充実性肺癌に対する消極的部分切除術の適応と成績

Wedge Resection in Poor Risk Patients with Clinical-N0 Pure Solid Lung Cancer

原発性肺癌に対する縮小手術に関して，国内ではJapan Clinical Oncology Group（JCOG）0802やJCOG0804の解析結果がまたれるが，小型肺癌に関してはスリガラス状陰影（GGO）の比率が高いなどの条件を満たせば予後が期待できることから，積極的に縮小手術を選択するようになりつつある1）．また高齢化に伴い，合併症などを理由に縮小手術を選択する機会も増えている．日本胸部外科学会の年次報告では，2014年度に肺癌に対して38,085例の手術が行われ，部分切除術は5,438例（14％）であった2）．

Objective：Sublobar resection is practically indicated in poor risk patients compromised cardiopulmonary reserve or for small ground-glass opacity-dominant adenocarcinomas. The aim of this study was to clarify the surgical outcomes of wide wedge resection in poor risk patients with clinical-N0 pure solid lung cancers.

Methods：Between 2008 and 2015, 55 poor risk patients, who underwent wedge resection for clinical-N0 pure solid lung cancer, were retrospectively reviewed.

Results：The 5-year overall, recurrence-free, and lung cancer specific survivals of all patients were 38.1％，15.6％ and 53.6％，respectively, while other malignancies were frequently found as causes of death. Only cancer specific survival was favorable in patients with low carcinoembryonic antigen（CEA）level ≦ 3.0 ng/ml. No significant differences were observed in tumor size and histological type.

Conclusions：Wide wedge resection could not be radical treatment option for clinical-N0 pure solid lung cancer regardless of tumor size. The operative indication should be carefully considered especially in patients with elevated serum CEA level, which showed high risk of postoperative recurrence.