胸壁浸潤肺癌に対して術前化学放射線治療後にロボット支援併用下に根治切除した1例

Hybrid robotic-assisted lobectomy with en-bloc chest wall resection after induction chemoradiotherapy for lung cancer

◆要旨：胸壁浸潤肺癌，特に第7肋骨より下位背側に浸潤する場合，開胸アプローチでは皮膚切開の設定に苦慮する場合がある．今回，第7肋骨背側の胸壁浸潤肺癌に対し，術前治療後にロボット支援胸腔鏡下手術（以下，RATS）併用下胸壁合併切除を行い，良好な成績を得た．症例は69歳，女性．胸壁浸潤肺癌cT3N1M0に対して，術前化学放射線治療を行い，RATS下に骨切以外の胸壁切除と肺葉切除を行い，浸潤部直上小開胸創から骨切とアシストを行うことで，根治切除した．拡大視・3D画像による評価と，自由なアプローチ角などのRATSの利点により胸壁切除が容易となり，かつ，最低限の小開胸創で切除が可能であったため，本術式は有用と思われた．

　For lung cancers with chest wall invasion, especially those invading the chest wall dorsally below the seventh rib, it would be difficult to determine the appropriate surgical incisions for thoracotomy. Here, we report a 69-year-old woman with non-small cell lung cancer（cT3N1M0）invading the dorsal aspect of the seventh rib, who underwent radical resection by robot-assisted thoracoscopic lobectomy combined with en-bloc chest wall resection after induction chemoradiotherapy. The postoperative course was uneventful, and the patient was discharged home on the ninth postoperative day. This technique appears to be useful because the advantages of RATS, such as evaluation by magnification and 3D imaging and free approach angles, facilitate chest wall resection, which can be performed under minimal additional thoracotomy.