黄疸を主症状とする癌（胆管癌および膵癌）の診断と治療 ―難治性癌を治療させるために―

Primary malignant diseases manifesting jaundice as a main symptom are the carcinomas of the bile duct and the pancreatic head, both of which have very poor survival rates after surgical resection or other treatments. Statistically, unresectable cases of the diseases are absolutely fatal within one or two years. Pathologically curative resection in early stage could only give the patients a chance to survive without diseases. Role of early detection of the diseases at the primary clinics of internal physicians is essentially important, because the patients noticing jaundice would firstly visit them under the impression of having the liver deseases. They should not waste much time in examining various liver function tests. Image diagnosis on the bile duct and the pancreatic duct by ultrasonography, followed by PTC or ERCP, detect the diseases. Tumor marker, CT, MRI and angiography are also performed supplementally to determine the tumor expansion or resectability. Surgery should be the histologically curative resection, including extended skeletonization of the retroperitoneum. Recent five years' survival rates of the bile duct carcinoma after resection in all over Japan are 64.5% in stage-Ⅰ, 50.4% in stage-Ⅱ, 30.7% in stage-Ⅲ and 9.4% in stage-Ⅳ. And those of the pancreatic carcinoma are 39.3% in T(1) (within 2cm in tumor diameter), 21.3% in T(2) (2-4cm), 13.1% in T(3) (4-6cm) and 12.1% in T(4) (over 6cm). From these data, curative resection in the early stages (stage-Ⅰ or -Ⅱ in bile duct carcinoma ant T(1) or T(2) in pancreatic carcinoma) is recommended, but even in the stage-Ⅲ the chance to live longer by extended resection is preserved. To achieve furhter improvement, author has devised the NEW surgical technigues, "block resection of the hepatoduodenal ligament" for carcinoma of the bile duct and "isolated pancreatectomy" for pancreatic carcinoma. Curative resectabilities are increasing by applying these techniques and hepatic recurrence rate in pancreatic carcinoma is decreasing by "isolated pancreatectomy", although the statistical results of improvement in five years' survival rates are not yet achieved because of shortage in cases' numbers and time duration.