| 特集名 | 胃癌診療2019―現状と課題 | |
|---|---|---|
| 題名 | 胃癌治療の現状と課題 (5) 開腹手術 | |
| 発刊年月 | 2019年 10月 | |
| 著者 | 安福 至 | 岐阜大学腫瘍外科 |
| 著者 | 吉田 和弘 | 岐阜大学腫瘍外科 |
| 著者 | 山口 和也 | 岐阜大学腫瘍外科 |
| 著者 | 棚橋 利行 | 岐阜大学腫瘍外科 |
| 著者 | 今井 健晴 | 岐阜大学腫瘍外科 |
| 著者 | 末次 智成 | 岐阜大学腫瘍外科 |
| 【 要旨 】 | 2018年1月に「胃癌治療ガイドライン」第5版が出版され，開腹手術に関する新たなエビデンスが収載された．第Ⅲ相試験の結果，大彎にかからない上部進行胃癌に対する根治的胃切除術においては脾温存術式の脾摘術に対する非劣性が示された．一方根治切除不能Stage Ⅳ胃癌に対する減量手術は，日韓共同第Ⅲ相試験の結果化学療法単独に対する優越性を示すことができず，その意義は否定された． Stage Ⅳ胃癌に対しては，近年化学療法が奏効した症例に対してR0切除を目指した根治切除を行うconversion therapyの有用性が報告されている．化学療法が奏効した症例を慎重に選択し手術を行うことで，Stage Ⅳであっても治癒を含めた長期生存が期待できる． |
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| Theme | Clinical Diagnosis and Management of Gastric Cancer 2019 -- Current Status and Issues | |
|---|---|---|
| Title | Advances in the Treatment for Gastric Cancer in Advanced Stage: New Evidences Relevant to Open Surgery | |
| Author | Itaru Yasufuku | Department of Surgical Oncology, Gifu University Graduate School of Medicine |
| Author | Kazuhiro Yoshida | Department of Surgical Oncology, Gifu University Graduate School of Medicine |
| Author | Kazuya Yamaguchi | Department of Surgical Oncology, Gifu University Graduate School of Medicine |
| Author | Toshiyuki Tanahashi | Department of Surgical Oncology, Gifu University Graduate School of Medicine |
| Author | Takeharu Imai | Department of Surgical Oncology, Gifu University Graduate School of Medicine |
| Author | Tomonari Suetsugu | Department of Surgical Oncology, Gifu University Graduate School of Medicine |
| [ Summary ] | Japanese Gastric Cancer Treatment Guidelines 5th edition was published recently and new evidence to support open surgery for advanced stage gastric cancer was established. A Phase III clinical trial showed non‒inferiority of spleen preserving total gastrectomy for gastric cancer located in upper third of the stomach which did not invade greater curvature over total gastrectomy with splenectomy. Splenectomy merely caused postoperative complications. Another phase III clinical trial indicated that palliative gastrectomy did not offer survival benefits for gastric cancer patients with non‒curable Stage IV factor. Palliative gastrectomy was likely to increase adverse events in chemotherapy patients and decrease patients' tolerance of chemotherapy. Though the standard treatment for advanced gastric cancer is chemotherapy, several recent reports have shown excellent long term outcomes using conversion therapy. Conversion therapy was defined as a surgical treatment aiming at an R0 resection after chemotherapy for tumors that were originally unresectable or marginally resectable for technical and/or oncological reasons. Conversion therapy may offer survival benefits including even a cure for Stage IV gastric cancer patients. |
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