1. 再発肺癌に対する手術

Surgery for Recurrent Lung Cancer

再発肺癌に対する手術は，初回手術の影響で肺門部肺動脈周囲の癒着がある場合に，きわめて繊細な手技が必要な高難易度手術となる．強固な癒着がある状態でむやみに肺門部の肺動脈・肺静脈の剝離を試みる操作は，制御不能の大出血を生じる危険がある．したがって再発肺癌に対する手術の際には，安全性を第一に考えた手術戦略の組み立てが必要である．

Treatment strategies for oligo-recurrence of lung cancer have recently been discussed well. Some studies have reported a favorable prognosis after the definitive local treatment for oligo-recurrent lung cancer. The definitive local treatment, including surgery, may be effective for recurrent lung cancer in selected patients. The time to recurrence and number of recurrence regions should be considered when selecting appropriate candidates for surgery. Thoracic surgeons will likely have more opportunities to perform surgery for recurrent lung cancer in the near future. Surgery for recurrent lung cancer requires a high level of skill owing to the difficulty in dissecting the pulmonary artery because of intrathoracic adhesions and the risk of major bleeding. To perform safe surgery, securing the central portion of the pulmonary artery is necessary. By reaching the pericardial cavity, the central portion of the pulmonary artery can be secured relatively safely.