Faculty Profiles - CHEN-YOSHIKAWA Toyofumi

Papers - CHEN-YOSHIKAWA Toyofumi

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Commentary: Less is more in modified subxiphoid approach for thymic malignancy Invited Reviewed

Chen-Yoshikawa T.F.

Journal of Thoracic and Cardiovascular Surgery 2024

Effects of the COVID-19 pandemic on surgical treatment for thoracic malignant tumor cases in Japan: a national clinical database analysis

Shintani Y., Yamamoto H., Sato Y., Inoue M., Asakura K., Ito H., Uramoto H., Okada Y., Sato T., Fukui M., Hoshikawa Y., Chen-Yoshikawa T.F., Chida M., Ikeda N., Yoshino I.

Surgery Today 2024

Publisher：Surgery Today

Objective: Surgical care has been significantly affected by the COVID-19 pandemic. This study was conducted to evaluate the effects of the pandemic on lung cancer and mediastinal tumor surgery. Methods: Changes in the number of surgical procedures for lung cancer and mediastinal tumors were analyzed using the National Clinical Database of Japan. Patient characteristics, including disease stage and histological type, from 2019 to 2022 were evaluated using annual datasets. Results: Comparisons with 2019 showed that the number of patients who underwent surgery for primary lung cancer or a mediastinal tumor decreased in 2020 and then remained stable. There were no clinically significant changes in the trend over the four-year period regarding the number of patients for each clinical and pathological stage of lung cancer. Regarding mediastinal tumors, there was no significant difference in tumor size between years. There was a slight change in the selection of surgical indication during the second quarter of 2020, although its impact on annual trends in the stage distribution for lung cancer and primary disease for mediastinal tumors was minimal. Conclusions: Analyses of lung cancer and mediastinal tumor surgery cases in Japan during the COVID-19 pandemic showed no significant disease profile changes related to treatment delay.

DOI： 10.1007/s00595-024-02907-w

Scopus

Clinical, radiological, and pathological features of idiopathic and secondary interstitial pneumonia cases with pleuroparenchymal fibroelastosis undergoing lung transplantation Reviewed

Ikegami Naoya, Nakajima Naoki, Yoshizawa Akihiko, Handa Tomohiro, Chen-Yoshikawa Toyofumi, Kubo Takeshi, Tanizawa Kiminobu, Ohsumi Akihiro, Yamada Yoshito, Hamaji Masatsugu, Nakajima Daisuke, Yutaka Yojiro, Tanaka Satona, Watanabe Kizuku, Nakatsuka Yoshinari, Murase Yuko, Nakanishi Tomoko, Niwamoto Takafumi, Chin Kazuo, Date Hiroshi, Hirai Toyohiro

Tenri Medical Bulletin Vol. 26 ( 1 ) page： 56 - 57 2023.12

Immunosuppressive treatment for myasthenia gravis crises improve the taste disorder in patients with thymoma: two case reports Reviewed

Yuko Ohara, Shoji Okado, Hiroki Watanabe, Osamu Noritake, Keita Nakanishi, Yuka Kadomatsu, Harushi Ueno, Taketo Kato, Shota Nakamura, Toyofumi Fengshi Chen-Yoshikawa, Koichi Fukumoto

Mediastinum Vol. 7 2023.12

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

Background: Taste disorders in patients with thymoma accompanied by myasthenia gravis (MG) is rare. Case Description: The first case was a male in his 50s who underwent surgery for Masaoka stage III type B3 thymoma. He experienced a loss of taste before surgery, which showed no improvement after surgery. Due to a MG crisis 44 days after surgery, the patient underwent intensive treatment with mechanical ventilation, steroid pulse therapy, and intravenous immunoglobulin (IVIG) therapy. The patient recovered taste when he started oral food intake after the treatment for the MG crisis (about 3 months after surgery). Despite the recovery of taste after steroid pulse therapy and IVIG therapy, taste disorder gradually worsened about 1 year and 9 months after surgery, resulting in an almost complete loss of sweet taste 2 years after surgery. The second case was a male in his 60s who underwent surgery for Masaoka stage II type B1 thymoma. He experienced loss of taste before surgery, which showed no improvement after surgery. Five years and two months after surgery, the patient was diagnosed with a MG crisis and underwent steroid pulse therapy. Along with improvements in MG symptoms, taste disorders gradually improved. After 6 years and 10 months of surgery, the patient is still alive without MG symptoms (only pyridostigmine, 180 mg/body/day), taste disorder, and thymoma recurrence. Conclusions: The autoimmune mechanism may contribute to taste disorders in patients with thymoma, which can be recovered by immunosuppressive treatment in our cases.

