臨床外科72巻2号

2017年02月発行

特集 ビッグデータにもとづいた—術前リスクの評価と対処法 術式別　評価と対処法

術前リスク評価に基づいた直腸癌術式選択

著者： 赤木智徳¹ 蔀由貴¹ 猪股雅史¹

所属機関： ¹大分大学消化器・小児外科

ページ範囲：P.194 - P.197

【ポイント】
◆直腸癌に対する術式はおもに腫瘍学的因子と患者側因子（術前リスク評価）にて決定する．
◆最近では肛門機能温存のため，ISRや超低位前方切除術が広く普及している．
◆Diverting stomaの適応は一定のコンセンサスはなく，各施設において総合的に判断しているのが現状である．

参考文献

1）Shiomi A, Ito M, Saito N, et al：The indications for a diverting stoma in low anterior resection for rectal cancer：a prospective multicentre study of 222 patients from Japanese cancer centers. Colorectal Dis 13：1384-1389, 2011

2）Matthiessen P, Hallbook O, Rutegard J, et al：Defunctioning stoma reduces symptomatic anastomotic leakage after low anterior resection of the rectum for cancer：a randomized multicenter trial. Ann Surg 246：207-214, 2007

3）Matsubara N, Miyata H, Gotoh M, et al：Mortality after common rectal surgery in Japan：a study on low anterior resection from a newly established nationwide large-scale clinical database. Dis Colon Rectum 57：1075-1081, 2014

4）Eriksen MT, Wibe A, Norstein J, et al：Anastomotic leakage following routine mesorectal excision for rectal cancer in a national cohort of patients. Colorectal Dis 7：51-57, 2005

5）Morris EJ, Taylor EF, Thomas JD, et al：Thirty-day postoperative mortality after colorectal cancer surgery in England. Gut 60：806-813, 2011

6）Matthiessen P, Hallbook O, Andersson M, et al：Risk factors for anastomotic leakage after anterior resection of the rectum. Colorectal Dis 6：462-469, 2004

7）Snijders HS, Wouters MW, van Leersum NJ, et al：Meta-analysis of the risk for anastomotic leakage, the postoperative mortality caused by leakage in relation to the overall postoperative mortality. Eur J Surg Oncol 38：1013-1019, 2012

8）Xiao L, Zhang WB, Jiang PC, et al：Can transanal tube placement after anterior resection for rectal carcinoma reduce anastomotic leakage rate? A single-institution prospective randomized study. World J Surg 35：1367-1377, 2011

9）Yamamoto S, Fujita S, Akasu T, et al：Risk factors for anastomotic leakage after laparoscopic surgery for rectal cancer using a stapling technique. Surg Laparosc Endosc Percutan Tech 22：239-243, 2012

10）Marusch F, Koch A, Schmidt U, et al：Value of a protective stoma in low anterior resections for rectal cancer. Dis Colon Rectum 45：1164-1171, 2002

11）Zhu QL, Feng B, Lu AG, et al：Laparoscopic low anterior resection for rectal carcinoma：complications and management in 132 consecutive patients. World J Gastroenterol 16：4605-4610, 2010

12）Piecuch J, Wiewiora M, Jopek J, et al：Mortality and anastomotic leakage after anterior resection for rectal cancer. Hepatogastroenterology 59：721-723, 2012

13）Yang L, Huang XE, Zhou JN：Risk assessment on anastomotic leakage after rectal cancer surgery：an analysis of 753 patients. Asian Pac J Cancer Prev 14：4447-4453, 2013

14）Mrak K, Uranitsch S, Pedross F, et al：Diverting ileostomy versus no diversion after low anterior resection for rectal cancer：A prospective, randomized, multicenter trial. Surgery 159：1129-1139, 2016

15）Moran BJ：Predicting the risk and diminishing the consequences of anastomotic leakage after anterior resection for rectal cancer. Acta Chir Iugosl 57：47-50, 2010

16）Taflampas P, Christodoulakis M, Tsiftsis DD：Anastomotic leakage after low anterior resection for rectal cancer：facts, obscurity, and fiction. Surg Today 39：183-188, 2009

17）Meade B, Moran B：Reducing the incidence and managing the consequences of anastomotic leakage after rectal resection. Acta Chir Iugosl 51：19-23, 2004