切除不能進行胃癌に対する低侵襲Conversion手術の治療成績

Outcomes of minimally invasive conversion surgery for unresectable advanced gastric cancer

◆要旨：切除不能進行胃癌でもConversion手術でR0切除が得られれば長期予後が期待できるとされる．当院では積極的に低侵襲手術を実施しており，2011年から2022年にcStageⅣBと診断され全身化学療法後に低侵襲手術を施行した23例の治療成績を検討した．アプローチは腹腔鏡21例，ロボット2例で，手術時間中央値は343分．術後合併症はGradeⅡが5例，GradeⅢa 2例．R0切除は21例で，術後化学療法は17例で施行され再発は14例，うち腹膜播種再発が10例であった．低侵襲手術によるConversion手術は安全に施行でき有用な治療選択肢となりうるが，さらなる研究が必要である．

　It has been reported that for patients with unresectable advanced gastric cancer, long-term prognosis can be improved if R0 resection is achieved through conversion surgery. This study aims to evaluate the surgical outcomes of minimally invasive conversion surgery at our institution. We retrospectively analyzed the treatment outcomes of 23 patients diagnosed with cStageⅣB gastric cancer who received systemic chemotherapy followed by minimally invasive surgery aimed at curative resection between 2011 and 2022. The approaches were laparoscopic in 21 and robotic in 2 cases, respectively, with a median operative time of 343 minutes. Postoperative complications of GradeⅡandⅢwere observed in 5 and 2 cases, respectively. In 21 cases, R0 resection was achieved. Seventeen patients received adjuvant chemotherapy. Fourteen patients had recurrences, among which 10 peritoneal recurrences were the most common. Minimally invasive conversion surgery can be safely performed with high R0 resection rates. However, the high incidence of peritoneal recurrence suggests the need for multimodal treatment strategies. Minimally invasive conversion surgery could be a valuable treatment option, but further research is required to show its efficacy.