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[Gastric tube cancer. ½Äµµ¾Ï ÈÄ À§¾Ï] - End of document

1. How to describe ¾î¶»°Ô À§Ä¡¸¦ ±â¼úÇÒ °ÍÀΰ¡?

2. Representative cases of synchronous and metachronous cancers

3. ½Äµµ¾Ï ȯÀÚÀÇ Å¸ Àå±â ¾ÏÀÇ ºóµµ

4. Gastric tube cancerÀÇ cumulative incidence

5. Gastric tube cancer - SMC experience

6. Early gastric tube cancers

7. Advanced gastric tube cancers

8. Gastric tube cancerÀÇ ¼ö¼úÀû ȤÀº ³»½Ã°æÀû Ä¡·á

9. Clipping for localization

10. Cases

11. References

PDF, 0.2 M


1. How to describe. ¾î¶»°Ô À§Ä¡¸¦ ±â¼úÇÒ °ÍÀΰ¡?

½Äµµ¾Ï ¼ö¼ú ÈÄ À§ÀÇ À§Ä¡¸¦ Ç¥½ÃÇÏ´Â °ÍÀº ¾î·Æ½À´Ï´Ù. ÀüÁ¤ºÎ üºÎ¸¦ ±¸ºÐÇϱ⵵ ¾î·Æ°í ¼Ò¸¸ ´ë¸¸À» ³ª´©±âµµ ¾î·Æ½À´Ï´Ù. ±×·¡¼­ upper incisor teeth·ÎºÎÅÍÀÇ °Å¸®¸¦ Áß¿ä½ÃÇÏ°í ÀÖ½À´Ï´Ù.

Gastric tube cancerÀε¥ °á°úÁö¿¡ "On the LC side of MB, a about 1cm sized round flat yellowish mucosal lesion"À̶ó°í ¾º¿© ÀÖ¾ú½À´Ï´Ù. Ivor-Lewis ¼ö¼ú ÈÄ¿¡´Â ÇغÎÇÐÀû ±¸Á¶°¡ º¯°æµÇ¾î ÀÖÀ¸¹Ç·Î midbody lesser curvature¶ó°í ½áµµ ¼Ò¿ëÀÌ ¾ø½À´Ï´Ù. ¾îµðÂëÀÎÁö ÁüÀÛÇϱ⠾î·Æ½À´Ï´Ù.

»óÀýÄ¡·ÎºÎÅÍ ¸î cmÀÎÁö°¡ Áß¿äÇÕ´Ï´Ù. Diaphragmatic orficeº¸´Ù »ó´ÜÀÎÁö ÇÏ´ÜÀÌÁöµµ Áß¿äÇÕ´Ï´Ù. "»óÀýÄ¡·ÎºÎÅÍ 20 cm¿¡ ½Äµµ-À§ ¹®Çպΰ¡ ÀÖ°í, 33 cm¿¡ À§¾Ï º´¼Ò°¡ ÀÖÀ¸¸ç, À̺¸´Ù ÇÏ´ÜÀÎ 40 cm¿¡ diaphragmatic orfice°¡ ÀÖ´Ù"°í ¾²¸é 100Á¡ÀÔ´Ï´Ù. ¾Æ·¡ ±×¸²À» ÂüÁ¶Çϱ⠹ٶø´Ï´Ù.


2. Representative cases of synchronous and metachronous cancers

°£È¤ À§¾Ï°ú ½Äµµ¾ÏÀÌ µ¿½Ã¿¡ ¹ß°ßµÇ°ï ÇÕ´Ï´Ù. ¾Æ·¡ ȯÀÚ´Â ½Äµµ high grade dysplasia·Î ÀǷڵǾú½À´Ï´Ù. ³»½Ã°æ Àç°ËÀ» ÅëÇÏ¿© À§¾Ï°ú ½Äµµ¾ÏÀÌ µ¿½Ã¿¡ Áø´ÜµÇ¾ú½À´Ï´Ù. À§¾Ï¿¡ ´ëÇÑ ESD ÈÄ Ivor Lewis ¼ö¼úÀ» ÇÏ¿´½À´Ï´Ù. À¶±âµÈ ½Äµµ¾Ï ÁÖÀ§¿¡ ¸Å¿ì ³ÐÀº superficial spreadingÀ» º¸ÀÌ´Â °æ¿ì·Î¼­ ¾ÏÀÇ Å©±â°¡ 14cm·Î º¸°íµÇ¾ú½À´Ï´Ù. ¸²ÇÁÀý ÀüÀ̵µ ÀÖ¾ú½À´Ï´Ù.


