臨床外科70巻4号

2015年04月発行

特集 膵・消化管神経内分泌腫瘍（GEP-NET）のアップデート

GEP-NETの集学的治療における外科治療はどう変わったか

著者： 工藤篤¹ 田邉稔¹

所属機関： ¹東京医科歯科大学肝胆膵・総合外科学分野

ページ範囲：P.456 - P.463

【ポイント】
◆GEP-NETは良悪性を判断することが難しいが，P-NETの術後5年生存率は60〜80%，肝転移再発率は30〜85%であり，初診時の遠隔転移症例は約2割（非機能性NETに限れば半数）を占める．
◆肝転移を伴う症例の予後は極めて不良であり，集学的治療の一環としての外科切除が果たす役割は極めて重い．本来なら切除できない腫瘍が縮小し，down stagingや残肝容量の確保ができるようになれば，完全切除の可能性が出てくる．
◆従来のソマトスタチンアナログ製剤に加えて，2011年にエベロリムスが，2012年にスニチニブが保険適用となった．分子標的療法の発展に伴い，外科治療の適応は今後ますます拡大していくことが予想される．
◆しかしながら，この分野はこれまで稀少疾患であったために，WHO分類，TNM分類，原発巣切除，リンパ節郭清，切除方法（核出術，部分切除など），経過観察の功罪など未解決な課題が山積みである．初回治療から長期的視野に立ち，集学的医療の一環としての外科治療の役割を考えることが重要である．

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