肺癌の外科療法　非小細胞癌治療のこの２０年の進歩

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  • 藤村 重文
    東北大学加齢医学研究所呼吸器再建研究分野

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  • Twenty-year Progress in Surgical Treatment for Non-small Cell Bronchogenic Carcinoma.

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Recent advances in surgery for non-small cell lung cancer is are reviewed, based mainly on the results obtained from the patients who have undergone operation in our institute during the past decades. The overall survival rate of patients with resected lung cancer has improved; it is now nearly 50%. This is mainly due to an increase in the number of patients in whom lung was detected early enough to allow curative resection. The spread of mass screening and the remarkable improvement in diagnostic procedures for lung cancer, including differential brushing of all segmental bronchi, and radiologic tools have contributed to recent increases in postoperative survival rates. Experience with treatment of a number of early-stage lung cancers had led to new knowledge of these tumors. Nearly 20% of patients with early squamous cell carcinoma were found to have a second primary cancer. To many chest physicians, operating on patients with N2 disease has been controversial. However, this problem seems to be changing when they face certain subgroups of patients with N2 disease. In addition to this, operative procedures, including dissection of lymph nodes, have improved, which apparently increased postoperative survival. En bloc mediastinal lymph node dissection is being evaluated. A 12u lymphadenectomy during middle or lower lobectomy, or both, is beneficial. Postoperative prognostic factors and the rationale of segmentectomy for early lung cancer according to histologic type are also discussed in relation to non-small cell lung cancer.

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