臨床外科71巻5号

2016年05月発行

特集 外科臨床研究のノウハウと重要研究の総まとめ Part2：押さえておきたい外科臨床研究の総まとめ

膵癌

著者： 廣野誠子¹ 宮澤基樹¹ 山上裕機¹

所属機関： ¹和歌山県立医科大学第2外科

ページ範囲：P.570 - P.580

【ポイント】
◆膵癌は生存期間の短い癌腫のため，生存期間延長を目指した多くの臨床研究が報告されており，本稿では日本から報告されたエビデンスレベルの高い臨床研究を中心に紹介する．
◆膵癌における外科的切除術は，合併症率の高い高難度手術であるが，合併症頻度を低下させる目的で施行された無作為化臨床試験について紹介する．

参考文献

1）Fortner JG：Regional resection of cancer of the pancreas：a new surgical approach. Surgery 73：307-320, 1973

2）Fortner JG, Kim DK, Cubilla A, et al：Regional pancreatectomy：en bloc pancreatic, portal vein and lymph node resection. Ann Surg 186：42-50, 1977

3）Pedrazzoli S, DiCarlo V, Dionigi R, et al：Standard versus extended lymphadenectomy associated with pancreatoduodenectomy in the surgical treatment of adenocarcinoma of the head of the pancreas：a multicenter, prospective, randomized study. Lymphadenectomy Study Group. Ann Surg 228：507-517, 1998

4）Yeo CJ, Cameron JL, Lillemore KD, et al：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 236：355-368, 2002

5）Farnell MB, Pearson RK, Sarr MG, et al：A prospective randomized trial comparing standard pancreatoduodenectomy with pancreatoduodenectomy with extended lymphadenectomy in resectable pancreatic head adenocarcinoma. Surgery 138：618-628；discussion 628-630, 2005

6）Nimura Y, Nagino M, Takao S, et al：Standard versus extended lymphadenectomy in radical pancreatoduodenectomy for ductal adenocarcinoma of the head of the pancreas. Long-term results of a Japanese multicenter randomized controlled trial. J Hepatobiliary Pancreat Sci 19：230-241, 2012

7）Jang JY, Kang MJ, Heo JS, et al：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 259：654-664, 2014

8）Okada K, Kawai M, Tani M, et al：Surgical strategy for patients with pancreatic body/tail carcinoma：Who should undergo distal pancreatectomy with en-bloc celiac axis resection? Surgery 153：365-372, 2013

9）Oettle H, Neuhaus P, Hochhaus A, et al：Adjuvant chemotherapy with gemcitabine and long-term outcomes among patients with resected pancreatic cancer. The CONKO-001 randomized trial. JAMA 310：1473-1481, 2013

10）Tani M, Terasawa H, Kawai M, et al：Improvement of delayed gastric emptying in pylorus-preserving pancreaticoduodenectomy. Results of a prospective, randomized, controlled trial. Ann Surg 243：316-320, 2006

11）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-preserving pancreatoduodenectomy. Ann Surg 253：495-501, 2011

12）Traverso LW, Longmire WJ：Preservation of the pylorus in pancreaticoduodenectomy. Surg Gynecol Obstet 146：959-962, 1978

13）Kawai M, Tani M, Hirono S, et al：Pylorus-resecting pancreaticoduodenectomy offers long-term outcomes similar to those of pylorus-preserving pancreaticoduodenectomy：results of a prospective study. World J Surg 38：1476-1483, 2014

14）Tani M, Kawai S, Hirono S, et al：Randomized clinical trial of isolated Roux-en-Y versus conventional reconstruction after pancreaticoduodenectomy. Br J Surg 101：1084-1091, 2014

15）Tani M, Kawai M, Hirono S, et al：A prospective randomized controlled trial of internal versus external drainage with pancreaticojejunostomy for pancreaticoduodenectomy. Am J Surg 199：759-764, 2010

16）Kawai M, Tani M, Terasawa H, et al：Early removal of prophylactic drains reduces the risk of intra-abdominal infections in patients with pancreatic head resection. Prospective study for 104 consecutive patients. Ann Surg 244：1-7, 2006

17）Kawai M, Tani M, Okada K, et al：Stump closure of thick pancreas using stapler cosure increases pancreatic fistula after distal pancreatectomy. Am J Surg 206：352-359, 2013

18）Kawai M, Hirono S, Okada K, et al：Randomized controlled trial of pancreaticojejunostomy versus stapler closure of the pancreatic stump during distal pancreatectomy to reduce pancreatic fistula. Ann Surg, 2015（in press）

19）Ueno H, Ioka T, Ikeda M, et al：Randomized phase Ⅲ study of gemcitabine plus S-1, S-1 alone, or gemcitabine alone in patients with locally advanced and metastatic pancreatic cancer in Japan and Taiwan：GEST study. J Clin Oncol 13：1640-1648, 2013

20）Conroy T, Desseigne F, Ychou M, et al：FOLFIRINOX versus gemcitabine for metastatic pancreatic cancer. N Engl J Med 364：1817-1825, 2011

21）Okusaka T, Ikeda M, Fukutomi A, et al：Phase Ⅱ study of FOLFIRINOX for chemotherapy-naïve Japanese patients with metastatic pancreatic cancer. Cancer Sci 105：1321-1326, 2014

22）Frese KK, Neesse A, Cook N, et al：nab-Paclitaxel potentiates gemcitabine activity by reducing cytidine deaminase levels in a mouse model of pancreatic cancer. Cancer Discov 2：260-269, 2012

23）Von Hoff DD, Ervin T, Arena FP, et al：Increased survival in pancreatic cancer with nab-paclitaxel plus gemcitabine. N Engl J Med 369：1691-1703, 2013

24）Ueno H, Ikeda M, Ueno M, et al：Phase Ⅰ/Ⅱ study of nab-paclitaxel plus gemcitabine for chemotherapy-naive Japanese patients with metastatic pancreatic cancer. Cancer Chemother Pharmacol 77：595-603, 2016

25）Miyazawa M, Ohsawa R, Tsunoda T, et al：Phase Ⅰ clinical trial using peptide vaccine for human vascular endothelial growth factor receptor 2 in combination with gemcitabine for patients with advanced pancreatic cancer. Cancer Sci 101：433-439, 2010

26）Yamaue H, Tsunoda T, Tani M, et al：Randomized phase Ⅱ/Ⅲ clinical trial of elpamotide for patients with advanced pancreatic cancer：PEGASUS-PC Study. Cancer Sci 106：883-890, 2015