DOI： 10.21037/med-23-8

Scopus

Influencing Factors on Intersegmental Identification Adequacy in Segmentectomy with Intraoperative Indocyanine Green (ICG) Intravenous Administration. Reviewed International journal

Harushi Ueno, Tomohiro Setogawa, Ayaka Makita, Yuko Ohara, Yoshito Imamura, Shoji Okado, Hiroki Watanabe, Yuta Kawasumi, Yuka Kadomatsu, Taketo Kato, Shota Nakamura, Tetsuya Mizuno, Toyofumi Fengshi Chen-Yoshikawa

Cancers Vol. 15 ( 24 ) 2023.12

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

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

Scopus

PubMed

Perioperative changes in radiographic density in erector spinae muscle and mortality after lung transplantation. Reviewed International journal

Yohei Oshima, Susumu Sato, Toyofumi F Chen-Yoshikawa, Daisuke Nakajima, Yuji Yoshioka, Ryota Hamada, Taishi Kajimoto, Ayumi Otagaki, Manabu Nankaku, Naoya Tanabe, Ryosuke Ikeguchi, Hiroshi Date, Shuichi Matsuda

Respiratory medicine Vol. 221 page： 107482 - 107482 2023.12

Language：English Publishing type：Research paper (scientific journal)

RATIONALE: The radiographic density of the erector spinae muscle (ESM) is often decreased early after lung transplantation (LTx). The prognostic impact of this change has not been elucidated. OBJECTIVE: To investigate whether the decrease in the radiographic density of ESMs early after LTx is associated with a poor prognosis. METHODS: This study is a single center retrospective cohort study. Routine follow-up chest computed tomography scan data just before and 12 weeks after LTx were retrospectively retrieved for adult patients who underwent primary LTx at Kyoto University Hospital. The radiographic density of ESM was quantitatively evaluated as the mean attenuation of the ESM (ESMct), and the impact of the decreased ESMct during the 12 weeks after LTx on overall survival (OS) was examined by Cox proportional hazard regression. RESULTS: A total of 151 recipients (94 cadaveric LTx, 57 living-donor lobar LTx) were included in this study. The median duration of postoperative observation was 4.4 years, during which time 39 recipients (26%) died. Decreased postoperative ESMct was significantly associated with poor OS (HR, 1.64; 95% CI, 1.14-2.35, P = 0.008 per 1 Z score decrease) in the multivariate model adjusted for age, sex, episodes of acute rejection, and preoperative ESMct. Similar results were obtained when the subjects were limited to those with cadaveric LTx. CONCLUSION: A decreased perioperative ESMct was strongly associated with a poor prognosis after LTx in addition to low preoperative ESMct. Maintaining postoperative muscle radiographic density, which reflects muscle quality, may be important for a better prognosis after LTx.

DOI： 10.1016/j.rmed.2023.107482

Scopus

PubMed

Novel intrathoracic irrigation using ultrafine ozone bubbles in a rat empyema model Reviewed

Ikeda M., Yutaka Y., Chen-Yoshikawa T.F., Tanaka M., Yamamoto M., Tanaka S., Yamada Y., Ohsumi A., Nakajima D., Hamaji M., Yoshizawa A., Kusaka E., Nagao M., Date H.

