Language：English  

DOI： 10.21873/anticanres.18017

Open Access

PubMed

Language：Japanese   Publisher：The Japan Lung Cancer Society  

<p><b><i>Background. </i></b>In patients undergoing maintenance hemodialysis, the frailty of their general condition often complicates the selection of an appropriate treatment strategy for lung cancer, particularly in advanced stages. <b><i>Case. </i></b>A 75-year-old man on maintenance dialysis due to nephrosclerosis was referred for evaluation of an abnormal chest shadow. The image revealed a 67-mm mass in the left upper lobe with infiltration into the soft tissue of the first intercostal space. He was diagnosed with squamous cell carcinoma of the lung (cT3N0M0, stage IIB), with no evidence of distant metastasis. Concurrent chemoradiotherapy with carboplatin and paclitaxel (40 Gy in 20 fr) was administered. The therapeutic response was classified as stable disease, and the patient subsequently underwent left upper lobectomy with combined resection of the first and second ribs. A pathological examination showed a major pathological response with 90% tumor necrosis, and complete resection was achieved. Postoperatively, the patient developed pneumonia, which resolved with antibiotic therapy. No recurrence has been observed; however, at 8 months postoperatively, the patient was transferred to a long-term care facility due to a decline in his overall condition following pneumonia. <b><i>Conclusion. </i></b>This case demonstrates that a multimodal therapy, including chemoradiotherapy followed by extended surgery, can be a feasible option for patients on maintenance dialysis. Although postoperative complications occurred, local tumor control was achieved. Given the limited physiological reserve in such patients, the treatment of advanced lung cancer involves considerable physical and psychological challenges, underscoring the need for comprehensive supportive care and meticulous perioperative management.</p>

DOI： 10.2482/haigan.65.1041

Open Access

Scopus

CiNii Research

Language：English   Publisher：General Thoracic and Cardiovascular Surgery  

Objective: Long-term prognosis in patients with early-stage non-small cell lung cancer (NSCLC) achieving 5-year postoperative recurrence-free survival (RFS) has been examined in previous studies. However, no prognostic factors have been identified that contribute to the management of long-term NSCLC survivors. Therefore, this study aims to investigate the factors affecting long-term prognosis, with a focus on the percent predicted diffusing capacity of the lung for carbon monoxide divided by alveolar volume (%DLCO/VA). Methods: A retrospective analysis was performed on 642 patients with stage I NSCLC who achieved a 5-year postoperative RFS. Patients were categorized based on the value of %DLCO/VA. We assessed the impact of low %DLCO/VA on long-term prognosis and analyzed cause of death using propensity score matching. Results: Sixty-seven (10.4%) patients died after achieving 5-year postoperative RFS, and the 5–10-year overall survival (OS) rate was 85.0%. After propensity score matching, there are 186 patients in the normal %DLCO/VA group and 93 patients in the low %DLCO/VA group. The 5–10year OS rate was significantly better in normal %DLCO/VA group than low %DLCO/VA group (81.5% vs. 64.0%; HR: 1.86). Moreover, among causes of 5–10year death, pneumonia-related deaths were significantly more frequent in the low %DLCO/VA group after propensity score matching (p = 0.04). Conclusions: Our findings suggest that low %DLCO/VA value is a significant factor in long-term prognosis even after achieving 5-year postoperative RFS, and significantly increases the incidence of pneumonia-related deaths. Postoperative management to prevent pneumonia is essential for long-term survival of patients with low %DLCO/VA value.

