体外循環下に大動脈合併切除を併施した局所進行肺癌

Combined Resection of the Aorta under Cardiopulmonary Bypass for Locally Advanced Lung Cancer

大動脈浸潤肺癌の治療戦略や手術適応は確立されておらず，症例ごとに検討を要している．われわれは下行大動脈へ直接浸潤した局所進行肺癌の60歳台の男性2例に，体外循環下の大動脈合併切除と人工血管置換を左肺全摘に併施したので，予後も含めて報告する．

We present two cases with locally advanced lung cancer invading the descending aorta. Case 1 is a 67 years old male, who had been followed up for stroke. Enlargement of a mass lesion in the left lung was pointed out on further examination. Case 2 is a 64-year-old man, who was referred to our hospital because of cough and abnormal shadow on the chest X-ray and computed tomography （CT）. We suspected that both tumors were lung carcinoma invading the descending aorta based on enhanced CT findings. In both cases, the clinical stage was cT4N0M0 stageⅢA. They underwent left pneumonectomy with combined en bloc tubular resection and reconstruction of the descending aorta via a posterolateral thoracotomy using cardiopulmonary bypass in the right lateral decubitus position. The histologic type of both tumors was squamous cell carcinoma. The pathological staging was pT4N0M0 in case 1, and pT4N2M0 in case 2. After surgery, the first patient received chemotherapy consisting of carboplatin and vinorelbine plus pembrolizumab. He survived 17 months until sudden death of unknown reason. The second did not receive adjuvant treatment because his postoperative performance status was slightly reduced. He died of local recurrence 6 months after the operation.