Scientific Reports Vol. 13 ( 1 ) 2023.12

Language：English Publisher：Scientific Reports

Dissolved ozone is generally used for sanitization, but it has not been used for thoracic cavity sanitization because of its short half-life (< 20 min) and possible toxicity. We developed a novel solution containing ultrafine ozone bubbles (ozone-UFB) with a fivefold longer half-life than non-UFB ozone. Using an in vitro model, Staphylococcus aureus colonies were counted after exposure to ozone-UFB or non-UFB ozone at the same ozone concentration (0.4 mg/L). The colony count was significantly lower in the ozone-UFB group than in the non-UFB ozone group (p = 0.034). The effect of repeated pleural irrigation using ozone-UFB and saline was compared in a rat empyema model of S. aureus infection. The bacterial count in the pleural effusion was decreased by at least fivefold following intrathoracic lavage with ozone-UFB (3 mg/L). To examine the safety of ozone-UFB for intrathoracic use, ozone-UFB with a higher ozone concentration (10 mg/L) was injected into the thoracic cavities of normal rats. The treatment did not result in any specific pleural damage or elevated serum interleukin-6 concentrations. The findings highlighted the efficacy and safety of ozone-UFB for intrathoracic sanitization, but further studies are needed to determine the optimal therapeutic ozone concentration with appropriate safety margins.

DOI： 10.1038/s41598-023-43787-3

Scopus

Postoperative Complications of Open Window Thoracostomy:Report of a Case. Reviewed

Toshinari Ito, Shota Nakamura, Shoji Okado, Keiyu Sato, Koichi Fukumoto, Toyofumi F Chen-Yoshikawa

Kyobu geka. The Japanese journal of thoracic surgery Vol. 76 ( 12 ) page： 1069 - 1072 2023.11

Language：Japanese Publishing type：Research paper (scientific journal)

While open window thoracostomy is used to treat empyema with a high rate of infection control, it is an invasive procedure that leads to a decline in the quality of life. An 80-year-old man who had undergone wedge resection for pulmonary nodules subsequently developed postoperative empyema and underwent open window thoracostomy. After thoracostomy, the patient developed several complications, including bleeding from the lung surface and air leakage. Window closure was planned at this time;however, the plan was scuttled due to his low nutritional status and pulmonary air leakage. After the patient's condition improved with persistent conservative treatment, window closure was performed, and he overcame his complications. Patients with postoperative empyema requiring thoracostomy are at a high risk of developing postoperative complications. Therefore, it is important to manage the patients' condition persistently so that they can receive window closure at an appropriate time.

PubMed

Complete visualization using indocyanine green in thoracic surgery for pulmonary sequestration. Reviewed International journal

Keita Nakanishi, Yuka Kadomatsu, Harushi Ueno, Taketo Kato, Shota Nakamura, Tetsuya Mizuno, Toyofumi Fengshi Chen-Yoshikawa

Journal of thoracic disease Vol. 15 ( 10 ) page： 5714 - 5722 2023.10

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

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

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PubMed

NOTCH1 and CREBBP co-mutations negatively affect the benefit of adjuvant therapy in completely resected EGFR-mutated NSCLC: translational research of phase III IMPACT study. Reviewed International journal

Satoshi Ikeda, Masahiro Tsuboi, Kazuko Sakai, Toshihiro Misumi, Hiroaki Akamatsu, Hiroyasu Shoda, Noriaki Sakakura, Atsushi Nakamura, Yasuhisa Ohde, Hidetoshi Hayashi, Kyoichi Okishio, Morihito Okada, Ichiro Yoshino, Jiro Okami, Kazuhisa Takahashi, Norihiko Ikeda, Masayuki Tanahashi, Yuichi Tambo, Haruhiro Saito, Shinichi Toyooka, Hidetoshi Inokawa, Toyofumi Chen-Yoshikawa, Toshihide Yokoyama, Tatsuro Okamoto, Noriko Yanagitani, Masahide Oki, Makoto Takahama, Kenji Sawa, Hirohito Tada, Kazuhiko Nakagawa, Tetsuya Mitsudomi, Kazuto Nishio

Molecular oncology Vol. 18 ( 2 ) page： 305 - 316 2023.10

Language：English Publishing type：Research paper (scientific journal)

