臨床外科72巻9号

2017年09月発行

FOCUS

胃癌における脾摘の是非

著者： 岩槻政晃¹ 吉田直矢¹ 馬場秀夫¹

所属機関： ¹熊本大学大学院 生命科学研究部 消化器外科学

ページ範囲：P.1110 - P.1115

文献概要

はじめに
　胃癌はリンパ節転移を伴いやすく，予後不良である．本邦では徹底したリンパ節郭清による予後の向上を目指し，様々な試みが先達により行われてきた．しかし，臨床試験による検証により，必ずしもリンパ節郭清のさらなる拡大が予後の向上につながらないことも明らかになってきた．それは，癌の生物学的な悪性度のみならず，手術や術後合併症が生体に与える侵襲が影響していると考えられる．
　本稿では，本邦で独自に発展してきた胃癌の系統的なリンパ節郭清の変遷を海外の臨床試験と比較しながら考察する．特に最近，臨床試験で明らかとなったリンパ節郭清のための脾摘の是非，功罪に注目して述べる．

参考文献

1）Cuschieri A, Fayers P, Fielding J, et al：Postoperative morbidity and mortality after D1 and D2 resections for gastric cancer：preliminary results of the MRC randomised controlled surgical trial. The Surgical Cooperative Group. Lancet 347：995-999, 1996

2）Bonenkamp JJ, Hermans J, Sasako M, et al：Extended lymph-node dissection for gastric cancer. N Engl J Med 340：908-914, 1999

3）Sasako M, Sano T, Yamamoto S, et al：D2 lymphadenectomy alone or with para-aortic nodal dissection for gastric cancer. N Engl J Med 359：453-462, 2008

4）Sasako M, Sano T, Yamamoto S, et al：Left thoracoabdominal approach versus abdominal-transhiatal approach for gastric cancer of the cardia or subcardia：a randomised controlled trial. Lancet Oncol 7：644-651, 2006

5）Songun I, Putter H, Kranenbarg EM, et al：Surgical treatment of gastric cancer：15-year follow-up results of the randomised nationwide Dutch D1D2 trial. Lancet Oncol 11：439-449, 2010

6）Ajani JA, D'Amico TA, Almhanna K, et al：Gastric Cancer, Version 3. 2016, NCCN Clinical Practice Guidelines in Oncology. J Natl Compr Canc Netw 14：1286-1312, 2016

7）Smyth EC, Verheij M, Allum W, et al：Gastric cancer：ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up. Ann Oncol 27：v38-v49, 2016

8）Sasako M：Risk factors for surgical treatment in the Dutch Gastric Cancer Trial. Br J Surg 84：1567-1571, 1997

9）Kitamura K, Nishida S, Ichikawa D, et al：No survival benefit from combined pancreaticosplenectomy and total gastrectomy for gastric cancer. Br J Surg 86：119-122, 1999

10）Adachi Y, Kitano S, Sugimachi K：Surgery for gastric cancer：10-year experience worldwide. Gastric Cancer 4：166-174, 2001

11）Higashijima J, Shimada M, Chikakiyo M, et al：Effect of splenectomy on antitumor immune system in mice. Anticancer Res 29：385-393, 2009

12）Winslow ER, Brunt LM, Drebin JA, et al：Portal vein thrombosis after splenectomy. Am J Surg 184：631-635, 2002

13）Davies JM, Lewis MP, Wimperis J, et al：Review of guidelines for the prevention and treatment of infection in patients with an absent or dysfunctional spleen：prepared on behalf of the British Committee for Standards in Haematology by a working party of the Haemato-Oncology task force. Br J Haematol 155：308-317, 2011

14）Hartgrink HH, van de Velde CJ, Putter H, et al：Extended lymph node dissection for gastric cancer：who may benefit? Final results of the randomized Dutch gastric cancer group trial. J Clin Oncol 22：2069-2077, 2004

15）Watanabe Y, Ohtsuka T, Matsunaga T, et al：Long-term outcomes after total pancreatectomy：special reference to survivors' living conditions and quality of life. World J Surg 39：1231-1239, 2015

16）Kosuga T, Ichikawa D, Okamoto K, et al：Survival benefits from splenic hilar lymph node dissection by splenectomy in gastric cancer patients：relative comparison of the benefits in subgroups of patients. Gastric Cancer 14：172-177, 2011

17）Shin SH, Jung H, Choi SH, et al：Clinical significance of splenic hilar lymph node metastasis in proximal gastric cancer. Ann Surg Oncol 16：1304-1309, 2009