DOI： 10.1007/s11748-025-02237-9

Web of Science

Scopus

PubMed

Language：English   Publisher：Jtcvs Techniques  

DOI： 10.1016/j.xjtc.2025.05.018

Open Access

Web of Science

Scopus

PubMed

Language：English   Publisher：Journal of Thoracic Disease  

Background: Azithromycin (AZI) has proven effective in improving pulmonary function and survival in certain patients with established chronic lung allograft dysfunction (CLAD) following lung transplantation (LTx), but its prophylactic effects on CLAD remain controversial. This study aimed to assess the outcomes of prophylactic AZI for CLAD following LTx. Methods: A systematic review was conducted based on PubMed, Embase and Cochrane Library. All included studies reported the primary or secondary outcomes in the prophylactic azithromycin (pAZI) and control groups. The CLAD onset, disease-free survival and overall survival (OS) data were pooled using fixed-effect or random-effect models. Sensitivity analysis was employed to evaluate the robustness of the pooled results, while a funnel plot was utilized to assess the publication bias. Results: Six eligible studies involving 1,251 LTx recipients were included. The pooled analysis revealed a lower risk of CLAD onset in the pAZI group compared to the control group [relative risk (RR) 0.64, 95% confidence interval (CI): 0.51–0.81, P<0.001]. Moreover, the pAZI group exhibited superiority in the 3-year [hazard ratio (HR) 0.57, 95% CI: 0.39–0.83, P=0.003] and 5-year CLAD-free survival (HR 0.61, 95% CI: 0.43–0.86, P=0.005); but this superiority was not observed in the 3-year (HR 0.69, 95% CI: 0.31–1.54, P=0.36) and 5-year OS (HR 0.59, 95% CI: 0.30–1.14, P=0.12). Conclusions: Prophylactic AZI may reduce the risk of CLAD onset and improve 3- and 5-year CLAD-free survival, providing supporting evidence for its application in LTx community. More high-quality and well-designed studies are warranted to determine the prophylactic effects of AZI on CLAD and its phenotypes following LTx.

DOI： 10.21037/jtd-2025-365

Open Access

Web of Science

Scopus

PubMed

Language：English   Publisher：Respirology Case Reports  

In cases of thymoma with autoimmune disease, extended thymectomy may improve disease symptoms and medication effects. Myasthenia gravis (MG) is the most common complication, but thymoma with Stiff-Person syndrome (SPS) is rare, and there are few reports of surgery. In the present case, we performed robot-assisted extended thymectomy on a 74-year-old man with thymoma who had MG and SPS. At 6 months after surgery, his MG and SPS symptoms had improved and the dose of prednisolone had been reduced, confirming that surgical treatment contributed to disease control. Thus far, only two studies have been published on thymoma surgery in conjunction with MG and SPS, and both have documented the progression of neurological symptoms after surgery. To the best of our knowledge, this is the first report of a resected thymoma with MG and SPS, both of which were controlled after surgery.

DOI： 10.1002/rcr2.70149

Web of Science

Scopus

PubMed

Language：English   Publisher：Surgery Today  

Purpose: This study compared the peri- and postoperative outcomes of robot-assisted thoracic surgery (RATS) and video-assisted thoracic surgery (VATS) lobectomy for primary lung cancer. Methods: This retrospective cohort study included patients who underwent RATS or VATS at Nagoya University Hospital between April 2018 and March 2022. Propensity score matching was used to balance patient characteristics between the two groups. The following long-term outcomes were assessed: the 3-year overall survival (OS), causes of death, 3-year disease-free survival (DFS), and recurrence patterns. Various peri- and postoperative outcomes were examined as short-term outcomes. Results: After propensity score-matching, 137 patients were included in each group. RATS was associated with a longer operative time (median 180 vs. 144 min, p < 0.001), less blood loss (median 5 vs. 12 ml, p = 0.005), and a lower rate of conversion to open thoracotomy (1 [0.7%] vs. 10 [7.4%], p = 0.010) than VATS. The 3-year OS and DFS were comparable between the groups. Conclusion: In lobectomy for lung cancer, RATS demonstrated long-term outcomes that were comparable to those of VATS. Although RATS has a longer operative time, it is associated with less blood loss and a lower conversion rate to open thoracotomy than VATS, suggesting that it is a beneficial surgical approach for patients.

DOI： 10.1007/s00595-025-03000-6

Web of Science

Scopus

PubMed

Publisher：株式会社　医学書院  

DOI： 10.11477/mf.243232680730010067

CiNii Research

Language：English   Publisher：Journal of Thoracic Disease  

Background: There are few papers on three-dimensional (3D) images of the lungs using non-enhanced computed tomography (CT). This study aimed to investigate the accuracy of 3D images of the lungs using non-enhanced CT. Methods: The study included 10 consecutive cases for each lung lobe, totalling 50 cases between March and December 2022. The patients had both non-enhanced and contrast-enhanced CT taken within 2 months before surgery. A 3D image analysis system (SYNAPSE VINCENT) was used to obtain 3D images of the pulmonary artery (PA), pulmonary vein (PV), and bronchus (Br). The system automatically generated 3D images based on both non-enhanced and contrast-enhanced CTs, which were then compared with each other and also with actual surgical findings. Results: The coincidence rate of PA, PV, and Br between 3D images based on non-enhanced CT and enhanced CT was 70% for the right lung and 65% for the left lung. The coincidence rate of PA, PV, and Br between 3D images based on non-enhanced CT and actual surgical findings was 100% for the right middle, right lower, and left lower lobes, but 50% for the right upper lobe and 60% for the left upper lobe. Conclusions: The 3D images of the lungs based on non-enhanced CT showed that the right middle lobe and both lower lobes were correctly depicted. The right and left upper lobes were poorly visualized using non-enhanced CT, while the right upper lobe was poorly visualized using contrast-enhanced CT.

