臨床外科79巻4号

2024年04月発行

特集 エキスパートに聞く！膵頭十二指腸切除のすべて

拡大手術

Conversion手術の展望

著者： 深澤美奈¹ 渋谷和人¹ 藤井努¹

所属機関： ¹富山大学学術研究部医学系消化器・腫瘍・総合外科

ページ範囲：P.418 - P.424

文献概要

【ポイント】
◆UR-LA膵癌に対するConversion手術は，化学放射線療法や重粒子線治療の保険適用により報告が増えている．手術適応に関しては十分に検討するべきである．
◆UR-M膵癌に対するConversion手術の報告も増えてきているが，その有用性は現時点では明らかでない．
◆CY陽性膵癌は他の遠隔転移に比較して病勢コントロールが得やすく，CY陰転化により遠隔転移のない症例と同等の予後が期待される．

参考文献

1）公益財団法人がん研究振興財団：がんの統計2022〔https://ganjoho.jp/public/qa_links/report/statistics/2022_jp.html〕

2）Gillen S, Schuster T, Meyer Zum Buschenfelde C, et al：Preoperative/neoadjuvant therapy in pancreatic cancer：a systematic review and meta-analysis of response and resection percentages. PLoS Med 7：e1000267, 2010

3）日本膵臓学会：膵癌取扱い規約 第8版，金原出版，2023

4）NCCN Guidelines Version 1.2023. Pancreatic adenocarcinoma. 〔https://www.nccn.org/guidelines/category_2〕

5）Callery MP, Chang KJ, Fishman EK, et al：Pretreatment assessment of resectable and borderline resectable pancreatic cancer：expert consensus statement. Ann Surg Oncol 16：1727-1733, 2009

6）Varadhachary GR, Tamm EP, Abbruzzese JL, et al：Borderline resectable pancreatic cancer：definitions, management, and role of preoperative therapy. Ann Surg Oncol 13：1035-1046, 2006

7）Conroy T, Desseigne F, Ychou M, et al：FOLFIRINOX versus gemcitabine for metastatic pancreatic cancer. N Engl J Med 364：1817-1825, 2011

8）Von Hoff DD, Ervin T, Arena FP, et al：Increased survival in pancreatic cancer with nab-paclitaxel plus gemcitabine. N Engl J Med 369：1691-1703, 2013

9）Frigerio I, Regi P, Giardino A, et al：Downstaging in Stage IV Pancreatic Cancer：A New Population Eligible for Surgery? Ann Surg Oncol 24：2397-2403, 2017

10）Kharofa J, Tsai S, Kelly T, et al：Neoadjuvant chemoradiation with IMRT in resectable and borderline resectable pancreatic cancer. Radiother Oncol 113：41-46, 2014

11）Ikeda M, Ioka T, Ito Y, et al：A multicenter phase Ⅱ trial of S-1 with concurrent radiation therapy for locally advanced pancreatic cancer. Int J Radiat Oncol Biol Phys 85：163-169, 2013

12）Fiore M, Trodella L, Valeri S, et al：Prospective study of cetuximab and gemcitabine in combination with radiation therapy：feasibility and efficacy in locally advanced pancreatic head cancer. Radiat Oncol 10：255, 2015

13）Hurt CN, Falk S, Crosby T, et al：Long-term results and recurrence patterns from SCALOP：a phase II randomised trial of gemcitabine- or capecitabine-based chemoradiation for locally advanced pancreatic cancer. Br J Cancer 116：1264-1270, 2017

14）Oonishi K, Cui X, Hirakawa H, et al：Different effects of carbon ion beams and X-rays on clonogenic survival and DNA repair in human pancreatic cancer stem-like cells. Radiother Oncol 105：258-265, 2012

15）Gemenetzis G, Groot VP, Blair AB, et al：Survival in Locally Advanced Pancreatic Cancer After Neoadjuvant Therapy and Surgical Resection. Ann Surg 270：340-347, 2019

