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今日でもなお発見される多くが進行肺癌であり,化学療法や放射線療法を主体とした治療がなされているが,その予後は一般に不良である.一方外科切除は肺癌治療において現在もなお唯一信頼性の高い根治療法であり,局所進行肺癌例に対して日常臨床として隣接臓器合併切除が行われている.隣接臓器浸潤はTNM分類上T3またはT4に区分され,一般的に切除可能と思われる臓器への浸潤を示す腫瘍はT3とされ,切除不能と考えられる臓器浸潤を伴う腫瘍がT4とされている.T3病変に対する外科治療は一般化してはいるが,その治療成績は満足できる結果とは言いがたい.一方近年の外科学および麻酔学の進歩や合併療法の発展により,今まで切除不能と考えられていたT4症例にまで根治を目的とした外科治療が行われ始めている.本稿では,これら隣接臓器浸潤例に対する外科治療成績を,胸壁,肺尖部胸壁,横隔膜,気管分岐部,左心房,上大静脈,大動脈,椎体の各臓器毎に,さらにT4に分類される癌性胸膜炎についての外科治療についてもレビューし,局所進行肺癌における外科治療の役割と今後の方向性を考察する., In the majority of patients lung cancer are only detected at advanced stages, they are mostly treated with chemotherapy or radiotherapy, or both, and the prognoses are usually poor. At present surgical resection is the only reliable curative method for the treatment of patients with lung cancer, and combined resection of the primary tumor and involved neighboring structures is performed when possible in patients with locally advanced disease. Tumors with direct extrapulmonary extension have been subdivided on the basis of the anatomic extent of disease and its potential for surgical treatment in the TNM classification for lung cancer: T3 lesions with limited, circumscribed extrapulmonary extension are considered potentially surgically resectable, whereas T4 tumors with extensive extrapulmonary extension are considered unresectable. Although surgical treatment for T3 lesions is generally accepted, the outcome is frequently not satisfactory. On the other hand, advanced surgical techniques are now being applied for T4 lesions due to the improvement of surgery and anesthesiology and progress in combined treatment modalities. This article reviews the results of surgical therapy for patients with lung cancer invading neighboring structures, including chest wall, superior sulcus, diaphragm, tracheal carina, left atrium, superior vena cava, aorta, and vertebrae. Furthermore, the surgical treatment of carcinomatous pleuritis is also assessed, and the role and future direction of surgical resection for locally advanced lung cancer is discussed.

金沢大学医薬保健研究域医学系, Sixty-seven patients with thymoma were surgically treated during the past 19 years in our department. The 5-year, 10-year and 15-year survival rates of total cases with thymomas were 69.2%, 59.6% and 59.6%, respectively. Survival rates of thymoma with MG and without MG were not significantly different. According to clinical stages in Masaoka's classification, there were significant difference between Stage I and Stag III (p < 0.05), Stage I and Stage IV a (p < 0.01), and Stage I and Stage IV b (p < 0.01). We can conclude that complete resection of thymomas lead to better prognosis, and immunochemotherapy using cyclophosphamide, vincristine and OK-432 are effective., 1