3ポート胸腔鏡下による周囲臓器合併切除を含めた胸腺全摘術の手術手技と周術期成績

Surgical Procedure and Perioperative Outcomes of Three-port Video-assisted Thoracoscopic Surgery Thymectomy for Thymoma, Including en-bloc Resection of Adjacent Organs

肺疾患と同様，縦隔腫瘍である胸腺腫に対しても積極的に胸腔鏡下手術（VATS）を施行する施設は増加傾向にある．2018年日本胸部外科学会の学術調査では，胸腺腫手術例のうち65.7％がVATSによるものであった1）．

This report discusses the treatment and outcomes of three-port video-assisted thoracoscopic surgery （VATS） thymectomy for thymoma. We reviewed perioperative results of 159 thymoma cases （excluding thymic carcinoma） over 16 years. Thoracoscopic surgery was indicated for Masaoka stagesⅠ to Ⅲ, tumor diameter up to 12 cm, and resection of surrounding organs up to the lung, pericardium＋reconstruction, internal thoracic artery and vein, left brachiocephalic vein, and phrenic nerve＋reconstruction. The mean age of patients was 56.9±12.7, with 71 males and 88 females. The surgical approach was right-sided in 110 cases, left-sided in 47 cases, and bilateral in 2 cases. Total thymectomy was performed in 141 cases, with total thymectomy plus combined resection of other organs （lungs, pericardium, and phrenic nerve） ±reconstruction in 18 cases. The World Health Organization （WHO） classification （5th edition） was type A/AB/B1/B2/B3/micronodular thymoma with lymphoid stroma （MNTLS） ＝20/49/32/45/11/2, and Masaoka classification was stageⅠ/Ⅱ/Ⅲ＝69/86/4. The three-port VATS technique offers several advantages, including its applicability to other surgeries, avoidance of contralateral thoracic cavity opening, safety in thymectomy without open conversion, and a mean postoperative hospital stay of 3 days.