研究者詳細 - 芳川　豊史

論文 - 芳川　豊史

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Development of a machine learning-based risk model for postoperative complications of lung cancer surgery 査読有り

Kadomatsu Y., Emoto R., Kubo Y., Nakanishi K., Ueno H., Kato T., Nakamura S., Mizuno T., Matsui S., Chen-Yoshikawa T.F.

Surgery Today 2024年6月

担当区分：最終著者記述言語：英語掲載種別：研究論文（学術雑誌）出版者・発行元：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

Updated outcomes of surgical treatment for recurrent thymic tumour: a report from the Japanese nationwide database 査読有り

Mizuno T., Chen-Yoshikawa T.F., Yoshino I., Okumura M., Ikeda N., Kuroda K., Maniwa Y., Kanzaki M., Suzuki M.

Interdisciplinary Cardiovascular and Thoracic Surgery 38 巻 ( 6 ) 2024年6月

担当区分：責任著者記述言語：英語出版者・発行元：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

Bronchial occlusion with endobronchial Watanabe spigots using a two-scope technique for massive haemoptysis 査読有り国際誌

Baba T., Ito T., Sato Y., Hayai S., Koyama J., Nakamura S., Tokuda Y., Chen-Yoshikawa T.F., Ishii M.

Respirology Case Reports 12 巻 ( 6 ) 頁： e01405 2024年6月

記述言語：英語掲載種別：研究論文（学術雑誌）出版者・発行元：Respirology Case Reports

Massive haemoptysis is a life-threatening condition whose cause needs to be identified rapidly so that prompt interventions can ensue. Bronchial occlusion with endobronchial Watanabe spigots (EWSs) may be useful when endovascular treatment or surgery proves to be difficult. An 84-year-old woman developed massive haemoptysis during percutaneous mitral valve repair for refractory heart failure due to severe mitral regurgitation (MR). Interventional radiology (IVR) and surgery were contraindicated, and bronchial occlusion with EWSs was attempted to control bleeding. The bleeding was so persistent that it was difficult to secure the visual field without aspiration with a bronchoscope. Herein, we report a two-scope technique, also used in cryobiopsy of peripheral lung lesions, to control bleeding and perform bronchial occlusion with EWSs.

DOI： 10.1002/rcr2.1405

The consecutive impact of COVID-19 on thoracic surgical procedures in Japan: an analysis of data from the National Clinical Database 査読有り

Sato Y., Yamamoto H., Ikeda N., Konishi H., Hibi T., Endo S., Inoue M., Okada Y., Shintani Y., Toyooka S., Nakamura H., Hoshikawa Y., Chen-Yoshikawa T.F., Uramoto H., Tsubochi Y., Kakizoe T., Chida M., Yoshino I.

Surgery Today 54 巻 ( 6 ) 頁： 627 - 633 2024年6月

記述言語：英語出版者・発行元：Surgery Today

Purpose: The current study was designed to analyze the impact of the COVID-19 pandemic on general thoracic surgeries in Japan. Methods: Changes in surgeries for lung cancer and metastatic lung tumors were evaluated based on National Clinical Database data regarding cancer screening. Results: In 2021, surgeries for primary lung cancer increased by 3.4% compared to 2020, which, given the increase from 2014 to 2019, indicates an overall 11.1% decrease. In contrast, surgeries for metastatic lung tumors in 2021 decreased by 5.8% compared to 2020, which, given the increase from 2014 to 2020, indicates an overall 9.2% decrease. Half of the primary diseases for metastatic lung tumor were cases of colorectal cancer. Low anterior resection procedures in 2020 decreased by 5.5% compared to 2019. Lung and colon cancer screening examinees in 2021 were increased compared to 2020; however, they still showed respective decreases of 11% and 9.0% compared to 2019. Conclusions: Surgeries for primary lung cancer still decreased substantially during the COVID-19 pandemic. The continued stagnation of screening was responsible for this decrease. Surgeries for metastatic lung tumors decreased profoundly, and the decrease in screening for primary tumors was responsible for this reduction. Our findings emphasize the significance of maintaining cancer screening efforts, even during a pandemic.