Invasive squamous cell carcinoma (M/D)
1) tumor size: 14x2.5 cm
2) extension to perimuscular adventitia
3) endolymphatic tumor emboli: not identified
4) perineural invasion: not identified
5) negative resection margins
6) metastasis to 2 out of 48 regional lymph nodes (RRLN, 2/2)

¾Ï ȯÀÚÀÇ »ýÁ¸À²ÀÌ Çâ»óµÇ°í ÀÖ½À´Ï´Ù. ±× °á°ú À§¾Ï ¼ö¼ú ¸î ³â ÈÄ ½Äµµ¾ÏÀÌ ¹ß°ßµÇ°Å³ª ½Äµµ¾Ï ¼ö¼ú ¸î ³â ÈÄ À§¾ÏÀÌ ¹ß°ßµÇ´Â ¿¹°¡ Á¡Â÷ Áõ°¡ÇÏ°í ÀÖ½À´Ï´Ù.

½Äµµ¾Ï ¼ö¼ú ÈÄ À§¾Ï°ú ´ëÀå¾ÏÀÌ ¹ß°ßµÈ ¿¹

¾Æ·¡ ȯÀÚ´Â À§¾Ï ESD¿Í ½Äµµ¾Ï ¼ö¼úÀ» µ¿½Ã¿¡ ½ÃÇàÇÏ¿´°í 12³â ÈÄ À̼Ҽº À§¾Ï (signet ring cell carcinoma) Áø´Ü ÈÄ È¯ÀÚ¿Í »óÀÇÇÏ¿© ESD ½ÃÇàÇÏ¿´½À´Ï´Ù.

ù ½Ã¼ú

12³â ÈÄ µÎ¹ø° ½Ã¼ú

¾Æ·¡ ȯÀÚ´Â ½Äµµ¾ÏÀ¸·Î ÀǷڵǾî EUSÀ» ÇÏ´ø Áß À§¾ÏÀÌ ¹ß°ßµÇ¾î Ivor-Lewis ¼ö¼ú°ú Partial gastrectomy¸¦ ½ÃÇàÇÏ¿´½À´Ï´Ù. ¾à 2³â ÈÄ ÇϺ¹ºÎ Áõ»ó ¹ß»ýÇÏ¿© ´ëÀå³»½Ã°æ °Ë»ç¸¦ ½ÃÇàÇÏ¿´´Âµ¥ ´ëÀå¾ÏÀÌ ¹ß°ßµÇ¾î anterior resectionÀ» ÇÏ¿´½À´Ï´Ù.

¾Æ·¡ ȯÀÚ´Â ½Äµµ¾Ï ¼ö¼úÇÑ ÈÄ ¼ö³â ÈÄ¿¡ À§¾Ï(P/D)ÀÌ ¹ß°ßµÇ¾î ½Äµµ¾ÏÀ¸·Î ÀǷڵǾî EUSÀ» ÇÏ´ø Áß À§¾ÏÀÌ ¹ß°ßµÇ¾î Ivor-Lewis ¼ö¼ú°ú Partial gastrectomy¸¦ ½ÃÇàÇÏ¿´½À´Ï´Ù. ¾à 2³â ÈÄ ÇϺ¹ºÎ Áõ»ó ¹ß»ýÇÏ¿© ´ëÀå³»½Ã°æ °Ë»ç¸¦ ½ÃÇàÇÏ¿´´Âµ¥ ´ëÀå¾ÏÀÌ ¹ß°ßµÇ¾î anterior resectionÀ» ÇÏ¿´½À´Ï´Ù.