16）Napolitano F, Formisano L, Giardino A, et al：Neoadjuvant Treatment in Locally Advanced Pancreatic Cancer（LAPC）Patients with FOLFIRINOX or Gemcitabine NabPaclitaxel：A Single-Center Experience and a Literature Review. Cancers（Basel）11：981, 2019

17）Kimura Y, Nakamura T, Hayashi T, et al：Clinical usefulness of conversion surgery for unresectable pancreatic cancer diagnosed on multidetector computed tomography imaging：Results from a multicenter observational cohort study by the Hokkaido Pancreatic Cancer Study Group（HOPS UR-01）. Ann Gastroenterol Surg 3：523-533, 2019

18）Lee M, Kang JS, Kim H, et al：Impact of conversion surgery on survival in locally advanced pancreatic cancer patients treated with FOLFIRINOX chemotherapy. J Hepatobiliary Pancreat Sci 30：111-121, 2023

19）Ushida Y, Inoue Y, Oba A, et al：Optimizing Indications for Conversion Surgery Based on Analysis of 454 Consecutive Japanese Cases with Unresectable Pancreatic Cancer Who Received Modified FOLFIRINOX or Gemcitabine Plus Nab-paclitaxel：A Single-Center Retrospective Study. Ann Surg Oncol 29：5038-5050, 2022

20）Igarashi T, Yamada S, Hoshino Y, et al：Prognostic factors in conversion surgery following nab-paclitaxel with gemcitabine and subsequent chemoradiotherapy for unresectable locally advanced pancreatic cancer：Results of a dual-center study. Ann Gastroenterol Surg 7：157-166, 2023

21）日本膵臓学会膵癌診療ガイドライン改訂委員会：膵癌診療ガイドライン2022年版，金原出版，2022

22）Truty MJ, Kendrick ML, Nagorney DM, et al：Factors Predicting Response, Perioperative Outcomes, and Survival Following Total Neoadjuvant Therapy for Borderline/Locally Advanced Pancreatic Cancer. Ann Surg 273：341-349, 2021

23）van Veldhuisen E, Vogel JA, Klompmaker S, et al：Added value of CA19-9 response in predicting resectability of locally advanced pancreatic cancer following induction chemotherapy. HPB（Oxford）20：605-611, 2018

24）Moon D, Kim H, Han Y, et al：Preoperative carbohydrate antigen 19-9 and standard uptake value of positron emission tomography-computed tomography as prognostic markers in patients with pancreatic ductal adenocarcinoma. J Hepatobiliary Pancreat Sci 29：1133-1141, 2022

25）Kanda M, Fujii T, Kodera Y, et al：Nutritional predictors of postoperative outcome in pancreatic cancer. Br J Surg 98：268-274, 2011

26）Kimura N, Yamada S, Takami H, et al：Optimal Preoperative Multidisciplinary Treatment in Borderline Resectable Pancreatic Cancer. Cancers（Basel）13：36, 2020

27）Shinoto M, Yamada S, Yasuda S, et al：Phase 1 trial of preoperative, short-course carbon-ion radiotherapy for patients with resectable pancreatic cancer. Cancer 119：45-51, 2013

28）篠藤　誠：膵癌に対する重粒子線治療の意義．胆と膵41：499-505，2020

29）Fujii T, Nakao A, Yamada S, et al：Vein resections ＞3 cm during pancreatectomy are associated with poor 1-year patency rates. Surgery 157：708-715, 2015

30）Shibuya K, Kimura N, Watanabe T, et al：Usefulness of the femoral vein as a graft for portal vein/superior mesenteric vein reconstruction during pancreatectomy. J Hepatobiliary Pancreat Sci 30：1196-1197, 2023

31）Sakai A, Igarashi T, Yoshioka I, et al：A 47-Year-Old Man with Advanced Distal Pancreatic Carcinoma and an Initial Partial Response to Chemotherapy Requiring Celiac Axis Reconstruction of the Common Hepatic Artery and Left Gastric Artery. Am J Case Rep 23：e936840, 2022

32）Satoi S, Yamamoto T, Yamaki S, et al：Surgical indication for and desirable outcomes of conversion surgery in patients with initially unresectable pancreatic ductal adenocarcinoma. Ann Gastroenterol Surg 4：6-13, 2020

