腹腔鏡下膵切除の現状と内視鏡外科技術認定医の役割—第7回膵臓内視鏡外科研究会学術集会アンケート調査から

The present state of laparoscopic pancreatic resection in Japan and the role of endoscopic surgical skill qualification system : A report from the questionnaire survey for the 7th conference of Japanese Society for Endoscopic Pancreatic Surgery

◆要旨：第7回膵臓内視鏡外科研究会学術集会において現在の腹腔鏡下膵切除の現状と意識を把握するため，同研究会会員にアンケート調査を行い，全国113施設（452症例）より回答を得た．1施設あたりの年間症例数は中央値4例と少なく，施設間差があることが明らかとなった．80％の施設で，日本内視鏡外科学会技術認定医が手術に参加しており，内視鏡外科技術認定医の有無が腹腔鏡下膵切除の施設経験の有無と有意に相関していた（p＝0.0128）ことから，膵臓内視鏡手術を広げるためにはさらなる内視鏡外科技術認定医の養成が必要であることが示唆された．また，2016年より膵癌への保険適応拡大が行われたが，多くの施設がT2までの膵癌を適応と考えていた．膵癌に対しては開腹手技と同等の生存成績が得られる対象を臨床研究で明らかにする必要がある．

To comprehend the present state of laparoscopic pancreatic resection in Japan and the opinion of the members, the secretariat sent a questionnaire to the members of Japanese Society for Endoscopic Pancreatic Surgery（JSEPS） and 113 institutions replied. A total number of 452 patients had undergone laparoscopic pancreatic resection during 12 months of 2014. The median number was 4 patients per one institution per year and many institutions did not perform laparoscopic pancreatic resection for more than a year. Some desired wider application of laparoscopic surgery. The morbidity rate was not different among the institutions irrespective of the number of patients experienced. In 80％ of the institutions, one or more surgeons, qualified by the endoscopic surgical skill qualification system, participated in the laparoscopic pancreatic resection. Their participation was significantly related to the experience of laparoscopic pancreatic resection performed in institutions, suggesting that promotion of qualified endoscopic surgeons is necessary for the prevalence of laparoscopic pancreatic resection in Japan.