本邦における膵臓外科の歴史と私の経験

Abstract

The first case of pancreatoduodenectomy(PD) in Japan was done by Kuru in 1946, then Yoshioka in 1947, and then Honjyo performed a total pancreatectomy in 1949. Portal vein resection combined with PD was reported by Kikuchi in 1956 and by Asada in 1963. They used 70% alcohol-preserved homograft of the vein. Fortner's report of regional pancreatectomy in 1973 greatly impressed Japanese pancreatic surgeons. Then in 1981, I developed my own catheter-bypass method of the portal vein using antithrombogenic material. The isolated pancreatoduodenectomy combined with portal vein resection was completed. This bypass method made it possible to prevent portal congestion or hepatic ischemia during portal vein resection or simultaneous resection of the hepatic artery. Thus, vascular resection has become safer and easier during pancreatic surgery. Extended radical pancreatic resection was developed during the 1970s and 1980s. The high mortality rate of PD in the 1950s and 1960s decreased gradually to within 10% in the 1980s and 5% in the 1990s. Hanyu had performed a landmark 1000 PDs in 1997, and the mortality rate has been 1% since 1989. We have performed 825 pancreatic resections, for various diseases since 1981 and mortality was observed in 14 cases (1.7%). Moreover 441 pancreatic resections for pancreatic cancer along with combined resection of the portal vein were performed in 282 cases during 1981-2009. The mortality rate of PD for pancreatic cancer was 2.7% in my series, but no mortality has been experienced in the last 11 years. However, the prognosis for pancreatic cancer is still poor and adjuvant therapy has been combined with radical surgery such as intraoperative radiotherapy using linac, and intraportal continuous infusion of 5-FU. Adjuvant chemotherapy using gemcitabine or TS-1 and clinical trial of oncolytic virus therapy using herpes simplex virus (HF10) have been performed, yet numerous problems remained to be solved. I have devised techniques such as isolated pancreatoduodenectomy combined with portal vein resection using catheter-bypass method for the portal vein and a mesenteric approach and pancreatic head resection with segmental duodenectomy(PHRSD) for IPMN. Every day I still feel great pleasure and a sense of fulfillment in performing surgery. Surgeons are able to care for patients all the way from diagnosis and surgery through postoperative management and follow-up after the patient leaves the hospital. This sense of accomplishment is truly great, and it is a specialty that I believe we should be sure to pass down to younger people. Let me say that I am filled with gratitude to my colleagues and the younger doctors I have worked with in medical practice and research.