内容紹介
Surgical Treatment of Gastroentero-Pancreatic Neuroendocrine Tumor
Summary
The treatment of choice for gastroentero-pancreatic neuroendocrine tumor(NET)is resection. Because it is difficult to determine the histological grade of NET before operation, the treatment strategy is usually made based on an imaging study including the tumor's size. Some selected gastrointestinal NETs are indicated for endoscopic resection, while others are resected surgically with lymph node dissection. The types of resections for pancreatic NETs vary from enucleation to pancreatectomy with or without regional lymph node dissection, based on the type of excessive hormone, tumor size, distance from the main pancreatic duct, and the presence of type 1 multiple endocrine neoplasia. Hepatic metastases are also resected, if indicated, and even in patients having unresectable metastatic lesions, multidisciplinary therapy including reduction surgery of over 90% of tumor volume might lead to a favorable prognosis. Postoperative adjuvant therapy is recommended for neuroendocrine carcinoma, while there is no evidence to support adjuvant therapy for curatively resected well-differentiated NET.
要旨
膵・消化管の神経内分泌腫瘍(neuroendocrine tumor: NET)の治療方針の基本は切除術である。組織型で術式は異なってくるが,高分化型NETや低分化型神経内分泌癌の組織型を術前に確定することは通常困難であり,腫瘍径を含む画像診断である程度予測して術式を決定する。消化管NETでは内視鏡的切除術の適応病変が示されているが,それ以外の病変はリンパ節郭清を伴う腸切除術を行う。また膵NETでは,腫瘍径,主膵管との距離,機能性・非機能性,多発内分泌腫瘍の合併の有無により切除法を決定する。膵・消化管NETの肝転移巣も切除可能なら切除術を行い,切除不能例でも90%以上の減量が望める場合には切除術を含む集学的治療を行う。神経内分泌癌術後には補助化学(放射線)療法が推奨されているが,高分化型NET根治切除後に対しては補助療法を推奨するだけのエビデンスはない。
目次
Summary
The treatment of choice for gastroentero-pancreatic neuroendocrine tumor(NET)is resection. Because it is difficult to determine the histological grade of NET before operation, the treatment strategy is usually made based on an imaging study including the tumor's size. Some selected gastrointestinal NETs are indicated for endoscopic resection, while others are resected surgically with lymph node dissection. The types of resections for pancreatic NETs vary from enucleation to pancreatectomy with or without regional lymph node dissection, based on the type of excessive hormone, tumor size, distance from the main pancreatic duct, and the presence of type 1 multiple endocrine neoplasia. Hepatic metastases are also resected, if indicated, and even in patients having unresectable metastatic lesions, multidisciplinary therapy including reduction surgery of over 90% of tumor volume might lead to a favorable prognosis. Postoperative adjuvant therapy is recommended for neuroendocrine carcinoma, while there is no evidence to support adjuvant therapy for curatively resected well-differentiated NET.
要旨
膵・消化管の神経内分泌腫瘍(neuroendocrine tumor: NET)の治療方針の基本は切除術である。組織型で術式は異なってくるが,高分化型NETや低分化型神経内分泌癌の組織型を術前に確定することは通常困難であり,腫瘍径を含む画像診断である程度予測して術式を決定する。消化管NETでは内視鏡的切除術の適応病変が示されているが,それ以外の病変はリンパ節郭清を伴う腸切除術を行う。また膵NETでは,腫瘍径,主膵管との距離,機能性・非機能性,多発内分泌腫瘍の合併の有無により切除法を決定する。膵・消化管NETの肝転移巣も切除可能なら切除術を行い,切除不能例でも90%以上の減量が望める場合には切除術を含む集学的治療を行う。神経内分泌癌術後には補助化学(放射線)療法が推奨されているが,高分化型NET根治切除後に対しては補助療法を推奨するだけのエビデンスはない。