The phase III IMPACT study (UMIN000044738) compared adjuvant gefitinib with cisplatin plus vinorelbine (cis/vin) in completely resected epidermal growth factor receptor (EGFR)-mutated non-small cell lung cancer (NSCLC). Although the primary endpoint of disease-free survival (DFS) was not met, we searched for molecular predictors of adjuvant gefitinib efficacy. Of 234 patients enrolled in the IMPACT study, 202 patients were analyzed for 409 cancer-related gene mutations and tumor mutation burden using resected lung cancer specimens. Frequent somatic mutations included tumor protein p53 (TP53; 58.4%), CUB and Sushi multiple domains 3 (CSMD3; 11.8%), and NOTCH1 (9.9%). Multivariate analysis showed that NOTCH1 co-mutation was a significant poor prognostic factor for overall survival (OS) in the gefitinib group and cAMP response element binding protein (CREBBP) co-mutation for DFS and OS in the cis/vin group. In patients with NOTCH1 co-mutations, gefitinib group had a shorter OS than cis/vin group (Hazard ratio 5.49, 95% CI 1.07-28.00), with a significant interaction (P for interaction = 0.039). In patients with CREBBP co-mutations, the gefitinib group had a longer DFS than the cis/vin group, with a significant interaction (P for interaction = 0.058). In completely resected EGFR-mutated NSCLC, NOTCH1 and CREBBP mutations might predict poor outcome in patients treated with gefitinib and cis/vin, respectively.

DOI： 10.1002/1878-0261.13542

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PubMed

グローバルスタンダードを目指した肺がん縮小手術開発の現状と課題肺野末梢小型非小細胞肺がん例に対する実臨床での術式選択と術後成績

中村彰太, 高田裕里, 今村由人, 岡戸翔嗣, 野亦悠史, 渡邉裕樹, 門松由佳, 上野陽史, 加藤毅人, 水野鉄也, 芳川豊史

肺癌 Vol. 63 ( 5 ) page： 374 - 374 2023.10

充実性結節として描出され,転移性肺腫瘍や原発性肺癌との鑑別を要したperibronchiolar metaplasiaの1例

高田裕里, 中村彰太, 芳川豊史, 水野鉄也, 加藤毅人, 上野陽史, 門松由佳, 仲西慶太, 則竹統, 渡邉裕樹, 岡戸翔嗣, 野亦悠史, 今村由人, 岩清水寿徳

肺癌 Vol. 63 ( 5 ) page： 623 - 623 2023.10

New method for delineation of the intersegmental line in a deflated lung. Reviewed International journal

Shoji Okado, Yuka Kadomatsu, Megumi Nakao, Harushi Ueno, Koichi Fukumoto, Shota Nakamura, Toyofumi Fengshi Chen-Yoshikawa

Journal of thoracic disease Vol. 15 ( 9 ) page： 4736 - 4744 2023.9

Authorship：Last author,　Corresponding author Language：English Publishing type：Research paper (scientific journal)

BACKGROUND: Preoperative three-dimensional (3D) computed tomography (CT) images have been widely used as surgical guides in lung surgery; however, the lungs tend to be deflated during surgery. Discrepancies between the preoperatively constructed 3D image and the intraoperative view of the deflated lungs often require preoperative and/or intraoperative marking methods for sublobar pulmonary resection. We have developed a lung deflation simulation algorithm in which 3D CT images of the deflated lungs can be predicted only based on the preoperative CT taken in an inflated phase of respiration. Using this system, we conducted a preliminary study to retrospectively compare the intersegmental line predicted by our lung deflation simulation algorithm with the intersegmental line delineated by the intravenous administration of indocyanine green. METHODS: Sixteen patients who underwent unilateral segmentectomy between January 1, 2020, and June 30, 2022, were included in the study. The identified intersegmental lines were confirmed intraoperatively using indocyanine green. These actual intersegmental lines were compared with those delineated on 3D images using the lung deflation simulation algorithm. RESULTS: Of the 16 patients who underwent pulmonary segmentectomy, the consistency of these intersegmental lines was in complete agreement in twelve patients, partial agreement in three patients, and disagreement in one patient. The concordance rate of the intersegmental lines was 75%. CONCLUSIONS: The lung deflation simulation algorithm provides a new surgical guide in addition to the currently utilized ones. Continuous innovation might lead to a less invasive surgical technique for delineating the intersegmental line.

