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

膵癌外科治療におけるrandomized controlled trial―標準郭清vs拡大郭清

著者： 横山幸浩¹ 二村雄次¹ 梛野正人¹ 共通プロトコールに基づく膵がんの外科的療法の評価に関する研究班¹

所属機関： ¹名古屋大学大学院医学系研究科腫瘍外科

ページ範囲：P.789 - P.794

要旨：膵癌は消化器癌のなかでも最も予後不良な悪性腫瘍の1つで，根治切除術を施行できたものでも5年生存率はわずか10～20％である．これまで膵癌に対して化学療法，放射線療法，分子標的治療，免疫療法など様々な補助療法が試みられているが，外科的治療が未だ唯一根治を得られる治療法である．

　膵癌はいったん発生すると容易に周辺臓器に浸潤し，神経叢浸潤やリンパ節転移を伴うことも多い．そこで周辺組織を広範に切除するいわゆる「拡大郭清手術」と膵臓に付属する組織のみを切除する「標準郭清手術」の比較を行ったrandomized controlled trial（RCT）がいくつか施行されてきた．しかしいずれの試験でも拡大手術は生存率向上に寄与することはなかった．したがって膵癌に対しては手術的治療のみでは不十分で，何らかの補助療法を組み合わせる必要がある．

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