3ポート胸腔鏡下手術による同時異時多発肺癌に対する治療戦略と成績

The Strategy and Outcome of Three-port Thoracoscopic Surgery for Synchronous and Metachronous Multiple Lung Cancer

近年の高齢化の進行に加え，画像診断技術の向上と普及により，同時・異時性に多発陰影を認める機会が増加し，多発肺癌の発生頻度は増加傾向にあるといわれている．しかし患者の高齢化に伴い背景疾患や低肺機能症例も多く，手術適応や術式の選択では，根治性を十分に考慮するとともに，術後残存肺機能や生活の質も加味したうえで術式を決定しなければならない．そこでわれわれは，当科で経験した多発肺癌症例に対する胸腔鏡手術（TS）の治療内容および成績を検討し，考察する．

The treatment contents and the outcome of three-port thoracoscopic surgery for multiple lung cancer are studied and discussed in this report. 239 cases of synchronous or metachronous multiple lung cancer （11.5％） out of 2,076 cases of primary lung cancer resected in our department from the year of 2010 to 2018 are subjected to this study. There are 158 cases of synchronous multiple lung cancer and 81 cases of the metachronous. The pathological findings for both synchronous and metachronous multiple lung cancer are adenocarcinoma for 194 cases. The pathological stages for the both are stageⅠfor 208 cases. For the synchronous group, there are 156 cases, in which the patients underwent one-stage surgery was performed. For metachronous group, lobectomy was performed for the first surgery in 69 cases. For the second surgery, bilateral lobectomy was performed in the 13 cases, and there was one case of right completion pneumonectomy. There was no intraoperative death or critical postoperative complication. The five-year survival rates are 84.9％ for the synchronous group, and 75.2％ for the metachronous group. Above all, three-port thoracoscopic surgery for multiple lung cancer was carried out safely. Bilateral lobectomy and completion pneumonectomy are also possible for metachronous multiple lung cancer if a patient has a decent lung function and good performance status. Especially for stageⅠcases, we could expect a good prognosis, and therefore surgical treatment should actively be performed.