DOI： 10.1007/s00595-023-02763-0

Evolution of Three-Dimensional Computed Tomography Imaging in Thoracic Surgery 査読有り

Chen-Yoshikawa T.F.

Cancers 16 巻 ( 11 ) 2024年6月

担当区分：筆頭著者,　責任著者記述言語：英語出版者・発行元：Cancers

Radiologic reconstruction technology allows the wide use of three-dimensional (3D) computed tomography (CT) images in thoracic surgery. A minimally invasive surgery has become one of the standard therapies in thoracic surgery, and therefore, the need for preoperative and intraoperative simulations has increased. Three-dimensional CT images have been extensively used, and various types of software have been developed to reconstruct 3D-CT images for surgical simulation worldwide. Several software types have been commercialized and widely used by not only radiologists and technicians, but also thoracic surgeons. Three-dimensional CT images are helpful surgical guides; however, in almost all cases, they provide only static images, different from the intraoperative views. Lungs are soft and variable organs that can easily change shape by intraoperative inflation/deflation and surgical procedures. To address this issue, we have developed a novel software called the Resection Process Map (RPM), which creates variable virtual 3D images. Herein, we introduce the RPM and its development by tracking the history of 3D CT imaging in thoracic surgery. The RPM could help develop a real-time and accurate surgical navigation system for thoracic surgery.

DOI： 10.3390/cancers16112161

Extralobar Pulmonary Sequestration Diagnosed as a Mediastinal Tumor and Resected by Robotic Surgery. 国際誌

Harushi Ueno, Hiroki Watanabe, Shoji Okado, Yuka Kadomatsu, Taketo Kato, Shota Nakamura, Tetsuya Mizuno, Toyofumi Fengshi Chen-Yoshikawa

Annals of thoracic surgery short reports 2 巻 ( 2 ) 頁： 185 - 188 2024年6月

記述言語：英語掲載種別：研究論文（学術雑誌）

A 55-year-old woman with no significant medical history or symptoms was incidentally diagnosed with a mediastinal tumor during a routine health checkup. The intraoperative findings of robot-assisted thoracoscopic surgery led to the diagnosis of extralobar pulmonary sequestration (EPS), with multiple vessels connecting to the pulmonary artery and superior pulmonary vein. EPS, an extremely rare condition, is typically supplied with blood from the aorta. Whereas it is uncommon for blood to be supplied from the pulmonary artery and to drain into the pulmonary vein in EPS, it is safely excised through robot-assisted thoracoscopic surgery.

DOI： 10.1016/j.atssr.2024.01.009

直視下生検にて診断に至った骨髄脂肪腫の1例査読有り

清利紘子, 中尾心人, 平田雄也, 木下亮輔, 杉原雅大, 栗山満美子, 武田典久, 露木琢司, 芳川豊史, 村松秀樹

気管支学 46 巻 ( 3 ) 頁： 177 - 181 2024年5月

記述言語：日本語出版者・発行元：特定非営利活動法人日本呼吸器内視鏡学会

<p><b>背景．</b>骨髄脂肪腫の多くは副腎皮質に発生し胸部領域に発生するのは稀で，胸部では縦隔発生例が多いとされている．<b>症例．</b>71歳の男性．健康診断の胸部単純X線写真で右下肺野の腫瘤影を指摘され，当科を受診した．胸部CTで，右中葉の無気肺と右中葉支に長径約18 mmの脂肪成分を含む結節影を認め，造影効果はわずかであった．気管支鏡検査では右中葉支に表面平滑な腫瘤性病変を認め，直視下生検を行ったところ，脂肪組織および造血細胞を3系統認め骨髄脂肪腫と診断した．骨髄穿刺では正形成骨髄であり，3系統ともに分化良好で線維化は認めなかった．右中葉は無気肺となっており肺炎を繰り返すリスクがあったため，手術目的に呼吸器外科へ紹介したが，患者の手術希望がなかったため，経過観察となっている．<b>結論．</b>肺および気管支に発生する骨髄脂肪腫は非常に稀であり，直視下生検を行い診断できた点からも貴重な症例と考え報告する．</p>