DOI： 10.21037/jtd-24-1406

Web of Science

Scopus

PubMed

Publisher：JTCVS Techniques  

DOI： 10.1016/j.xjtc.2025.02.004

Open Access

Scopus

Language：English   Publisher：Japan Surgical Society  

<p><b>INTRODUCTION:</b> A bronchopleural fistula (BPF) is a serious and potentially life-threatening complication of pulmonary resection, with a particularly high incidence following pneumonectomy. Although surgical repair is the mainstay of treatment, conservative management with bronchoscopic intervention also results in complete resolution in some cases. Spontaneous closure of the BPF, especially after full dehiscence of the bronchial stump, remains exceptionally uncommon.</p><p><b>CASE PRESENTATION:</b> A 60-year-old man with diabetes mellitus and interstitial pneumonia underwent right upper lobectomy for suspected lung cancer. The tumor adhered to the superior vena cava, requiring pericardial dissection and phrenic nerve resection. The bronchial stump was sutured and covered with a free pericardial fat pad. Postoperative recovery was initially uneventful; however, on POD 18, the patient presented with dyspnea and was diagnosed with right lower lobe pneumonia. On POD 31, he spat out all suture material and fat tissue with hemosputum. Imaging findings confirmed the presence of a BPF at the bronchial stump without pneumothorax or empyema. He was then conservatively managed with antibiotics and glycemic control. The hilar air space gradually decreased over the following weeks, and CT confirmed complete spontaneous closure of the fistula by POD 151.</p><p><b>CONCLUSIONS:</b> Our case highlights that, under selected conditions—such as absence of empyema, confined necrosis of the bronchial stump, and reduced residual pleural space due to phrenic nerve paralysis and adhesions surrounding the hilum—spontaneous closure of a BPF without a surgical or bronchoscopic intervention is possible. Conservative management with careful monitoring may be a feasible option in selected patients.</p>

DOI： 10.70352/scrj.cr.25-0432

Open Access

Web of Science

PubMed

CiNii Research

Language：English   Publisher：Mediastinum  

Thymic epithelial tumors (TETs) are rare neoplasms that include thymomas, thymic carcinomas (TCs), and thymic neuroendocrine neoplasms (TNENs). These three tumor categories differ in aggressiveness, the incidence of recurrence after resection, the pattern of recurrence, and survival outcomes. Owing to the tumor’s rarity, randomized trials have not been performed in the initial treatment setting. Furthermore, such trials have never been performed in recurrent cases after the initial resection. Thymomas have indolent characteristics, with a wide range of biological spectra compared to TCs and TNENs; therefore, several authors have reported favorable outcomes after re-resection for recurrent thymomas. Common recurrent sites are the local site and pleura, and recurrent disease progresses slowly after detection. Additionally, long-term survivors are sometimes observed after recurrence, and whether re-resections contribute to post-recurrent and cause-specific survival remains unclear. Multimodal therapies are indicated in patients with locally or regionally advanced recurrence, similar to those performed in the initial treatment settings. TCs and TNENs exhibit more aggressive behavior than thymomas. Surgical resection was performed on selected patients who experienced recurrence. Currently, there are no guidelines on selecting patients for re-resection. Therefore, it is most likely that each physician selects based on favorable factors, including the extent of disease, disease-free intervals, and histology. No evidence of nonsurgical treatments, such as radiotherapy or chemotherapy, has yet to be established. This review article summarizes the limited evidence on managing recurrent TETs after resection compared to thymomas, TCs, and TNENs, focusing on re-resection.

