Precision surgeryと患者視点評価，そして患者参加型医療へ

Precision Surgery, Patient Reported Outcome, and Participatory Medicine

胸腔鏡やロボット支援手術に関して，技術的な論考は大いに行われているが，患者側からどのように評価されるかという考察はまだ少ない．近年，患者や家族を中心としたpeople-centered care（PCC）の概念1）が重要度を増している．本稿では，主に肺癌手術の動向と患者視点評価（PRO）の現状を中心に考察する．

The word “precision surgery” indicates the practical and perioperative implementation of the concepts of P-medicine：precise, personalized, predictive, preventive, participatory, and people-centered. Successful achievements in the arena of thoracic surgery are fully appreciated from the perspective of these concepts：precise radiomics assessment of target lesion, date-based preventive risk assessment, minimally invasive approach （for example robot and single-port）， anatomical segmentectomy, high-resolution endoscope, 3D and navigational assist during procedure, clinical pathway for enhanced recovery, personalized outpatient follow-up, and so on. These new health technologies require assessment based on patient reported outcomes in addition to the traditional hard-endpoints of surgery：curability, mortality, or morbidity. Patient-generated health data plays a key role in further assessment, not to mention in empowerment, activation and participation under the outpatient settings.