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―ワークショップ―
ワークショップは完成した研究成果より，むしろ未完成の進行中の研究をとりあげるセクションである．聴衆との討論の中で助言や今後の方向性が指摘される．斬新な考えや新しい方向などを示すような発表が望ましい．発表内容が多岐にわたることから総合討論は司会者の判断で有無を検討する．
（日本消化器外科学会「学術集会プログラムの定義」）
1.【総論】外科教育・働き方改革のためのオンライン活用術
詳細
デジタル技術と通信技術を活用した新しい社会システムの構築が各分野で進んでいる．外科教育では，手術動画のクラウド共有，ビデオクリニック，ウェビナー，バーチャル学会などが日常となり，働き方改革でも，診療情報のオンライン共有やチャット機能，勤怠管理の導入が進められている．本セッションでは，外科教育・働き方改革のためのオンライン活用術をご紹介いただき，消化器外科医の仕事と生活の充実につなげたい．
How to Use Online Systems for Surgical Education and Work-Style Reform
The construction of new social systems utilizing digital and communication technologies is progressing in various fields. In surgical education, cloud sharing of surgical videos, video clinics, webinars, and virtual conferences have become routine. In this session, we would like to learn new ways of using online systems for surgical education and work style reform at each institution to help gastroenterological surgeons enhance their work and life.
2.【総論】ロボット支援手術時代の若手消化器外科医の教育
詳細
現時点では手術支援ロボットの導入台数は限定的であるが，今後低侵襲手術に対する社会の要望と急速な技術革新により，ロボット支援下手術が標準となる時代が想定される．ソロサージェリーの要素が多いロボット支援下手術において，今後の消化器外科治療を担う若手外科医がいかに術者としてのトレーニングを積むかは重要な課題である．また，消化器外科全般の修練の中にどのように組み込んでゆくかも課題である．本セッションでは若手外科医に対する消化器外科修練のロードマップならびにロボット支援下手術トレーニングの開始時期と具体的な方法，課題について，各施設での実例を挙げて議論いただきたい．
How to Educate Young Gastroenterological Surgeons in the Era of Robot-Assisted Surgery
Although the number of surgical robots is limited at present, it is expected that robot-assisted surgery will become the standard in the future due to society's demand for minimally invasive surgery and rapid technological innovation. In robot-assisted surgery, which has many elements of solo surgery, it is an important issue how young surgeons, who will be responsible for the future of gastroenterological surgery, can be trained as surgeons. It is also an issue how to integrate the training into the overall training of gastroenterological surgeons. In this session, we would like to discuss the roadmap for training young surgeons in gastroenterological surgery, as well as the timing, specific methods, and challenges of robot-assisted surgical training, with examples from each institution.
3.【総論】こだわりの体腔内吻合
詳細
消化管の体腔内吻合は，創部や授動範囲の縮小による手術侵襲軽減をメリットとする手技である．しかし，体腔内感染や腹膜播種への懸念と，限られた視野での煩雑さから，手技にはまだまだ改善の余地がある．本セッションでは，臓器を問わず，各施設のこだわりの体腔内吻合と手術成績をご紹介いただき，それぞれのメリットを共有することで体腔内吻合の技術水準向上の一助としたい．
Intracorporeal Anastomosis: Challenges and Solutions
Intracorporeal anastomosis of the gastrointestinal tract is a technique that has the advantage of reducing surgical invasiveness by reducing the size of the wound and the extent of organ mobilization. However, there is still room for improvement due to concerns about intracorporeal infection and peritoneal seeding, and the complexity of the limited field of view. In this session, we would like to share the advantages of intracorporeal anastomosis and its surgical outcomes at each institution, regardless of the organ, to help improve the technical level of intracorporeal anastomosis.
4.【総論】サルコペニア・フレイルに対する周術期・外来管理の工夫
詳細
サルコペニア・フレイルは，手術短期成績のみならず長期予後への影響も報告され，その対策は，消化器外科手術成績向上のために必須の課題である．しかしながら，高齢や基礎疾患，長期に及ぶ身体機能の低下が背景となり，改善に向けた対策の構築は容易ではない．本セッションでは手術の短期・長期成績の向上を目的とした各施設でのサルコペニア・フレイル対策とその評価を提示いただき，外来支持療法を含めた効果的な介入方法について議論を深めたい．
Perioperative and Outpatient Management of Sarcopenia and Frailty
Sarcopenia/frailty has been reported to affect not only short-term surgical outcomes but also long-term prognosis, and its countermeasures are essential for improving gastrointestinal surgical outcomes. However, it is not easy to establish countermeasures against the background of advanced age, underlying diseases, and long-term deterioration of physical functions. In this session, we would like to share sarcopenia/frailty measures and their evaluation at each institution to improve short- and long-term surgical outcomes, and discuss effective intervention methods including outpatient supportive care.
