28
（ 3 ）: 324－329, 2016.
2 ）Bray F, Ferlay J, Soerjomataram I, Siegel RL, Torre LA,
Jemal A: Global Cancer Statistics 2018: GLOBOCAN
13）Yoda Y, Ikematsu H, Matsuda T, et al: A large-scale
multicenter study of long-term outcomes after
endoscopic resection for submucosal invasive colorectal
cancer. Endoscopy, 45（ 9 ）: 718－724, 2013.
14）Suh JP, Youk EG, Lee EJ, et al: Endoscopic submucosal
dissection for nonpedunculated submucosal invasive
colorectal cancer: is it feasible? Eur J Gastroenterol
Hepatol, 25（ 9 ）: 1051－1059, 2013.
Estimates of Incidence and Mortality Worldwide for 36
15）Yoshii S, Nojima M, Nosho K, et al: Factors Associated
Cancers in 185 Countries. CA CANCER J CLIN, 68
With Risk for Colorectal Cancer Recurrence After
（ 6 ）: 394－424, 2018.
3 ）Winawer SJ, Zauber AG, Ho MN, et al: Prevention of
Colorectal Cancer by Colonoscopic Polypectomy. N Engl
J Med, 329（27）: 1977－1981, 1993.
4 ）Winawer SJ, Zauber AG, O'Brien MJ, et al: Randomized
Comparison of Surveillance Intervals after Colonoscopic
Removal of Newly Diagnosed Adenomatous Polyps. N
Engl J Med, 328（13）: 901－906, 1993.
E n d o s c o p i c R e s e c t i o n o f T 1 Tu m o r s . C l i n .
Gastroenterol. Hepatol, 12: 292－302, 2014.
16）Takatsu Y, Fukunaga Y, Hamasaki S, et al: Recurrent
colorectal cancer after endoscopic resection when
additional surgery was recommended. World J
Gastroenterol, 22（ 7 ）: 2336－2341, 2016.
17）Kim B, Kim EH, Park SJ, et al: The risk of lymph node
metastasis makes it unsafe to expand the conventional
5 ）Tanaka S, Asayama N, Shigita K, Hayashi N, Oka S,
indications for endoscopic treatment of T 1 colorectal
Chayama K: Towards safer and appropriate application of
cancer: A retrospective study of 428 patients. Medicine
endoscopic submucosal dissection for T 1 colorectal
carcinoma as total excisional biopsy: Future perspectives.
Dig Endosc, 27（ 2 ）: 216－222, 2015.
6 ）大腸癌研究会編． 大腸癌治療ガイドライン 医師用
2019年版，金原出版，東京，2018．
7 ）Kobayashi H, Mochizuki H, Morita T, et al: Characteristics
of recurrence after curative resection for T 1 colorectal
cancer: Japanese multicenter study. J Gastroenterol, 46
（ 2 ）: 203－211, 2011.
（Baltimore）, 95（37）: e4373, 2016.
18）Belderbos TD, van Erning FN, de Hingh IH, van Oijen MG,
Lemmens VE, Siersema PD: Long-term Recurrence-free
Survival After Standard Endoscopic Resection Versus
Surgical Resection of Submucosal Invasive Colorectal
Cancer: A Population-based Study. Clin Gastroenterol
Hepatol, 15（ 3 ）: 403－411, 2017.
19）Tamaru Y, Oka S, Tanaka S, et al: Long-term outcomes
after treatment for T 1 colorectal carcinoma: a
8 ）正木忠彦，渡辺聡明，武藤徹一郎：大腸 sm 癌に対す
multicenter retrospective cohort study of Hiroshima GI
る内視鏡的治療の適応と限界：主にリスクファクター
Endoscopy Research Group. J Gastroenterol, 52（11）:
の面からの検討． 胃と腸，34（ 6 ）: 752－756，1999．
1169－1179, 2017.
