臨床外科71巻1号

2016年01月発行

特集 十二指腸乳頭部病変に対する新たな治療戦略—新規約・新ガイドラインに基づいて

外科的治療アプローチ

十二指腸乳頭部癌に対する膵頭十二指腸切除の治療成績

著者： 清水敦史¹ 川井学¹ 山上裕機¹

所属機関： ¹和歌山県立医科大学第二外科学講座

ページ範囲：P.54 - P.58

文献概要

【ポイント】
◆T1乳頭部癌のリンパ節転移は9〜45%の頻度であり，標準術式は膵頭十二指腸切除術（PD）である．
◆乳頭部癌に対するPDにおいて，上腸間膜動脈リンパ節（No. 14）の郭清が重要なポイントである．
◆胆道癌取扱い規約第6版はUICCに準拠する形で改訂され，今後本邦と欧米の治療成績が比較しやすくなる．

参考文献

1）Kawai M, Tani M, Hirono S, et al：Pylorus ring resection reduces delayed gastric emptying in patients undergoing pancreatoduodenectomy：a prospective, randomized, controlled trial of pylorus-resecting versus pylorus-preserving pancreatoduodenectomy. Ann Surg 253：495-501, 2011

2）Terasawa H, Uchiyama K, Tani M, et al：Impact of lymph node metastasis on survival in patients with pathological T1 carcinoma of the ampulla of Vater. J Gastrointest Surg 10：823-828, 2006

3）Yoon YS, Kim SW, Park SJ, et al：Clinicopathologic analysis of early ampullary cancers with a focus on the feasibility of ampullectomy. Ann Surg 242：92-100, 2005

4）Amini A, Miura JT, Jayakrishnan TT, et al：Is local resection adequate for T1 stage ampullary cancer? HPB（Oxford）17：66-71, 2015

5）Hornick JR, Johnston FM, Simon PO, et al：A single-institution review of 157 patients presenting with benign and malignant tumors of the ampulla of Vater：management and outcomes. Surgery 150：169-176, 2011

6）日本肝胆膵外科学会胆道癌診療ガイドライン作成委員会（編）：エビデンスに基づいた　胆道癌診療ガイドライン，改訂第2版．医学図書出版，2014

7）Chen SC, Shyr YM, Chou SC, et al：The role of lymph nodes in predicting the prognosis of ampullary carcinoma after curative resection. World J Surg Oncol 13：224, 2015

8）Robert PE, Leux C, Ouaissi M, et al：Predictors of long-term survival following resection for ampullary carcinoma：a large retrospective French multicentric study. Pancreas 43：692-697, 2014

9）Kang HJ, Eo SH, Kim SC, et al：Increased number of metastatic lymph nodes in adenocarcinoma of the ampulla of Vater as a prognostic factor：a proposal of new nodal classification. Surgery 155：74-84, 2014

10）Miyakawa S, Ishihara S, Horiguchi A, et al：Biliary tract cancer treatment：5,584 results from the Biliary Tract Cancer Statistics Registry from 1998 to 2004 in Japan. J Hepatobiliary Pancreat Surg 16：1-7, 2009

11）Lee JH, Lee KG, Ha TK, et al：Pattern analysis of lymph node metastasis and the prognostic importance of number of metastatic nodes in ampullary adenocarcinoma. Am Surg 77：322-329, 2011

12）安永昌史，木下壽文：【胆道癌外科治療の現況】十二指腸乳頭部癌の外科治療の現況．至適リンパ節郭清範囲，外科的乳頭切除を含めて．日外会誌115：195-200，2014

13）Kayahara M, Ohta T：Gross appearance of the ampullary tumor predicts lymph node metastasis and outcome. Dig Surg 27：127-131, 2010

14）廣野誠子，山上裕機：【胆道癌外科切除再発防止のストラテジー】術中戦略．リンパ節郭清範囲—十二指腸乳頭部癌．臨外70：80-82，2015

15）Roland CL, Katz MH, Gonzalez GM, et al：A high positive lymph node ratio is associated with distant recurrence after surgical resection of ampullary carcinoma. J Gastrointest Surg 16：2056-2063, 2012

16）Tol JA, Brosens LA, van Dieren S, et al：Impact of lymph node ratio on survival in patients with pancreatic and periampullary cancer. Br J Surg 102：237-245, 2015

