十二指腸乳頭部癌の予後

Prognosis, Morbidity, and Mortality of Patients with Carcinoma of the Papilla Vater

要旨　当科における乳頭部癌の手術症例は94例で，その切除率は81.9％であった．非切除例17例の平均生存期間は9.8か月で，膵頭十二指腸切除術耐術例70例の5年生存率は56.3％であった．耐術例の組織学的進展度と予後を比較検討し，乳頭部癌の予後を左右する因子について検討した．Oddi筋内に限局した乳頭部癌の予後は良好である．乳頭部癌の予後決定因子は十二指腸固有筋層浸潤，膵実質浸潤，リンパ節転移，脈管侵襲であり，特に膵実質浸潤例はリンパ節転移率，脈管侵襲率とも高率で予後不良であった．膵実質浸潤例は外科治療，放射線療法，免疫療法，化学療法などの集学的治療の併用の必要性が示唆された．

　Ninety-four patients with carcinoma of the papilla Vater were operated on in our department. The resectability was 81.9％. The average survival time for 17 patients who had palliative operation was only 9.8 months, while the five-year survival rate for 70 patients who underwent pancreatico-duodenectomy was 56.3％. Histology of resected tumors was examined in relation to the prognosis and factors determining the prognosis of those patients. The prognosis was closely related to such factors as infiltration into the pancreatic parenchyma, metastasis to lymph nodes, and invasion into the vasculature. Both lymph node metastasis and vascular invasion occurred with high frequency among those with infiltration into the pancreatic parenchyma. The five-year survival rate for panc_1b, group was 28.3％, while there was no survivers exceeding two years after operation among panc₂ or more advanced groups. In case of infiltration into the pancreatic parenchyma, surgical treatment is of limited efficacy and it seems to be necessary to combine radiotherapy, immunotherapy and/or chemotherapy with surgical treatment.