DOI： 10.21037/med-24-26

Open Access

Scopus

PubMed

Language：English   Publisher：Surgery Today  

Purpose: To develop a comorbidity risk score specifically for lung resection surgeries. Methods: We reviewed the medical records of patients who underwent lung resections for lung cancer, and developed a risk model using data from 2014 to 2017 (training dataset), validated using data from 2018 to 2019 (validation dataset). Forty variables were analyzed, including 35 factors related to the patient’s overall condition and five factors related to surgical techniques and tumor-related factors. The risk model for postoperative complications was developed using an elastic net regularized generalized linear model. The performance of the risk model was evaluated using receiver operating characteristic curves and compared with the Charlson Comorbidity Index (CCI). Results: The rate of postoperative complications was 34.7% in the training dataset and 21.9% in the validation dataset. The final model consisted of 20 variables, including age, surgical-related factors, respiratory function tests, and comorbidities, such as chronic obstructive pulmonary disease, a history of ischemic heart disease, and 12 blood test results. The area under the curve (AUC) for the developed risk model was 0.734, whereas the AUC for the CCI was 0.521 in the validation dataset. Conclusions: The new machine learning model could predict postoperative complications with acceptable accuracy. Clinical registration number: 2020–0375.

DOI： 10.1007/s00595-024-02878-y

Web of Science

Scopus

PubMed

Language：English   Publisher：Nagoya Journal of Medical Science  

Peribronchiolar metaplasia is an uncommon lesion characterized by fibrosis and bronchiolar epithelial cell proliferation along the peribronchiolar alveolar walls, primarily in response to bronchiolar and peribronchiolar injuries. Peribronchiolar metaplasia usually appears as ground glass nodules or sub-solid nodules on computed tomography. However, we present an exceptional case of peribronchiolar metaplasia that appeared as a solitary solid nodule on computed tomography. A 62-year-old woman with conjunctival icterus was diagnosed with ampullary cancer and nodal metastasis. A solid predominant nodule (0.7 cm maximum diameter) in the left lower lobe was identified on computed tomography, requiring accurate differentiation between primary lung cancer and pulmonary metastasis. Due to the location, histological confirmation via transbronchial biopsy was not feasible. Hence, the patient underwent surgery for both diagnosis and treatment. The pathological findings revealed the growth of columnar epithelium containing ciliated cells replacing alveolar epithelium in the bronchioloalveolar wall with no malignant component. The final pathological diagnosis of the lesion was peribronchiolar metaplasia. This unique case highlights an atypical presentation of peribronchiolar metaplasia as a solitary solid nodule on computed tomography. Recognizing that peribronchiolar metaplasia can also manifest as solid nodules, as illustrated in our current case, is essential.

DOI： 10.18999/nagjms.86.4.720

Web of Science

Scopus

PubMed

Language：English   Publisher：General Thoracic and Cardiovascular Surgery  

Objective: Following the introduction of robot-assisted thoracoscopic surgery (RATS) as a health insurance-covered treatment in Japan, we investigated the current status and impact of the expansion of the indications for RATS for mediastinal tumors. Methods: Between 2018 and 2022, 209 cases of total mediastinal tumor resection were performed in our hospital. The study period was divided into the first half (January 2018 to June 2020) and the second half (July 2020 to December 2022), and perioperative parameters were compared between the two groups. Results: Ninety-six surgical procedures were performed in the first half and 113 in the second half. The percentage of RATS approach was significantly higher in the second half compared with the first half (P < 0.001). Indications for RATS in the second half compared with the first half were significantly increased in patients with stage II (P < 0.001) and stage III (P = 0.026) thymomas, tumor diameter ≥ 50 mm (P < 0.011), and patients undergoing extended thymectomy for myasthenia gravis (P < 0.009). In respect of short-term postoperative parameters, the estimated intraoperative blood loss (P < 0.035), postoperative drain duration (P < 0.037), and postoperative hospital stay (P < 0.011) were significantly lower in the second half than in the first half. Conclusions: RATS has recently been expanded for mediastinal tumors with improved short-term outcomes in our hospital after health insurance was applied in Japan. In the future, it will be necessary to discuss the further expansion of its indications by taking into account safety and long-term outcomes.

