■綜説
我が国の膵癌診療の現状とこれから
横山 正
日本医科大学多摩永山病院消化器外科
Current Status of Treatment for Pancreatic Cancer in Japan and Prospects for the Future
Tadashi Yokoyama
Department of Gastrointestinal and Hepato-Biliary-Pancreatic Surgery, Nippon Medical School Tama Nagayama Hospital
Pancreatic cancer still has a poor prognosis, although prognosis is improved by early diagnosis. The current diagnostic strategy for pancreatic cancer is to select high-risk groups and perform various clinical examinations in stages, including ultrasound (US), enhanced computed tomography (CE-CT), endoscopic ultrasound (EUS), magnetic resonance cholangiopancreatography (MRCP), endoscopic retrograde cholangiopancreatography (ERCP), and positron emission tomography (PET). When pancreatic cancer is suspected on diagnostic imaging, pathological investigation is important to make a definitive diagnosis.
Surgery is still the only curative treatment, but with the advent of several effective chemotherapeutic regimens, the treatment strategy has changed from extensive to less-invasive surgical procedures. Technically, it is important to use the so-called artery-first approach, which treats the tumor influx artery in advance, and to achieve sufficient (R0) dissection without residual carcinoma. The prognostic effect of perioperative adjuvant therapy has been verified, and it can be clinically implemented for borderline resectable as well as resectable and unresectable cases.
In the future, clinical research will clarify the establishment of chemotherapy and radiotherapy as well as immunotherapy and molecular-targeted therapy using genomic medicine, and we hope that customized treatment strategies for pancreatic cancer will be realized.
日医大医会誌 2021; 17(3), 98-107
Key words
pancreatic cancer, artery-first approach, perioperative adjuvant therapy
Correspondence to
Tadashi Yokoyama, Department of Gastrointestinal and Hepato-Biliary-Pancreatic Surgery, Nippon Medical School Tama Nagayama Hospital, 1-7-1 Nagayama, Tama, Tokyo 206-8512, Japan
E-mail：yokotada@nms.ac.jp
受付：2021年2月7日 受理：2021年5月10日 |
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