葉間を操作しない逆行性S（9＋）10区域切除

Retrograde S（9＋）10 Segmentectomy without Interlobar Fissurelectomy

小型早期肺癌の増加や人口の高齢化に伴い，低侵襲で呼吸機能を温存できる肺区域切除のニーズが増加している．肺区域切除は，肺葉切除と比較してより正確な解剖の理解と緻密な手術操作が必要とされる．特に肺底区でS9，S10のような背側の区域切除は，肺動脈と気管支が葉間から深部にあることから困難で，通常は葉間を切開して肺門から順行性に行う必要がある．

Backgrounds：With increase of patients with a small-sized lung cancer, there is an increasing need for minimally invasive lung segmentectomy that can preserve respiratory function. We perform S（9＋）10 segmentectomy with retrograde dissection of the pulmonary vein, bronchus, pulmonary artery, in order, without interlober fissurelectomy and staple dissection of the peripheral lung parenchyma.

Methods：Seven patients who underwent retrograde S（9＋）10 segmentectomy between June, 2021 and May, 2022 in our hospital were retrospectively reviewed.

Results：No patient was converted to the open thoracotomy, without any complications including prolonged air leakage. The average operation time was 171 minutes （range 125 to 221）, amount of bleeding was 25 ml （range 0 to 75）. Median duration of chest tube insertion was 4 days （range 3 to 6）, length of stay after surgery was 6 days （range 5 to 9）. Pathologic stage showed pT1mi in 3 patients, pT1a in 3 patients, pT2a in 1 patient. No local recurrence was seen at this time.

Conclusions：Retrograde S（9＋）10 segmentectomy is feasible and facilitates interlobar procedure at the time of repeated segmentectomy or completion lobectomy.