DOI： 10.1007/s11748-024-02093-z

Web of Science

Scopus

PubMed

Web of Science

Language：English   Publisher：Cancers  

The widespread implementation of lung cancer screening and thin-slice computed tomography (CT) has led to the more frequent detection of small nodules, which are commonly referred to thoracic surgeons. Surgical resection is the final diagnostic and treatment option for such nodules; however, surgeons must perform preoperative or intraoperative markings for the identification of such nodules and their precise resection. Historically, hook-wire marking has been performed more frequently worldwide; however, lethal complications, such as air embolism, have been reported. Therefore, several surgeons have recently attempted to develop novel preoperative and intraoperative markers. For example, transbronchial markings, such as virtual-assisted lung mapping and intraoperative markings using cone-beam computed tomography, have been developed. This review explores various marking methods that have been practically applied for a better understanding of preoperative and intraoperative markings in thoracic surgery. Recently, several attempts have been made to perform intraoperative molecular imaging and dynamic virtual three-dimensional computed tomography for the localization, diagnosis, and margin assessment of small nodules. In this narrative review, the current status and future perspectives of preoperative and intraoperative markings in thoracic surgery are examined for a better understanding of these techniques.

DOI： 10.3390/cancers16193284

Web of Science

Scopus

PubMed

Language：English   Publisher：Nagoya Journal of Medical Science  

Postoperative air leakage is the most common complication in surgery for malignant lung tumors, leading to extended hospital stays and substantial medical expenses. This study aimed to identify the incidence and characteristics of intraoperative and postoperative air leaks in both robotic-assisted thoracic surgery (RATS) and video-assisted thoracic surgery (VATS), as well as the causes of persistent air leakage following RATS. We conducted a retrospective analysis of patients who underwent lung resection for malignant lung tumors at our institution from October 2018 to August 2022. We compared the incidence rates of intraoperative air leak, postoperative air leak, and persistent air leak between patients who underwent RATS and those who underwent VATS. Background factors were adjusted using propensity score matching. A subanalysis was performed to compare unexpected air leaks, defined as air leaks not observed intraoperatively but confirmed postoperatively. The study included 295 cases of RATS and 227 cases of VATS. In both the overall population and the matched group (187 cases each for RATS and VATS), RATS demonstrated a significantly higher incidence of persistent air leaks compared to VATS (11% vs 3%, p < 0.01; 9% vs 3%, p = 0.02, respectively). RATS also had a significantly higher incidence of unexpected air leaks compared with VATS (29% vs 18%, p = 0.05). Although there was no statistically significant difference in hospital stays, RATS showed a higher incidence of postoperative persistent air leaks and unexpected postoperative air leaks than VATS.

DOI： 10.18999/nagjms.86.3.464

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Scopus

PubMed

Language：English   Publisher：Anticancer Research  

Background/Aim: Immune checkpoint inhibitors (ICIs) have been widely used in the treatment of non-small cell lung cancer (NSCLC), but specific outcomes of ICIs treatment among patients with postoperative recurrence of NSCLC remain unclear. The objective of the study was to compare the efficacy of ICIs and chemotherapy with conventional chemotherapy only in patients with postoperative recurrence of epidermal growth factor receptor (EGFR) wild-type NSCLC. Patients and Methods: A retrospective analysis was performed on patients who underwent anatomical lung resection at the Nagoya University Hospital and were treated for postoperative recurrence of wild-type EGFR NSCLC. This study evaluated the prognosis for postoperative recurrence, including ICIs treatment and other clinicopathological factors. Results: Of the 83 patients included in the analysis, 20 patients underwent chemotherapy and 63 patients underwent chemotherapy combined with ICIs. The combination of ICIs and chemotherapy significantly prolonged survival after recurrence (median survival: 33.1 months vs. 22.0 months, p=0.01). In the ICIs group, no significant differences in survival were detected between patients with different programmed death ligand 1 (PD-L1) status (Tumor Proportion Scores: <1%, 1%-49%, ≥50%, p=0.27). Multivariate analysis revealed that postoperative distant recurrence was a significant poor prognostic factor for survival after recurrence (HR=1.85, 95% CI=1.06-3.25, p=0.03), and combining ICIs with chemotherapy significantly improved survival after recurrence (HR=0.43, 95% CI=0.24-0.78, p<0.01). Conclusion: Combination of ICIs with chemotherapy significantly prolonged survival of postoperative recurrence with wild-type EGFR NSCLC regardless of PD-L1 status.

