低侵襲肺悪性腫瘍縮小手術に対する手術手技の工夫

Novel Surgical Techniques for Lung Segmentectomy of Malignant Lung Tumors

これまで非小細胞癌における標準術式は肺葉切除術とリンパ節郭清術とされてきたが，近年，早期肺癌に対しては肺区域切除術も術式として選択されてきている．肺区域切除術の適応術式選択に関しては議論の余地があるが，高齢患者の増加，すりガラス状陰影を有した早期肺癌や2 cm以下の末梢局在の早期肺癌などの増加により，その低侵襲肺区域切除は適応の広がりをみせている1）．

For a long time, lobectomy and lymph node dissection have been the standard surgery for treating non-small cell lung cancer. Recently, segmentectomy has been introduced as an alternative surgical procedure for treating early-stage lung cancer. Moreover, a growing number of segmentectomies are performed due to the increasing number of elderly patients, and the expansion of indications, including early-stage lung cancer with a ground glass nodule or peripheral nodule under 2 cm in diameter. However, the use of segmentectomy remains under debate. We have been performing thoracoscopic lung segmentectomy for malignant lung tumors since 2003. The number of surgeries has increased over the past few years, since robot-assisted lung resection of the right lobe became covered by health insurance in April 2018. In addition, lung segmentectomy is performed for lung metastases of malignant tumors in other organs. In deciding on the surgical approach, the increased technical difficulty of segmentectomy compared to lobectomy, owing to the anatomical complexity of the peripheral vessels and bronchi, needs to be considered, and novel surgical procedures and preoperative planning based on three-dimensional computed tomography （CT） images are necessary. We describe the preoperative management and surgical techniques used in approximately 250 lung segmentectomy procedures performed at our hospital up to May 2022, with no conversion to thoracotomy.