3. ½Äµµ¾Ï ȯÀÚÀÇ Å¸ Àå±â ¾ÏÀÇ ºóµµ

½Äµµ¾Ï°ú ¿¬°üµÈ ´Ù¸¥ Àå±âÀÇ ¾Ï¿¡ ´ëÇÑ Keio ´ëÇÐÀÇ ÀÚ·áÀÔ´Ï´Ù (Okamoto. Ann Thorac Surg 2004). ÀϺδ antecedent, ÀϺδ synchronous, ÀϺδ metachronousÀÔ´Ï´Ù. Synchronous°¡ ¹«·Á 49%¶ó´Â Á¡ÀÌ ³î¶ø½À´Ï´Ù. ¹«Ã´ ÀϺ»ÀûÀÎ ÀÚ·áÀÌ°í ¿ì¸®³ª¶ó¿Í´Â »ç¹µ ´Ù¸¨´Ï´Ù. ÀϺ»ÀÇ À§¾Ï°ú ¿ì¸®³ª¶óÀÇ À§¾ÏÀÌ ¾ó¸¶³ª ´Ù¸¥Áö ¾î·ÅDzÀÌ ´À²¸Áý´Ï´Ù. ¿©ÇÏÆ° Èï¹Ì·Ó½À´Ï´Ù. Gastric tube cancer´Â 7%¿´½À´Ï´Ù.

Ann Thorac Surg 2004

Èï¹Ì·Î¿î Á¡Àº ºñ±³Àû ÁÁÀº Ä¡·á°á°úÀÔ´Ï´Ù (Okamoto. Ann Thorac Surg 2004). 7¸í Áß 5¸íÀÇ Ä¡·á°á°ú°¡ ¼º°øÀûÀ̾ú´Ù°í º¸°íÇÏ¿´½À´Ï´Ù. ¿ä¾àÀÇ ÀϺθ¦ ¿Å±é´Ï´Ù.

"Gastric cancer was detected during follow-up endoscopic examinations or in an upper gastrointestinal series in seven patients. All of the cancers were diagnosed as adenocarcinoma histopathologically. Endoscopic mucosal resection was performed in two patients, partial resection of the residual stomach was performed in three patients. One patient was treated by endoscopic mucosal resection as palliative therapy, since he had severe pulmonary emphysema. Total resection of the gastric tube was attempted in 2 advanced cases but was unsuccessful because of direct invasion of other organ by the cancer. The 5 patients who underwent curative resection are alive with no subsequent recurrence."


4. Gastric tube cancerÀÇ cumulative incidence

Niigata ´ëÇп¡¼­ gastric tube cancerÀÇ ´©Àû ¹ß»ý·ü ÀڷḦ ¹ßÇ¥ÇÏ¿´½À´Ï´Ù (Bamba. Surg Endosc 2010). 10³â ´©Àû ¹ß»ý·üÀÌ 8.6%¿´½À´Ï´Ù. ¿ä¾àÀÇ ÀϺθ¦ ¿Å±é´Ï´Ù.

"The median interval between esophagectomy and GTC detection was 86 months, and the 10-year cumulative incidence rate of GTC was 8.6%. Of 18 asymptomatic GTCs, 17 lesions (94.4%) were detected by periodic endoscopy and 15 (88.2%) of them were treated endoscopically. Of all 29 GTCs, endoscopic submucosal dissection (ESD) was performed in 10 GTCs with a completely curative resection rate of 90%, which was significantly higher than that of 7 GTCs treated with endoscopic mucosal resection (EMR) (14.3%, P = 0.004). In these 17 GTCs, no cancer recurrence developed during a median follow-up period of 24 months, and the 3-year survival rate was 80.8%."

