腹腔鏡下骨盤内臓全摘術のコツとピットフォール

Tips and pitfalls of laparoscopic total pelvic exenteration

◆要旨：腹腔鏡下骨盤内臓全摘術（Lap-TPE）は，局所進行/再発直腸癌に対する根治的治療法の一手段として，近年その低侵襲性が注目されている．開腹手術に比べ，出血や術後合併症の軽減が期待される一方で，高度な技術と周到な準備が求められる．本稿ではLap-TPEのエビデンス，適応，手術に必要な局所解剖，手技の実際，術後管理を包括的に解説し，安全な導入に向けた指針を示す．

　Laparoscopic total pelvic exenteration（Lap-TPE） has emerged as a potential curative treatment option for patients with locally advanced or recurrent rectal cancer, gaining attention for its minimally invasive nature. Compared to open surgery, Lap-TPE offers advantages such as reduced intraoperative blood loss and fewer postoperative complications. However, it also demands advanced surgical skills and meticulous preoperative assessment and planning. This review provides a comprehensive overview of the current evidence, indications, essential anatomical knowledge, surgical techniques, and postoperative management related to Lap-TPE. It also outlines key considerations for the safe and effective implementation of this complex procedure.