5.【総論】大腸癌以外のoligometastasisに対する集学的治療の現状と課題
詳細
Oligometastasisは少数の遠隔転移を有する状態である．手術を含む集学的治療により長期予後が得られるとの報告があるものの，原疾患ごとの明確な治療戦略は定まっていない．本セッションでは大腸癌以外のoligometastasisに対する各施設の集学的治療の現状と成績を提示いただき，予後因子，原発巣と転移巣への至適治療介入法とタイミングについて議論いただきたい．
Current Status and Challenges of Multidisciplinary Treatment for Oligometastasis other than Colorectal Cancer
Oligometastasis is a condition with a small number of distant metastases. Although it has been reported that long-term prognosis can be achieved by multimodality treatment including surgery, a clear treatment strategy for each primary disease has not been established. In this session, we would like to share the current status and results of multidisciplinary treatment of oligometastasis other than colorectal cancer at each institution, and discuss prognostic factors, optimal intervention methods and timing of treatment for primary tumors and metastases.
6.【総論】術後合併症発生後のFailure to Rescue回避の取り組み
詳細
Failure to rescue(FTR)とは，有害事象発生の後に防ぎ得なかった院内死亡を指し，病院の安全の質に関連するとされる．合併症に伴う術後死亡に関しては，患者因子，外科医因子のみならず，スタッフ数や閉鎖型ICUなどの院内体制や，合併症の早期認知および適切な対応，安全意識，チーム連携などの質的因子もその発生率に影響すると報告されている．本セッションでは，術後合併症発生後のFTR回避のための取り組みをご紹介いただき，多くの病院が実施可能な介入策を提案していただきたい．
Avoiding Failure to Rescue after Postoperative Complications
Failure to rescue (FTR) refers to in-hospital deaths that could not be prevented after an adverse event and is related to the quality of hospital safety. The incidence of postoperative death due to complications has been reported to be influenced not only by patient and surgeon factors, but also by qualitative factors such as the number of staff, hospital organization such as closed ICUs, early recognition of complications and appropriate response, safety awareness, and team collaboration. In this session, we would like to learn the efforts to avoid FTR after postoperative complications at each institution and propose interventions that can be implemented in many hospitals.
7.【総論】減量・代謝改善手術の現状と将来展望
詳細
減量・代謝改善手術は２型糖尿病に対し検討するべき治療選択肢として位置づけられている一方で，高度肥満患者に対する手術の安全性の担保，長期的な効果など課題も多い．各施設における減量・代謝改善手術の工夫や留意点，減量効果や合併疾患の制御，QOLの向上などの治療成績を提示しつつ手術の妥当性や今後の展望について議論いただきたい．
Current Status and Future Prospects for Bariatric and Metabolic Surgery
Bariatric and metabolic surgeryis now considered a treatment option for type 2 diabetes, but there are still many issues to be addressed, such as assuring the safety of surgery for severely obese patients and its long-term effectiveness. In this session, we would like to share the results of weight loss, control of complications, and improvement of quality of life at each institution, and discuss the validity and future prospects of this surgery.
8.【上部】胸部食道癌に対する縦隔鏡アプローチの手技と工夫
詳細
胸部食道癌に対する縦隔鏡アプローチは，開胸操作が不要とのメリットとの一方で，導入に際しては視野展開や解剖認識の困難さなどを克服する必要がある．本セッションでは各施設における縦隔鏡アプローチの手術手技の工夫と成績を提示いただき，本術式の標準化に向けて議論いただきたい．
Surgical Techniques and Innovations of Mediastinoscopic Esophagectomy for Thoracic Esophageal Cancer
The mediastinoscopic approach to thoracic esophageal cancer has the advantage of not requiring an open chest, but it is necessary to overcome difficulties in visual field development and anatomical recognition in the early stages of introduction. In this session, we would like to share the innovations and results of the mediastinoscopic approach at each institution and discuss the standardization of this technique.
