左肺癌と食道癌の合併例に対する一期的切除術

Synchronous Double Cancer of Left Lung and Esophagus Which Was Performed Simultaneous Resection

左肺癌と食道癌の一期的手術は，両側開胸では高侵襲のため回復に時間を要し，補助療法に支障をきたす可能性が高く，左開胸のみでは食道操作が困難で，郭清が不十分になりやすい．そのため二期的手術を選択することが多いが，左肺切除術後の分離肺換気が困難となることや食道切除術の合併症や侵襲により，想定外に肺切除まで期間を要する懸念がある．一方で，複数の進行癌を同時に切除する場合には，術後早期再発や補助療法導入の遅れが予後に影響する可能性もあり，慎重な治療戦略の立案が求められる．われわれは左上葉肺癌と進行食道癌に対して，胸腔鏡下肺切除術と縦隔鏡下食道切除術による一期的手術を施行した症例を経験したため報告する．

We report a case of synchronous double cancer involving the left lung and esophagus treated with a minimally invasive one-stage procedure combining thoracoscopic lobectomy and mediastinoscopic esophagectomy. Although a two-stage approach is often selected due to the technical complexity and invasiveness of simultaneous surgery, both tumors in this case were advanced, and a single-stage resection was considered the most appropriate option to avoid losing the opportunity for curative treatment. The postoperative course was complicated by anastomotic leakage, which was managed conservatively；however, early recurrence of esophageal cancer occurred, followed by multiple brain metastases from small cell lung carcinoma. These recurrences may have been related to limited mediastinal lymph node dissection, performed to preserve bronchial blood flow, and to the delayed initiation of adjuvant therapy due to treatment for esophageal recurrence. This case demonstrates not only the feasibility and advantage of a less invasive simultaneous approach but also emphasizes the need to optimize lymph node dissection strategies and the timing of postoperative therapy in complex synchronous malignancies.