臨床外科73巻1号

2018年01月発行

特集 閉塞性大腸癌—ベストプラクティスを探す

閉塞性大腸癌の予後と補助化学療法

著者： 牛込充則¹ 船橋公彦¹

所属機関： ¹東邦大学医療センター大森病院 一般・消化器センター外科

ページ範囲：P.54 - P.59

【ポイント】
◆閉塞性大腸癌の予後は，一般に非閉塞性大腸癌に対して不良とされるが，根治的手術が施行されれば同等であり，根治性を高めるためには術前減圧の管理が重要となる．
◆高い根治性を目的としたbridge to surgery（BTS）の術前減圧の効果は高く，また患者のQOLも向上するため臨床的意義は大きい．大腸ステント留置の短期成績から安全性と有用性は示されているが，大腸ステントの長期的な予後に及ぼす影響についてはまだ明確とはなっていない．
◆閉塞性大腸癌を対象とした補助化学療法の有用性の有無についてのエビデンスはないため，現状では補助療法の適応は最終病期に準じて選択される．

参考文献

1）肥田仁一，安富正幸：【イレウス】大腸癌イレウスの治療戦略．手術53：331-342，1999

2）Winner M, Mooney SJ, Hershman DL, et al：Incidence and predictors of bowel obstruction in elderly patients with stage Ⅳ colon cancer：a population-based cohort study. JAMA Surg 148：715-722, 2013

3）Jullumstro E, Wibe A, Lydersen S, et al：Colon cancer incidence, presentation, treatment and outcomes over 25 years. Colorectal Dis 13：512-518, 2011

4）Cheynel N, Cortet M, Lepage C, et al：Trends in frequency and management of obstructing colorectal cancers in a well-defined population. Dis Colon Rectum 50：1568-1575, 2007

5）Cortet M, Grimault A, Cheynel N, et al：Patterns of recurrence of obstructing colon cancers after surgery for cure：a population-based study. Colorectal Dis 15：1100-1106, 2013

6）長谷川久美，杉原健一，榎本雅之，他：閉塞性大腸癌の検討．日消外会誌33：709-715，2000

7）木戸川秀生，伊藤重彦，中谷博之，他：大腸癌イレウス症例における臨床病理学的因子と長期予後の検討．日臨外会誌59：2223-2229，1998

8）林　勝知，宮田知幸，渡辺　敬，他：イレウスを伴った大腸癌の検討．日本大腸肛門病会誌45：118-122，1992

9）神垣　隆，島田悦司，裏川公章：イレウスをともなう大腸癌の臨床病理学的検討．日消外会誌26：76-81，1993

10）沢田寿仁，早川　健：結腸癌イレウス例の検討．日臨外会誌54：1185-1192，1993

11）黒田勝哉，堀田芳樹，加藤道男，他：イレウス症状を呈した大腸癌症例の臨床病理学的特徴と治療法に関する検討．日消外会誌26：2626-2631，1993

12）山本隆行，松本好市：大腸癌イレウス症例の臨床病理学的特徴と治療法についての検討．外科58：100-104，1996

13）長田真二，種村廣巳，大下裕夫：大腸癌イレウス症例の臨床病理学的特徴．日臨外会誌57：2918-2923，1996

14）保田尚邦，諸原浩二，御子神哲也，他：年齢からみた閉塞性大腸癌の特徴．日消外会誌35：266-271，2002

15）Chen HS, Sheen-Chen SM：Obstruction and perforation in colorectal adenocarcinoma：an analysis of prognosis and current trends. Surgery 127：370-376, 2000

16）Sebastian S, Johnston S, Geoghegan T, et al：Pooled analysis of the efficacy and safety of self-expanding metal stenting in malignant colorectal obstruction. Am J Gastroenterol 99：2051-2057, 2004

17）Biagi JJ, Raphael MJ, Mackillop WJ, et al：Association between time to initiation of adjuvant chemotherapy and survival in colorectal cancer：a systematic review and meta-analysis. JAMA 305：2335-2342, 2011

18）Kronborg O：Acute obstruction from tumor in the left colon without spread. A randomized trial of emergency colostomy versus resection. Int J Colorectal Dis 10：1-5, 1995

19）Jiang JK, Lan YT, Lin TC, et al：Primary vs. delayed resection for obstructive left-sided colorectal cancer：impact of surgery on patient outcome. Dis Colon Rectum 51：306-311, 2008

20）堂元又厳：閉塞性直腸癌のstentを用いた新内視鏡的直腸prosthesis法．消内視鏡3：1507-1512，1991

21）Tejero E, Mainar A, Fernández L, et al：New procedure for the treatment of colorectal neoplastic obstructions. Dis Colon Rectum 37：1158-1159, 1994

22）Wallis F, Campbell KL, Eremin O, et al：Self-expanding metal stents in the management of colorectal carcinoma--a preliminary report. Clin Radiol 53：251-254, 1998

23）Chung TS, Lim SB, Sohn DK, et al：Feasibility of single-stage laparoscopic resection after placement of a self-expandable metallic stent for obstructive left colorectal cancer. World J Surg 32：2275-2280, 2008

24）Tilney HS, Lovegrove RE, Purkayastha S, et al：Comparison of colonic stenting and open surgery for malignant large bowel obstruction. Surg Endosc 21：225-233, 2007

