@article{oai:mie-u.repo.nii.ac.jp:00007530,
 author = {伊佐地, 秀司 and Isaji, Shuji and 長沼, 達史 and Naganuma, Tatsushi and 川原田, 嘉文 and Kawarada, Yoshifumi},
 issue = {4},
 journal = {日本消化器外科学会雑誌},
 month = {Apr},
 note = {application/pdf, 1976年9月～1998年8月までの浸潤性膵管癌手術172例中切除は84例(48.8%)であった. 1981年4月までの標準手術を行った初期34例, 1981年5月～93年3月までの拡大手術を行った中期100例, 1993年4月～98年8月までのQOLを考慮し準標準手術を行った後期38例に分け拡大手術の適応と限界を検討した. 切除率は初期32.4%, 中期54%, 後期50%で, 治癒切除率はそれぞれ9.1%, 68.5%, 63.2%であった. 3, 5年生存率は初期9.1%, 0%, 中期18.1%, 13.5%, 後期36.4%, 25.8%と年代とともに向上した. StageIV症例では拡大手術を行っても非治癒切除となったものはbypass手術と術後生存期間に差はなかったが, 入院期間は拡大手術で著明に長くQOLは損なわれた. 以上より, 進行膵癌に対してはすべてに拡大手術を施行すべきではなく, 非治癒切除が予想される症例ではQOLを考慮してbypass手術を選択すべきである., Results of extended resection for invasive ductal carcinoma of the pancreas were assessed to determine its indication and limits. From September 1979 to August 1998, 84 (48.8%) of 172 surgical patients underwent resection. The cases were divided as follows: 34 cases in the early period (through April 1981), which were treated by pancreatic resection limited to D1 lymph node dissection; 100 cases in the middle period (May 1991 through March 1993), which were treated by extended surgery and included either D2 lymph node dissection or combined resection of the portal vein; and 38 cases in the late period (April 1993 through August 1998), in which indication of resection included consideration of curability and patient QOL. The resection rate was 32.4% in the early period, which was significantly lower than 54.0% and 50.0%, respectively, in the middle and late periods. Curative resection rates were significantly higher in the middle (68.5%) and late periods (63.2%) than in the early period. The 3-year survival rates improved, from 9.1% in the early period, to 18.1% in the middle period and to 36.4% in the late period. For stage IV cancer, however, patients in whom extended resections proved to be noncurative had extremely poor prognosis, and showed very poor QOL and similar survival results to those who received palliative bypass surgery. Extended surgery should not be employed in all cases with advanced pancreatic cancer, and bypass procedures should be selected for cases in which curative resection is considered to be impossible.},
 pages = {1127--1131},
 title = {浸潤性膵管癌に対する拡大手術の適応と限界 : 長期予後とQOLからみた進行膵癌の治療戦略},
 volume = {32},
 year = {1999}
}