臨牀消化器内科 Vol.34 No.12(2-1)


特集名 遭遇の機会が増えたIPMN/膵囊胞―現状と課題
題名 IPMN／膵囊胞の診療 (1) 国際診療ガイドラインによる診断とサーベイランスの現状と問題点
発刊年月 2019年 11月
著者 渡邉 雄介 九州大学大学院医学研究院臨床・腫瘍外科
著者 大塚 隆生 九州大学大学院医学研究院臨床・腫瘍外科
著者 森 泰寿 九州大学大学院医学研究院臨床・腫瘍外科
著者 池永 直樹 九州大学大学院医学研究院臨床・腫瘍外科
著者 仲田 興平 九州大学大学院医学研究院臨床・腫瘍外科
著者 中村 雅史 九州大学大学院医学研究院臨床・腫瘍外科
【 要旨 】 2017年に「膵管内乳頭粘液性腫瘍（intraductal papillary mucinous neoplasm；IPMN）国際診療ガイドライン」が改訂され，おもにIPMNの切除基準と経過観察法が修正された．切除基準では，high‒risk stigmataとworrisome featuresの項目や内容が見直され，壁在結節高のカットオフ値が導入されるなど，より実臨床に則した基準となった．経過観察法では，IPMNの囊胞径に応じた経過観察間隔がより詳しく記載されたが，この経過観察法はIPMN併存膵癌発症のリスクは考慮していないため，IPMNの進展と同時にIPMN併存膵癌の出現に対する注意も必要である．本稿では，2017年改訂版「IPMN国際診療ガイドライン」に基づく切除適応と経過観察の現状と問題点を，海外の他のガイドラインとも比較し，概説する．
Theme IPMN/Pancreatic Cyst as an Increasing Common Disease -- Current Status and Issues
Title Revised Points of the International Consensus Guidelines 2017 for the Management of Intraductal Papillary Mucinous Neoplasm of the Pancreas
Author Yusuke Watanabe Department of Surgery and Oncology, Graduate School of Medical Sciences, Kyushu University
Author Takao Ohtsuka Department of Surgery and Oncology, Graduate School of Medical Sciences, Kyushu University
Author Yasuhisa Mori Department of Surgery and Oncology, Graduate School of Medical Sciences, Kyushu University
Author Naoki Ikenaga Department of Surgery and Oncology, Graduate School of Medical Sciences, Kyushu University
Author Kohei Nakata Department of Surgery and Oncology, Graduate School of Medical Sciences, Kyushu University
Author Masafumi Nakamura Department of Surgery and Oncology, Graduate School of Medical Sciences, Kyushu University
[ Summary ] The International association of pancreatology (IAP) published the revision of international consensus guidelines for the management of intraductal papillary mucinous neoplasm (IPMN) in 2017. In the revised guidelines, several alterations were made in surgical indication and surveillance strategies. The main alteration in surgical indication was the introduction of the mural nodule size as a predictive factor and recommendations became more practical and conservative. Regarding the surveillance strategy for non‒resected IPMN, the intervals of surveillance according to the size stratification were mentioned more in detail. However, this strategy did not take into account the risk of the metachronous development of concomitant pancreatic ductal adenocarcinoma during surveillance for IPMN without resection. This review article discusses the surgical indication and surveillance strategies for IPMN advocated by the 2017 revised international consensus guidelines. Moreover, international guidelines for the management of IPMN advocated by the European Study Group on Cystic Tumors of the Pancreas and American Gastroenterological Association were introduced and compared with the 2017 revised international consensus guidelines advocated by IAP.
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