25）Saito S, Yoshida S, Isayama H, et al：A prospective multicenter study on self-expandable metallic stents as a bridge to surgery for malignant colorectal obstruction in Japan：efficacy and safety in 312 patients. Surg Endosc 30：3976-3986, 2016

26）Kim HJ, Huh JW, Kang WS, et al：Oncologic safety of stent as bridge to surgery compared to emergency radical surgery for left-sided colorectal cancer obstruction. Surg Endosc 27：3121-3128, 2013

27）van Hooft JE, Fockens P, Marinelli AW, et al；Dutch Colorectal Stent Group：Early closure of a multicenter randomized clinical trial of endoscopic stenting versus surgery for stage Ⅳ left-sided colorectal cancer. Endoscopy 40：184-191, 2008

28）Sloothaak DA, van den Berg MW, Dijkgraaf MG, et al；collaborative Dutch Stent-In study group：Oncological outcome of malignant colonic obstruction in the Dutch Stent-In 2 trial. Br J Surg 101：1751-1757, 2014

29）Gorissen KJ, Tuynman JB, Fryer E, et al：Local recurrence after stenting for obstructing left-sided colonic cancer. Br J Surg 100：1805-1809, 2013

30）Ansaloni L, Andersson RE, Bazzoli F, et al：Guidelenines in the management of obstructing cancer of the left colon：consensus conference of the world society of emergency surgery（WSES）and peritoneum and surgery（PnS）society. World J Emerg Surg 5：29, 2010 doi：10.1186/1749-7922-5-29

31）van Hooft JE, van Halsema EE, Vanbiervliet G, et al：Self-expandable metal stents for obstructing colonic and extracolonic cancer：European Society of Gastrointestinal Endoscopy（ESGE）Clinical Guideline. Endoscopy 46：990-1053, 2014

32）Self-expandable metal stents for obstructing colonic and extracolonic cancer：European Society of Gastrointestinal Endoscopy（ESGE）Clinical Guideline. Gastrointest Endosc 80：747-761, 2014

33）Sabbagh C, Browet F, Diouf M, et al：Is stenting as “a bridge to surgery” an oncologically safe strategy for the management of acute, left-sided, malignant, colonic obstruction? A comparative study with a propensity score analysis. Ann Surg 258：107-115, 2013

34）大腸癌研究会（編）：大腸癌治療ガイドライン医師用2016年版．金原出版，2016

35）Suárez J, Jimenez-Pérez J：Long-term outcomes after stenting as a “bridge to surgery” for the management of acute obstruction secondary to colorectal cancer. World J Gastrointest Oncol 8：105-112, 2016 doi：10.4251/wjgo.v8.i1.105

36）Ghazal AH, El-Shazly WG, Bessa SS, et al：Colonic endolumenal stenting devices and elective surgery versus emergency subtotal/total colectomy in the management of malignant obstructed left colon carcinoma. J Gastrointest Surg 17：1123-1129, 2013

37）Saida Y, Sumiyama Y, Nagao J, et al：Long-term prognosis of preoperative “bridge to surgery” expandable metallic stent insertion for obstructive colorectal cancer：comparison with emergency operation. Dis Colon Rectum 46：44-49, 2003

38）Alcántara M, Serra-Aracil X, Falcó J, et al：Prospective, controlled, randomized study of intraoperative colonic lavage versus stent placement in obstructive leftsided colonic cancer. World J Surg 35：1904-1910, 2011

39）Tung KL, Cheung HY, Ng LW, et al：Endolaparoscopic approach versus conventional open surgery in the treatment of obstructing left-sided colon cancer：long-term followup of a randomized trial. Asian J Endosc Surg 6：78-81, 2013

40）Gianotti L, Tamini N, Nespoli L, et al：A prospective evaluation of short-term and long-term results from colonic stenting for palliation or as a bridge to elective operation versus immediate surgery for large-bowel obstruction. Surg Endosc 27：832-842, 2013

41）van den Berg MW, Sloothaak DA, Dijkgraaf MG, et al：Bridge-to-surgery stent placement versus emergency surgery for acute malignant colonic obstruction. Br J Surg 101：867-873, 2014

42）Kim HJ, Choi GS, Park JS, et al：Higher rate of perineural invasion in stent-laparoscopic approach in comparison to emergent open resection for obstructing left-sided colon cancer. Int J Colorectal Dis 28：407-414, 2013

43）Kavanagh DO, Nolan B, Judge C, et al：A comparative study of short-and medium-term outcomes comparing emergent surgery and stenting as a bridge to surgery in patients with acute malignant colonic obstruction. Dis Colon Rectum 56：433-440, 2013

44）Ishibe A, Ota M, Yamaguchi Y, et al：Long-term outcomes and prognostic factors of patients with obstructive colorectal cancer：A multicenter retrospective cohort study. World J Gastroenterol 22：5237-5245, 2016

45）Rosen SA, Buell JF, Yoshida A, et al：Initial presentation with stage Ⅳ colorectal cancer：how aggressive should we be? Arch Surg 135：530-534；discussion 534-535, 2000

46）Lee WS, Baek JH, Kang JM et al：The outcome after stent placement or surgery as the initial treatment for obstructive primary tumor in patients with stage IV colon cancer. Am J Surg 203：715-719, 2012