DOI： 10.21873/anticanres.17165

Web of Science

Scopus

PubMed

Language：English   Publisher：Translational Lung Cancer Research  

Background: Nuclear protein in testis (NUT) carcinoma (NC) of the lung is a rare cancer that occurs mainly in young adolescents and adults. NC is genetically characterized by NUTM1 rearrangements, which usually take the form of BRD4-NUT fusions. The prognosis for NC is dismal, and treatment with conventional chemotherapeutic regimens is ineffective. Case Description: We herein describe the case of a 53-year-old woman with recurrent NC of the lung 14 years after surgery for nasal cavity cancer. Chest computed tomography revealed a 5.5-cm tumor in the lower lobe of the left lung. We completely resected the recurrent lung NC via thoracotomy. Immunohistochemistry (IHC) of the lung and nasal cavity cancers showed diffuse strong expression of NUT. RNA-seq of the lung NC revealed NUTM1 rearrangement, with a fusion of BRD4 exon 10 to NUTM1 exon 4. This breakpoint has never been reported before. In addition, IHC revealed elevated expression of parathyroid hormone-like hormone in the lung NC but not in the nasal cavity NC, indicating that the lung and nasal cavity NCs were metachronous multiple primary cancers. Conclusions: We experienced a rare recurrence of lung NC 14 years after the initial surgery. The BRD4-NUT fusion consisted of a new breakpoint. Furthermore, the expression pattern of parathyroid hormone-like hormone (PTHLH) suggested that the NCs in the nasal cavity and lung may be metachronous multiple lung cancers. This extremely rare case highlighted the possibility of identifying less malignant NCs in patients with poorly differentiated tumors via fusion gene analysis and the need to develop more effective treatment strategies for this malignancy.

DOI： 10.21037/tlcr-24-259

Open Access

Web of Science

Scopus

PubMed

Language：English  

DOI： 10.1186/s40792-024-01970-2

Web of Science

PubMed

Language：English   Publisher：Interdisciplinary Cardiovascular and Thoracic Surgery  

OBJECTIVES: This study aimed to analyse the surgical outcomes for recurrent thymic epithelial tumours and identify the factors associated with post-recurrence survival, using an updated Japanese nationwide database. METHODS: The cohort that developed recurrence after the initial resection was extracted from an updated database of patients whose thymic epithelial tumours were treated surgically between 1991 and 2010. Furthermore, we reviewed clinicopathological and prognostic factors of re-resected cases. Post-recurrence survival outcomes and cause-specific deaths in non-re-resected cases were also reviewed. RESULTS: We enrolled 191 patients who underwent re-resection and 259 patients who did not. In the surgery group, more patients with early stage disease, less aggressive World Health Organization (WHO) histological classification, initial complete resection and shorter recurrence-free intervals were included. Non-thymic carcinoma, absence of preoperative treatment, longer recurrent-free interval, single-site recurrence and R0-1 re-resection were all significantly favourable prognostic factors for post-recurrence survival in the surgery group, according to univariable analyses. Non-thymic carcinoma histology, longer recurrence-free interval and R0-1 re-resection were identified as independent prognostic factors according to multivariable analysis. The post-recurrence survival of the entire cohort with R2 re-resection was significantly better than that of the non-surgery group, although it was not demonstrated that patients with thymoma who underwent R2 re-resection had significantly better post-recurrence and lower cause-specific death. CONCLUSIONS: R0-1 re-resection was newly identified as a prognostic factor after re-resection, in addition to non-thymic carcinoma histological classification and longer recurrence-free intervals, as documented in the initial report.

DOI： 10.1093/icvts/ivae064

Open Access

Web of Science

Scopus

PubMed

Language：English  

DOI： 10.1016/j.atssr.2024.01.009

Open Access

PubMed

Authorship：Lead author   Language：English   Publishing type：Research paper (scientific journal)  

DOI： 10.1007/s11748-023-01993-w.

Language：English   Publisher：International Journal of Molecular Sciences  

Malignant pleural mesothelioma (MPM) develops primarily from asbestos exposures and has a poor prognosis. In this study, The Cancer Genome Atlas was used to perform a comprehensive survival analysis, which identified the CHST4 gene as a potential predictor of favorable overall survival for patients with MPM. An enrichment analysis of favorable prognostic genes, including CHST4, showed immune-related ontological terms, whereas an analysis of unfavorable prognostic genes indicated cell-cycle-related terms. CHST4 mRNA expression in MPM was significantly correlated with Bindea immune-gene signatures. To validate the relationship between CHST4 expression and prognosis, we performed an immunohistochemical analysis of CHST4 protein expression in 23 surgical specimens from surgically treated patients with MPM who achieved macroscopic complete resection. The score calculated from the proportion and intensity staining was used to compare the intensity of CHST4 gene expression, which showed that CHST4 expression was stronger in patients with a better postoperative prognosis. The median overall postoperative survival was 107.8 months in the high-expression-score group and 38.0 months in the low-score group (p = 0.044, log-rank test). Survival after recurrence was also significantly improved by CHST4 expression. These results suggest that CHST4 is useful as a prognostic biomarker in MPM.

