本邦における腹腔鏡下膵切除の現状—全国アンケート調査結果

Current status of laparoscopic pancreatectomy in Japan : Results of a questionnaire survey

◆要旨：【目的】本邦における腹腔鏡下膵切除術の現状を把握する．【方法】膵臓内視鏡外科研究会施設会員および個人会員に対して，腹腔鏡下膵切除に関するアンケート調査を郵送にて行った．【結果】回答率は49.6％であった．補助下を含む腹腔鏡下膵尾側切除術（laparoscopic distal pancreatectomy；以下，LDP）は計1,337件，膵頭十二指腸切除術（laparoscopic pancreaticoduodenectomy；以下，LPD）は計204件であった．平均手術時間は，LDP 288分，LPD 552分であり，平均術中出血量は，LDP 179g，LPD 321gであった．Grade B/Cの膵液瘻発生率は，LDP 17.7％，LPD 26.5％で，Clavien-Dindo分類Grade Ⅲ以上の術後合併症発症率は，LDP 13.8％，LPD 25.0％であった．【結論】LDPは良好な治療成績が得られているが，LPDは今後のさらなる症例蓄積の必要があると考えられた．

［Objectives］ In Japan, laparoscopic distal pancreatectomy（LDP） has been covered by the national health insurance since 2012. The objectives of this study were to clarify the current status of the clinical results of laparoscopic pancreatectomy in Japan. ［Methods］ A questionnaire was sent to 295 individual and 127 institutional members of the Japanese Society for Endoscopic Pancreatic Surgery（JSEPS）. ［Results］ Responses were received from 98 institutions including 63（49.6％） institutional members of JSEPS. The cumulative number of LDP and laparoscopic pancreatoduodenectomy （LPD） was 1,337 and 204, respectively. IPMN was the most frequent indication for each procedure. Mean operative time of LDP and LPD was 288 and 552 min, intraoperative blood loss was 179 and 321 g, the rate of Grade B/C pancreatic fistulas was 17.7 and 26.5 ％, hospital motality rate was 0.2 and 0.5 ％, and length of postoperative hospital stay was 15.9 and 30.5 days, respectively. Statistical analysis revealed significant inverse relationship between hospital volume and operative time in LPD procedure. ［Conclusion］ LDP seems to be an established surgical procedure for pancreatic neoplasm that do not require lymph node dissection, while LPD is still in the evolving phase in Japan.