Bamba. Surg Endosc 2010

ÁßÇϺΠ½Äµµ¾ÏÀÇ ´ëÇ¥ÀûÀÎ ¼ö¼úÀû Ä¡·á¹æ¹ý¹ýÀº Ivor-Lewis operationÀÔ´Ï´Ù. ÁßÇϺνĵµ¸¦ ÀýÁ¦ÇÑ ÈÄ À§¸¦ ´ç°Ü¼­ ³²¾ÆÀÖ´Â ½Äµµ¿Í ¿¬°áÇÏ´Â ¼ú½ÄÀÔ´Ï´Ù. Screening endoscopy°¡ º¸ÆíÈ­µÇ¸é¼­ Á¶±â¿¡ ¹ß°ßµÇ´Â ½Äµµ¾Ï ȯÀÚ°¡ Áõ°¡ÇÏ°í ÀÖ½À´Ï´Ù. ƯÈ÷ ½Äµµ¾Ï ¼ö¼ú ÈÄ Àå±â »ýÁ¸Çϴ ȯÀÚ°¡ ¸¹¾ÆÁö¸é¼­ gastric tube cancer°¡ ¹®Á¦°¡ µÇ°í ÀÖ½À´Ï´Ù. ´ÙÇེ·´°Ô Á¶±â¿¡ ¹ß°ßµÇ¸é ³»½Ã°æ ÀýÁ¦¼úÀ» ½ÃÇàÇÒ ¼ö ÀÖ°ÚÁö¸¸ ÁøÇàµÈ »óÅ¿¡¼­ ¹ß°ßµÇ¸é ¼ö¼úÀ» ÇÇÇÒ ¼ö ¾ø½À´Ï´Ù. À̶§ÀÇ ¼ö¼úÀº colonic interpositionÀÏ ¼ö ¹Û¿¡ ¾øÀ¸¸ç »ó´çÇÑ morbidity¿Í mortality°¡ µ¿¹ÝµÉ ¼ö ¹Û¿¡ ¾ø´Ù°í »ý°¢µË´Ï´Ù.

¾Æ·¡ Áõ·Ê´Â ½Äµµ¾Ï ¼ö¼ú ÈÄ 5³â¸¸¿¡ ¹ß°ßµÈ intra-thoracic stomachÀÇ ¾ÏÀÔ´Ï´Ù. ½Äµµ¾Ï ¼ö¼ú ÈÄ º¸´Ù ºñ±³Àû À̸¥ ½Ã±â¿¡ À§¾ÏÀÌ ¹ß°ßµÈ ¿¹µµ ¾øÁö ¾Ê½À´Ï´Ù. ½Äµµ¾Ï Áø´Ü½Ã À§µµ ÀÚ¼¼È÷ °üÂûÇÒ ÇÊ¿ä°¡ ÀÖ½À´Ï´Ù.


5. Gastric tube cancer - SMC experience

´Ù¼Ò ¿À·¡µÈ ÀÚ·áÀÔ´Ï´Ù¸¸ Àúµµ gastric tube cancer ÀڷḦ ¹ßÇ¥ÇÑ ¹Ù ÀÖ½À´Ï´Ù (Kim. Hepatogastroenterology 2008). ¼ö¼ú ÈÄ ÃßÀû°üÂû±â°£ÀÌ Âª¾Ò±â ¶§¹®¿¡ Niigata ´ëÇÐó·³ ´©Àû¹ß»ý·üÀ» ±¸Çϱâ´Â ¾î·Á¿ü½À´Ï´Ù. ´Ù¸¸ ½Äµµ¾Ï ¼ö¼ú ȯÀÚ 728¸í Áß 11¸í(1.1%)¿¡¼­ ¹ß°ßÇÑ gastric tube cancer¿¡ ´ëÇÑ À̾߱⿴½À´Ï´Ù. ½Äµµ¾Ï¿¡¼­ À§¾Ï±îÁöÀÇ °£°ÝÀº 8 - 85 °³¿ù(median : 37)À̾ú½À´Ï´Ù.

