5）腹腔鏡下切除術

Laparoscopic Surgery for Early Colorectal Cancer

要旨　腹腔鏡手術は低侵襲手術として急速に普及した．大腸癌手術においても腹腔鏡手術が年々増加している．2009年版の「大腸癌治療ガイドライン」では腹腔鏡手術は結腸癌および直腸S状部癌のcStage 0，Iがよい適応とされている．腹腔鏡手術の短期成績は，海外でのRCTやメタアナリシスの結果で腹腔鏡下手術の有用性が示された．当院での成績は腹腔鏡下手術は開腹手術と比べて手術時間は有意に長かったが，出血量は有意に少なく，術後在院日数も有意に短かった．術後合併症は開腹手術と比べて有意に少なかった．腹腔鏡手術の長期予後は，厚生労働省の多施設共同研究ではStage I大腸癌の予後に腹腔鏡手術と開腹手術との差はなかった．当院での早期大腸癌の長期予後も5年全生存率は腹腔鏡手術と開腹手術で有意差はなかった．本邦では結腸進行癌についてのRCTや直腸癌についての第1，2相試験が進行中である．腹腔鏡手術の現状は施設間で適応や手術手技にばらつきがあり，今後は手術手技や適応の均てん化が求められる．さらに，本邦独自のRCTや前向き第1，2相試験の結果が待たれる．

　Laparoscopic surgery has rapidly spread as a low-invasive surgery, and it has been increasingly applied for colorectal cancer.

　In the guidelines for colorectal cancer（2009 edition）, laparoscopic surgery is indicated for c-Stage 0 and I cancers of the colon and rectosigmoid junction. 　Short-term outcome of laparoscopic surgery : The usefulness of laparoscopic surgery was shown by metaanalysis of RCT overseas. 　At our hospital, the operation time for laparoscopic surgery was significantly longer than that for open surgery, but the blood loss was significantly smaller, the postoperative hospital stay was significantly shorter, and the incidence of postoperative complications was significantly lower. Long-term outcome of laparoscopic surgery : In a multicenter study performed by the Ministry of Health, Labour and Welfare, there was no difference in the outcome between laparoscopic and open surgeries for stage I colorectal cancer. There was no significant difference in the long-term outcome（5-year survival rate）between patients who underwent laparoscopic surgery and those who underwent open surgery.

　RCT on advanced colon cancer and phase I and II clinical studies on rectal cancer are underway in Japan.

　Currently, the indication and surgical procedure for laparoscopic surgery vary among facilities. 　Therefore, standardization of the surgical procedure and indication is necessary. The results of the Japanese original RCT and prospective phase I and II clinical studies are anticipated.