9.【上部】食道癌術後外来栄養介入と長期成績
詳細
食道癌手術における周術期栄養療法の重要性は広く認識されているが，外来栄養療法が長期予後に及ぼす効果についてはいまだエビデンスに乏しい．本セッションで各施設での周術期から外来診療に至る長期的な取り組みと成績を提示いただき，長期予後に寄与する栄養療法について議論いただきたい．
Postoperative Outpatient Nutritional Intervention and Long-Term Outcomes after Esophageal Cancer Surgery
The importance of perioperative nutritional therapy in esophageal cancer surgery is widely recognized, but there is still a lack of evidence regarding the effect of outpatient nutritional therapy on long-term outcomes. In this session, we would like to share the long-term results of perioperative and outpatient nutritional therapy at each institution, and discuss how nutritional therapy contributes to long-term prognosis.
10.【上部】切除可能進行食道癌に対する集学的治療の最前線
詳細
JCOG1109試験や国際共同治験であるCheckMate 577試験などの知見により，周術期の化学療法・放射線療法・免疫チェックポイント阻害剤の予後改善効果が明らかになりつつある．本セッションではこれら最新の知見を踏まえた各施設での取り組みと成績を示していただき，さらなる予後改善を目指した治療戦略について議論いただきたい．
Frontiers in Multidisciplinary Treatment of Resectable Advanced Esophageal Cancer
The JCOG1109 trial and the international CheckMate 577 trial have revealed the prognostic value of perioperative chemotherapy, radiation therapy, and immune checkpoint inhibitors. In this session, we would like to share the efforts and results of each institution based on these latest findings, and discuss treatment strategies for further improvement of prognosis.
11.【上部】進行食道胃接合部癌に対する集学的治療への取り組み
詳細
進行食道胃接合部癌の予後は不良であり，集学的治療の開発が期待されている．一方，本邦では周術期補助療法は未だ確立しておらず，海外の臨床試験結果をもとに様々な試みが行われている．本セッションでは，各施設で行われている周術期補助療法の取り組みと治療成績を紹介していただき，集学的治療の開発に向けたエビデンスの構築に繋げたい．
Multidisciplinary Treatment for Advanced Esophagogastric Junction Cancer
The prognosis of advanced esophagogastric junction cancer is poor, and the development of multidisciplinary treatment is expected. However, perioperative adjuvant therapy has not yet been established in Japan, and various attempts are being made based on the results of overseas clinical trials. In this session, we would like to share the approaches and results of perioperative adjuvant therapy at each institution, and to build evidence for the development of multidisciplinary treatment.
12.【上部】高度腹膜転移を伴う胃癌に対する新たな治療戦略
詳細
高度腹膜転移を伴う胃癌は治療抵抗性が高く予後不良である．PHOENIX-GC試験では，標準治療に対するパクリタキセルを用いた腹腔内化学療法の生存期間の延長は示されなかったもののの，一定の臨床的有効性が示唆されガイドラインに記載された．また分子標的薬やがん遺伝子パネル検査による薬剤選択などの新しい治療選択肢も登場している．本セッションでは高度腹膜転移を伴う胃癌に対する各施設の取り組みをご発表いただき，同病態に対する新しい治療の可能性を探りたい．
New Treatment Strategies for Gastric Cancer with Advanced Peritoneal Metastases
Gastric cancer with advanced peritoneal metastases is highly refractory to treatment and has a poor prognosis, and the PHOENIX-GC trial suggested some clinical benefit of intraperitoneal chemotherapy with paclitaxel over standard therapy, although it did not demonstrate a survival advantage, and was included in guidelines. In addition, new treatment options such as molecular-targeted agents and drug selection based on cancer gene panel tests have been introduced. In this session, we would like to explore the possibility of new treatment for gastric cancer with advanced peritoneal metastasis by sharing the efforts of each institution.
13.【上部】超高齢者胃癌に対する手術適応と術式選択
詳細
高齢者胃癌症例の増加と周術期管理の進歩により手術適応年齢は拡がりつつある．しかし，多様な併存疾患やフレイル，家庭環境なども考慮する必要があり，個々の手術適応や術式の選択については慎重さが求められる．本セッションでは，各施設の超高齢者(85歳以上)胃癌への手術適応，術式選択，そして手術を乗り越えるための創意工夫を議論いただきたい．
Surgical Indication and Selection of Surgery for Very Elderly Patients with Gastric Cancer
With the increase in the number of elderly patients with gastric cancer and advances in perioperative management, the age of indication for surgery is expanding. However, the selection of surgical indications and procedures must be done carefully, taking into consideration various co-morbidities, frailty, and family environment. In this session, we would like to discuss the indications for surgery for the very elderly (over 85 years old), the selection of surgical procedures, and creative ideas to overcome the difficulties of surgery.