DOI： 10.3390/ijms25042270

Web of Science

Scopus

PubMed

Language：Japanese   Publisher：一般社団法人 日本移植学会  

<p>【背景】当院は2023年3月に国内11施設目の肺移植実施施設の認定を受け、同年8月より脳死肺移植の待機登録申請を開始した。肺移植適応評価入院の際に冠動脈疾患を新たに指摘された症例が複数認められたことから、そのリスク因子との関連を調べた。</p><p>【方法】2024年4月末時点で、肺移植を目的に紹介された患者28例のうち、今後の適応評価入院予定5例を除き、適応評価した13例を対象とし、患者背景および検査結果と冠動脈所見について調査した。</p><p>【結果】13例の原疾患は間質性肺疾患10例、造血幹細胞移植後肺障害1例、慢性閉塞性肺疾患1例、びまん性汎細気管支炎1例であった。冠動脈疾患のリスク因子とされている項目に関して調査した結果、喫煙歴あり7例、高血圧症4例、糖尿病6例、脂質異常症4例、CT画像上冠動脈石灰化あり3例認めた（重複あり）。上記リスク因子を3個以上認められた4例に冠動脈造影CT検査が施行され、うち2例で冠動脈狭窄が新規に指摘されたが、心筋シンチグラフィーで虚血性心疾患は否定的なことから移植適応について他科と協議し慎重に検討を行っている。</p><p>【結語】当院の肺移植適応評価13例のうち2例に新規の冠動脈狭窄が判明し、いずれも3個以上の冠動脈疾患リスク因子を有していた。冠動脈疾患の併存は肺移植周術期の重篤な合併症発生のリスクであるため、今後も慎重に適応評価を継続していく。</p>

DOI： 10.11386/jst.59.supplement_s373_2

Open Access

CiNii Research

Language：Japanese   Publisher：一般社団法人 日本移植学会  

<p>背景：中部地方には長らく肺移植実施施設がなかったが、藤田医大に続き2023年3月に名古屋大学が肺移植実施施設となった。目的：新規肺移植実施施設の視点から肺移植後慢性期患者の管理について検討する。方法：肺移植非実施施設から、新規肺移植実施施設の申請、そして承認にいたる中で経験したことを基に、肺移植後慢性期患者の管理について、新規肺移植実施施設の立場から検討する。結果：2019年9月、名大病院で管理していた肺移植術の慢性期患者は4名で、全例、当院から肺移植実施施設に紹介し肺移植を受けた患者であった。その後、術後患者の紹介を受け入れ、肺移植実施施設としての申請を行うと決断した2021年4月には、その数は9名となった。2022年1月に申請を行い、2023年3月に肺移植実施施設として認定され、同年8月より脳死肺移植登録のための評価入院を開始し、2024年5月現在、10名の脳死肺移植登録を完了した。これまでに、のべ19名の肺移植術後患者の管理を行ったが、2名の死亡を経験した。死因は、CLAD１名、感染症1名であり、名大病院で最期を看取った。現在、HOTが必要なCLADを2名に認め、名大病院での入退院を繰り返しているが、移植を行った施設に連絡をとりながら管理している。他に、小児症例の管理、種々の合併症の管理や生体腎移植の施行なども経験した。結論：名古屋大学では、今後も、慢性期管理を通して、肺移植の経験をサステイナブルに積んでいく方針である。</p>