DOI： 10.21037/jtd-23-421

Scopus

PubMed

Prognostic impact of highly solid component in early-stage solid lung adenocarcinoma. Reviewed International journal

Taketo Kato, Shingo Iwano, Yuki Hanamatsu, Masato Nakaguro, Ryo Emoto, Shoji Okado, Keiyu Sato, Osamu Noritake, Keita Nakanishi, Yuka Kadomatsu, Harushi Ueno, Naoki Ozeki, Shota Nakamura, Koichi Fukumoto, Tamotsu Takeuchi, Kennosuke Karube, Shigeyuki Matsui, Toyofumi Fengshi Chen-Yoshikawa

Quantitative imaging in medicine and surgery Vol. 13 ( 9 ) page： 5641 - 5652 2023.9

Authorship：Last author,　Corresponding author Language：English Publishing type：Research paper (scientific journal)

BACKGROUND: Based on computed tomography (CT) findings of lung cancer, solid nodules have a much worse prognosis than subsolid nodules, even if the nodules are subcentimeter in size. There is, however, no systematic method for determining the prognosis of solid tumors on CT. This study aimed to discover the prognostic factor of early-stage solid lung adenocarcinoma using three-dimensional CT volumetry. METHODS: Patients with pathological stage I solid lung adenocarcinoma who underwent complete resection between 2007 and 2012 were selected in this retrospective study. Clinicopathological data and preoperative multidetector CT findings, such as tumor size on the two-dimensional axial image, three-dimensional tumor volume between -600 and 199 HU, and three-dimensional solid volume between 0 and 199 HU, which corresponded to highly solid components, were compared between recurrence and non-recurrence. Furthermore, these radiological values were compared to pathological invasive volume (PIV). RESULTS: During this time, 709 patients had their lung cancer completely removed. From this cohort, 90 patients with pathological stage I solid lung adenocarcinoma were selected. In addition, recurrence was found in 26 patients (28.9%). Although two-dimensional axial image, serum carcinoembryonic antigen (CEA) level, and SUVmax on 18F fluorodeoxyglucose positron emission tomography/computed tomography (FDG-PET/CT) did not differ statistically between recurrent and non-recurrent patients, three-dimensional tumor and solid tumor volume did. Multivariate analysis indicated that three-dimensional solid tumor volume [hazard ratio: 2.440; 95% confidence interval (CI): 1.110-5.361, P=0.026] and epidermal growth factor receptor (EGFR) mutation (hazard ratio: 4.307; 95% CI: 1.328-13.977, P=0.015) were significantly associated with disease-free survival (DFS). When three-dimensional tumor and solid tumor volume were compared to PIV, three-dimensional solid tumor volume (3,091 mm3 on average) showed a highly similar value with PIV (2,930 mm3 on average), whereas three-dimensional tumor volume (6,175 mm3 on average) was significantly larger than PIV (P<0.001). CONCLUSIONS: In patients with early-stage solid lung adenocarcinoma, the measurement of three-dimensional solid tumor volume, which is correlated with PIV, accurately predicted the postoperative outcome.

DOI： 10.21037/qims-23-36

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PubMed

Investigation of the Current Surgical Practice in Patients with Thymic Epithelial Tumors Among Board-certified Surgeons of the Japanese Association for Chest Surgery: Does a Discrepancy Exist Between Clinical Practice Guidelines and Clinical Practice?

Fukumoto Koichi, Mori Shoichi, Yoshioka Hiromu, Okasaka Toshiki, Taniguchi Tetsuo, Shigemitsu Kikuo, Narita Kunio, Fukui Takayuki, Nakamura Shota, Fengshi Chen-Yoshikawa Toyofumi

