臨床外科72巻12号

2017年11月発行

特集 徹底解説！ここが変わった膵癌診療—新規約・ガイドラインに基づいて 膵癌集学的治療の最前線

切除不能膵癌に対するconversion surgery

著者： 里井壯平¹ 柳本泰明¹ 山本智久¹ 小坂久¹ 廣岡智¹ 山木壮¹ 小塚雅也¹ 道浦拓¹ 井上健太郎¹ 松井陽一¹ 權雅憲¹

所属機関： ¹関西医科大学外科学講座

ページ範囲：P.1318 - P.1322

【ポイント】
◆conversion surgeryを受けた患者の予後は，切除可能膵癌で切除を受けた患者と同様の成績である．
◆当院での手術適応（患者選択）は，腫瘍縮小，腫瘍マーカー低下，全身状態良好，初回治療後8か月経過，である．
◆conversion surgeryやその予後に関するsurrogate markerは不明であり，今後の研究が必要である．

参考文献

1）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 31：1640-1648, 2013

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

3）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

4）日本膵臓学会（編）：膵癌取扱い規約，第7版．金原出版，2016，pp 48-53

5）北川裕久：切除可能性分類について．膵臓31：799-804，2016

6）Satoi S, Yamaue H, Kato K, et al：Role of adjuvant surgery for patients with initially unresectable pancreatic cancer with a long-term favorable response to non-surgical anti-cancer treatments：results of a project study for pancreatic surgery by the Japanese Society of Hepato-Biliary-Pancreatic Surgery. J Hepatobiliary Pancreat Sci 20：590-600, 2013

7）Bickenbach KA, Gonen M, Tang LH, et al：Downstaging in pancreatic cancer：a matched analysis of patients resected following systemic treatment of initially locally unresectable disease. Ann Surg Oncol 19：1663-1669, 2012

8）Donahue TR, Isacoff WH, Hines OJ, et al：Downstaging chemotherapy and alteration in the classic computed tomography/magnetic resonance imaging signs of vascular involvement in patients with pancreaticobiliary malignant tumors：influence on patient selection for surgery. Arch Surg 146：836-843, 2011

9）Satoi S, Yanagimoto H, Yamamoto T, et al：Survival benefit of intravenous and intraperitoneal paclitaxel with S-1 in pancreatic ductal adenocarcinoma patients with peritoneal metastasis：a retrospective study in a single institution. J Hepatobiliary Pancreat Sci 24：289-296, 2017

10）Sadot E, Doussot A, O' Reilly EM, et al：FOLFIRINOX induction therapy for Stage 3 pancreatic adenocarcinoma. Ann Surg Oncol 22：3512-3521, 2015

11）Suker M, Beumer BR, Sadot E, et al：FOLFIRINOX for locally advanced pancreatic cancer：a systematic review and patient-level meta-analysis. Lancet Oncol 17：801-810, 2016

12）Satoi S, Yanagimoto H, Yamamoto T, et al：A clinical role of staging laparoscopy in patients with radiographically defined locally advanced pancreatic ductal adenocarcinoma. World J Surg Oncol 14：14, 2016 doi：10.1186/s12957-016-0767-y

13）Akita H, Takahashi H, Ohigashi H, et al：FDG-PET predicts treatment efficacy and surgical outcome of pre-operative chemoradiation therapy for resectable and borderline resectable pancreatic cancer. Eur J Surg Oncol 43：1061-1067, 2017

14）Okada KI, Hirono S, Kawai M, et al：Value of apparent diffusion coefficient prior to neoadjuvant therapy is a predictor of histologic response in patients with borderline resectable pancreatic carcinoma. J Hepatobiliary Pancreat Sci 24：161-168, 2017

15）Lee SM, Katz MH, Liu L, et al：Validation of a proposed tumor regression grading scheme for pancreatic ductal adenocarcinoma after neoadjuvant therapy as a prognostic indicator for survival. Am J Surg Pathol 40：1653-1660, 2016

16）Wright GP, Poruk KE, Zenati MS, et al：Primary tumor resection following favorable response to systemic chemotherapy in Stage Ⅳ pancreatic adenocarcinoma with synchronous metastases：a bi-institutional analysis. J Gastrointest Surg 20：1830-1835, 2016

17）Hackert T, Sachsenmaier M, Hinz U, et al：Locally advanced pancreatic cancer：neoadjuvant therapy with FOLFIRINOX results in resectability in 60% of the patients. Ann Surg 264：457-463, 2016