DOI： 10.18907/jjsre.46.3_177

日本におけるsublobar切除とマーキング法の現状肺精密縮小手術研究会からの報告

小島史嗣, 分島良, 河北直也, 上田雄一郎, 豊洋次郎, 小林正嗣, 佐藤雅昭, 清水公裕, 新谷康, 滝沢宏光, 津谷康大, 中島崇裕, 芳川豊史, 佐藤寿彦

日本呼吸器外科学会雑誌 38 巻 ( 3 ) 頁： PS5 - 8 2024年4月

The Tumor Immune Microenvironment Is Associated With Recurrence in Early-Stage Lung Adenocarcinoma 査読有り

Kanemura H., Yokoyama T., Nakajima R., Nakamura A., Kuroda H., Kitamura Y., Shoda H., Mamesaya N., Miyata Y., Okamoto T., Okishio K., Oki M., Sakairi Y., Chen-Yoshikawa T.F., Aoki T., Ohira T., Matsumoto I., Ueno K., Miyazaki T., Matsuguma H., Yokouchi H., Otani T., Ito A., Sakai K., Chiba Y., Nishio K., Yamamoto N., Okamoto I., Nakagawa K., Takeda M.

JTO Clinical and Research Reports 5 巻 ( 4 ) 2024年4月

記述言語：英語出版者・発行元：JTO Clinical and Research Reports

Introduction: Immune checkpoint inhibitors have recently been approved for the treatment of early-stage NSCLC in the perioperative setting on the basis of phase 3 trials. However, the characteristics of such patients who are susceptible to recurrence after adjuvant chemotherapy or who are likely to benefit from postoperative immunotherapy have remained unclear. Methods: This biomarker study (WJOG12219LTR) was designed to evaluate cancer stem cell markers (CD44 and CD133), programmed death-ligand 1 (PD-L1) expression on tumor cells, CD8 expression on tumor-infiltrating lymphocytes, and tumor mutation burden in completely resected stage II to IIIA NSCLC with the use of archived DNA and tissue samples from the prospective WJOG4107 trial. Tumors were classified as inflamed or noninflamed on the basis of the PD-L1 tumor proportion score and CD8+ tumor-infiltrating lymphocyte density. The association between each potential biomarker and relapse-free survival (RFS) during adjuvant chemotherapy was assessed by Kaplan-Meier analysis. Results: A total of 117 patients were included in this study. The median RFS was not reached (95% confidence intervals [CI]: 22.4 mo–not reached; n = 39) and 23.7 months (95% CI: 14.5–43.6; n = 41) in patients with inflamed or noninflamed adenocarcinoma, respectively (log-rank p = 0.02, hazard ratio of 0.52 [95% CI: 0.29–0.93]). Analysis of the combination of tumor inflammation category and TP53 mutation status revealed that inflamed tumors without TP53 mutations were associated with the longest RFS. Conclusions: PD-L1 expression on tumor cells, CD8+ T cell infiltration, and TP53 mutation status may help identify patients with early-stage NSCLC susceptible to recurrence after adjuvant chemotherapy.

DOI： 10.1016/j.jtocrr.2024.100658

Circulating microRNA Panel for Prediction of Recurrence and Survival in Early-Stage Lung Adenocarcinoma 査読有り国際誌

Tai M.C., Bantis L.E., Parhy G., Kato T., Tanaka I., Chow C.W., Fujimoto J., Behrens C., Hase T., Kawaguchi K., Fahrmann J.F., Ostrin E.J., Yokoi K., Chen-Yoshikawa T.F., Hasegawa Y., Hanash S.M., Wistuba I.I., Taguchi A.