Hepatogastroenterology 2008

BACKGROUND/AIMS: With the improvement of the outcome after esophagectomy for esophageal cancer, patients with metachronous gastric cancer (MGC) in the reconstructed thoracic stomach have been observed in clinical practice. This study is a report of experiences with MGC with an emphasis on clinical pictures and treatment results. METHODOLOGY: Medical records were reviewed of 728 patients who underwent surgery for esophageal cancer at Samsung Medical Center between 1994 and 2004. MGC was defined as follows; (1) diagnosed more than 6 months after esophagectomy, (2) squamous cell carcinoma in histology of the surgically resected esophagus, (3) adenocarcinoma in histology of the stomach biopsy or surgical specimen. The clinicopathologic characteristics of MGC were evaluated. RESULTS: Eight patients (1.1%) of 728 patients were diagnosed with MGC. All patients were male and had a history of active smoking and drinking. The median age at the time of diagnosis of MGC was 67.8 years old (range: 62-76). Three patients (37.5%) were asymptomatic. Two patients (25%) complained of epigastric pain and 3 patients (37.5%) complained of obstructive symptoms including regurgitation, aspiration, dysphagia, and vomiting. The median interval between diagnosis of MGC and esophagectomy was 37 months (range: 8-85). Three MGCs (37.5%) were detected by endoscopic examination but not by computed tomography (CT). Three patients (37.5%) received surgery and were alive without recurrence for 12, 18 and 63 months respectively. One patient (12.5%) received radiation therapy and was alive for 69 months. Four patients (50%) received no treatment because of follow-up loss in 2 patients (25%) and death within days of MGC diagnosis in 2 patients (25%). CONCLUSIONS: Favorable outcomes can be obtained by active treatment in patients with MGC after esophagectomy. Regular endoscopic follow-up is important for early detection and more effective treatment of MGC, especially in areas where the incidence of gastric cancer is high.


6. Early gastric tube cancers

½Äµµ¾Ï ¼ö¼ú ÈÄ Á¤±âÀûÀÎ ³»½Ã°æ °Ë»ç¸¦ ½ÃÇàÇϸé gastric tube cancerµµ ºñ±³Àû Á¶±â¿¡ ¹ß°ßÇÒ ¼ö ÀÖ½À´Ï´Ù. ¾Æ·¡¿¡ ÁÁÀº ¿¹µéÀÌ ÀÖ½À´Ï´Ù.


7. Advanced gastric tube cancers

Gastric tube cancerÀÇ ¿¹ÈÄ°¡ ³ª»Û ÀÌÀ¯´Â ÁøÇàµÈ »óÅ¿¡¼­ ¹ß°ßµÇ±â ¶§¹®ÀÔ´Ï´Ù (¾Æ·¡ »çÁø ÂüÁ¶). À§¾ÏÀÌ ÈçÇÑ ¿ì¸®³ª¶ó¿¡¼­´Â ½Äµµ¾Ï ¼ö¼ú ÈÄ¿¡µµ Á¤±âÀûÀÎ À§³»½Ã°æ °Ë»ç°¡ ÇÊ¿äÇÒ °ÍÀ¸·Î »ý°¢ÇÕ´Ï´Ù.

½Äµµ¾Ï ¼ö¼ú ÈÄ gastric tube¿¡¼­ º¸¸¸ 4Çü ÁøÇ༺ À§¾ÏÀÌ Áø´ÜµÈ »ç·Êµµ ÀÖ¾ú½À´Ï´Ù.


8. Gastric tube cancerÀÇ ¼ö¼úÀû ȤÀº ³»½Ã°æÀû Ä¡·á

Gastric tube cancerÀÇ Ç¥ÁØ Ä¡·á´Â ¼ö¼úÀÔ´Ï´Ù. ±×·¯³ª ÀÏÂï ¹ß°ßµÇ¸é ³»½Ã°æ Ä¡·á¸¦ ÇÒ ¼ö ÀÖ½À´Ï´Ù. ¾Æ·¡ Keio ´ëÇÐÀÇ º¸°í¿¡¼­µµ ¼ö¼ú°ú EMRÀÌ ¼¯¿© ÀÖ½À´Ï´Ù.

Ann Thorac Surg 2004

Gastric tube cancer¿¡ ´ëÇÑ ESD¸¦ ½ÃÇàÇÏ´Â ¿¹°¡ Áõ°¡µÇ°í ÀÖ½À´Ï´Ù.

Gastric tube high grade dysplasia¿¡ ´ëÇÑ ESD¸¦ °æÇèÇÑ ÀûÀÌ ÀÖ½À´Ï´Ù.

ÀϺ»¿¡¼­ gastric tube cancer ESD¿¡ ´ëÇÑ case series¸¦ º¸°íÇÑ ¹Ù ÀÖ½À´Ï´Ù´Ù.

Endoscopy 2009


[A difficult case]

13 years after Ivor Lewis operation and chemotherapy for upper esophageal cancer (squamous cell carcinoma, pT3N1), gastric tube cancer was found at 37 cm from the incisor teeths. Biopsy showed tubular adenocarcinoma, moderately differentiated with focal poorly differentiated component.

