臨床外科69巻4号

2014年04月発行

特集 サルベージとコンバージョン―集学的治療で外科手術に求められるもの 各論

肝転移―切除不能大腸癌に対するconversion therapy―CareからCureへのconversion

著者： 林洋光¹ 坂本快郎¹ 宮本裕二¹ 黒木秀幸¹ 東孝暁¹ 坂本慶太¹ 新田英利¹ 今井克憲¹ 近本亮¹ 石河隆敏¹ 別府透¹ 馬場秀夫¹

所属機関： ¹熊本大学大学院消化器外科学

ページ範囲：P.454 - P.460

【ポイント】

◆切除不能大腸癌肝転移は全身化学療法（care）が主体となるが，転移巣が化学療法の奏効により根治切除術（cure）へ移行（コンバージョン）できることがある．

◆コンバージョンにより根治が期待でき，化学療法後にR0肝切除が可能となれば積極的に肝切除を考慮すべきである．

◆画像上消失した病巣でもviableな癌病巣の残存を認めるため，肝切除を行うことが推奨される．

◆化学療法による肝毒性（オキサリプラチンによる類洞拡張，イリノテカンによる脂肪性肝炎など）が報告されており，コンバージョンを行う際には十分な休薬と術前リスク評価を行うべきである．

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