T4b大腸癌を腹腔鏡下でいかに安全に切除するか

How to safely resect T4b colorectal cancer with laparoscopic surgery

◆要旨：現在，多くの大腸癌が腹腔鏡手術で治療されているが，腫瘍径が大きく術野展開が困難なT4b病変に対しては，『大腸癌治療ガイドライン』においても慎重な対応が求められている．確実なR0切除と手術の安全性を高めるために，われわれは“通常以上に臓器を愛護的に操作する”ことと“多方向から観察し浸潤範囲を明確にする”ことが重要と考えている．そして，まず病変から離れた部位の剝離を先行して授動の大枠を整えたうえで，多方向から腫瘍に迫り，浸潤部分は手術終盤に切離することを原則としている．これまで経験した腹腔鏡下切除例を開腹切除例と比較したところ，短期成績は良好で予後でも差は認められなかった．われわれの手技の実際と要点を報告する．

　Nowadays, many colorectal cancer patients are treated by laparoscopic surgery. However, many guidelines for colorectal cancer treatment call for a cautious attitude toward T4b lesions, which invade adjacent organs. They are generally difficult to perform laparoscopic surgery because of its large size and poor visibility. In order to perform safe and complete resection in laparoscopic surgery, we recognize that it is important to“manipulate the organ more gently than usual”and“observe from multiple directions to clarify the invaded lesion”. Our principal strategy is as follows : Firstly, we dissect and mobilize the organ that is away from the tumor, and secondly, we approach the tumor from multiple directions, and then resect the whole invaded lesion at the end of the operation. We compared the treatment result of laparoscopic surgery for T4b tumor experienced so far with those of open surgery. We confirmed that the short-term results of laparoscopic surgery were better, and there was no difference in the prognosis data between them. We report our actual procedures and key points in laparoscopic surgery for T4b colorectal cancer.