Based on the endoscopic findings (depressed lesion, converging folds) and histologic findings, I recommended surgery. However, the surgeon recommended performing ESD due to the high surgical risk. ESD was done.


ESD: Early gastric carcinoma
1. Location : Intrathoracic stomach, IT 37cm
2. Gross type : EGC type IIa+IIb
3. Histologic type : tubular adenocarcinoma, moderately differentiated, >> tubular adenocarcinoma, poorly differentiated (poorly cohesive)
4. Histologic type by Lauren : mixed
5. Size of carcinoma : (1) longest diameter,14 mm (2) vertical diameter, 18 mm
6. Depth of invasion : invades submucosa, (depth of sm invasion : 2000 §­) (pT1b)
7. Resection margin : involved deep resection margin by carcinoma, safety margin : distal 4 mm, proximal 1 mm, anterior 4 mm, posterior 2 mm, deep 0 §­
8. Lymphatic invasion : present (+++)
9. Venous invasion : not identified(N)
10. Perineural invasion : not identified(N)
11. Microscopic ulcer : absent
12. Histologic heterogeneity: present

Based on the pathology, surgery is necessary. The problem is the surgical risk. Surgical consultation was done. I explained the situation to the patient in detail.

¾î´À Á¤µµ ¿ì·ÁÇÑ ¹Ù¿´Áö¸¸ ¾Æ½¬¿î °á°ú¿´½À´Ï´Ù.

ºñ±³Àû ÀÛÀº Á¶±âÀ§¾ÏÀÌÁö¸¸ ÇÔ¸ôÇüÀÌ°í Á¶Á÷°Ë»ç¿¡¼­ ¹ÌºÐÈ­ ¿ä¼Ò°¡ ÀÖ´Â °ÍÀ¸·Î ³ª¿Í ¼ö¼úÀû Ä¡·á°¡ ÇÊ¿äÇÑ »óȲÀ̾ú½À´Ï´Ù. ±×·¯³ª ½Äµµ¾Ï ¼ö¼úÀ» ¹ÞÀ¸½Å ºÐÀÌ°í °Ô´Ù°¡ ÀÎÈÄºÎ¾Ï ¹æ»ç¼± Ä¡·á ÇϽŠºÐÀ̽ùǷΠÀ§ ¼ö¼úÀ» ÇÏ¸é ½Äµµ¿Í ÀåÀ» ¿¬°áÇØ¾ß Çϴµ¥ ½ÄµµÀÇ ´ëºÎºÐÀÌ ¾ø¾î¼­ ¸Å¿ì À§ÇèÇÏ°í Å« ¼ö¼úÀÌ µÉ ¼ö ¹Û¿¡ ¾ø´Â »óȲÀÎ °Íµµ »ç½ÇÀ̾ú½À´Ï´Ù. µû¶ó¼­ ¼ö¼ú¿¡ µû¸¥ À§Ç輺ÀÌ ¸Å¿ì ³ô¾Æ¼­ Àß »óÀÇÇÏ¿© Ä¡·á¹ýÀ» ¼±ÅÃÇÏ´Â ¼ö ¹Û¿¡ ¾ø´Ù°í ¼³¸íµå·È½À´Ï´Ù. µû¶ó¼­ ÁÖ Áø·á°úÀÎ ÈäºÎ¿Ü°ú¿Í »óÀǸ¦ ÇÏ¿´°í ÀÏ´Ü ³»½Ã°æ Ä¡·á (ESD)¸¦ ÇØ º¼ °ÍÀ» ±ÇÀ¯¹Þ¾Æ ½Ã¼úÀ» ¹Þ¾Ò½À´Ï´Ù. À§¾ÏÀ̱â´Â ÇÏÁö¸¸ À§Ä¡°¡ Èä°­³»¿´±â ¶§¹®¿¡ »ó´çÈ÷ °í³­À̵µ ½Ã¼úÀ̾ú½À´Ï´Ù¸¸ ´ÙÇེ·´°Ô ³»½Ã°æ ½Ã¼úÀº Àß µÇ¾ú½À´Ï´Ù. ±×·±µ¥ ³»½Ã°æÀ¸·Î ÀýÁ¦ÇÑ Ç¥º»¿¡ ´ëÇÑ ÃÖÁ¾ º´¸®°á°ú¿¡¼­ ¼¼Æ÷Çü, ±íÀÌ, ¹üÀ§, ¸²ÇÁ°ü/Ç÷°ü¿¡ ¸ðµÎ ¹®Á¦°¡ ¾ø¾î¾ß Çϴµ¥ ¾Æ½±°Ôµµ ¹®Á¦°¡ »ó´çÈ÷ ÀÖ´Â °ÍÀ¸·Î ³ª¿Ô½À´Ï´Ù. (1) Á¶Á÷Çü¿¡¼­ ¹ÌºÐÈ­ ¿ä¼Ò°¡ ¼¯¿© ÀÖ°í (»çÀü¿¡ ¾Ë°í ÀÖ´ø ¹ÙÀÓ) (2) Á¦2ÃþÀÎ Á¡¸·ÇÏÃþ¿¡ ±í°Ô ħÀ±µÇ¾î ÀÖ°í, (3) ÀýÁ¦º¯¿¬ ¾ç¼ºÀÌ°í, (4) Á¾¾çÀÌ ¸²ÇÁ°ü ħÀ±ÀÌ ¶Ñ·ÈÇÏ¿´½À´Ï´Ù. Áï ¼ö¼úÀÌ ÇÊ¿äÇÑ °ÍÀ¸·Î ³ª¿Ô½À´Ï´Ù.

