臨床外科69巻12号

2014年11月発行

臨床の疑問に答える「ドクターAのミニレクチャー」・30

消化器がんの手術—リンパ節郭清で再発が減るか

著者： 安達洋祐¹

所属機関： ¹久留米市大学医学部外科

ページ範囲：P.1398 - P.1401

文献概要

素朴な疑問

　がんは浸潤してリンパ節や臓器に転移する．がん手術の原則は原発巣の完全切除とリンパ節の予防的摘出であり，リンパ節郭清は範囲が広く個数が多いほどよいと考えられてきた．拡大リンパ節郭清の先陣を切った乳がん手術は腋窩郭清の縮小や省略に向かっているが，消化器がん手術は今後どうなるのだろうか．リンパ節郭清を行わないと再発は増えるのだろうか．

参考文献

1）Bonenkamp JJ（Netherlands）：Randomised comparison of morbidity after D1 and D2 dissection for gastric cancer in 996 Dutch patients. Lancet 345：745-748, 1995

2）Bonenkamp JJ（Netherlands）：Extended lymph node dissection for gastric cancer. N Engl J Med 340：908-914, 1999

3）Hartgrink HH（Netherlands）：Extended lymph node dissection for gastric cancer：who may benefit? Final results of the randomized Dutch gastric cancer group trial. J Clin Oncol 22：2069-2077, 2004

4）Songun I（Netherlands）：Surgical treatment of gastric cancer：15-year follow-up results of the randomised nationwide Dutch D1D2 trial. Lancet Oncol 11：439-449, 2010

5）Cuschieri A（UK）：Postoperative morbidity and mortality after D1 and D2 resections for gastric cancer：preliminary results of the MRC randomized controlled surgical trial. Lancet 347：995-999, 1996

6）Cuschieri A（UK）：Patient survival after D1 and D2 resections for gastric cancer：long-term results of the MRC randomized surgical trial. Br J Cancer 79：1522-1530, 1999

7）McColloch P（UK）：Gastrectomy with extended lymphadenectomy for primary treatment of gastric cancer. Br J Surg 92：5-13, 2005

8）Degiuli M（Italy）：Randomized clinical trial comparing survival after D1 or D2 gastrectomy for gastric cancer. Br J Surg 101：23-31, 2014

9）Seevaratnam R（Canada）：A meta-analysis of D1 versus D2 lymph node dissection. Gastric Cancer 15：S60-69, 2012

10）Memon MA（Australia）：Meta-analysis of D1 versus D2 gastrectomy for gastric adenocarcinoma. Ann Surg 253：900-911, 2011

11）Yang SH（China）：An evidence-based medicine：review of lymphadenectomy extent for gastric cancer. Am J Surg 197：246-251, 2009

12）Jiang L（China）：Systematic review and meta-analysis of the effectiveness and safety of extended lymphadenectomy in patients with resectable gastric cancer. Br J Surg 101：595-604, 2014

13）Maeta M（Japan）：A prospective pilot study of extended（D3）and superextended para-aortic lymphadenectomy（D4）in patients with T3 or T4 gastric cancer managed by total gastrectomy. Surgery 125：325-331, 1999

14）Sasako M（Japan）：D2 lymphadenectomy alone or with para-aortic nodal dissection for gastric cancer. N Engl J Med 359：453-462, 2008

15）Yonemura Y（Japan）：Randomized clinical trial of D2 and extended paraaortic lymphadenectomy in patients with gastric cancer. Int J Clin Oncol 13：132-137, 2008

16）Chen XZ（China）：Meta-analysis of effectiveness and safety of D2 plus para-aortic lymphadenectomy for resectable gastric cancer. J Am Coll Surg 210：100-105, 2010

17）Marutsuka T（Japan）：Mechanisms of peritoneal metastasis after operation for non-serosa-invasive gastric carcinoma：an ultrarapid detection system for intraperitoneal free cancer cells and a prophylactic strategy for peritoneal metastasis. Clin Cancer Res 9：678-685, 2003

18）Rouffet F（France）：Curative resection for left colonic carcinoma：hemicolectomy vs. segmental colectomy. A prospective, controlled, multicenter trial. Dis Colon Rectum 37：651-659, 1994

19）Kusters M（Netherlands）：A comparison between the treatment of low rectal cancer in Japan and the Netherlands, focusing on the patients of local recurrence. Ann Surg 249：229-235, 2009

20）Georgiou P（UK）：Extended lymphadenectomy versus conventional surgery for rectal cancer：meta-analysis. Lancet Oncol 10：1053-1062, 2009

