11. 転移性肺腫瘍に対する再手術

Reoperation for Recurrent Pulmonary Metastases

転移性肺腫瘍に対する手術数は年々増加している．全国統計では2000年から5年ごとに3,269件（呼吸器外科手術数全体の7.7％），4,330件（8.4％），6,748件（9.9％），そして2015年は8,226件（10.3％）となっており，件数のみならず割合も増加している．当院では1990～2019年に256例の転移性肺腫瘍に対する手術を施行しており，そのうち左右二期的手術を除く複数回手術例は23例（9.0％）であった．内訳は原発巣別に大腸癌（結腸癌＋直腸癌）15例，腎癌2例，乳癌2例，その他4例で，大腸癌が65％を占め，直近10年はすべて大腸癌であった．手術回数は左右二期的手術を1回とすると2回18例，3回4例，4回1例であった．

From 1990 to 2019, 256 patients underwent surgery for metastatic lung tumors in our hospital, of which 23 （9.0％） had multiple surgeries. There were 15 cases of colorectal cancer, 2 cases of renal cancer, 2 cases of breast cancer, and 4 cases of others according to the primary lesion, and the number of operations was 2 times 18 cases, 3 times 4 cases, and 4 times 1 case. The average disease-free interval （DFI） was 27.2 months, and the average interval between the first and second operations was 25 months. The median observation period from the last surgery was 58.5 months, the 5-year survival rate was 67％, and the 10-year survival rate was 39％. If the surgical indication for metastatic lung tumor is satisfied and the prognostic factors such as long DFI or a small number of recurrences are met, re-surgery should be actively considered, and the significance of lung metastasectomy remains even now that drug therapy has advanced.