臨床外科64巻6号

2009年06月発行

特集 消化器癌外科治療のrandomized controlled trial

胃癌外科治療におけるrandomized controlled trial

著者： 比企直樹¹ 山口俊晴¹ 佐野武¹ 福永哲¹ 大山繁和¹ 山田和彦¹ 藤本佳也¹ 大矢雅敏¹ 上野雅資¹ 黒柳洋弥¹ 斉浦明夫¹ 古賀倫太郎¹ 関誠¹

所属機関： ¹癌研有明病院消化器外科

ページ範囲：P.757 - P.763

要旨：胃癌治療において，手術に頼った治療には限界があることが近年のRCTで確認された．これらのRCTの代表としてJCOG9501（D2リンパ節郭清vs. D3リンパ節拡大郭清）で大動脈周囲リンパ節拡大郭清の意義が否定され，JCOG9502（下部食道浸潤胃癌に対する開胸＋開腹手術vs. 開腹手術）では下縦隔の拡大郭清の意義が否定された．一方，術後補助化学療法の領域ではACTS-GCにおいて，術後補助化学療法の有用性がインパクトのある結果として発表され，胃癌術後の予後改善という点において，大きな貢献をした．ステージⅢ以上の症例ではさらなる予後改善が目指されるが，いずれにせよD2リンパ節郭清を伴う胃癌の標準治療と化学療法を組み合わせた集学的治療のRCTが多く行われてゆくだろう．

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