14.【上部】噴門側胃切除術の再建方法の工夫
詳細
胃上部の早期癌や食道胃接合部癌に対して，噴門側胃切除術が選択される場合が増加している．一方で，術後の逆流性食道炎や狭窄，縫合不全などの合併症も報告されており，再建方法には工夫を要する．本セッションでは，噴門側胃切除術の再建における各施設の工夫と治療成績をご発表いただき，術後合併症回避に向けた至適再建法について議論いただきたい．
Optimal Reconstruction Method for Proximal Gastrectomy
Proximal gastrectomy is increasingly being performed for early-stage cancer of the epigastric region and esophagogastric junction. However, postoperative complications such as reflux esophagitis, stricture, and anastomotic failure have been reported. In this session, we would like to discuss the optimal reconstruction method after proximal gastrectomy to avoid postoperative complications by sharing the innovations and results of each institution.
15.【上部】長期的視点に立った残胃温存胃癌術式の工夫
詳細
胃癌患者の高齢化，診断能向上による早期胃癌の増加により，胃全摘の回避と残胃容量温存が注目されている．具体的には，胃体上部胃癌に対する極小残胃温存幽門側胃切除や，噴門側胃切除時の半分以下の幽門側残胃の温存，また，残胃癌における極小残胃の温存など，様々なものが考えられる．一方，残胃温存による長期QOLの改善についてはエビデンスが得られていない．本セッションでは，残胃温存に対する各施設の工夫を供覧していただき，残胃温存による長期の術後QOL向上を目指して議論いただきたい．
Indications for residual stomach preservation from a long-term perspective
With the aging of gastric cancer patients and the increase in early-stage gastric cancer due to improved diagnostic capabilities, the avoidance of total gastrectomy and the preservation of residual gastric volume are attracting attention. Specifically, there are various possibilities, such as pylorus-preserving gastrectomy with minimal residual stomach for upper gastric cancer, preservation of the pyloric residual stomach less than half of that during proximal gastrectomy, and preservation of the minimal stomach in residual gastric cancer. On the other hand, no evidence has been obtained for the improvement of long-term quality of life by the preservation of the residual stomach. In this session, we would like to discuss the innovations of each institution for the preservation of the residual stomach, aiming at improving long-term postoperative quality of life.
16.【下部】ASA3以上の全身併存疾患を有する高齢者に対する大腸癌治療の現状
詳細
高齢の大腸癌患者，特に肺気腫，肝硬変，糖尿病，ステロイド長期服用者，透析状態などの重度全身併存疾患を有する大腸癌患者では，一旦合併症を併発するとQOLの顕著な低下や手術死亡率の上昇をきたしうる点が課題である．そのため，手術術式やストーマ造設の選択に迷う機会も多い．本セッションでは，ASA3以上の全身併存疾患を有する高齢者大腸癌に対する手術選択の現状とQOLを含めた手術成績について提示いただき，宿主因子による大腸癌治療選択のあり方について議論いただきたい．
Current Status of Colorectal Cancer Treatment for Elderly Patients with Systemic Comorbidities of ASA 3 or Higher
Elderly patients with colorectal cancer, especially those with severe systemic comorbidities such as emphysema, cirrhosis, diabetes, long-term steroid use, and dialysis, face the challenge that once complications develop, quality of life may be significantly reduced and surgical mortality may increase. Therefore, surgeons are often faced with the choice of surgical technique and stoma placement. In this session, we would like to share surgical experiences for elderly patients with colorectal cancer with systemic comorbidities of ASA3 or higher and the surgical outcomes including quality of life at each institution, and discuss how to select colorectal cancer treatment based on host factors.
17.【下部】閉塞性大腸癌に対する治療戦略のアップデート
詳細
ESGEガイドライン改訂では，閉塞性大腸癌に対するBridge to Surgery目的のステント留置が一つの治療選択肢に含まれた．一方で局所高度進展例または遠隔転移を伴う場合には，予後改善を念頭においた集学的治療も必要となる．腫瘍学的治療成績向上の観点から閉塞性大腸癌に対する至適治療戦略について議論いただきたい．また，各戦略による経済的観点からの報告も歓迎する．
Update on Treatment Strategies for Obstructive Colorectal Cancer
The revised ESGE guidelines include stenting as a bridge to surgery for obstructive colorectal cancer as a treatment option. On the other hand, multimodality treatment with a view to improving prognosis is also necessary in cases of advanced local extension or distant metastasis. We would like to discuss optimal treatment strategies for obstructive colorectal cancer from the viewpoint of improving oncological outcomes. We also welcome reports on the economic aspects of each strategy.