21）Nagawa H（Japan）：Randomized, controlled trial of lateral node dissection vs. nerve-preserving resection in patients with rectal cancer after preoperative radiotherapy. Dis Colon Rectum 44：1274-1280, 2001

22）Fujita S（Japan）：Postoperative morbidity and mortality after mesorectal excision with and without lateral lymph node dissection for clinical stage Ⅱ or stage Ⅲ lower rectal cancer（JCOG0212）：results from a multicentre, randomised controlled, non-inferiority trial. Lancet Oncol 13：616-621, 2012

23）Benedetti PP（Italy）：Systematic pelvic lymphadenectomy vs. no lymphadenectomy in early-stage endometrial carcinoma：randomized clinical trial. J Natl Cancer Inst 100：1707-1716, 2008

24）May K（UK）：Lymphadenectomy for the management of endometrial cancer. Cochrane Database Syst Rev, CD007585, 2010

25）Nishihara T（Japan）：A prospective randomized trial of extended cervical and superior mediastinal lymphadenectomy for carcinoma of the thoracic esophagus. Am J Surg 175：47-51, 1998

26）Hulscer JB（Netherlands）：Extended transthoracic resection compared with limited transhiatal resection for adenocarcinoma of the esophagus. N Engl J Med 347：1662-1669, 2002

27）Boshier PR（UK）：Transthoracic versus transhiatal esophagectomy for the treatment of esophagogastric cancer：a meta-analysis. Ann Surg 254：894-906, 2011

28）Darling GE（Canada）：Randomized trial of mediastinal lymph node sampling versus complete lymphadenectomy during pulmonary resection in the patient with N0 or N1（less than hilar）non-small cell carcinoma：results of the American College of Surgery Oncology Group Z0030 trial. J Thorac Cardiovasc Surg 14：662-670, 2011

29）Pedrazzoli S（Italy）：Standard versus extended lymphadenectomy associated with pancreatoduodenectomy in the surgical treatment of adenocarcinoma of the head of the pancreas：a multicenter, prospective, randomized study. Ann Surg 228：508-517, 1998

30）Farnell MB（USA）：A prospective randomized trial comparing standard pancreatoduodenectomy with pancreatoduodenectomy with extended lymphadenectomy in resectable pancreatic head adenocarcinoma. Surgery 138：618-628, 2005

31）Yeo CJ（USA）：Pancreaticoduodenectomy with or without distal gastrectomy and extended retroperitoneal lymphadenectomy for periampullary adenocarcinoma, part 2：randomized controlled trial evaluating survival, morbidity, and mortality. Ann Surg 236：355-366, 2002

32）Riall TS（USA）：Pancreaticoduodenectomy with or without distal gastrectomy and extended retroperitoneal lymphadenectomy for periampullary adenocarcinoma, part 3：update on 5-year survival. J Gastrointest Surg 9：1191-1204, 2005

33）Michalski CW（Germany）：Systematic review and meta-analysis of standard and extended lymphadenectomy in pancreaticoduodenectomy for pancreatic cancer. Br J Surg 94：265-273, 2007

34）Pawlik TM（USA）：Feasibility of a randomized trial of extended lymphadenectomy for pancreatic cancer. Arch Surg 140：584-591, 2005

35）Jang JY（Korea）：A prospective randomized controlled study comparing outcomes of standard resection and extended resection, including dissection of the nerve plexus and various lymph nodes, in patients with pancreatic head cancer. Ann Surg 259：656-664, 2014

36）Martelli G（Italy）：A randomized trial comparing axillary dissection to no axillary dissection in older patients with T1N0 breast cancer：results after 5 years of follow-up. Ann Surg 242：1-6, 2005

37）Martelli G（Italy）：Axillary dissection versus no axillary dissection in older patients with T1N0 breast cancer：15-year results of a randomized controlled trial. Ann Surg 256：920-924, 2012

38）Sanghani M（USA）：Impact of axillary lymph node dissection on breast cancer outcome in clinically node negative patients：a systematic review and meta-analysis. Cancer 115：1613-1620, 2009

39）Giuliano AE（USA）：Locoregional recurrence after sentinel lymph node dissection with or without axillary dissection in patients with sentinel lymph node metastases：the American College of Surgeons Oncology Group Z0011 randomized trial. Ann Surg 252：426-432, 2010

40）Giuliano AE（USA）：Axillary dissection vs no axillary dissection in women with invasive breast cancer and sentinel lymph node metastasis：a randomized clinical trial. JAMA 305：569-575, 2011

41）Galimberti V（Italy）：Axillary dissection versus no axillary dissection in patients with sentinel-node micrometastases（IBCSG 23-01）：a phase 3 randomised controlled trial. Lancet Oncol 14：297-305, 2013