º´¸®°á°ú¿¡ ¹®Á¦°¡ ¾øÀ» ¶§ Àç¹ß·üÀÌ 5% Á¤µµÀε¥ ¹ÝÇÏ¿©, ÇöÀçÀÇ Àç¹ß À§ÇèÀº ÈξÀ ÈξÀ ´õ ³ô½À´Ï´Ù. Àç¹ßÇÏ¸é ¿ÏÄ¡ÀÇ ±âȸ´Â ÈçÄ¡ ¾Ê½À´Ï´Ù. µû¶ó¼­ ¼ö¼úÀÌ ÇÊ¿äÇÕ´Ï´Ù.

¹®Á¦´Â ¼ö¼ú¿¡ µû¸¥ À§Ç輺ÀÔ´Ï´Ù. ÀϹÝÀûÀÎ ºÐµé°ú ¸¶Âù°¡Áö·Î Àü½Å¸¶Ãë¿¡ µû¸¥ À§Çè, ÅëÁõ, ¼ö¼úÀÇ ÇÕº´Áõ, ¼ö¼ú ÈÄ »îÀÇ Áú ÀúÇÏ µîÀÇ ¾î·Á¿î Á¡ »Ó¸¸ ¾Æ´Ï¶ó °ú°Å ½Äµµ¾ÏÀ¸·Î ¼ö¼úÇÏ¿© ´ëºÎºÐÀÇ ½Äµµ¸¦ Á¦°ÅÇÏ¿´°í Èä°­ ³»¿¡ À§Ä¡ÇÑ À§¿¡¼­ ¾ÏÀÌ ¹ß»ýÇÏ¿´±â ¶§¹®¿¡ ¼ö¼ú¿¡ µû¸¥ À§Ç輺Àº ¸Å¿ì ³ô½À´Ï´Ù. ÇöÀç ¾ÏÀÌ ³²¾ÆÀÖ´Ù´Â Áõ°Å°¡ ÀÖ¾î ¼ö¼úÀ» ±ÇÇÏ´Â °ÍÀº ¾Æ´Õ´Ï´Ù. ÀÏ´Ü ³»½Ã°æÀ¸·Î´Â º¸ÀÌ´Â ¾ÏÀº Á¦°ÅÇß½À´Ï´Ù. ´ÜÁö º´¸® °á°ú¿¡¼­ Àç¹ßÀ§ÇèÀÌ ¾ÆÁÖ ¸¹ÀÌ ³ô´Ù°í ³ª¿Ô±â ¶§¹®¿¡ ¼ö¼úÀ» ±ÇÇÏ´Â °ÍÀÔ´Ï´Ù. ¼ö¼úÀ» Çغ¸¸é ´«¿¡ º¸ÀÏ Á¤µµÀÇ ¾ÏÀÌ ³²¾ÆÀÖ´Â °æ¿ìµµ ÀÖ°í ±×·¸Áö ¾ÊÀº °æ¿ìµµ ÀÖ½À´Ï´Ù. ÀÏ´Ü ¼ö¼úÀ» ±ÇÇÒ ¼ö ¹Û¿¡ ¾ø´Â »óȲÀÌ°í ¼ö¼úÀÇ À§Ç輺À» °í·ÁÇÑ Ãß°¡ ÆÇ´ÜÀº ÈäºÎ¿Ü°ú¿¡ ÀÇ·ÚÇÒ ¼ö ¹Û¿¡ ¾ø½À´Ï´Ù.