18.【下部】直腸癌の治療効果予測と再発リスク診断
詳細
StageII-III直腸癌に対し，高解像度MRI導入により詳細なリスク分類がなされ，upfront surgeryから集学的治療内容まで層別化が進んでいる．一方で集学的治療抵抗例もみられ，集学的治療の有用例，不要例，早期再発などの不十分例を層別化できる新しい診断modalityが求められている．直腸癌に対する個別化治療に向けたリスク層別化の取り組みを提示いただきたい．
Prediction of treatment response and recurrence risk in rectal cancer
The introduction of high-resolution MRI for Stage II-III rectal cancer has led to detailed risk classification and stratification of patients from upfront surgery to multimodality treatment. On the other hand, there are cases that are resistant to multimodality treatment and cases of early recurrence. Therefore, a new diagnostic modality is required to stratify cases in which multimodality treatment is useful, unnecessary, or inadequate. We would like to discuss appropriate risk stratification for personalized treatment of rectal cancer.
19.【下部】ロボット支援下結腸癌手術の定型化に向けて
詳細
結腸癌に対するロボット支援下手術も保険適応が認められ，腹腔鏡手術で難易度が高いとされるSurgical trunkの郭清，左側横行結腸癌手術や下行結腸癌手術への活用が期待される．一方でロボット手術の欠点として術野制限があり，広範な術野操作を円滑に行う戦略が必要である．本セッションでは，ロボット支援下結腸癌手術の定型化に向けた課題と工夫を討論いただきたい．
Standardization of Robot-Assisted Colon Cancer Surgery
Robotic-assisted surgery for colon cancer is now covered by insurance, and is expected to be utilized for dissection of the surgical trunk, left-sided transverse colon cancer surgery, and descending colon cancer surgery, which are considered difficult to perform by laparoscopic surgery. On the other hand, the disadvantage of robotic surgery is the limited surgical field, which requires a strategy to smoothly perform a wide range of surgical operations. In this session, we would like to discuss the challenges and innovations for the standardization of robot-assisted colon cancer surgery.
20.【下部】切除不能な遠隔転移を有する局所進行大腸癌に対する集学的治療戦略
詳細
JCOG1007の結果から，原発巣による症状がなく，切除不能転移を有する大腸癌に対しては，原発巣非切除，化学療法先行が標準治療となった．一方で，腫瘍遺残がQOLを損なう直腸癌やBulky腫瘍に対しては，集学的治療とともに積極的に原発巣切除を行う施設も見られる．各施設の治療方針と成績から，本病態に対する至適治療戦略について議論いただきたい．
Multidisciplinary Treatment Strategies for Locally Advanced Colorectal Cancer with Unresectable Distant Metastases
Based on the results of JCOG1007, the standard of care for colorectal cancer patients with unresectable metastases and no symptoms from the primary tumor is immediate chemotherapy without resection of the primary tumor. On the other hand, for rectal cancer and bulky tumors where tumor remnants impair quality of life, some centers aggressively resect the primary tumor along with multimodality therapy. We would like to discuss the optimal treatment strategy for this condition based on the treatment strategy and results at each institution.
21.【下部】大腸癌同時性肝転移の術後再発高リスク群に対する補助療法の意義
詳細
JCOG0603の結果から，切除可能大腸癌肝転移に対する術後補助化学療法の効果は限定的であるとされた．一方で，特に同時性肝転移における術後再発高リスク群に対する術後補助化学療法の要否は議論のあるところと考えられる．各施設の現状と成績を提示いただき，大腸癌同時性肝転移の再発高リスク群に対する補助療法の意義について議論いただきたい．
Role of Adjuvant Therapy in High-Risk Group for Postoperative Recurrence of Simultaneous Liver Metastases from Colorectal Cancer
The results of JCOG0603 suggest that adjuvant chemotherapy is of limited benefit in the treatment of resectable liver metastases of colorectal cancer. On the other hand, the necessity of adjuvant chemotherapy for patients at high risk of postoperative recurrence, especially for simultaneous liver metastases, is a matter of debate. We would like to discuss the significance of adjuvant chemotherapy for high-risk patients in this complicated situation.
