c-T1肺癌に対する区域切除術の成績と工夫

The Outcome and Surgical Strategy of Segmentectomy for c-T1 Lung Cancer

原発性肺癌の外科治療の第一選択は肺葉切除とリンパ節郭清術であるが，早期小型病変の場合，患者状態や腫瘍性状に合わせた縮小手術も治療手段としてあげられる．われわれは当院の手術例の中で，3 cm以下の原発性肺癌に対して施行された区域切除術例を後方視的に検討・解析した．手術成績について当科での区域切除に対する取組みとともに報告する．

Objectives：Segmentectomy has been performed as an alternative surgical procedure for small-size lung cancer, while its benefits and risks are still unclear. This retrospective study aimed to examine the outcomes of patients undergoing segmentectomy for early stage lung cancer.

Patients and methods：From 2010 to 2018, 90 patients with clinical-T0/1N0M0 lung cancer who underwent segmentectomy were enrolled. We analyzed the postoperative morbidity, tumor recurrence and survival rate after surgery.

Results：Postoperative complications were observed in 9 patients, and significant difference was found in passive limited surgery （p＝0.003）. Recurrence was observed in 4 patients, and pathological vessel invasion was a significant risk factor （p＝0.035）， but there was no local recurrence. The 5-year overall survival rate for all patients, active and passive limited surgery group were 90.7％， 91.5％ and 58.0％， respectively. There was significant difference in surgical indication （p＜0.001）.

Conclusions：Active segmentectomy which had considered the tumor characteristics was able to obtain a good tumor control effect by combining adjacent lung resection. Passive segmentectomy should be determined after careful consideration of the effects on comorbidities.