International Journal of Molecular Sciences 25 巻 ( 4 ) 2024年2月

記述言語：英語掲載種別：研究論文（学術雑誌）出版者・発行元：International Journal of Molecular Sciences

Early-stage lung adenocarcinoma (LUAD) patients remain at substantial risk for recurrence and disease-related death, highlighting the unmet need of biomarkers for the assessment and identification of those in an early stage who would likely benefit from adjuvant chemotherapy. To identify circulating miRNAs useful for predicting recurrence in early-stage LUAD, we performed miRNA microarray analysis with pools of pretreatment plasma samples from patients with stage I LUAD who developed recurrence or remained recurrence-free during the follow-up period. Subsequent validation in 85 patients with stage I LUAD resulted in the development of a circulating miRNA panel comprising miR-23a-3p, miR-320c, and miR-125b-5p and yielding an area under the curve (AUC) of 0.776 in predicting recurrence. Furthermore, the three-miRNA panel yielded an AUC of 0.804, with a sensitivity of 45.8% at 95% specificity in the independent test set of 57 stage I and II LUAD patients. The miRNA panel score was a significant and independent factor for predicting disease-free survival (p < 0.001, hazard ratio [HR] = 1.64, 95% confidence interval [CI] = 1.51–4.22) and overall survival (p = 0.001, HR = 1.51, 95% CI = 1.17–1.94). This circulating miRNA panel is a useful noninvasive tool to stratify early-stage LUAD patients and determine an appropriate treatment plan with maximal efficacy.

DOI： 10.3390/ijms25042331

CHST4 Gene as a Potential Predictor of Clinical Outcome in Malignant Pleural Mesothelioma 国際誌

Okado S., Kato T., Hanamatsu Y., Emoto R., Imamura Y., Watanabe H., Kawasumi Y., Kadomatsu Y., Ueno H., Nakamura S., Mizuno T., Takeuchi T., Matsui S., Chen-Yoshikawa T.F.

International Journal of Molecular Sciences 25 巻 ( 4 ) 2024年2月

担当区分：最終著者,　責任著者記述言語：英語掲載種別：研究論文（学術雑誌）出版者・発行元：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

The efficacy of pulmonary rehabilitation training program for patients after lung transplantation 査読有り

Mei J., Hu J., Krause E.M., Chen-Yoshikawa T.F., Alvarez A., Wang X.

Journal of Thoracic Disease 16 巻 ( 1 ) 頁： 530 - 541 2024年1月

記述言語：英語出版者・発行元：Journal of Thoracic Disease

Background: Pulmonary rehabilitation is recognized widely as one of the most effective measures to promote postoperative recovery of lung transplant recipients (LTRs), and it has positive effects on both short- and long-term quality of life (QoL) and survival outcomes. However, no standardized pulmonary rehabilitation training programs exist specifically for LTRs. The pulmonary rehabilitation programs widely used in clinical practice focus mainly on exercise or respiratory training, to some extent neglecting other therapeutic methods that could promote patient health, such as nutrition support, pain control, spiritual comfort, and so on. This study aimed to develop a postoperative pulmonary rehabilitation training program for LTRs and evaluate its effectiveness. Methods: Using convenience sampling, all patients who underwent lung transplantation (LTx) at Shanghai Pulmonary Hospital from January 2021 to December 2022 were screened for inclusion and exclusion criteria, and a total of 68 patients were finally included in this study. A non-synchronous quasi-experimental design was used, with patients who underwent LTx in 2021 as the control group and patients who underwent LTx in 2022 as the experimental group. The control group received routine treatment, health education, and rehabilitation guidance when patients determined the date of surgery. In addition to this, the experimental group received pulmonary rehabilitation training. The incidence of postoperative pulmonary complications (pulmonary infections), duration of chest tube drainage, intensive care unit (ICU) length of stay, postoperative pain scores, postoperative QoL, pulmonary function, oxygenation index, and the distance in the 6-minute walking test (6MWD) were compared between the two groups. Results: The length of ICU stay and duration of chest tube drainage in the experimental group were lower than those in the control group, and the results of oxygenation index, 6MWD, and St. George’s Respiratory Questionnaire (reflecting the QoL) were better than those of the control group (P<0.05). There was no significant difference in the pain of the two groups 1 week after surgery and 3 months after surgery, and the pain score of the experimental group was lower than that of the control group at 1 month after surgery (P<0.05). There was no significant difference in the incidence of complications between the two groups (P>0.05). Conclusions: The postoperative pulmonary rehabilitation training program for LTRs is safe and effective. It can shorten both the duration of chest tube drainage and ICU stay, it can also improve patients’ exercise capacity and pulmonary function while also promote safety outcomes of LTRs, and improve QoL scores.

