肺癌再発に対する残肺全摘除術

Completion Pneumonectomy for the Recurrence of Lung Cancer

肺癌の術後再発や経過観察中に発生した第2癌に対する治療方針は，腫瘍の局在，呼吸機能をはじめとした耐術能，薬物療法に対する感受性の有無などを考慮したうえで決定される．病変が胸腔内に限局しており，耐術能が保持されている症例においては，根治を目的とした手術が治療の選択肢の一つとなる．同側の再手術は特に肺門部の癒着のため手術の難度が高いが，中でも残肺全摘除術（CP）は手術侵襲が大きく，術後合併症率や死亡率が高い術式である．そのため，手術適応を決定する際には慎重な判断が求められるが，CPにより長期生存を得られる症例もある．肺癌再発に対するCPの手術成績について，当科におけるCP症例を検討した．

Introductions：The morbidity and mortality after completion pneumonectomy （CP） are reportedly high. We, herein, report the outcomes of CP at our institution.

Subjects：Nine consecutive patients ［7 men and 2 women, average age of 72 years（range 44～84 years）］ who underwent CP for recurrence of lung cancer during 2012～2018 were retrospectively reviewed.

Results：Right-sided sleeve CP was performed in two cases and left-sided CP in seven cases. The indications for surgery were lymph node metastasis of the cancer, pulmonary metastasis, and bronchial stump recurrence in 4, 3, and 2 cases, respectively. Postoperative complications occurred in six patients. One of the patients who underwent right sleeve pneumonectomy developed bronchopleural fistula and died 68 days after the surgery. The mean follow-up period was 33 months, and four patients died during follow-up. Of the 5 patients still alive, 4 had no recurrence and 1 had recurrence in the stump of the main bronchus. The five-year overall survival rate was 78％.

Conclusions：Although only few cases were assessed, the prognosis after CP at our institution was relatively good.