9 ）中里友彦，塚越洋元，高丸博之，他：大腸 sm 癌の内
20）Backes Y, de Vos Tot Nederveen Cappel WH, van Bergeijk
視鏡治療後の再発様式および再発時期について．胃
J, et al: Risk for Incomplete Resection after Macroscopic
38
pT1 直腸癌内視鏡的摘除後に局所再発を来した 1 例
Radical Endoscopic Resection of T 1 Colorectal Cancer:
25）Nishikawa Y, Horimatsu T, Nishizaki D, et al: Qualitative
A Multicenter Cohort Study. Am J Gastroenterol, 112
and Quantitative Analysis of Posttreatment Strategy After
Endoscopic Resection for Patients with T 1 Colorectal
（ 5 ）: 785－796, 2017.
21）Shin JW, Han KS, Hyun JH, et al: Risk of recurrence after
Cancer at High Risk of Lymph Node Metastasis. Journal
of Gastrointestinal Cancer, 51（ 1 ）: 242－249, 2020.
endoscopic resection of early colorectal cancer with
positive margins. Endoscopy, 50（ 3 ）: 241－247, 2018.
26）Iguchi K, Mushiake H, Aoyama T, et al: Additional Surgical
22）Kouyama Y, Kudo S, Miyachi H, et al: Risk factors of
Resection After Endoscopic Resection for Patients With
recurrence in T 1 colorectal cancers treated by
High-risk T 1 Colorectal Cancer. In Vivo, 33（ 4 ）: 1243
endoscopic resection alone or surgical resection with
－1248, 2019.
lymph node dissection. Int J Colorectal Dis, 33（ 8 ）:
27）佐藤裕美，寺井崇二：内視鏡的摘除大腸 pSM 癌の治
療方針に関する病理学的研究．新潟医学会雑誌，130
1029－1038, 2018.
23）Antonelli G, Berardi G, Rampioni Vinciguerra GL, et al:
（ 3 ）: 163－175，2016．
Clinical management of endoscopically resected pT 1
28）Primrose JN, Perera R, Gray A, et al: Effect of 3 to 5
colorectal cancer. Endosc Int Open, 6 （12）: E1462－
Years of Scheduled CEA and CT Follow-up to Detect
1469, 2018.
R e c u r r e n c e o f C o l o r e c t a l C a n c e r : T h e FA C S
24）南出竜典，池松弘朗，新村健介，大野康寛，矢野友
規：早期大腸癌内視鏡摘除後のサーベイランス．臨
Randomized Clinical Trial. JAMA, 311（ 3 ）: 263－270,
2014.
牀消化器内科，33（ 8 ）: 995－1000，
2018．
Abstract
A CASE OF LOCAL RECURRENCE IN THE PARARECTAL LYMPH NODES
2 YEARS AFTER ENDOSCOPIC RESECTION OF PT1 RECTAL CANCER
Akira Takenouchi 1 ）, Mayumi Ozawa 1 ）, Atsushi Ishibe 1 ）, Yusuke Suwa 2 ）,
Kazuya Nakagawa 1 ）, Jun Watanabe 2 ）, Takashi Hibiya 3 ）, Itaru Endo 1 ）
1）
Department of Gastroenterological Surgery, Yokohama City University Graduate School of Medicine
2）
Department of Surgery, Yokohama City University Medical Center, Gastroenterological Center
3）
Department of Pathology, Yokohama City University Graduate School of Medicine
A 66-year-old male underwent colonoscopy, which identified an 0-Is polyp in the rectum. Endoscopic resection
was then performed, and the histopathological examination showed SM massive, unknown vertical margin, and
venous invasion. He was thus referred to our department for the purpose of additional resection. However, follow-up
every 6 months was performed because of his wish to avoid additional resection. He underwent contrast-enhanced
CT 2 years after the start of follow-up, and a swollen pararectal lymph node was found. Based on this examination,
he was diagnosed with recurrent lymph node metastasis and underwent laparoscopic ultra-low anterior resection and
diverting ileostomy. Histopathological examination showed well to moderately differentiated tubular adenocarcinoma
in the mesorectum and metastasis in a pararectal lymph node. After 8 courses of XELOX therapy as postoperative
adjuvant chemotherapy, he underwent stoma closure. He is alive without recurrence 4 years after surgery. Patients
should be informed of the expected course of pT1 colorectal cancer along with factors that should be considered for
additional resection, and they should be followed carefully.
39
...
論文の公開元へ
