臨床外科69巻4号

2014年04月発行

特集 サルベージとコンバージョン―集学的治療で外科手術に求められるもの

各論

乳腺―乳癌手術におけるサルベージ手術―適応と治療成績

著者： 稲治英生¹ 井上共生¹ 中野芳明¹ 西敏夫¹ 石飛真人² 菰池佳史³

所属機関： ¹市立貝塚病院乳腺外科 ²大阪府立病院機構大阪府立成人病センター乳腺・内分泌外科 ³近畿大学医学部外科乳腺・内分泌部門

ページ範囲：P.408 - P.414

文献概要

【ポイント】

◆乳癌手術の縮小化に伴い，一定の許容範囲内で乳房や腋窩リンパ節から再発することは避けられない．こうした局所再発病巣に対する根治性を期待した再手術が乳腺外科領域ではサルベージ手術と称される．コンバージョンの用語は乳腺領域では使用されない．

◆乳房温存療法後の乳房内再発に対するサルベージ手術としては，現時点では乳房切除術が標準術式であるが，ある条件下では再度の乳房温存も選択肢となりうる．

◆乳房・腋窩リンパ節いずれの再発もサルベージ手術後の遠隔再発のリスクが高いので，サルベージ手術後に適切な全身療法を考慮すべきである．ただ，乳房内再発に関しては，真の再発と新発生の癌との鑑別など，病態に応じた治療戦略が望まれる．

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