臨床外科63巻13号

2008年12月発行

特集 外科におけるadjuvant/neoadjuvant chemotherapy update

大腸癌肝転移に対するadjuvant/neoadjuvant chemotherapy

著者： 田中邦哉¹ 高倉秀樹¹ 松山隆生¹ 松尾憲一¹ 武田和永¹ 永野靖彦¹ 遠藤格¹ 市川靖史¹ 嶋田紘¹

所属機関： ¹横浜市立大学大学院消化器病態外科学

ページ範囲：P.1725 - P.1736

要旨：大腸癌に対する化学療法の進歩に伴い，切除困難な肝転移例に対しても術前化学療法によるreductionで切除適応となる症例が散見されるようになった．その切除率は化学療法の奏効度に依存し，高い奏効率のレジメンでは切除率は向上する．この場合の切除成績は診断時に切除可能であった肝転移の成績に匹敵する．ただし，術前化学療法の肝組織毒性および術後臨床経過に及ぼす影響は無視できない問題である．したがって，切除前化学療法には分子標的治療薬，肝動注化学療法などを積極的に応用して短期間に高い奏効率を獲得し，切除適応となった時点で早急に肝切除に踏み切るべきである．一方，肝切除後の補助化学療法の効果は未だエビデンスに乏しく，対象とすべき肝転移grade，レジメン，投与期間などのさらなる検討が必要である．大腸癌肝転移は依然治癒切除率が低率で，切除後再発も高率な疾患である．このため長期予後の獲得には周術期の効果的な化学療法の併用が重要である．

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