DOI： 10.21037/jtd-23-1774

Efficacy and safety of intraoperative partial spray of 50% glucose for patients with spontaneous pneumothorax 査読有り国際誌

Kiriyama R., Nakamura S., Oyamatsu H., Niimi S., Fujimura T., Okagawa T., Chen-Yoshikawa T.F.

Journal of Cardiothoracic Surgery 19 巻 ( 1 ) 頁： 14 - 14 2024年1月

担当区分：最終著者記述言語：英語掲載種別：研究論文（学術雑誌）出版者・発行元：Journal of Cardiothoracic Surgery

Objectives: The management for pneumothorax patients involves surgical intervention, nevertheless postoperative recurrences are often encountered. To reduce the rates of recurrence, thoracic surgeons have experimented with various novel techniques, such as pleural abrasion, chemical pleurodesis, and staple line coverage with absorbable sheets, in addition to bullectomy. And in recent years, there have been reports of the effectiveness of the use of intraoperative glucose intrapleural spray (GIS) containing 50 ml of 50% glucose solution in addition to bullectomy. However, information on the effects and adverse events of GIS is limited. Current study was aimed to assess the efficacy and safety of GIS in preventing recurrence of pneumothorax. Patients and methods: We conducted a retrospective study with 74 cases of bullectomy with or without GIS between 2018 and 2021 at Okazaki City Hospital. Of these cases, 50 received GIS (GIS group) while 24 were treated conservatively (C group). Result: The GIS group consisted of 46 males and 4 females, whereas the C group consisted of 23 males and 1 female, with mean ages of 38.5 ± 5.7 years and 30.5 ± 6.7 years, respectively. The GIS group exhibited a mean increase in blood glucose of 23.8 mg/dL postoperatively, and postoperative infections were observed in 2 cases in the GIS group (4.0%) and 2 cases in the C group (8.3%). The NRS scores of the patients in the GIS group and the C group three hours postoperatively were 4.0 and 3.1, respectively (p = 0.28). No prolongation of postoperative drainage period by GIS was observed (1.2 days and 1.4 days in the GIS and C groups, respectively). Postoperative recurrence occurred in two patients from the C group. The postoperative total drainage volumes were 341.8 ± 25.2 ml and 74.2 ± 25.5 ml in the GIS and C groups, respectively, showing a significant increase in drainage volume (p < 0.01). None of them presented dehydration-related symptoms. Conclusions: The use of intraoperative glucose intrapleural spray is effective and safe in terms of preventing recurrences and postoperative complications.

DOI： 10.1186/s13019-024-02486-4

Prognostic impact of adjuvant therapy for cisplatin-unfit patients with non-small-cell lung cancer: A multicenter analysis 査読有り国際誌

Noritake O., Nakamura S., Kinoshita F., Aokage K., Asao T., Matsuura Y., Chen-Yoshikawa T.F.

