1．定型的区域切除における基本手技

Surgery of Segmentectomy for Lung Cancer

小型末梢非小細胞肺癌における区域切除と肺葉切除を比較した多施設共同ランダム化比較試験［日本臨床腫瘍グループ（JCOG）0802/西日本がん研究機構（WJOG）4607L試験］の結果をふまえ1），今後は肺の区域切除が増加してくると予想される．しかし，区域切除は局所再発が多いことが課題であり1，2），局所再発を起こさないための手技の工夫や，術前画像に基づいたリンパ節郭清の必要性と郭清範囲の決定が必要となる．

Based on the results of the recent Japan Clinical Oncology Group （JCOG） 0802 trial, thoracic surgeons will have more opportunities to perform segmentectomy for primary lung cancer soon. Segmentectomy requires a high level of skill due to the importance of accurate anatomical understanding and proper intersegmental plane formation. This procedure involves the precise identification and dissection of anatomical structures within the lung, which is more complex than lobectomy. However, techniques such as pulmonary vein taping and pulmonary artery dissection are fundamental procedures that extend from those required for lobectomy. These techniques must be performed with great care to ensure patient safety and optimal outcomes. Surgeons must perform meticulous surgery by understanding the correct anatomical layers in daily practice, as this knowledge is crucial for avoiding complications and achieving successful resections. Additionally, variations in the courses of intersegmental veins, bronchi, and pulmonary arteries necessitate careful preoperative computed tomography （CT） image interpretation. Understanding anatomy from multiple angles, such as from the ventral and dorsal sides, is important for segmentectomy, as it allows for a comprehensive approach to the procedure.