演題抄録

臓器別シンポジウム

開催概要
開催回
第55回・2017年・横浜
 

直腸癌の手術治療 現状と展望

演題番号 : OSY15-4

[筆頭演者]
長谷川 博俊:1 
[共同演者]
岡林 剛史:1、鶴田 雅士:1、石田 隆:1、北川 雄光:1

1:慶應義塾大学・医学部・外科

 

During the last 30 years surgery for rectal cancer has evolved greatly. The most important advancement in rectal cancer surgery is total mesorectal excision (TME) introduced by Bill Heald in 1982. The TME became the standard procedure together with preoperative radiation or chemoradiation in Western countries. However, in Japan TME with lateral lymph node dissection has been regarded as standard for T3/4 lower rectal cancer to improve the local control. The Japan Clinical Oncology Group conducted a randomised controlled trial to compare TME with lateral lymph node dissection with TME alone, and the long-term outcome has recently been published.
The past 15 years have brought further technical advances in laparoscopic surgery and an evolving interest in organ preserving surgery. Laparoscopic surgery has been shown to provide equivalent oncological outcomes to open surgery in COREAN and COLOR II trials, however, ACOSOG and ALaCaRT trials have failed to demonstrate the non-inferiority in terms of the completeness of TME. Potential cost benefits, particularly of robotic surgery, remain to be proven. New techniques such as transanal TME may also enhance the quality of surgery for rectal cancer and reduce the morbidity. In the future, the need for surgery may decrease in conjunction with advanced imaging technologies and reliable indicators that can predict the response to neoadjuvant chemoradiotherapy.

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