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臨床外科79巻4号

2024年04月発行

文献概要

特集 エキスパートに聞く!膵頭十二指腸切除のすべて PDの標準術式

Mesenteric approach

著者: 廣野誠子1

所属機関: 1兵庫医科大学消化器外科学講座肝胆膵外科

ページ範囲:P.408 - P.413

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【ポイント】
◆膵癌に対する膵頭十二指腸切除術におけるmesenteric approachは,切除段階において上腸間膜動脈(SMA)からアプローチするartery-first approachの一手法である.
◆Mesenteric approachにより,下膵十二指腸動脈(IPDA)を早期に切離することで,術中出血量の減量が期待できる.
◆Mesenteric approachは,患部である膵頭部を手で強く把持しないisolated procedureとして,膵癌細胞の揉み出しが回避できる可能性がある.
*本論文中、[▶動画]マークのある図につきましては、関連する動画を見ることができます(公開期間:2027年4月末まで)。

参考文献

1)日本膵癌学会(編):膵癌取扱い規約第8版.金原出版,2023
2)日本膵癌学会(編):膵癌取扱い規約第7版.金原出版,2016
3)Pedrazzoli S, DiCarlo V, Dionigi R, et al:Standard versus extended lymphadenectomy associated with pancreatoduodenectomy in the surgical treatment of adenocarcinoma of the head of the pancreas:a multicenter, prospective, randomized study. Lymphadenectomy Study Group. Ann Surg 228:508-517, 1998
4)Yeo CJ, Cameron JL, Sohn TA, et al:Pancreaticoduodenectomy with or without extended retroperitoneal lymphadenectomy for periampullary adenocarcinoma:comparison of morbidity and mortality and short-outcomes. Ann Surg 229:613-622, 1999
5)Farnell MB, Pearson RK, Sarr MG, et al:Pancreas Cancer Working Group. A prospective randomized trial comparing standard pancreatoduodenectomy with pancreatoduodenectomy with extended lymphadenectomy in resectable pancreatic head adenocarcinoma. Surgery 138:618-628, 2005
6)Nimura Y, Nagino M, Takao S, et al:Standard versus extended lymphadenectomy in radical pancreatoduodenectomy for distal adenocarcinoma of the head of the pancreas:long-term results of a Japanese multicenter randomized controlled trial. J Hepatobiliary Pancreat Sci 19:230-241, 2012
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8)Hirono S, Kawai M, Okada KI, et al:Complete circumferential lymphadenectomy around the superior mesenteric artery with preservation of nerve plexus reduces locoregional recurrence after pancreatoduodenectomy for resectable pancreatic ductal adenocarcinoma. Eur J Surg Oncol 47:2586-2594, 2021
9)Nakao A, Takagi H:Isolated pancreatectomy for pancreatic head carcinoma using catheter bypass of the portal vein. Hepato-Gastroenterol 40:426-429, 1993
10)Nakao A:The mesenteric approach in pancreatoduodenectomy. Dig Surg 33:308-313, 2016
11)Hirono S, Yamaue H:Tips and ticks of the surgical technique for borderline resectable pancreatic cancer:mesenteric approach and modified distal pancreatectomy with en-bloc celiac axis resection. J Hepatobiliary Pancreat Sci 22:E4-E7, 2015
12)Hirono S, Kawai M, Okada K, et al:Mesenteric approach during pancreaticoduodenectomy for pancreatic ductal adenocarcinoma. Ann Gastrointest Surg 1:208-218, 2017
13)Hirono S, Kawai M, Okada K, et al:MAPLE-PD trial(mesenteric approach vs. conventional approach for pancreatic cancer during pancreaticoduodenectomy):study protocol for a multicenter randomized controlled trial of 354 patients with pancreatic ductal adenocarcinoma. Trials 19:613, 2018

掲載誌情報

出版社:株式会社医学書院

電子版ISSN:1882-1278

印刷版ISSN:0386-9857

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