タイムテーブル 第 1 日目 5 月30日（水） - æ ªå¼ä¼šç¤¾ã‚³ãƒ³ã‚°ãƒ¬

KL4 Current Status of Pancreatic Surgery in Korea
Department of Surgery, Seoul National University College of Medicine, Seoul, Korea
○Sun-Whe…Kim…
Malignant… lesions… of… the… pancreatic… and… periampullary… area… and… cystic… neoplasms… of… the… pancreas…
requiring…pancreatic…surgery…have…been…increasing…during…the…last…couple…of…decades…in…Korea,.…Since…the…
first…series…of…pancreatoduodenectomy(PD)…was…reported…in…1961,…different…extents…or…types…of…surgery…
have…been…introduced…thereafter,…extended/regional…pancreatectomy…in…1984…and…pylorus-preserving…PD…
in…1990,…partial…or…total…duodenal…preserving…pancreatectomy…in…1995,…laparoscopic…distal…pancreatectomy…
in…early…2000s,…laparoscopic…PD…in…2004…and…robotic…assisted…PD…in…2009.……(1)…For…pancreatic…head…cancer,…
most…surgeons…prefer…less…extensive…surgery…to…the…one…with…dissection…of…para-aortic…lymph…nodeS…and…
nerve…plexus…around…superior…mesenteric…artery…according…to…the…recent…Korean…RCT.…vascular…resection…
is… becoming… more… popular… for… portal… vein/superior… mesenteric… vein… involvement,… even… by… using…
autologous…or…bovine…patch…graft,…but…most…are…reluctant…to…arterial…resection.……(2)…For…cancer…of…the…distal…
pancreas,…RAMPS…are…tried…in…different…surgeons,…and…they…are…reporting…encouraging…early…results.…We…
are…now…discussing… about…RCT…on…this…type…of…surgery.…A…few…reports…about…Appleby…operation…are…
available,…mainly…from…large…volume…centers.…(3)…For…cystic…neoplasm,…not…a…few…gastroenterologists…are…
challenging… by… EUS… guided… intervention… for… some… cystic… lesions,… most… surgeons… do… not… agree… their…
strategic…approach.…Laparoscopic…approach…for…the…lesion…of…the…distal…pancreas…is…becoming…a…standard…
procedure,…either…spleen…preserving…or…not,…and…recently…cyst…enucleation…is…being…tried…more…often…in…
many…centers…than…before.…(4)…As…for…the…minimal…invasive…surgery,…laparoscopic…distal…pancreatectomy…
has…become…a…standard…procedure…for…benign…and…low-grade…malignancy…and…recently…a…few…large…volume…
centers…are…trying…the…laparoscopic…surgery…for…pancreatic…cancer.…Laparoscopic…PD…has…been…cautiously…
tried…by…surgeons…in…high…volume…centers,…one…of…which…has…more…than…200…cases…of…laparoscopic…PD.…
Robotic…surgery…also…has…been…tried…for…pancreatectomy…in…a…few…centers,…however,…the…benefit…of…the…
procedure…has…not…been…accepted…yet.…In…conclusion,…not…only…newly…introduced…above…surgeries…in…terms…
of… different… extents,… types… and… approaches,… but… also… different… ways… of… reconstruction… and… stump…
management… for… better… early… and… late… outcome… have… been… being… tried… in… Korea.… To… advance… our…
techniques…on…the…basis…of…high…level…of…evidences,…we…need…to…get…together,…standardize…the…techniques…
and…plan…to…do…RCTs…if…possible.
-182-