福島医学雑誌 57 巻 2 号　2007

〔原　　著〕

原発性肺癌外科治療成績の検討
——▽福島赤十字病院に於ける▽——

大石　明雄¹⁾，岡部　直行¹⁾，塩　　　豊⁴⁾，樋口　光徳⁴⁾
長谷川剛生⁴⁾，山田　文彦⁴⁾，土屋　貴男²⁾，今野　　修²⁾
芳賀　甚市²⁾，佐久間文隆³⁾

¹⁾福島赤十字病院呼吸器外科
²⁾同　外科
³⁾同　呼吸器内科
⁴⁾福島県立医科大学外科学第一講座

（受付　2006年10月31日）

Results of Pulmonary Resection of Primary Lung Cancer
in Fukushima Red Cross Hospital

AKIO OHISHI¹⁾, NAOYUKI OKABE¹⁾, YUTAKA SHIO⁴⁾, MITSUNORI HIGUCHI⁴⁾,
TAKEO HASEGAWA⁴⁾, FUMIHIKO YAMADA⁴⁾, TAKAO TSUCHIYA²⁾,
OSAMU KONNO²⁾,JINICHI HAGA²⁾and FUMITAKA SAKUMA³⁾

¹⁾Department of Respiratory Surgery, Fukushima Red Cross Hospital, Fukushima
²⁾Surgery
³⁾Respiratory Medicine
⁴⁾Department of First Surgery, Fukushima Medical University School of Medicine, Fukushima

要旨: 1996年4月から2005年12月までの原発性肺癌肺切除術230例の治療成績を検討した。
　手術関連死亡は3.5%（術死7例，在院死1例）であった。全症例の5年生存率は50.4% であった。女性の5年生存率は56.1% で男性の47.6% に比べ良好な傾向があった（p=0.058）。臨床病期別5年生存率はc-IA期67.2%, c-IB期46.1%, c-II期40.0%, c-III期36.7%, c-IV期28.6% であった。病理病期別5年生存率はp-IA期71.7%, p-IB期68.8%, p-II期36.7%, p-III期28.5%, p-IV期20.0% であった。術式別では肺葉切除術56.4%，肺摘除術24.1% で肺葉切除術群が良好であった（p<0.001）。系統的縦隔リンパ節郭清（ND2a(+)）は全体の84.8% に行った。系統的縦隔リンパ節郭清の有無での5年生存率はND2a(+)群55.9%, ND2a(−) 群22.0% でND2a(+) 群が良好であった（p=0.018）。
　結論: 肺癌手術治療成績の改善のためには，1）術後合併症死を減少させる必要があり，心肺機能低下症例や高度進行症例では術前管理や周術期管理の工夫が必要である。2）一部の小型肺癌を除き完全切除が可能な症例では系統的縦隔リンパ節郭清を標準として行うべきである。3）II期以上の外科成績は不良であり，最近報告のEvidenceに基づいた術後補助化学療法が必要である。しかし，術後は全身状態が低下し補助療法が行えない場合がある。より効果が高く安全で容易に使用可能な化学療法の開発が望まれる。

索引用語: 原発性肺癌，手術成績，系統的縦隔リンパ節郭清，補助化学療法

Abstract: We investigated benefits of pulmonary resection in 230 patients with primary lung cancer in our hospital from April 1996 through December 2005.
The operation-related mortality rate was 3.5% (7 cases of 30-day operational death and one of 3-month in-hospital death). The overall 5-year-survival rate was 50.4%. The 5-year-survival rate of females was 56.1%, which tended to be better than that of males (47.6%, p=0.058). The 5-year-survival rate of c-stage IA was 67.2%, c-stage IB 46.1%, c-II stage 40.4%, c-III stage 36.7% and c-IV stage 28.6%. The 5-year-survival rate of p-stage IA was 71.7%, p-stage IB 68.8%, p-stage II 36.7%, p-stage III 28.5% and p-stage IV 20.0%. The 5-year-survival rate after lobectomy was significantly better than that after pneumonectomy (56.4% v.s. 24.1%, p<0.001). Systematic mediastinal lymphadenectomy (ND2a(+)) was performed in 84.8% of total series. The 5-year-survival rate in ND2a(+) group was significantly better than that in ND2a(−) group (55.9% v.s. 22.0%, p=0.018).
Conclusion: To improve current survival rates, 1) more precise pre-and peri-operative management should be provided for patients with low cardiopulmonary reserves or with diseases of highly advanced stages to reduce the operation-related mortality. 2) Systematic mediastinal lymphadenectomy should be performed as routinely as possible in all patients with completely resectable lung cancer, except for some subtypes of small-sized lung cancer. 3) Postoperative adjuvant chemotherapy based on recent reports should be planned to use for patients with completely resected stage II-III non-small-cell cancer because of their poor surgical results. However, it is not easy for patients with reduced condition by surgical stress to receive adjuvant chemotherapy. So, more effective and unharmed chemotherapy needs to be explored.

Key words: lung cancer, surgical result, systematic mediastinal lymphadenectomy, adjuvant chemotherapy