膵癌外科治療の問題点

Problems of Surgical Management of Pancreatic Cancer

　近年，本邦における膵癌の発生頻度は，漸次増加傾向にあり，ここ10年間で約2倍の発生率を示しているが，膵癌の治療成績は他の消化器癌に比し，切除率，手術死亡率，遠隔成績のいずれにおいても極めて不良である．

　このような現状より，膵癌の治療成績の向上を期して，早期発見の方法が模索され，他方では広範なリンパ節郭清と門脈や隣接臓器の合併切除，さらには，膵全摘術によって根治性の改善をはかるという拡大根治術の方向がうち出され，新たな検討が進められつつある．

　As compared with other cancers of the digestive tract, the results of treatment for pancreatic cancer are disappointing not only in the rate of resectability and operative mortality but also in the end results, although various efforts have been made up to now.

　For better results it goes without saying that detection of small cancer of the pancreas is very important, and its surgical operation, the basic treatment for it, demands improvement of safer and more effective method of curative resection. More careful pre- and postoperative management of the patient is also advisable.

　From this point of view, we have reviewed 209 such patients operated on in our department during the past 20 years. The results of surgical treatment are introduced along with the relationship of development patterns and prognosis. Patterns of recurrence in autopsied patients are also studied. We have discussed some mooted points for the resection of the pancreas with reference to the literature.

　As a result, we have come to the conclusion that for lowering operative mortality it is important to improve methods of easing preoperative jaundice, to introduce central venous nutrition and to better the way of pancreato-jejunal anastomosis. For the prevention of recurrence it is most important not only to painstakingly extirpate retroperitoneal and peripancreatic lymph nodes but also to resect completely any involved lymph nodes along with dissection of the plexus of the proximal part of the celiac artery and superior mesenteric artery. Stress is also laid on the necessity of total pancreatectomy and combined resection of the portal vein. On the other hand, reference is made to still unsolved problems regarding disorders of digestion and absorption and those of glucose metabolism, as they are important in the management of pathologie pictures presented by pancreatectomy.