スキルス胃癌の外科的治療

Surgical Treatment of Scirrhous Gastric Cancer

要旨●スキルス胃癌を含めた進行胃癌に対し，過去には拡大手術が行われた時代もあったが，その後多くの重要な臨床試験が決着し，現在は膵脾合併切除を伴わないD2リンパ節郭清が推奨される術式となっている．その特性上，スキルス胃癌に対する術式は胃全摘および脾摘を伴うD2リンパ節郭清となることが多い．近年では化学療法の発展に伴い補助療法のエビデンスが次々と生まれ，外科医は集学的治療における手術の役割を認識しつつ過不足ない胃切除術を安全に行うことが求められる．

　The scope of gastrectomy and lymphadenectomy has increased for advanced gastric cancer including scirrhous gastric cancer in the past. Then, many important clinical trials have been performed, and D2 gastrectomy without pancreatosplenectomy is recommended for advanced gastric cancer. Due to the characteristics of scirrhous gastric cancer, the surgical procedure often used is D2 total gastrectomy with splenectomy. Recently, successful evidence of survival benefit of adjuvant or neoadjuvant therapy has been shown, and surgeons are now expected to perform safe and sufficient gastrectomy while being aware of their role in multidisciplinary therapy.