Haigan Vol. 63 ( 4 ) page： 280 - 284 2023.8

Language：Japanese Publisher：The Japan Lung Cancer Society

Purpose. According to the current Japanese clinical practice guidelines on thymic tumors, complete tumor resection accompanied by thymectomy is recommended in surgery for early-stage thymic epithelial tumors (TETs). However, in some cases of early-stage TETs, partial thymectomy is performed. In addition to surgical procedures, the extent to which clinical practice guidelines concerning thymic tumors are used as a reference for perioperative care is unclear. Methods. A questionnaire survey was conducted regarding clinical practice, such as surgical procedures, adjuvant therapy, and the postoperative follow-up period, in patients with TETs. Results. A total of 30 board-certified surgeons of the Japanese Association for Chest Surgery (JACS) in Nagoya University and affiliated hospitals responded to the questionnaire survey. Two-thirds of the board-certified surgeons of the JACS (20/30) selected thymectomy for early-stage TETs without myasthenia gravis. In contrast, the remaining board-certified surgeons of the JACS (10/30) selected partial thymectomy in such cases. Answers regarding adjuvant therapy and the postoperative follow-up period were in accordance with the clinical practice guidelines. Conclusion. This questionnaire revealed that one-third of board-certified surgeons of the JACS selected partial thymectomy for early-stage TETs, which is not recommended in the Japanese clinical practice guideline.

DOI： 10.2482/haigan.63.280

CiNii Research

Risk stratification of postoperative pulmonary complications in elderly patients undergoing lung cancer resection: a propensity score-matched study Reviewed

Huang Q., Rauniyar R., Yang J., Zhou C., Cai D., Chen-Yoshikawa T.F., Yutaka Y., Orlandi R., Geraci T.C., Lin J., Hu H., Jiang Z., Zhao G., Ye L.

Journal of Thoracic Disease Vol. 15 ( 7 ) page： 3908 - 3918 2023.7

Language：English Publisher：Journal of Thoracic Disease

Background: In China, lung cancer mainly affects the elderly population. Surgery remains the standard treatment for lung cancer in elderly patients, however, postoperative pulmonary complications (PPCs) are major contributors to morbidity and mortality following lung resection. This study aimed to identify perioperative predictors of PPCs among elderly patients undergoing pulmonary resection for lung cancer to provide evidence for better prevention and intervention for PPCs. Methods: A retrospective study was conducted with 456 patients (age >65 years) undergoing pulmonary resection for lung cancer in Yunnan, China from January 2016 to March 2019. Propensity score matching (PSM) was performed to compare preoperative data and clinical characteristics between the PPC and non-PPC groups, followed by binary logistic regression to evaluate predictors of PPCs. Results: Pulmonary complications occurred in 142/456 (31.1%) patients age >65 years, with pneumonia being the most common event (21.7%). Both PSM and binary logistic regression analysis identified American Society of Anesthesiologists (ASA) class <II [odds ratio (OR): 0.177, 95% confidence interval (CI): 0.037–0.854] and video-assisted thoracoscopic surgery (VATS) (OR: 0.576, 95% CI: 0.334–0.992) as protective factors for PPCs. Conclusions: PPCs following lung cancer resection in elderly patients were associated with a higher ASA classification and open thoracotomy. An adequate and comprehensive evaluation of the operative strategies and enhanced recovery methods should be implemented among elderly patients undergoing lung resection with an ASA class > II or those undergoing an open thoracotomy to help prevent the occurrence of PPCs.

DOI： 10.21037/jtd-23-923

Scopus

[Robot-assisted Extended Thymectomy via a Bilateral Approach for Patients with Myasthenia Gravis]. Reviewed

Shota Nakamura, Keita Nakanishi, Yuka Kadomatsu, Harushi Ueno, Taketo Kato, Toyofumi F Chen-Yoshikawa

Kyobu geka. The Japanese journal of thoracic surgery Vol. 76 ( 7 ) page： 523 - 527 2023.7

Authorship：Last author Language：Japanese Publishing type：Research paper (scientific journal)

Extended thymectomy is a procedure to remove the thymus gland and surrounding adipose tissue, while the traditional approach via a median sternotomy, minimally invasive approaches such as video-assisted thoracoscopic surgery (VATS) and robot-assisted thoracoscopic surgery (RATS) have been adopted. This report described the technique of bilateral approach for extended thymectomy in patients with myasthenia gravis (MG) by robot-assisted thoracoscopic surgery, and also showed the perioperative outcomes and postoperative exacerbation rates of 11 patients. In most patients, score of MG symptom were reduced and levels of anti-acetylcholine receptor antibodies declined postoperatively. In a small number of cases, the safety and efficacy of a RATS bilateral approach for extended thymectomy were confirmed.