22.【下部】直腸癌に対するwatch and wait戦略の現状と課題
詳細
直腸癌に対するwatch and wait戦略が注目をあび，欧米において手術単独で治癒が期待できる早期癌に対しても積極的に導入されている．一方再増殖も一定頻度でみられ，臨床的寛解の判断のみならずwatch and waitを狙う適応条件が重要であるが，それらの基準は明確ではない．直腸癌に対するwatch and wait戦略の最大化に向けた工夫と現状の限界を議論していただきたい．
Current Status and Challenges of Watch and Wait Strategies for Rectal Cancer
The watch-and-wait strategy for rectal cancer has attracted much attention and is being actively introduced in Europe and the United States for patients with early-stage cancer who can be cured by surgery alone. However, re-proliferation is also observed at a certain frequency, and it is important to determine not only the clinical remission but also the indications for watch and wait, but these criteria are not clear. We would like to discuss the indicaions and limitations of the current watch-and-wait strategy for rectal cancer and its efforts to maximize its potential.
23.【下部】膿瘍または瘻孔形成を伴う結腸憩室炎に対する至適治療戦略
詳細
膿瘍または瘻孔形成を伴う結腸憩室炎は切除が根治的であるが，炎症や憩室の範囲から拡大手術となることが多い．敗血症を有する場合はドレナージやストーマ造設などのdamage control後の根治手術戦略も妥当と考えられ，その場合はさらに腹腔鏡下アプローチなどの選択肢も広がる．膿瘍または瘻孔形成を伴う結腸憩室炎の至適治療戦略について議論いただきたい.
Optimal Treatment Strategy for Colonic Diverticulitis with Abscess or Fistula Formation
Resection is curative for colonic diverticulitis with abscess or fistula formation, but often results in extensive surgery because of the wide extent of inflammation and diverticula. In the case of sepsis, radical surgical strategy after damage control such as drainage and stoma creation may be appropriate, and in such cases, options such as laparoscopic approach are also available. We would like to discuss optimal treatment strategies for colonic diverticulitis with perforation or fistula formation.
24.【下部】急性汎発性腹膜炎の救命率向上を目指して
詳細
NCD解析によると，2019年症例の急性汎発性腹膜炎術後90日死亡率は11.4%であり，過去10年間大きな改善は見られていない．宿主因子や施設環境因子，治療因子が複雑に影響し，救命率向上は一筋縄では行かないのも事実であるが，外科的集中治療の進歩，敗血症治療の進歩，damage control 戦略，open abdominal managementの活用，院内診療連携，施設の集約化などにより治療成績の向上も報告されている．本セッションでは，下部消化管穿孔症例を中心に各施設で治療経験を持ち寄り，急性汎発性腹膜炎の救命率向上を目指したこれからの治療戦略について議論いただきたい．
Toward Improving the Surgical Rescue Rate of Acute Diffuse Peritonitis
According to NCD analysis, the 90-day postoperative mortality rate for acute diffuse peritonitis in 2019 was 11.4%, with no significant improvement over the past decade. It is true that host factors, facility environmental factors, and treatment factors have complex influences, and improving the life-saving rate is not a simple matter. However, recent advances in intensive surgical care, sepsis treatment, damage control strategies, open abdominal management, in-hospital collaboration, and consolidation of facilities have been reported to improve outcomes. In this session, we would like to discuss the treatment strategies to improve the survival rate of acute diffuse peritonitis by sharing the experiences of treatment for colorectal perforation at each institution.
25.【下部】腸間膜動脈閉塞症に対する新たな治療戦略
詳細
腸間膜動脈閉塞症では，造影CTによる血流と腸管壊死所見に基づいて血栓除去や腸管切除術が選択される．近年では，腸管大量切除を避ける目的でIVRによる血栓吸引療法や，ICG蛍光法による術中血流評価，二期的手術などが導入されつつあるが，対応は施設毎，症例毎に一定しないのが現状である．本セッションでは各施設の経験を持ち寄り，腸管大量切除回避と術後QOL・生命予後向上を目指したこれからの治療戦略に関して議論いただきたい．
New Treatment Strategies for Mesenteric Artery Occlusive Diseases
In mesenteric artery occlusion, thrombectomy or bowel resection is selected based on contrast-enhanced computed tomography findings of blood flow and intestinal necrosis. Recently, IVR thrombus aspiration, intraoperative blood flow evaluation by ICG fluorescence, and two-stage surgery have been introduced to avoid massive resection of the intestine, but the response has not been consistent from institution to institution or case to case. In this session, we woud like to discuss treatment strategies to avoid massive resection of the intestinal tract and to improve postoperative quality of life (QOL) and prognosis.