Lung Cancer 188 巻頁： 107470 - 107470 2024年1月

担当区分：最終著者記述言語：英語掲載種別：研究論文（学術雑誌）出版者・発行元：Lung Cancer

Introduction: No evidence exists for postoperative adjuvant therapy in elderly or renal dysfunction patients with non-small-cell lung cancer (NSCLC) who are unfit to receive cisplatin (CDDP). Herein, we evaluated the efficacy of postoperative adjuvant therapy for CDDP-unfit patients. Materials and methods: We defined CDDP-unfit patients as those aged ≥75 years or with renal dysfunction based on criteria established by expert panels and from prospective studies. CDDP-fit patients comprised all others. Between 2010 and 2020, among 1,423 patients with pathological stage II–III (8th edition of the AJCC-TNM Classification) NSCLC, 454 were identified as unfit for CDDP. Following propensity score matching in CDDP-unfit patients with and without postoperative adjuvant therapy, we analyzed the overall survival (OS) and disease-free survival (DFS) of each group and assessed the impact of adjuvant therapy on survival. Results: OS was significantly better in patients who received adjuvant therapy than in those who did not (5-year OS rate: 76.1 % vs. 50.0 %, p < 0.01) among 255 propensity score-matched patients. DFS was also significantly better in patients who received adjuvant therapy than in those who did not (5-year OS: 54.6 % vs. 35.1 %, p < 0.01). Conclusions: Our findings suggest that postoperative adjuvant therapy could be beneficial for CDDP-unfit patients aged ≥75 years or with renal dysfunction. Future studies for CDDP-unfit patients should be designed based on the results of this study to determine the potential benefits of adjuvant therapy.

DOI： 10.1016/j.lungcan.2024.107470

Incidence of air leaks in patients undergoing robotic thoracic surgery and video-assisted thoracic surgery 査読有り

Ueno H., Takada Y., Imamura Y., Okado S., Nomata Y., Watanabe H., Nakanishi K., Kadomatsu Y., Kato T., Nakamura S., Mizuno T., Chen-Yoshikawa T.F.

Nagoya Journal of Medical Science 86 巻 ( 3 ) 頁： 464 - 471 2024年

担当区分：最終著者記述言語：英語出版者・発行元：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

A Case of Incidentally Discovered Congenital Complete Pericardial Defect during Lobectomy for Lung Cancer: A Case Report and Literature Review 査読有り

Setogawa T., Kato T., Watanabe H., Nakamura S., Mizuno T., Chen-Yoshikawa T.F.

Annals of Thoracic and Cardiovascular Surgery 30 巻 ( 1 ) 頁： n/a 2024年

担当区分：最終著者,　責任著者記述言語：英語掲載種別：研究論文（学術雑誌）出版者・発行元：Annals of Thoracic and Cardiovascular Surgery

An 82-year-old male patient underwent a left upper lobectomy with anterolateral thoracotomy for lung cancer. Although a complete left-pericardial defect was observed during surgery, the pericardial repair was not performed because the left lower lobe remained and the heart was considered stable. Postoperative pathological examination revealed primary synchronous double-lung squamous-cell carcinoma (pathological stage pT2a(2) N0M0 stage IB). He was discharged without complications on postoperative day 8. Leftward displacement of the heart and left diaphragmatic elevation, suspected of phrenicnerve paralysis, were found in the chest X-ray after discharge. However, the patient’s overall condition remained unaffected at the 5-month postoperative follow-up. To assess the need for pericardial repair, we compared cases of complete pericardial defects observed during lobectomy or pneumonectomy reported in the literature. Only one of 12 cases occurred postoperative death despite pericardial repair, and that case combined pectus excavatum and pericardial defects. Our assessment indicated that pericardial repair might not be necessary, excluding complex cases.

DOI： 10.5761/atcs.cr.24-00041

小児の肺移植の現状と未来招待有り査読有り

芳川豊史

日本小児放射線学会雑誌 40 巻 ( 1 ) 頁： 10 - 16 2024年

担当区分：筆頭著者,　責任著者記述言語：日本語出版者・発行元：日本小児放射線学会

<p>1983年のトロントグループによる世界初の肺移植の成功から15年遅れて，1998年に本邦初の生体肺移植が成功裡に行われた．その後20余年が経過し，本邦における肺移植は，1,000例を超えた．成績も良好で，5年生存率は70%を超え，10年生存率も60%を超えるなど，世界屈指のレベルとなった．世界の肺移植数は，世界的にも経年的にも増加しており，本邦でも2022年は年間100例を初めて超え，今後，増加する医療である．しかし，小児肺移植数は世界的にも少なく，未成年者に対する肺移植は，世界で年間100例程度の実施数であり，10歳以下の症例は20例前後に過ぎない．また，本邦では，世界で唯一生体肺移植が継続して行われており，小児に対する生体肺移植も必須の治療オプションである．そこで，慢性呼吸不全に罹患する小児患者の治療の一つとして，肺移植が定着し，将来的に増加していくことを期待し，今回，肺移植の現状と未来について概説する．</p>

