鈴木 和光

BACKGROUND: This study aimed to investigate the laparoscopic gastrectomy (LG) performance of non-Endoscopic Surgical Skill Qualification System (ESSQS)-qualified surgeons under the ESSQS-qualified surgeon guidance and compare oncological outcomes of gastric cancer to LG performed by the ESSQS-qualified surgeons. METHODS: This study enrolled 1,030 patients diagnosed with both clinical and pathological stage ≤ III gastric cancer and undergoing LG from January 2009 to June 2019. ESSQS-qualified surgeons served as the operator or the instructive assistant in all LG procedures involving them. A propensity score-matched analysis was used to retrospectively compare the long-term outcomes between the ESSQS-qualified and non-ESSQS-qualified surgeons. RESULTS: Each group included 315 pairs after propensity score matching. The 3-year recurrence-free survival rates were 84.4% and 81.7% in the non-ESSQS and ESSQS groups, respectively. The difference was 2.7% (95% confidence interval: - 3.20%-8.44%, P < 0.001), and the non-ESSQS group statistically demonstrated noninferiority as the lower 95% confidence limit was greater than the prespecified margin of -10%, indicating the achieved primary endpoint. No significant differences in 5-year recurrence-free survival (non-ESSQS: 78.5% vs. ESSQS: 77.4%, P = 0.627) and 5-year overall survival (non-ESSQS: 80.9% vs. ESSQS: 79.3%, P = 0.475) were found between the two groups. The oncological outcomes stratified according to the presence of pathological stage I, II, and III disease did not significantly differ between the two groups. CONCLUSIONS: LG performed by non-ESSQS-qualified surgeons achieved comparable oncological outcomes to the ESSQS-qualified surgeons, as long as ESSQS-qualified surgeons provided intraoperative instructions, in a high-volume center.

症例は49歳，女性．10年前より近医で貧血・低蛋白血症，胃内に多発するポリープを指摘されていた．2014年3月に嘔吐にて当院救急外来を受診．貧血・低蛋白血症を認め，緊急入院となった．上部消化内視鏡検査では，胃全体にポリープが多発し，前庭部では幽門を覆い通過障害をきたしていた．腹部造影CT検査で，胃体上部から幽門にかけて，造影効果を伴う腫瘤が胃の内腔を占拠し，胃内口側に液貯留を認めた．絶食と輸血による内科的治療にて全身状態が改善した後に，腹腔鏡下胃全摘術を実施した．切除標本においては，胃全体にびまん性浮腫状のポリポーシスを認めた．組織学的に胃限局性若年性ポリポーシスを診断された．術後合併症なく経過し，貧血・低蛋白血症はともに改善した．胃限局性若年性ポリポーシスは稀な疾患であるが，今回腹腔鏡下胃全摘術を行い，良好な経過をたどった症例を経験したので若干の文献的考察を加えて報告する．