臨牀消化器内科 Vol.32 No.6(2-3-4)


特集名 高齢者・超高齢者消化管癌の内視鏡治療
題名 各論(3)大腸癌 d.外科的治療の適応と実際
発刊年月 2017年 06月
著者 福長 洋介 がん研有明病院消化器外科
著者 上野 雅資 がん研有明病院消化器外科
著者 藤本 佳也 がん研有明病院消化器外科
著者 小西 毅
著者 秋吉 高志 がん研有明病院消化器外科
著者 長嵜 寿矢 がん研有明病院消化器外科
【 要旨 】 日本人の高齢化が進み,また食生活の欧米化に伴う大腸癌罹患率,死亡率が進むなか,高齢大腸癌患者に対する治療は実臨床において非常に重要かつ真剣に取り組むべきテーマの一つである.高齢者はさまざまな基礎疾患を有することが多いとされ,術前にいろいろな角度から評価する必要がある.簡単に指数として出せて,かつ術後合併症,さらには長期予後の予測にも有用であるというような指標も報告されているので,これらをうまく使って適応を考慮すべきである.また手術術式あるいは術中の指標を評価する方法も各種報告がある.当科では低侵襲な腹腔鏡手術が有用であろうと考えているが,その習熟や病院の環境にもよるので適切に判断する必要がある.さらに内視鏡治療と根治的外科手術の境界を埋めるような低侵襲治療も開発中である.
患者個々の背景因子,腫瘍因子を考慮して総合的に外科的治療の適応を決定すべきである.
Theme Endoscopic Treatment for Elderly Patients with Gastro‒intestinal Cancer
Title Surgical Treatment for Colorectal Cancer in Elderly Patient
Author Yosuke Fukunaga Department of Gastroenterological Surgery, The Cancer Institute Hospital of JFCR
Author Masashi Ueno Department of Gastroenterological Surgery, The Cancer Institute Hospital of JFCR
Author Yoshiya Fujimoto Department of Gastroenterological Surgery, The Cancer Institute Hospital of JFCR
Author Tsuyoshi Konishi
Author Takashi Akiyoshi Department of Gastroenterological Surgery, The Cancer Institute Hospital of JFCR
Author Toshiya Nagasaki Department of Gastroenterological Surgery, The Cancer Institute Hospital of JFCR
[ Summary ] One of the recent problems relating to cancer incidence and mortality is the increasing incidence of patients having colorectal cancer owing to the high age trend in Japan. Therapeutic strategies in such patients should be considered based on various characteristics of this age group who likely have several comorbidities, such as heart disease, respiratory disorders, and dementia, among others. We have to refer several indications which would expect their postoperative complications and long‒term outcomes. Those indices have been already reported as far as relating surgical outcomes of high age patients not limiting to colorectal cancer. Some of those are constructed by not only preoperative factors but also intraoperative data. Surgeons dealing with elderly patients having colorectal cancer need to choose the easiest and most effective index applicable. Laparoscopic surgery as a minimally invasive surgery is considered a relevant tool in our institution to decrease postoperative complications especially in elderly patients having colorectal cancer. We are also pursuing and developing further less invasive ways to help manage those patients who are classified as borderline candidates with respect to eligibility to undergo either endoscopic or surgical therapy.
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