DOI： 10.20844/jspr.40.1_10

Urticaria induced by continuous intravenous epoprostenol treatment in a patient with pulmonary arterial hypertension 査読有り

Sawada T., Kuwai T., Nakajima S., Chen-Yoshikawa T.F., Nomura T., Date H., Kabashima K.

Journal of Dermatology 2024年

Thoracoscopic Wedge Resection for Low-Grade Fibromyxoid Sarcoma (Evans Tumor) with Massive Calcification and Originating from the Lung: A Rare Case in an Unexpected Location 査読有り

Watanabe H., Nakanishi K., Ueno H., Kato T., Shimoyama Y., Chen-Yoshikawa T.F.

Annals of Thoracic and Cardiovascular Surgery 30 巻 ( 1 ) 頁： n/a 2024年

担当区分：最終著者,　責任著者記述言語：英語出版者・発行元：Annals of Thoracic and Cardiovascular Surgery

We encountered a rare case of low-grade fibromyxoid sarcoma, which is generally known as Evans tumor, with massive calcification originating from the lung. The patient was a 22-year-old man with Duchenne muscular dystrophy who was referred for a detailed investigation of an intrathoracic tumor with massive calcification. Although our preoperative diagnosis was a solitary fibrous tumor originating from the mediastinum or diaphragm, intraoperative thoracoscopy revealed the tumor arising from the left lower lobe without adhesion to the other organs. Considering his medical history, we aimed to preserve lung function and chose wedge resection, which completely removed the tumor. Based on the pathological findings, the tumor was diagnosed as low-grade fibromyxoid sarcoma with massive calcification originating from the lung. Although extremely rare, this tumor should be considered as a differential diagnosis for a solitary lung mass with massive calcification in young adults.

DOI： 10.5761/atcs.cr.23-00170

Lung cancer after kidney transplantation: a 50-year experience at a single institution 査読有り

Watanabe H., Kadomatsu Y., Hakiri S., Yoshioka H., Hiramitsu T., Futamura K., Okada M., Goto N., Narumi S., Watarai Y., Chen-Yoshikawa T.F.

Surgery Today 2024年

担当区分：最終著者記述言語：英語出版者・発行元：Surgery Today

Purpose: To investigate the clinical characteristics of lung cancer that develops after kidney transplantation. Methods: The clinical data of patients with lung cancer diagnosed after kidney transplantation were collected retrospectively. The medical records were extracted from our database. All patients underwent routine chest examination after kidney transplantation. Results: In total, 17 lung tumors were detected in 15 (0.6%) of 2593 patients who underwent kidney transplantation at our institution. Eleven lung tumors were completely resected from a collective 10 patients (surgical group). The remaining five patients did not receive surgical treatment (nonsurgical group). The surgical group underwent wedge resection (n = 5), segmentectomy (n = 1), lobectomy (n = 3), and bilobectomy (n = 1). The pathological stages were 0 (n = 1), IA1 (n = 2), IA2 (n = 4), IA3 (n = 2), and IB (n = 1). The surgical group had a significantly better prognosis than the nonsurgical group. There were no perioperative complications related to kidney transplantation in either group. Conclusions: Routine chest examination would be useful for the early diagnosis and treatment of lung cancer after kidney transplantation. Moreover, surgical resection for early-stage lung cancer was associated with a better prognosis for kidney transplantation patients.

DOI： 10.1007/s00595-024-02819-9

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