多発肺癌に対する再手術

Surgical Treatment of Metachronous Second Primary Lung Cancer

高齢化社会が進行したことや画像診断の発達により，早期発見・術後長期生存例が増えたことが原因なのか，肺癌の外科臨床において，多発肺癌のため同一の患者に複数回の肺手術を施行する事例は増えていると感じられる．しかし多発肺癌/再手術に関して，適切な術式選択や予後についてはまだ不明の点も多い．

Although the incidence of metachronous second primary lung cancer （MSPLC） after curative resection for primary lung cancer may be increasing, appropriate treatment and the outcome are unclear yet. We reviewed the literature and conducted a retrospective chart review of the patients who underwent surgery for MSPLC in our institute. We had 27 surgical cases for MSPLC during 2017 and 2018. The interval from the previous surgery was 59.4±35.2 months. Comparing to the patients who were underwent surgery for first primary lung cancer in the same period, the patients with MSPLC showed significantly older age and lower respiratory function. More than 90％ of resected MSPLC were stage 0 orⅠ and we selected limited surgery for more than 90％ of the MSPLC patients. Maybe due to limited surgery, time for surgical procedure and postoperative complication were significantly less than first primary lung cancer cases. No death or recurrence were observed until one year after surgery for MSPLC. For performing feasible limited surgery to early-stage MSPLC cases, continuous computed tomography surveillance in the late phase after the first primary lung cancer surgery should be important.