18）Zhu GL, Sun Z, Wang ZN, et al：Splenic hilar lymph node metastasis independently predicts poor survival for patients with gastric cancers in the upper and/or the middle third of the stomach. J Surg Oncol 105：786-792, 2012

19）Hayashi T, Yoshikawa T, Aoyama T, et al：Impact of infectious complications on gastric cancer recurrence. Gastric Cancer 18：368-374, 2015

20）Kubota T, Hiki N, Sano T, et al：Prognostic significance of complications after curative surgery for gastric cancer. Ann Surg Oncol 21：891-898, 2014

21）Tokunaga M, Tanizawa Y, Bando E, et al：Poor survival rate in patients with postoperative intra-abdominal infectious complications following curative gastrectomy for gastric cancer. Ann Surg Oncol 20：1575-1583, 2013

22）Csendes A, Burdiles P, Rojas J, et al：A prospective randomized study comparing D2 total gastrectomy versus D2 total gastrectomy plus splenectomy in 187 patients with gastric carcinoma. Surgery 131：401-407, 2002

23）Toge T, Kameda A, Kuroi K, et al：The role of the spleen in immunosuppression and the effects of splenectomy on prognosis in gastric cancer patients. Nihon Geka Gakkai Zasshi 86：1120-1123, 1985

24）Yu W, Choi GS, Chung HY：Randomized clinical trial of splenectomy versus splenic preservation in patients with proximal gastric cancer. Br J Surg 93：559-563, 2006

25）Sano T, Sasako M, Mizusawa J, et al：Randomized controlled trial to evaluate splenectomy in total gastrectomy for proximal gastric carcinoma. Ann Surg 265：277-283, 2017

26）Katai H, Sasako M, Fukuda H, et al：Safety and feasibility of laparoscopy-assisted distal gastrectomy with suprapancreatic nodal dissection for clinical stage Ⅰ gastric cancer：a multicenter phase II trial（JCOG 0703）. Gastric Cancer 13：238-244, 2010

27）Katai H, Mizusawa J, Katayama H, et al：Short-term surgical outcomes from a phase Ⅲ study of laparoscopy-assisted versus open distal gastrectomy with nodal dissection for clinical stage IA/IB gastric cancer：Japan Clinical Oncology Group Study JCOG0912. Gastric Cancer, 2016［Epub ahead of print］

28）Kim W, Kim HH, Han SU, et al：Decreased morbidity of laparoscopic distal gastrectomy compared with open distal gastrectomy for Stage Ⅰ gastric cancer：short-term outcomes from a multicenter randomized controlled trial（KLASS-01）. Ann Surg 263：28-35, 2016

29）Hur H, Lee HY, Lee HJ, et al：Efficacy of laparoscopic subtotal gastrectomy with D2 lymphadenectomy for locally advanced gastric cancer：the protocol of the KLASS-02 multicenter randomized controlled clinical trial. BMC Cancer 15：355, 2015

30）Inaki N, Etoh T, Ohyama T, et al：A multi-institutional, prospective, phase Ⅱ feasibility study of laparoscopy-assisted distal gastrectomy with D2 lymph node dissection for locally advanced gastric cancer（JLSSG0901）. World J Surg 39：2734-2741, 2015

31）Hyung WJ, Lim JS, Song J, et al：Laparoscopic spleen-preserving splenic hilar lymph node dissection during total gastrectomy for gastric cancer. J Am Coll Surg 207：e6-e11, 2008

32）Kinoshita T, Shibasaki H, Enomoto N, et al：Laparoscopic splenic hilar lymph node dissection for proximal gastric cancer using integrated three-dimensional anatomic simulation software. Surg Endosc 30：2613-2619, 2016

33）Usui S, Tashiro M, Haruki S, et al：Spleen preservation versus splenectomy in laparoscopic total gastrectomy with D2 lymphadenectomy for gastric cancer：A comparison of short-term outcomes. Asian J Endosc Surg 9：5-13, 2016

34）Son T, Lee JH, Kim YM, et al：Robotic spleen-preserving total gastrectomy for gastric cancer：comparison with conventional laparoscopic procedure. Surg Endosc 28：2606-2615, 2014

35）Hosogi H, Okabe H, Shinohara H, et al：Laparoscopic splenic hilar lymphadenectomy for advanced gastric cancer. Transl Gastroenterol Hepatol 1：30, 2016