| 特集名 | 悪性胆道狭窄に対する診断・治療の進歩 | |
|---|---|---|
| 題名 | 胆道癌に対する外科治療 | |
| 発刊年月 | 2014年 08月 | |
| 著者 | 水野 隆史 | 名古屋大学大学院腫瘍外科 |
| 著者 | 江畑 智希 | 名古屋大学大学院腫瘍外科 |
| 著者 | 横山 幸浩 | 名古屋大学大学院腫瘍外科 |
| 著者 | 伊神 剛 | 名古屋大学大学院腫瘍外科 |
| 著者 | 菅原 元 | 名古屋大学大学院腫瘍外科 |
| 著者 | 山口 淳平 | 名古屋大学大学院腫瘍外科 |
| 著者 | 梛野 正人 | 名古屋大学大学院腫瘍外科 |
| 【 要旨 】 | 胆道癌において外科治療は根治が期待できる治療法である．腫瘍の局在により膵頭十二指腸切除または胆管切除を伴う肝葉切除が標準手術となるが，局所進行症例に対し三区域切除，血管合併切除，肝膵十二指腸切除といった拡大手術も適応とされる．R0切除が達成されても，その長期予後は未だ満足のできるものではなく，補助化学療法の開発に期待が寄せられている．欧米ではR1切除例やリンパ節陽性症例に対し補助治療が考慮されているが，これまでに前向き比較試験で有効性が報告されたregimenは存在していない．集学的治療の開発により奏効例でのconversion terapyとしての外科切除の可能性が期待される． | |
| Theme | Malignant Biliary Stricture -- Recent Advancements on Diagnosis & Treatment | |
|---|---|---|
| Title | Surgical Therapy for Biliary Malignancy | |
| Author | Takashi Mizuno | Department of Surgical Oncology, Nagoya University Graduate School of Medicine |
| Author | Tomoki Ebata | Department of Surgical Oncology, Nagoya University Graduate School of Medicine |
| Author | Yukihiro Yokoyama | Department of Surgical Oncology, Nagoya University Graduate School of Medicine |
| Author | Takeshi Ikami | Department of Surgical Oncology, Nagoya University Graduate School of Medicine |
| Author | Hajime Sugawara | Department of Surgical Oncology, Nagoya University Graduate School of Medicine |
| Author | Junpei Yamaguchi | Department of Surgical Oncology, Nagoya University Graduate School of Medicine |
| Author | Masato Nagino | Department of Surgical Oncology, Nagoya University Graduate School of Medicine |
| [ Summary ] | Surgical resection is the only promising therapy for the cure of biliary malignancies. Pancreaticoduodenectomy or major hepatic resection with extrahepatic bile duct resection is indicated as the standard procedure, depending on tumor location. Recent advances in surgical techniques and knowledge have increased the number of procedures available. These include bilateral trisectionectomy, combined portal vein resection, combined portal vein and hepatic artery resection, as well as hepatopancreaticoduodenectomies, which are being adapted to treatment of an extensive range of diseases. In leading hepatobiliary centers, patientsʼ postoperative courses are reported on and it is decided if treatment was acceptable compared with that provided in unresectable cases. Even if the patients undergo R0 resection, their long term survival may still be unsatisfactory. While efficacious adjuvant treatment regimens are under development, at this time, there is no promising regimen being tested in prospective phase III randomized trials. Some meta-analysis has shown the efficacy of adjuvant chemoand chemoradiotherapy in the R1 or nodes of positive patients. With improvement being made in more promising regimens, more patients may undergo surgery for locally advanced, initially unresectable conditions. |
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