臨牀消化器内科 Vol.20 No.2(6)


特集名 消化器癌の遠隔転移をどうするか
題名 大腸癌肺転移に対する外科治療--手術の適応,工夫と成績について
発刊年月 2005年 02月
著者 東山 聖彦 大阪府立成人病センター呼吸器外科
著者 高見 康二 大阪府立成人病センター呼吸器外科
著者 檜垣 直純 大阪府立成人病センター呼吸器外科
著者 尾田 一之 大阪府立成人病センター呼吸器外科
著者 児玉 憲 大阪府立成人病センター呼吸器外科
著者 能浦 慎吾 大阪府立成人病センター消化器外科
著者 大植 雅之 大阪府立成人病センター消化器外科
著者 村田 幸平 市立吹田市民病院外科
著者 横内 秀起 市立吹田市民病院外科
著者 亀山 雅男 ベルランド病院外科
【 要旨 】 大腸癌肺転移の外科治療に関し,当施設の適応,手術およびその手技の工夫,成績,予後因子について述べた.手術適応は積極的適応と妥協的適応に分けられ,前者は,胸部CTにて,I) 縦隔リンパ節腫大がない,II) 転移個数が2個まで,III) 悪性胸水,播種がない場合である.また後者の適応は,I) では肺門・縦隔リンパ節腫大あり,II) では4~6個までである.手術は,3cmを超える腫瘍径の場合は肺葉切除が必要であるが,それ以外は肺部分切除 (または区域切除) が主である.その際,局所遺残防止のための肺切離法,迅速肺切離面洗浄細胞診の導入などを紹介した.さらに開胸時胸腔内洗浄細胞診の意義も述べた.当施設の肺切除後成績は,3年生存率59%,5年生存率47%と比較的良好であった.予後不良因子として,縦隔リンパ節転移 (pN2),手術根治度 (非治癒切除),開胸前CEA値上昇が重要であった.
Theme How to Manage Distant Metastases from Gastrointestinal Cancer?
Title Surgical Treatment for Pulmonary Metastases from Colorectal Cancer : Indications, Technique, and Results
Author Masahiko Higashiyama Department of Thoracic Surgery, OMCCC Diseases
Author Koji Takami Department of Thoracic Surgery, OMCCC Diseases
Author Naozumi Higaki Department of Thoracic Surgery, OMCCC Diseases
Author Kazuyuki Oda Department of Thoracic Surgery, OMCCC Diseases
Author Ken Kodama Department of Thoracic Surgery, OMCCC Diseases
Author Shingo Noura Department of Surgery, OMCCC Diseases
Author Masayuki Ohue Department of Surgery, OMCCC Diseases
Author Kohei Murata Department of Surgery, Suita Municipal Hospital
Author Hideoki Yokouchi Department of Surgery, Suita Municipal Hospital
Author Masao Kameyama Department of Surgery, Bell Land General Hospital
[ Summary ] Surgical indications, techniques and examination of results of metastasectomies for lung metastases from colorectal cancer have been introduced in our institute. Pulmonary metastasectomy was aggressively performed on patients, in whom the number of pulmonary metastases was less than three, with signs of neither mediastinal nodal swelling, malignant pleural effusion nor dissemination on preoperativly in the chest as determined through computed tomography. Surgical treatment was also carefully selected, when the number was from four to six, or when mediastino-hilar nodes had radiologically related swelling. While lobectomy was usually conducted in the case of metastasis, with a diameter of more than 3 cm, a pulmonary wedge or segmental resections were performed. In such limited resections for lung metastases, intraoperative lavage cytologic techniques for surgical margins were routinely performed to check the tumor-free status at the surgical margin. Furthermore, the clinical significance of pleural lavage cytology immediately after thoracotomy for lung metastases from colorectal cancer was described. Postoperative 3-year-and 5-year-survival rates for patients undergoing pulmonary metastasectomy for this disease, in our institute, were 59 % and 47 % respectively. Mediastinal lymph node metastases (pN 2), in complete resection, and elevated prethoracotomy CEA levels were unfavorable prognostic factors for surgical treatment of patients with this metastatic disease.
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