33）Ueno H, Ioka T, Ikeda M, et al：Randomized phase Ⅲ study of gemcitabine plus S-1, S-1 alone, or gemcitabine alone in patients with locally advanced and metastatic pancreatic cancer in Japan and Taiwan：GEST study. J Clin Oncol 31：1640-1648, 2013

34）Satoi S, Fujii T, Yanagimoto H, et al：Multicenter Phase II Study of Intravenous and Intraperitoneal Paclitaxel With S-1 for Pancreatic Ductal Adenocarcinoma Patients With Peritoneal Metastasis. Ann Surg 265：397-401, 2017

35）Crippa S, Bittoni A, Sebastiani E, et al：Is there a role for surgical resection in patients with pancreatic cancer with liver metastases responding to chemotherapy? Eur J Surg Oncol 42：1533-1539, 2016

36）Wright GP, Poruk KE, Zenati MS, et al：Primary Tumor Resection Following Favorable Response to Systemic Chemotherapy in Stage IV Pancreatic Adenocarcinoma with Synchronous Metastases：a Bi-institutional Analysis. J Gastrointest Surg 20：1830-1835, 2016

37）Byun Y, Han Y, Kang JS, et al：Role of surgical resection in the era of FOLFIRINOX for advanced pancreatic cancer. J Hepatobiliary Pancreat Sci 26：416-425, 2019

38）Tanaka M, Heckler M, Mihaljevic AL, et al：CT response of primary tumor and CA19-9 predict resectability of metastasized pancreatic cancer after FOLFIRINOX. Eur J Surg Oncol 45：1453-1459, 2019

39）Mackay TM, van Erning FN, van der Geest LGM, et al：Association between primary origin（head, body and tail）of metastasised pancreatic ductal adenocarcinoma and oncologic outcome：A population-based analysis. Eur J Cancer 106：99-105, 2019

40）Yamada S, Fujii T, Yamamoto T, et al：Phase Ⅰ/Ⅱ study of adding intraperitoneal paclitaxel in patients with pancreatic cancer and peritoneal metastasis. Br J Surg 107：1811-1817, 2020

41）日本腹膜播種研究会：腹膜播種診療ガイドライン2021年版，金原出版，2021

42）Okui M, Yamamichi T, Asakawa A, et al：Resection for Pancreatic Cancer Lung Metastases. Korean J Thorac Cardiovasc Surg 50：326-328, 2017

43）Ilmer M, Schiergens TS, Renz BW, et al：Oligometastatic pulmonary metastasis in pancreatic cancer patients：Safety and outcome of resection. Surg Oncol 31：16-21, 2019

44）Tsuchida H, Fujii T, Mizuma M, et al：Prognostic importance of peritoneal washing cytology in patients with otherwise resectable pancreatic ductal adenocarcinoma who underwent pancreatectomy：A nationwide, cancer registry-based study from the Japan Pancreas Society. Surgery 166：997-1003, 2019

45）Aoki S, Mizuma M, Hayashi H, et al：Prognostic impact of intraoperative peritoneal cytology after neoadjuvant therapy for potentially resectable pancreatic cancer. Pancreatology 20：1711-1717, 2020

46）Fukasawa M, Watanabe T, Tanaka H, et al：Efficacy of staging laparoscopy for resectable pancreatic cancer on imaging and the therapeutic effect of systemic chemotherapy for positive peritoneal cytology. J Hepatobiliary Pancreat Sci 30：1261-1272, 2023

47）Igarashi T, Fukasawa M, Watanabe T, et al：Evaluating staging laparoscopy indications for pancreatic cancer based on resectability classification and treatment strategies for patients with positive peritoneal washing cytology. Ann Gastroenterol Surg 8：124-132, 2023

48）Ariake K, Mizuma M, Motoi F, et al：Preceding Systemic Chemotherapy for Patients with Pancreatic Ductal Adenocarcinoma with Positive Peritoneal Cytology Provides Survival Benefit Compared with Up-Front Surgery. Ann Surg Oncol 28：6246-6254, 2021