臨床外科69巻12号

2014年11月発行

特集 外科切除適応の境界領域—Borderline resectable cancerへの対応

がん種別の治療指針

直腸癌

著者： 永井雄三¹ 清松知充¹ 渡邉聡明¹

所属機関： ¹東京大学腫瘍外科

ページ範囲：P.1346 - P.1350

文献概要

【ポイント】

◆局所進行直腸癌の治療の原則はR0切除を達成することであり，浸潤が疑われれば他臓器合併切除が考慮される．

◆術前放射線化学療法は局所進行直腸癌のR0切除率の向上に寄与する可能性がある．

◆全身化学療法により遠隔転移を含めた切除不能病変が切除可能となるconversion therapyの概念が注目されている．

参考文献

1）大腸癌研究会（編）：大腸癌治療ガイドライン医師用2014年版，金原出版，2014

2）Quirke P, Durdey P, Dixon MF, et al：Local recurrence of rectal adenocarcinoma due to inadequate surgical resection. Histopathological study of lateral tumour spread and surgical excision. Lancet 2：996-999, 1986

3）Trakarnsanga A, Gonen M, Weiser MR, et al：What is the significance of the circumferential margin in locally advanced rectal cancer after neoadjuvant chemoradiotherapy? Ann Surg Oncol 20：1179-1184, 2013

4）Hwang MR, Park JW, Jeong SY, et al：Prognostic impact of circumferential resection margin in rectal cancer treated with preoperative chemoradiotherapy. Ann Surg Oncol 4：1345-1351, 2014

5）Bhangu A, Ali SM, Darzi A, et al：Meta-analysis of survival based on resection margin status following surgery for recurrent rectal cancer. Colorectal Dis 14：1457-1466, 2012

6）Dahlberg M, Glimelius B, Påhlman L：Improved survival and reduction in local failure rates after preoperative radiotherapy：evidence for the generalizability of the results of Swedish Rectal Cancer Trial. Ann Surg 229：493-497, 1999

7）Kapiteijn E, Marijnen CA, Nagtegaal ID, et al：Preoperative radiotherapy combined with total mesorectal excision for resectable rectal cancer. N Engl J Med 345：638-646, 2001

8）National Comprehensive Cancer Network：NCCN Clinical Practice Guidelines in Oncology （NCCN Guidelines）, Rectal Cancer, Version 4, 2013

9）Ishiguro S, Akasu T, Fujita S, et al：Pelvic exenteration for clinical T4 rectal cancer：oncologic outcome in 93 patients at a single institution over a 30-year period. Surgery 145：189-195, 2009

10）Mohan HM, Evans MD, Larkin JO, et al：Multivisceral resection in colorectal cancer：a systematic review. Ann Surg Oncol 20：2929-2936, 2013

11）Luo HL, Tsai KL, Lin SE, et al：Outcome of urinary bladder recurrence after partial cystectomy for en bloc urinary bladder adherent colorectal cancer resection. Int J Colorectal Dis 28：631-635, 2013

12）高橋慶一，山口達郎，松本　寛，他：前立腺浸潤を伴う直腸癌に対する前立腺部分切除術/前立腺全摘術．大腸癌Frontier 2：244-247, 2009

13）斎藤典男，酒井康之，駒井好信，他：隣接臓器合併切除を伴う拡大切除．外科75：250-256, 2013

14）Kato T, Yasui K, Hirai T, et al：Therapeutic results for hepatic metastasis of colorectal cancer with special reference to effectiveness of hepatectomy：analysis of prognostic factors for 763 cases recorded at 18 institutions. Dis Colon Rectum 46：S22-31, 2003

15）Hirosawa T, Itabashi M, Ohnuki T, et al：Prognostic factors in patients undergoing complete resection of pulmonary metastases of colorectal cancer：a multi-institutional cumulative follow-up study. Surg Today 43：494-499, 2013

16）Adam R, Delvart V, Pascal G, et al：Rescue surgery for unresectable colorectal liver metastases downstaged by chemotherapy：a model to predict long-term survival. Ann Surg 240：644-657, 2004

17）Bokemeyer C, Bondarenko I, Hartmann JT, et al：Efficacy according to biomarker status of cetuximab plus FOLFOX-4 as first-line treatment for metastatic colorectal cancer：the OPUS study. Ann Oncol 22：1535-1546, 2011

18）Van Cutsem E, Köhne CH, Láng I, et al：Cetuximab plus irinotecan, fluorouracil, and leucovorin as first-line treatment for metastatic colorectal cancer：updated analysis of overall survival according to tumor KRAS and BRAF mutation status. J Clin Oncol 29：2011-2019, 2011

19）Douillard JY, Siena S, Cassidy J, et al：Randomized, phase III trial of panitumumab with infusional fluorouracil, leucovorin, and oxaliplatin（FOLFOX4）versus FOLFOX4 alone as first-line treatment in patients with previously untreated metastatic colorectal cancer：the PRIME study. J Clin Oncol 28：4697-4705, 2010

20）Ozawa H, Kotake K, Kobayashi H, et al：Prognostic factors for peritoneal carcinomatosis originating from colorectal cancer：an analysis of 921 patients from a multi-institutional database. Surg Today, 2013［Epub ahead of print］