26.【下部】炎症性腸疾患に対する外科的治療の現状と展望
詳細
炎症性腸疾患診療は，新規バイオ製剤の登場と新たな内視鏡診断・治療モダリティの進歩により，治療戦略に大きな変化を遂げたが，長期予後を見据えた至適管理法について未だ不明な点も多い．また，未治療もしくは診断未確定の緊急手術例や複数の併存疾患を有する難治例など，それらの進歩を超えた病態も未だ存在する．本セッションでは，炎症性腸疾患に対する新たな治療体系の中で，外科的介入の適応と至適方法について，各施設の成績をもとに議論いただきたい．
Current Status and Prospects of Surgical Treatment for Inflammatory Bowel Disease
Inflammatory bowel disease treatment strategies have changed significantly with the advent of new biologics and new endoscopic diagnostic and therapeutic modalities, but there are still many unknowns regarding optimal management with a view to long-term prognosis. In addition, there are still some conditions that are beyond the scope of these advances, such as untreated or undiagnosed emergency surgery and refractory cases with multiple co-morbidities. In this session, we woud like to discuss the indications and optimal methods of surgical intervention in the new treatment system for inflammatory bowel disease, based on the results of each institution.
27.【肝胆膵】胆道癌取扱い規約第7版に基づいた遠位胆管癌の治療成績の再評価
詳細
胆道癌取扱い規約第7版では，遠位胆管癌のT因子の定義が大幅に変更され，癌浸潤の深さと厚さによる評価が組み込まれた．しかしながら，新規約に基づいた治療成績や旧規約との比較は十分に明らかではない．本セッションでは，各施設での規約改訂前後での治療成績を提示いただき，遠位胆管癌に対する胆道癌取扱い規約第7版の妥当性について議論いただきたい．
Reevaluation of treatment outcomes of distal cholangiocarcinoma based on the 7th edition of the General Rules for Clinical and Pathological Studies on Cancer of the Biliary Tract.
In the 7th edition of the Japanese Biliary Cancer Code, the definition of T-factor for distal cholangiocarcinoma has been substantially changed, and the evaluation by depth and thickness of cancer invasion has been incorporated. However, the results of treatment based on the new definition and comparison with the old definition are not clear enough. In this session, we would like to share the results of treatment before and after the revision of the new protocol at each institution, and discuss the validity of the 7th edition of the General Rules for the treatment of distal cholangiocarcinoma.
28.【肝胆膵】肝膵同時切除術の安全性と長期予後向上を目指した取り組み
詳細
進行胆道癌に対するR0切除を目指して肝膵同時切除術(HPD)が選択肢となる．しかし，未だ術後合併症発生率や周術期死亡率は高く，長期成績も十分に明らかではない．本セッションでは，各施設におけるHPDの手術手技の工夫，周術期管理のポイント，術後短期および長期成績を提示いただき，HPDの効果の最大化について議論いただきたい．
New Strategies to Improve Safety and Long-Term Prognosis of Simultaneous Hepato-Pancreatic Resection
Hepatopancreatic resection (HPD) is selectively adopted to pursue R0 resection of advanced biliary tract cancer. However, postoperative complication rates and perioperative mortality rates are still high, and long-term outcomes are not fully clear. In this session, we would like to discuss how to maximize the effectiveness of HPD by sharing the surgical techniques, perioperative management, and short-term and long-term postoperative outcomes at each institution.
29.【肝胆膵】急性胆嚢炎に対する治療戦略
詳細
急性胆嚢炎に対しては早期胆嚢摘出術が推奨されているが，患者の全身状態や施設事情によっては，経皮経肝的胆嚢ドレナージ(PTGBD)が選択される場合もある．また，PTGBD後の待機的胆嚢摘出術のタイミングに関しては未だ見解が分かれ，手術の困難性から生じる医原性胆道損傷のリスクなどの課題も多い．本セッションでは各施設の急性胆嚢炎治療の現状と成績を示していただき，急性胆嚢炎に対する外科的治療戦略について議論いただきたい．
Improved Treatment Strategies for Acute Cholecystitis
Although early cholecystectomy is recommended for acute cholecystitis, percutaneous transhepatic gallbladder drainage (PTGBD) may be the treatment of choice depending on the patient's general condition and the facility. There is still disagreement regarding the timing of cholecystectomy after PTGBD, and there are many issues such as the risk of iatrogenic biliary injury due to the difficulty of the procedure. In this session, we would like to share the current status and results of acute cholecystitis treatment at each institution, and discuss how surgical treatment strategies for acute cholecystitis can be improved.
