胸腔鏡下肺癌手術の適応について

The Current Status of Video-assisted Thoracic Surgery: On the Operative Indication

　胸腔鏡下肺癌手術がわが国に導入された当初は，末梢肺の小型腫瘤，T1N0M0，組織型としての扁平上皮癌が望ましいとの適応が用いられていた．しかし微小肺癌が増加する今日，あらゆる種類の末梢肺癌が本手術の適応と考えられている．手術法も肺葉切除術のみならず全切除術，区域切除術，部分切除術とすべての種類にVATS（video-assisted thoracic surgery）が応用されている．リンパ節病変については今後，右側肺癌の場合，N1あるいは孤在性リンパ節腫大を示すN2についてもVATSが適応とされていくであろう．

In Japan, at the time of starting of Video-assisted Thoracic Surgery (VATS), the operative indication had been limited to cases with ⅰ) small lung carcinoma in the peripheri, ⅱ) T1N0M0, and ⅲ) when possible, epidermoid carcinoma. Since then, the indication has been widened to include all types of non-small cell carci-noma as a candidate for VATS. Moreover, all kinds of operative procedures using techniques of VATS, including lobectomy, segmentectomy and partial resection have been adopted. In the near future it will be possible to per-form VATS in the right-side N1 or N2 cases with solitary lymph-node swelling.