°èȹ: ÈäºÎ ¿Ü°ú ÀÇ·Ú (½Äµµ¾Ï ¼ö¼ú ÈÄ intrathoracic gastric cancer¿¡ ´ëÇÑ ESD¸¦ ½ÃÇàÇÏ¿´À¸³ª ÃÖÁ¾ º´¸® °á°ú deep SM invasion, vertical margin positive, lymphatic invasion (+++) ¼Ò°ßÀ¸·Î ³ª¿Í ¼ö¼úÀû Ä¡·á¸¦ À§ÇÏ¿© ÀǷڵ帳´Ï´Ù. ¼ö¼ú À§Ç輺ÀÌ ¸Å¿ì ³ôÀº ºÐÀ̹ǷΠ±Í°úÀû »ó´ãÀ» ºÎŹµå¸³´Ï´Ù.)


9. Clipping for localization

¼ö ³â Àü ½Äµµ¾ÏÀ¸·Î ¼ö¼úÇÏ¿© ´ÙÀ½°ú °°Àº °á°ú¸¦ ¾òÀº ȯÀÚÀÔ´Ï´Ù.


Invasive squamous cell carcinoma
7x5 cm
Extension to perimuscular adventitia
Metastasis to 1 out of 108 regional lymph nodes.

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[Cases]

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Esophagus and upper stomach, Ivor Lewis operation:
Invasive squamous cell carcinoma, moderately differentiated, distal esophagus:
1) tumor size: 4.5x3 cm
2) extension to perimuscular adventitia (pT3)
3) endolymphatic tumor emboli: not identified
4) perineural invasion: not identified
5) negative resection margins (proximal, 6.5 cm ; distal, 4 cm)
6) metastasis to 5 out of 52 regional lymph nodes (pN2) (5/52: "LC omentum", 0/0; "RRLN", 0/1; "LRLN", 0/6; "LD", 0/1; "5", 0/6; "7", 0/6; "8u", 0/2; "R9", 0/2; "L9", 0/1; "R10", 0/2; "L10", 0/4; "G1", 0/7; "G2", 0/2; "G3", 5/12)

½Äµµ¾Ï Ä¡·á´Â Àß µÇ¾ú´Âµ¥ 6³â ÈÄ À§¾ÏÀÌ ¹ß°ßµÇ¾ú½À´Ï´Ù. ¸Å¿ì À۾ұ⠶§¹®¿¡ ESD·Î Ä¡·áÇÏ¿´½À´Ï´Ù.


ESD. EGC
1. Location : antrum, anterior wall
2. Gross type : EGC type IIc
3. Histologic type : tubular adenocarcinoma, well differentiated
4. Histologic type by Lauren : intestinal
5. Size : (1) longest diameter, 6mm (2) vertical diameter, 6mm
6. Depth of invasion : invades mucosa (pT1a)
7. Resection margin: free from carcinoma (N), safety margin: proximal 10mm, distal 10mm, anterior 6mm, posterior 12mm
8. Lymphatic invasion : not identified
9. Venous invasion : not identified
10. Perineural invasion : not identified
11. Microscopic ulcer : absent
12. Histologic heterogeneity : absent


[References]

© ÀÏ¿ø³»½Ã°æ±³½Ç ¹Ù¸¥³»½Ã°æ¿¬±¸¼Ò ÀÌÁØÇà. EndoTODAY Endoscopy Learning Center. Lee Jun Haeng.