30.【肝胆膵】切除可能膵癌に対する術前化学療法の至適戦略
詳細
膵癌診療ガイドラインでは，切除可能膵癌に対して術前化学療法を行うことが提案されている．一方で，術前化学療法によるPSの低下や術前治療期間中の病勢進行のため根治切除の機会を逸する可能性がある．また，予後延長効果のエビデンスも十分とは言えない．本セッションでは，切除可能膵癌に対する術前化学療法施行症例の長期成績を提示いただき，術前化学療法の予後改善効果を最大化する方略について議論いただきたい．
Optimal Strategy of Preoperative Chemotherapy for Resectable Pancreatic Cancer
Various guidelines for the treatment of pancreatic cancer suggest preoperative chemotherapy for resectable pancreatic cancer. However, preoperative chemotherapy may cause a decrease in PS and disease progression during the preoperative period, which may result in a missed opportunity for radical resection. In addition, there is insufficient evidence for a prognostic benefit of chemotherapy. In this session, we would like to share the long-term results of patients with resectable pancreatic cancer treated with preoperative chemotherapy and discuss strategies to maximize the prognostic value of preoperative chemotherapy.
31.【肝胆膵】膵切除後長期成績の向上を目指した周術期・外来管理 ENGLISH
詳細
膵切除の周術期管理法が向上した一方で，膵切除に伴う膵機能不全がもたらす栄養不良やQOLの低下，血糖コントロール不良などの長期合併症については未だ解決されていない．各施設における膵切除の周術期ならびに外来管理について提示いただき，長期合併症回避とQOL維持・向上のための適切な介入方法について議論いただきたい．
Perioperative and Outpatient Management to Improve Long-Term Outcomes after Pancreatectomy
While perioperative management methods for pancreatectomy have improved, long-term complications such as malnutrition, deterioration of quality of life, and poor glycemic control caused by pancreatic insufficiency associated with pancreatectomy have not yet been resolved. We would like to share the perioperative and outpatient management of pancreatectomy at each institution and discuss appropriate intervention to avoid long-term complications and to maintain and improve quality of life.
32.【肝胆膵】膵頭十二指腸切除術後膵液瘻の克服を目指した工夫
詳細
膵頭十二指腸切除術後の膵液瘻回避のため，吻合方法の改良，ドレーン管理の工夫，適正な抗菌薬治療など様々な対応策がとられてきた．しかしながら，膵液瘻は一定頻度で発生し続け，未だ理想的な術式や管理法に対する一定の見解はない．本セッションでは，膵頭十二指腸切除術後膵液瘻の克服をめざして，各施設の膵消化管吻合法と周術期管理の工夫を提示いただき，現時点で最も安全な手術法と周術期管理法について議論いただきたい．
Aiming to Reduce Pancreatic Fistula after Pancreaticoduodenectomy
Various measures have been taken to avoid pancreatic fistula after pancreatoduodenectomy, including improvement of anastomosis, drain management, and appropriate antimicrobial therapy. However, pancreatic fistula continues to occur with a certain frequency, and there is still no clear consensus on the ideal surgical technique and management. In this session, we would like to discuss the safest surgical technique and perioperative management of pancreaticoduodenectomy to overcome pancreatic fistula.
33.【肝胆膵】ロボット支援下肝切除の現況と今後の展望
詳細
ロボット支援下肝切除が保険収載され，先進施設を中心に導入が進められている．腹腔鏡下肝切除の課題を克服し，低侵襲肝切除の適応拡大に繋がると期待されているが，今のところ腹腔鏡手術に対する優越性は十分に明らかではない．本セッションでは，各施設におけるロボット支援下肝切除術の実際を提示いただき，本手術の普及や高難度術式への適応拡大に向けた課題と今後の展望について議論いただきたい．
Current Status and Future Prospects of Robotic-Assisted Liver Resection
Robotic-assisted liver resection is now covered by insurance and is being introduced mainly at advanced facilities. Although it is expected to overcome the problems of laparoscopic hepatectomy and expand the indications for minimally invasive liver resection, its superiority over laparoscopic surgery is not fully clear at present. In this session, we would like to share the actual situation of robot-assisted hepatectomy at each institution, and discuss the challenges and future prospects for the widespread use of this procedure and the expansion of its application to more difficult procedures.
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