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多発肺癌に対する外科治療


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Title: 多発肺癌に対する外科治療
Other Titles: Surgical Treatment for Multiple Primary Lung Cancer
Authors: 村岡, 昌司 / 岡, 忠之 / 赤嶺, 晋治 / 田川, 努 / 橋爪, 聡 / 松本, 桂太郎 / 田川, 泰 / 林, 徳眞吉 / 永安, 武
Authors (alternative): Muraoka, Masashi / Oka, Tadayuki / Akamine, Shinji / Tagawa, Tsutomu / Hashizume, Satoshi / Matsumoto, Keitaro / Tagawa, Yutaka / Hayashi, Tomayoshi / Nagayasu, Takeshi
Issue Date: 20-Aug-2005
Publisher: 日本肺癌学会
Citation: 肺癌 = Japanese Journal of Lung Cancer, 45(4), p.335-341; 2005
Abstract: 目的.多発肺癌に対する外科治療成績を検討し, 手術適応と術式選択につき検討する.対象と方法.臨床病理学的に多発肺癌と診断した64例を対象とした.結果.平均年齢64.3歳, 男女比49:15, 同時性27, 異時性37例.組織型は共に腺癌27, 共に扁平上皮癌14, 腺癌-扁平上皮癌11例で, 病期は共にI期35, I・II期14例.同時性では一期的手術14例, 二期的手術11例で, 複数回手術43例の初回手術は肺葉切除(27例)が多く, 2回目は縮小手術が多かった(28例).4例に両側肺葉切除, 3例に残存肺全摘術を行った.術死および重篤な術後合併症は認めなかった.予後は異時性が術後5年生存率(5生率)74.9%, 同時性は63.9%であった.異時性で二次癌がIA期では5生率85.1%, IB期で66.7%, II期以上は有意に予後不良であった.組織型では共に腺癌(81.5%)が最も良好であった.結論.多発肺癌に対する外科治療は合併症も少なく安全に施行できた.二次癌に対しても, 残存肺機能やperformance statusがよい症例には, 両側肺葉切除や残存肺全摘術も可能である.特にI期症例では予後も期待でき, 積極的に外科治療を行うべきである. / Objective. We conducted this study to determine the operative indication for multiple primary lung cancer, including the selection of the type of pulmonary resection, by analyzing the outcome, operative mortality and morbidity. Patients and Methods. We studied 64 patients with multiple primary lung cancer who underwent surgical treatment. Results. The average age at initial treatment was 64.3 years old. There were 49 men and 15 women. We operated on 64 patients for multiple primary lung cancer, which appeared to be synchronous in 27 cases and metachronous in 37 cases. There were two adenocarcinomas in different locations in 27 patients, two squamous cell carcinomas in 14, and the combination of an adenocarcinoma and a squamous cell carcinoma in 11. Thirty-five patients had two lesions diagnosed as p-stage I. Fourteen patients had a p-stage I lesion and a p-stage II lesion. In synchronous lung cancer, 14 patients underwent operation simultaneously, 11 patients underwent operation in two stages. Of 43 patients who underwent operations twice or more, 27 patients underwent lobectomies on the first operation. On the other hand, 28 patients underwent limited surgery on the second operation. Four patients underwent a lobectomy twice for metachronous bilateral lesions and three patients underwent completion pneumonectomy at the second operation. We encountered no operative death and no severe complications after surgery. The 5-year survival rate of the patients with synchronous and metachronous disease from the final treatment was 63.9% and 74.9%, respectively. The 5-year survival rate of the patients with p-stage IA disease in the second lesion of metachronous lung cancer was 85.1%, and that for patients with p-stage IB disease was 66.7%. The survival rate of the patients with p-stage II or more advanced second lesion was significantly less than that with p-stage I disease. The outcome of patients with two primary adenocarcinomas was the best (5-year survival : 81.5%) after analysis of patients by histological types. Conclusions. Surgical treatment for patients with multiple primary lung cancer was generally safe without any severe complications. We performed bilateral lobectomies in two stages or completion pneumonectomy after considering their predicted post-operative pulmonary function and performance status. We conclude that an aggressive surgical approach is recommended for the treatment for multiple primary lung cancer, especially for stage I disease, as it yield good survival.
Keywords: 多発肺癌 / 外科治療肺切除 / 予測肺機能 / Multiple primary lung cancer / Surgical treatment / Pulmonary resection / Predictive pulmonary function
URI: http://hdl.handle.net/10069/20225
ISSN: 03869628
Relational Links: http://ci.nii.ac.jp/naid/110003143636/
Rights: 日本肺癌学会 / 本文データは学協会の許諾に基づきCiNiiから複製したものである
Type: Journal Article
Text Version: publisher
Appears in Collections:Articles in academic journal

Citable URI : http://hdl.handle.net/10069/20225

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