日本消化器病学会 アーカイブシステム

セッション情報 The 4th International Forum

II　Challenge to the pancreatic and biliary cancers　3. Pancreatic cancer―Challenge to the better treatment
タイトル IFII-3-3：

Distal Pancreatectomy with Celiac Axis Resection（DP-CAR）for borderline resectable panceras body cancer
演者 Yamaue　Hiroki（Second Department of Surgery, Wakayama Medical University, Japan）
共同演者
抄録 　The indications for distal pancreatectomy with en-bloc celiac axis resection（DP-CAR）were extended recently to increase the R0 rate for advanced pancreatic body/tail carcinoma. Moreover, it is well recognized that neoadjuvant chemotherapy（NAC）or chemoradiotherapy（NACRT）is essential for obtaining R0 resection in patients with borderline resectable pancreatic cancer. We have conducted the clinical trial for NAC using gemcitabine and alternative day administration of S-1, and the incidence of R0 reached 81% by NAC in borderline resectable patients, whereas it was only 35% without NAC treatment（Okada, Yamaue et al. Surgery 2013；153：365-372）.
　Another problem of DP-CAR is a delayed gastric emptying（DGE）due to the ischemic gastropathy after resection of left gastric artery（LGA）. We have attempted preservation of LGA（modified DP-CAR）if the patients have a tumor situated more than 10mm away from the antecedent branching LGA. The ISGPS grades of DGE were：grade A=26%, B=13% and C=17% in the conventional DP-CAR group, and grade A=7%, grade B/C=0% in the modified DP-CAR group. Thus, we conclude that Modified DP-CAR significantly reduced the incidence of DGE in comparison to conventional DP-CAR（manuscript in submission）.
　Third problem I should address is how to decrease the incidence of pancreatic fistula（PF）after DP and DP-CAR. We are proceeding to examine whether anastomosis of pancreatic remnant and jejunum by duct-to-mucosa fashion will have a less incidence of PF comparing to conventional stapler closure method by multicenter randomized controlled trial.
　Thus, multidisciplinary treatment will bring better clinical outcome even in patients with locally advanced pancreatic cancer who require DP-CAR for obtaining R0 resection.
索引用語