PubMed

One-year change in the health status predicts the subsequent hospitalization and mortality in patients waitlisted for lung transplantation in Japan. Reviewed International journal

Masaki Ikeda, Yusuke Wakatsuki, Toru Oga, Junko Tokuno, Seiichiro Sugimoto, Megumi Ishihara, Yoshinori Okada, Miki Akiba, Hidenao Kayawake, Satona Tanaka, Yoshito Yamada, Yojiro Yutaka, Akihiro Ohsumi, Daisuke Nakajima, Masatsugu Hamaji, Jumpei Kimura, Toyofumi F Chen-Yoshikawa, Hiroshi Date

Respiratory investigation Vol. 61 ( 4 ) page： 478 - 484 2023.7

Language：English Publishing type：Research paper (scientific journal)

BACKGROUND: Poor health-related quality of life (HRQL) at the registration for lung transplantation is related to waitlist mortality. We investigated the relationship between 1-year change in HRQL and subsequent outcomes in patients waitlisted for lung transplantation. METHODS: In a 5-year longitudinal study, we analyzed the factors related to waitlist mortality in 197 lung transplant patients registered on the Japan Organ Transplant Network. HRQL was assessed using St. George's Respiratory Questionnaire (SGRQ), and factors related to changes in SGRQ scores were evaluated after 1 year. We assessed the relationship between the 1-year change in SGRQ score and subsequent mortality or hospitalization. RESULTS: Among 197 patients, 108 remained waitlisted during the first-year assessment. During the median follow-up period of 469 d, 28 patients died, and 54 underwent lung transplantation. Univariate Cox proportional hazards analysis revealed that the changes in all components and total score of the SGRQ after 1 year were associated with waitlist mortality (p < 0.05). Stepwise multivariate analysis revealed that the 1-year changes in SGRQ scores were significantly related to waitlist mortality. Forty-three patients with worsened HRQL after 1 year had higher likelihoods of hospitalization (p = 0.038) and mortality (p = 0.026) after 1 and 4 years of follow-up, respectively, than 61 patients without worsened HRQL. CONCLUSIONS: Patients with worsened health status during the first year after registration had higher likelihoods of hospitalization and mortality after 1 and 4 years of follow-up, respectively, than those without worsened HRQL. Strategies to improve health status while waiting are needed to reduce waitlist hospitalization or mortality.

DOI： 10.1016/j.resinv.2023.04.004

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PubMed

Lingular-segment torsion after extended left-upper division segmentectomy by video-assisted thoracic surgery with indocyanine green fluorescence imaging. Reviewed

Taketo Kato, Yuko Ohara, Shoji Okado, Osamu Noritake, Keita Nakanishi, Yuka Kadomatsu, Harushi Ueno, Shota Nakamura, Koichi Fukumoto, Toyofumi Fengshi Chen-Yoshikawa

Asian journal of endoscopic surgery Vol. 16 ( 3 ) page： 584 - 587 2023.7

Authorship：Last author,　Corresponding author Language：English

Lingular-segment torsion after left-upper division segmentectomy (LUDS) is a rare complication, and the cause remains unclear. Here we report the case of a patient who developed lingular-segment torsion after LUDS for multiple lung metastases of breast cancer. One lung nodule was located in the S1 + 2 segment and another between the upper lobe and S6 on an incomplete interlobar fissure. The lung metastases were resected by extended LUDS using video-assisted thoracic surgery with indocyanine green fluorescence imaging. The staple line on the lingular segment was vertically tilted against the interlobar line because of the atypical defect of the fluorescence plane and nodule position. Chest X-ray and contrast-enhanced computed tomography indicated ischemia and torsion of the lingular segment on the second postoperative day, and completion of lingular segmentectomy was performed. This case showed the vertical intersegment staple line during LUDS was one of the important causes of postoperative torsion of the lingular segment.

DOI： 10.1111/ases.13189

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PubMed

【縦隔・胸壁腫瘍に対する低侵襲手術】ロボット支援下手術重症筋無力症に対する両側アプローチによるロボット支援下拡大胸腺全摘の術後成績

中村彰太, 仲西慶太, 門松由佳, 上野陽史, 加藤毅人, 芳川豊史

胸部外科 Vol. 76 ( 7 ) page： 523 - 527 2023.7

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Papers - CHEN-YOSHIKAWA Toyofumi