縦隔腫瘍に対する低侵襲手術―術式の変遷

Minimally Invasive Surgery for Mediastinal Tumor

呼吸器外科手術は年々増加しており，日本胸部外科学会の年次報告で，2012年では全72,899件中，縦隔腫瘍4,671件（6.4％），胸壁腫瘍752件（1.0％）であったが1），2017年には全85,307件中，縦隔腫瘍8,950件（10.5％），胸壁腫瘍691件（0.8％）と縦隔腫瘍・胸壁腫瘍も増加傾向である2）．一方で，呼吸器外科領域においても低侵襲手術という言葉が一般化して久しい．当科は講座開設の2010年当初より胸腔鏡を使用した低侵襲手術を基本に行ってきたが，その間にも内視鏡システムは進化し，画質はハイビジョン，フルハイビジョン，4K，8Kと高画質になり，モニターも大型化・高精細化している．さらにはロボット支援下手術（RATS）も導入され，アプローチの多様化がすすんでいる．

We have been performing multiport thoracoscopic surgery as a minimally invasive procedure for mediastinal tumors. The criteria for thoracoscopic surgery are as follow；tumor under 6 cm without invasion of great vessels, chest wall, or lung. We started one port surgery since 2017 and robot-assisted thoracoscopic surgery since 2018. We retrospectively reviewed these three approaches for mediastinal tumor for 12 years. 269 patients underwent surgery for mediastinal tumor, 141 patients by multiport surgery, 21 patients by one port surgery, and 38 patients by robot-assisted thoracoscopic surgery. Of 203 patients with anterior mediastinal tumors, 141 patients underwent thymectomy for thymic tumors （72 patients by multiport surgery, 9 patients by one port surgery, 17 patients by robot-assisted thoracoscopic surgery, and 43 patients by open surgery）. There was no difference in tumor size, but the operating time and blood loss were significantly less in one port surgery than in multiport surgery or robot-assisted thoracoscopic surgery. The approaches have become more diverse, with a wider choice of surgical techniques, allowing us to offer more radical minimally invasive surgeries.