臨床外科65巻4号

2010年04月発行

特集 消化器癌neoadjuvant chemotherapyの新展開 〔機能温存〕

進行直腸癌に対する肛門温存外科切除

著者： 端山軍¹ 石原聡一郎¹ 赤羽根拓弥¹ 島田竜¹ 堀内敦¹ 渋谷肇¹ 青柳賀子¹ 中村圭介¹ 山田英樹¹ 野澤慶次郎¹ 松田圭二¹ 渡邉聡明¹

所属機関： ¹帝京大学医学部外科

ページ範囲：P.516 - P.521

要旨：直腸癌を治療するにあたって，根治性とQOLのバランスが重要である．直腸癌は結腸癌に比べて局所再発率が高く，局所再発率のコントロールを行わなければならない．人工肛門の有無により患者のQOLは大きく影響を受け，また人工肛門に抵抗感がある患者は多い．そこで局所のコントロールおよび肛門温存率を上げるため，下部直腸癌に対して術前化学放射線療法を行っている．現在のところ，局所のコントロールに関しては手術単独に比べて良好な成績を得ているという報告があるが，肛門温存率に関してはcontroversialである．今後，併用する化学療法の進歩によるpathological complete response率の上昇や切除marginを縮小することの安全性が確認されることで肛門温存率の上昇を得られる可能性がある．

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