異時性同側肺癌に対する解剖学的再切除の成績

The Outcome of Second Anatomical Pulmonary Resection for Ipsilateral Metachronous Lung Cancer

肺葉切除や区域切除といった解剖学的切除後に同側に肺癌が発生した場合，小型の末梢病変であれば部分切除を選択できるが，病変が中枢に存在する場合には再度の解剖学的切除が必要となり，手術の難度が高くなる．解剖学的切除を行った場合には，手術によって失われる呼吸機能も大きく，放射線治療や薬物療法と比較した場合の治療効果や，腫瘍学的根治性と予測残存肺機能をふまえた適切な術式選択の判断も要求される．われわれは，解剖学的切除を行った肺癌の同側再発あるいは第2癌に対して，再度の解剖学的肺切除を行った症例の成績について検討した．

Introductions：When the first intervention for lung cancer is anatomical resection, the ipsilateral repeat anatomical resection for metachronous second lung cancer becomes technically challenging. Herein, we report the outcomes of second anatomical pulmonary resection for ipsilateral metachronous lung cancer at our institution.

Subjects：Sixteen consecutive patients ［10 men and 6 women, average age 70 （range 59～81） years］ were reviewed in this retrospective study. These patients underwent ipsilateral repeat anatomical resection for metachronous second lung cancer between 2009 and 2020.

Results：All case required right-sided lung resections. The previous interventions of patients included upper lobectomy, lower lobectomy, middle lobectomy, S2 segmentectomy, and S6 and S10a segmentectomy in 9, 4, 1, 1, and 1 case, respectively. The second surgical interventions were middle lobectomy, S6 segmentectomy, upper lobectomy, lower lobectomy, S1 segmentectomy, and S2 segmentectomy, in 6, 4, 2, 2, 1, and 1 case, respectively. Postoperative complications occurred in three patients. The median follow-up period was 53.5 months. Three patients died during the follow-up period. Of the 13 patients still alive, 6 had recurrence. The five-year overall survival rate was 80％.

Conclusions：Although only a few cases were assessed, the prognosis after second anatomical pulmonary resection for ipsilateral metachronous lung cancer at our institution was satisfactory.