臨床外科78巻5号

2023年05月発行

特集 術後QOLを重視した胃癌手術と再建法

幽門側胃切除

幽門側胃切除術後の最適な再建方法とは

著者： 今井義朗¹ 田中亮¹ 松尾謙太郎¹ 本田浩太郎¹ 朝隈光弘¹ 李相雄¹

所属機関： ¹大阪医科薬科大学一般・消化器外科

ページ範囲：P.581 - P.589

文献概要

【ポイント】
◆幽門側胃切除術後の再建法は，それぞれに長所・短所があり，第一選択肢として推奨される再建術式は存在しない．
◆幽門側胃切除術後の再建術式を比較したRCTは多数存在するが，QOLに関しては大きな差はない．
◆Postgastrectomy Syndrome Assessment Scale（PGSAS）-45は，胃切除後のQOL評価に特化した質問票であり，幽門側胃切除術後の再建法に関する新たなエビデンス構築に有用な評価法になりえる．
◆再建法の長所・短所を十分に理解し，症例ごとに最適な再建法を選択することが望ましい．

参考文献

1）日本胃癌学会（編）：胃癌治療ガイドライン　第6版．金原出版，2021

2）「胃癌術後評価を考える」ワーキンググループ 胃外科胃外科・術後障害研究会（編）：胃切除後障害診療ハンドブック．南江堂，2015

3）Ishikawa M, Kitayama J, Kaizaki S, et al：Prospective Randomized Trial Comparing Billroth Ⅰ and Roux-en-Y Procedures after Distal Gastrectomy for Gastric Carcinoma. World J Surg 29：1415-1420, 2005

4）Yang K, Zhang WH, Liu K, et al：Comparison of quality of life between Billroth-Ⅰ and Roux-en-Y anastomosis after distal gastrectomy for gastric cancer：A randomized controlled trial. Sci Rep 7：11245, 2017

5）Nakamura M, Nakamori M, Ojima T, et al：Randomized clinical trial comparing long-term quality of life for Billroth I versus Roux-en-Y reconstruction after distal gastrectomy for gastric cancer. Br J Surg 103：337-347, 2016

6）Takiguchi S, Yamamoto K, Hirao M, et al：A comparison of postoperative quality of life and dysfunction after Billroth Ⅰ and Roux-en-Y reconstruction following distal gastrectomy for gastric cancer：results from a multi-institutional RCT. Gastric Cancer 15：198-205, 2012

7）Hirao M, Takiguchi S, Imamura H, et al：Comparison of Billroth Ⅰ and Roux-en-Y reconstruction after distal gastrectomy for gastric cancer：one-year postoperative effects assessed by a multi-institutional RCT. Ann Surg Oncol 20：1591-1597, 2013

8）Kimura Y, Mikami J, Yamasaki M, et al：Comparison of 5-year postoperative outcomes after Billroth Ⅰ and Roux-en-Y reconstruction following distal gastrectomy for gastric cancer：Results from a multi-institutional randomized controlled trial. Ann Gastroenterol Surg 15：93-101, 2020

9）Lee MS, Ahn SH, Lee JH, et al：What is the best reconstruction method after distal gastrectomy for gastric cancer? Surg Endosc 26：1539-1547, 2012

10）Yang D, He L, Tong WH, et al：Randomized controlled trial of uncut Roux-en-Y vs Billroth Ⅱ reconstruction after distal gastrectomy for gastric cancer：Which technique is better for avoiding biliary reflux and gastritis? World J Gastroenterol 23：6350-6356, 2017

11）So JBK, Rao J, Wong ASY, et al：Roux-en-Y or Billroth Ⅱ Reconstruction After Radical Distal Gastrectomy for Gastric Cancer：A Multicenter Randomized Controlled Trial. Ann Surg 267：236-242, 2018

12）Hikage M, Hato S, Uemura K, et al：Late complication after gastrectomy for clinical stage I cancer：supplementary analysis of JCOG0912. Surg Endosc：published online 13 December, 2022

13）Nomura E, Lee SW, Bouras G, et al：Functional outcomes according to the size of the gastric remnant and type of reconstruction following laparoscopic distal gastrectomy for gastric cancer. Gastric Cancer 14：279-284, 2011

14）Nakada K, Ikeda M, Takahashi M, et al：Characteristics and clinical relevance of postgastrectomy syndrome assessment scale（PGSAS）-45：newly developed integrated questionnaires for assessment of living status and quality of life in postgastrectomy patients. Gastric Cancer 18：147-158, 2015

15）Terashima M, Tanabe K, Yoshida M, et al：Postgastrectomy Syndrome Assessment Scale（PGSAS）-45 and changes in body weight are useful tools for evaluation of reconstruction methods following distal gastrectomy. Ann Surg Oncol 21：370-378, 2014

16）Igarashi M, Nakae H, Matsuoka T, et al：Alteration in the gastric microbiota and its restoration by probiotics in patients with functional dyspepsia. BMJ Open Gastroenterol 4：e000144, 2017

17）Imai Y, Lee SW, Sakaguchi S, et al：Comparison of the gastric microbiome in Billroth I and Roux-en-Y reconstructions after distal gastrectomy. Sci Rep 12：10594, 2022