17）Buchler MW, Wagner M, Schmied BM, et al：Changes in morbidity after pancreatic resection：toward the end of completion pancreatectomy. Arch Surg 138：1310-1314, 2003

18）Balcom JHt, Rattner DW, Warshaw AL, et al：Ten-year experience with 733 pancreatic resections：changing indications, older patients, and decreasing length of hospitalization. Arch Surg 136：391-398, 2001

19）McPhee JT, Hill JS, Whalen GF, et al：Perioperative mortality for pancreatectomy：a national perspective. Ann Surg 246：246-253, 2007

20）石原　慎，宮川秀一，堀口明彦，他：【十二指腸乳頭部腫瘍をめぐる最近の話題】本邦における十二指腸乳頭癌の現状．1998〜2004年登録症例の集計から．肝・胆・膵54：737-746，2007

21）O'Connell JB, Maggard MA, Manunga J Jr, et al：Survival after resection of ampullary carcinoma：a national population-based study. Ann Surg Oncol 15：1820-1827, 2008

22）Riall TS, Cameron JL, Lillemoe KD, et al：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；discussion 1204-1196, 2005

23）Kim RD, Kundhal PS, McGilvray ID, et al：Predictors of failure after pancreaticoduodenectomy for ampullary carcinoma. J Am Coll Surg 202：112-119, 2006

24）Colussi O, Voron T, Pozet A, et al：Prognostic score for recurrence after Whipple's pancreaticoduodenectomy for ampullary carcinomas；results of an AGEO retrospective multicenter cohort. Eur J Surg Oncol 41：520-526, 2015

25）石川博人，木下壽文，赤司昌謙，他：【十二指腸乳頭部癌—診断・治療の最前線】十二指腸乳頭部癌に対する膵頭十二指腸切除の長期成績と予後因子．胆と膵33：267-270，2012

26）Valsangkar NP, Ingkakul T, Correa-Gallego C, et al：Survival in ampullary cancer：potential role of different KRAS mutations. Surgery 157：260-268, 2015

27）Klein F, Jacob D, Bahra M, et al：Prognostic factors for long-term survival in patients with ampullary carcinoma：the results of a 15-year observation period after pancreaticoduodenectomy. HPB Surg 2014：970234, 2014

28）Partelli S, Crippa S, Capelli P, et al：Adequacy of lymph node retrieval for ampullary cancer and its association with improved staging and survival. World J Surg 37：1397-1404, 2013

29）Narang AK, Miller RC, Hsu CC, et al：Evaluation of adjuvant chemoradiation therapy for ampullary adenocarcinoma：the Johns Hopkins Hospital-Mayo Clinic collaborative study. Radiat Oncol 6：126, 2011

30）Jiang ZQ, Varadhachary G, Wang X, et al：A retrospective study of ampullary adenocarcinomas：overall survival and responsiveness to fluoropyrimidine-based chemotherapy. Ann Oncol 24：2349-2353, 2013

31）Ohtsuka M, Miyakawa S, Nagino M, et al：Revision concepts and distinctive points of the new Japanese classification for biliary tract cancers in comparison with the 7（th）edition of the Union for International Cancer Control and the American Joint Committee on Cancer staging system. J Hepatobiliary Pancreat Sci 22：197-201, 2015

32）Okano K, Oshima M, Yachida S, et al：Factors predicting survival and pathological subtype in patients with ampullary adenocarcinoma. J Surg Oncol 110：156-162, 2014

33）石原　慎，宮川秀一，堀口明彦，他：【十二指腸乳頭部癌—診断・治療の最前線】胆道癌登録からみた乳頭部癌の動向．進行度とリンパ節転移を中心に．胆と膵33：221-224，2012

34）Winter JM, Cameron JL, Olino K, et al：Clinicopathologic analysis of ampullary neoplasms in 450 patients：implications for surgical strategy and long-term prognosis. J Gastrointest Surg 14：379-387, 2010

35）川井　学，山上裕機：Liver, Pancreas, Biliary Tract Cancer. 肝・胆・膵癌．肝胆膵癌の新展開．Vater乳頭部癌における化学療法の現状．癌と化療40：1314-1317，2013

36）Neoptolemos JP, Moore MJ, Cox TF, et al：Effect of adjuvant chemotherapy with fluorouracil plus folinic acid or gemcitabine vs observation on survival in patients with resected periampullary adenocarcinoma：the ESPAC-3 periampullary cancer randomized trial. JAMA 308：147-156, 2012