浸潤・再発様式からみた膵頭部領域癌に対する上腸間膜動脈周囲郭清の意義  [in Japanese] Surgical Approach for Radical Dissection Around the Superior Mesenteric Artery for Carcinoma of the Pancreatic Head Area Based on th Pattern of Tumor Spread and Mode of Recurrence  [in Japanese]

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Abstract

膵頭部領域癌133例 (膵頭部癌70例, 下部胆管癌31例, 乳頭部癌32例) の再発・浸潤様式を検索し, 上腸間膜動脈神経叢一部温存郭清の可能性について検討した. リンパ節転移は膵頭部癌の79%, 下部胆管癌の67%, 乳頭部癌の44%に, 神経叢浸潤はそれぞれ60%, 26%, 3%に認められた. 神経叢浸潤部位は膵頭部癌では PL.phIIが, 下部胆管癌では Pl.phIが多かった. また, No.14リンパ節転移率はそれぞれ34%, 32%, 16%, No.16転移率はそれぞれ19%, 6%, 0%であった. 再発形式を膵頭部癌肉眼治癒再発確認40例でみると, リンパ節再発, 後腹膜局所再発が88%にみられた. 下部胆管癌治癒再発6例では全例に後腹膜再発がみられ, 膵臓浸潤の強いものが多かった. 以上より, 膵頭部癌では上腸間膜動脈神経叢と No.14, No.16リンパ節郭清を行うことが重要であり, 膵臓浸潤をみない下部胆管癌や乳頭部癌では上腸間膜動脈神経叢を一部温存した No.14リンパ節郭清が可能であると考えられた. The pattern of tumor spread and mode of recurrence of carcinoma of the pancreatic head area were investigated by clinicopathologic analysis for the preservation of superior mesenteric pleuxus. One hundred and thirty three patients with carcinoma of the pancreatic head area were examined histopathologically. These patients consisted of 70 with carcinoma of the head of the pancreas (Ph), 31 with distal bile duct cancer (Bi), and 32 with carcinoma of the papilla of Vater (A). Fifty-five (79%) of the patients with "Ph" disease, 21(67%) of those with "Bi" disease, and 14(44%) of those with "A" disease had nodal involvement. Frequencies of No.14 lymph node metastasis were 34%, 32%, and 16%, respectively. Extrapancreatic plexus invasion by these three carcinomas was observed in 60% of "Ph", 26% of "Bi", and 3% of "A" patients. Retroperitoneal recurrence including paraaortic lymph nodes was discovered in 88% of the patients with "Ph" who had undergone macroscopically curative resection. All six "Bi" patients with recurrence among patients who underwent curative resection had retroperitoneal recurcreatic plexus necessary for carcinoma of the head of the pancreas. It is possible to perform nodal dissection around the supperior mesenteric artery while preserving the nerve plexus for patients without far advanced distal bile duct cancer or carcinoma of the papilla of Vater.

The pattern of tumor spread and mode of recurrence of carcinoma of the pancreatic head area were investigated by clinicopathologic analysis for the preservation of superior mesenteric pleuxus. One hundred and thirty three patients with carcinoma of the pancreatic head area were examined histopathologically. These patients consisted of 70 with carcinoma of the head of the pancreas (Ph), 31 with distal bile duct cancer (Bi), and 32 with carcinoma of the papilla of Vater (A). Fifty-five (79%) of the patients with "Ph" disease, 21(67%) of those with "Bi" disease, and 14(44%) of those with "A" disease had nodal involvement. Frequencies of No.14 lymph node metastasis were 34%, 32%, and 16%, respectively. Extrapancreatic plexus invasion by these three carcinomas was observed in 60% of "Ph", 26% of "Bi", and 3% of "A" patients. Retroperitoneal recurrence including paraaortic lymph nodes was discovered in 88% of the patients with "Ph" who had undergone macroscopically curative resection. All six "Bi" patients with recurrence among patients who underwent curative resection had retroperitoneal recurcreatic plexus necessary for carcinoma of the head of the pancreas. It is possible to perform nodal dissection around the supperior mesenteric artery while preserving the nerve plexus for patients without far advanced distal bile duct cancer or carcinoma of the papilla of Vater.

Journal

  • The Japanese journal of gastroenterological surgery

    The Japanese journal of gastroenterological surgery 29(5), 1084-1088, 1996-05-01

    The Japanese Society of Gastroenterological Surgery

References:  14

Cited by:  1

Codes

  • NII Article ID (NAID)
    110001321175
  • NII NACSIS-CAT ID (NCID)
    AN00192066
  • Text Lang
    JPN
  • Article Type
    Journal Article
  • ISSN
    03869768
  • Data Source
    CJP  CJPref  NII-ELS  IR 
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