DOI： 10.11386/jst.59.supplement_s171_2

Open Access

CiNii Research

Language：Japanese   Publisher：一般社団法人 日本移植学会  

<p>【背景】当院は国内11施設目の肺移植実施施設の認定を受け、肺移植適応評価患者の受け入れを開始し、初回実施に向けて準備を進めている。実施施設への留学や見学を積極的に行っているが、移植医療の未経験者も多いため、本番を想定した修練が求められている。日頃のトレーニングのひとつを紹介する。【献体を用いた手術手技トレーニング】献体の固定方法は進化し、固定された状態は生体と類似しているため、手術トレーニングに有用である。臓器摘出やインプラントについて、心臓外科医と本番を想定し計12回トレーニングを継続し内容を定型化してきた。【トレーニング概要】開胸後に臓器評価し、心灌流液注入用と肺灌流液ドレナージ用のカテーテルを留置、大血管を遮断し心臓摘出、続いて肺摘出を学会が推奨する手順で施行する。左房の処理については、心臓外科・呼吸器外科の双方の考えを伝え、解剖を確認しながら行う。肺灌流液ドレナージ経路の方法や肺灌流のタイミングなど細やかな部分までシミュレーションしている。その後、別の献体でインプラント手技を修練する。【結語】本トレーニングは手技と順序確認に有用で、プログラムを定型化することで実践に役立つレベルに質を高め、繰り返し行っている。新規肺移植実施施設として、現実施施設のレベルに少しでも追いつくため、利用できるリソースを活用し工夫して準備している。</p>

DOI： 10.11386/jst.59.supplement_s297_1

Open Access

CiNii Research

Language：English   Publisher：Cancers  

Accurate identification of the intersegmental plane is essential in segmentectomy, and Indocyanine Green (ICG) assists in visualizing lung segments. Various factors, including patient-related, intraoperative, and technical issues, can influence boundary delineation. This study aims to assess the rate of unsuccessful intersegmental identification and identify the contributing factors. We analyzed cases of lung segmentectomy from April 2020 to March 2023, where intraoperative ICG was intravenously administered during robot-assisted or video-assisted thoracoscopic surgery. Cases where fluorescence extended beyond expected boundaries within 30 s were classified as the “unclear boundary group”. This group was then compared to the “clear boundary group”. The study encompassed 111 cases, 104 (94%) of which were classified under the “clear boundary group” and 7 (6%) under the “unclear boundary group”. The “unclear boundary group” had a significantly lower DLCO (15.7 vs. 11.8, p = 0.03) and DLCO/VA (4.3 vs. 3.0, p = 0.01) compared to the “clear boundary group”. All cases in the “unclear boundary group” underwent lower lobe segmentectomy. ICG administration effectively outlines pulmonary segments. Challenges in segment demarcation may occur in cases with low DLCO and DLCO/VA values, particularly during lower lobe segmentectomy.

DOI： 10.3390/cancers15245876

Open Access

Web of Science

Scopus

PubMed

Web of Science

Web of Science

Language：English   Publisher：Journal of Thoracic Disease  

Preoperative three-dimensional computed tomography (CT) facilitates accurate identification of aberrant systemic arteries in thoracic surgery for pulmonary sequestration (PS). Furthermore, the boundary between normal and sequestrated lungs can be visualized using the spread of fluorescent indocyanine green (ICG) when performing surgery for PS. This study aimed to determine how to completely visualize anatomical variations, safely treat aberrant arteries, remove only sequestrated lungs, and perform minimally invasive surgery for PS. Seventeen patients underwent lung resection for intralobar PS at our institution between 2009 and 2022. We retrospectively reviewed the surgical outcomes and intraoperative images using ICG to assess the efficacy and feasibility of near-infrared fluorescence imaging. Since 2019, intraoperative near-infrared fluorescence imaging with ICG has been used in six patients, including four females and two males (median age, 56 years), to visualize the boundary between normal and sequestrated lungs. Aberrant arteries were identified using preoperative three-dimensional CT, and the boundary between sequestrated and normal lungs could be clearly delineated intraoperatively using ICG in all cases. The median operative time was 145 min (range, 88–167 min), and the median blood loss was 5 mL (range, 1–191 mL). The overlay mode using near-infrared thoracoscopy, which merges visible light images with fluorescent images, was safer and more useful than conventional thoracoscopy for delineating boundaries with electrocautery. No intraoperative or postoperative complications occurred. The median postoperative hospital stay was 5 days (range, 3–7 days). Intraoperative identification of the boundary between normal and sequestrated lungs using ICG was simple and feasible. We suggested that this technique was effective for lesion resection and normal lung preservation during surgery for intralobar PS.

DOI： 10.21037/jtd-23-892

Open Access

Web of Science

Scopus

PubMed

Authorship：Lead author,　Corresponding author  

DOI： 10.21037/jtd-22-1603

Open Access

Authorship：Lead author,　Corresponding author  

DOI： 10.1007/s11748-023-01993-w