軟部肉腫などの希少がんは、その診断の難しさや、広範な外科的切除が必要となる特性から、しばしば肢体切断を余儀なくされることがある。がんの根治性と患者の機能温存を両立させることは、この分野における長年の大きな課題であり、患者のQOLに深刻な影響を与えてきた。
そこで、機能温存を「最大化する」ための集学的治療と精密な再建戦略が、患者に新たな「希望」をもたらす。川井科長は、国立がん研究センター中央病院において、軟部肉腫に対する手術、化学療法、放射線療法を組み合わせた集学的治療 を推進する。特に、血行再建を含む高度な精密再建戦略 を駆使し、90%という驚異的な肢体温存率 を実現する。
本講演では、この最先端の治療戦略を詳述し、がんの根治性を保ちつつ、いかに患者の肢体機能を最大限に温存し、QOLと社会復帰を向上させるかを解説する。難治性希少がん治療に新たな光を当て、患者の生活の質を重視する未来の腫瘍外科を牽引する、その具体的なアプローチと成果を提示する。

Rare cancers like soft tissue sarcoma often necessitate limb amputation due to diagnostic challenges and the need for extensive surgical resection. Balancing cancer curability with patient functional preservation has long been a significant challenge in this field, severely impacting patients' quality of life.
Therefore, multidisciplinary treatment and precise reconstructive strategies aimed at "maximizing" functional preservation bring new "hope" to patients. Dr. Kawai, Chief of the Department at the National Cancer Center Hospital, promotes multidisciplinary treatment for soft tissue sarcoma, combining surgery, chemotherapy, and radiation therapy. He particularly utilizes advanced precision reconstructive strategies, including revascularization , achieving an astonishing limb preservation rate of 90%. For instance, even in cases requiring resection of hip flexor muscles and the femoral nerve, postoperative rehabilitation enables patients to walk with a single cane , demonstrating high functional recovery even in challenging situations. He also manages complex cases, such as alveolar soft part sarcoma with femoral metastasis, where the tumor and femur are resected, and total femoral replacement is performed.
This lecture will detail these cutting-edge treatment strategies, explaining how to preserve limb function to the maximum extent while maintaining cancer curability, thereby improving patient QOL and facilitating social reintegration. This allows patients to lead active lives and continue social participation after cancer treatment. The presentation will shed new light on the treatment of intractable rare cancers, leading the future of oncological surgery that prioritizes patients' quality of life, and will present concrete approaches and achievements.

これまで「手術の未来」で講演された先生方のわくわくするような外科手術や最先端の研究内容を拝見しながら、今、光嶋先生からのお話を軽々しく受けてしまった自分を深く呪っています（笑）。骨軟部腫瘍の領域においては、1990 年代に切・離断術に代わって患肢温存術が局所根治術の主役になって以来、基本的な手術コンセプト（広範切除）に大きな変革はありません。腫瘍自体の多彩さに加えて、手術部位（四肢 vs.体幹）や組織（骨 vs.軟部組織）の variation、絶対的な症例数の少なさ等から、術式の定型化が難しく、今でも、ロボット手術に代表される Minimally Invasive Surgery のトレンドからは遠く離れた big incision による手術が行われています。講演では、あまり馴染みのない「骨軟部腫瘍の手術 in 2025」を紹介させていただき、次世代スーパーマイクロサージャリーによって、この領域がどのように変わりうるか、御意見、ご教示をいただければと思います。

While watching the exciting surgeries and cutting-edge research content of the doctors who have given lectures on "The Future of Surgery," I am now cursing myself for taking Dr. Mitsushima's talk so lightly (laughs). In the field of bone and soft tissue tumors, since limb-preserving surgery took over from resection and transection as the main local radical surgery in the 1990s, there has been no major change in the basic surgical concept (wide resection). In addition to the variety of tumors themselves, variations in the surgical site (limb vs. trunk) and tissue (bone vs. soft tissue), and the absolute small number of cases, make it difficult to standardize the surgical procedure, and even now, big incision surgery is performed, which is far from the trend of minimally invasive surgery represented by robotic surgery. In this lecture, I would like to introduce the not-so-familiar "surgery for bone and soft tissue tumors in 2025" and would like to hear your opinions and advice on how this field may change with next-generation super-microsurgery.