臨床外科72巻13号

2017年12月発行

特集 最新の胆道癌診療トピックス—新たな治療戦略の可能性を探る

術前治療と切除適応 胆道癌の予後不良因子とは—手術適応のborderlineはどこか？

肝門部領域胆管癌

著者： 尾上俊介¹ 江畑智希¹ 横山幸浩¹ 國料俊男¹ 角田伸行¹ 伊神剛¹ 菅原元¹ 深谷昌秀¹ 上原圭介¹ 水野隆史¹ 山口淳平¹ 宮田一志¹ 相場利貞¹ 梛野正人¹

所属機関： ¹名古屋大学大学院医学系研究科腫瘍外科学

ページ範囲：P.1419 - P.1422

文献概要

【ポイント】
◆肝門部領域胆管癌の切除適応や切除術式を決定する際に考慮すべき予後因子として，癌遺残度，胆管側方進展，血管浸潤，リンパ節転移，遠隔転移，腫瘍形態，術前減黄法が挙げられる．
◆肝門部領域胆管癌は積極的な手術により長期生存する症例が少なくないため，手術の安全が担保される限り切除を考慮すべきである．

参考文献

1）日本肝胆膵外科学会：臨床・病理　胆道癌取扱い規約　第6版．金原出版，2013

2）Kondo S, Hirano S, Ambo Y, et al：Forty consecutive resections of hilar cholangiocarcinoma with no postoperative mortality and no positive ductal margins：results of a prospective study. Ann Surg 240：95-101, 2004

3）Wakai T, Shirai Y, Moroda T, et al：Impact of ductal resection margin status on long-term survival in patients undergoing resection for extrahepatic cholangiocarcinoma. Cancer 103：1210-1216, 2005

4）Tsukahara T, Ebata T, Shimoyama Y, et al：Residual Carcinoma In Situ at the Ductal Stump has a Negative Survival Effect：An Analysis of Early-stage Cholangiocarcinomas. Ann Surg 266：126-132, 2017

5）Bismuth H, Nakache R, Diamond T：Management strategies in resection for hilar cholangiocarcinoma. Ann Surg 215：31-38, 1992

6）Mansour JC, Aloia TA, Crane CH, et al：Hilar cholangiocarcinoma：expert consensus statement. HPB（Oxford） 17：691-699, 2015

7）Matsuo K, Rocha FG, Ito K, et al：The Blumgart preoperative staging system for hilar cholangiocarcinoma：analysis of resectability and outcomes in 380 patients. J Am Coll Surg 215：343-355, 2012

8）Ebata T, Kosuge T, Hirano S, et al：Proposal to modify the International Union Against Cancer staging system for perihilar cholangiocarcinomas. Br J Surg 101：79-88, 2014

9）Ebata T, Mizuno T, Yokoyama Y, et al：Surgical resection for Bismuth type Ⅳ perihilar cholangiocarcinoma. Br J Surg, 2017. in press

10）National clinical database〔http://www.ncd.or.jp/〕

11）Kenjo A, Miyata H, Gotoh M, et al：Risk stratification of 7,732 hepatectomy cases in 2011 from the National Clinical Database for Japan. J Am Coll Surg 218：412-422, 2014

12）Ebata T, Nagino M, Kamiya J, et al：Hepatectomy with portal vein resection for hilar cholangiocarcinoma：audit of 52 consecutive cases. Ann Surg 238：720-727, 2003

13）Nagino M, Nimura Y, Nishio H, et al：Hepatectomy with simultaneous resection of the portal vein and hepatic artery for advanced perihilar cholangiocarcinoma：an audit of 50 consecutive cases. Ann Surg 252：115-123, 2010

14）Aoba T, Ebata T, Yokoyama Y, et al：Assessment of nodal status for perihilar cholangiocarcinoma：location, number, or ratio of involved nodes. Ann Surg 257：718-725, 2013

15）Noji T, Kondo S, Hirano S, et al：CT evaluation of paraaortic lymph node metastasis in patients with biliary cancer. J Gastroenterol 40：739-743, 2005

16）胆道癌診療ガイドライン作成委員会：胆道癌診療ガイドライン　改訂第2版．医学図書出版，2014

17）Onoe S, Shimoyama Y, Ebata T, et al：Prognostic delineation of papillary cholangiocarcinoma based on the invasive proportion：a single-institution study with 184 patients. Surgery 155：280-291, 2014

18）Komaya K, Ebata T, Fukami Y, et al：Percutaneous biliary drainage is oncologically inferior to endoscopic drainage：a propensity score matching analysis in resectable distal cholangiocarcinoma. J Gastroenterol 51：608-619, 2016

19）Ikeyama T, Nagino M, Oda K, et al：Surgical approach to bismuth Type Ⅰ and Ⅱ hilar cholangiocarcinomas：audit of 54 consecutive cases. Ann Surg 246：1052-1057, 2007

20）Komaya K, Ebata T, Yokoyama Y, et al：Verification of the oncologic inferiority of percutaneous biliary drainage to endoscopic drainage：A propensity score matching analysis of resectable perihilar cholangiocarcinoma. Surgery 161：394-404, 2017

21）Takahashi Y, Nagino M, Nishio H, et al：Percutaneous transhepatic biliary drainage catheter tract recurrence in cholangiocarcinoma. Br J Surg 97：1860-1866, 2010