研究者詳細 - 芳川　豊史

論文 - 芳川　豊史

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Predictive value of EGFR mutation in non–small-cell lung cancer patients treated with platinum doublet postoperative chemotherapy 査読有り

Takahashi T., Sakai K., Kenmotsu H., Yoh K., Daga H., Ohira T., Ueno T., Aoki T., Hayashi H., Yamazaki K., Hosomi Y., Chen-Yoshikawa T.F., Okumura N., Takiguchi Y., Sekine A., Haruki T., Yamamoto H., Sato Y., Akamatsu H., Seto T., Saeki S., Sugio K., Nishio M., Inokawa H., Yamamoto N., Nishio K., Tsuboi M.

Cancer Science 113 巻 ( 1 ) 頁： 287 - 296 2022年1月

記述言語：英語出版者・発行元：Cancer Science

The mutation status of tumor tissue DNA (n = 389) of resected stage II-III non-squamous non–small-cell lung cancer (Ns-NSCLC) was analyzed using targeted deep sequencing as an exploratory biomarker study (JIPANG-TR) for the JIPANG study, a randomized phase III study of pemetrexed/cisplatin (Pem/Cis) vs vinorelbine/cisplatin (Vnr/Cis). The TP53 mutation, common EGFR mutations (exon 19 deletion and L858R), and KRAS mutations were frequently detected. The frequency of the EGFR mutation was significant among female patients. Patients with an EGFR mutation-positive status had a significantly shorter recurrence-free survival (RFS) time (24 mo vs not reached) (HR, 1.64; 95% CI, 1.22-2.21; P =.0011 for EGFR mutation status). Multivariable analysis identified both the pathological stage and EGFR mutation status as independent prognostic factors for RFS (HR, 1.78; 95% CI, 1.30-2.44; P =.0003 for disease stage; and HR, 1.57; 95% CI, 1.15-2.16; P =.0050 for EGFR mutation status). This study demonstrated that the EGFR mutation has either a poor prognostic or predictive impact on a poor response to postoperative chemotherapy with platinum doublet chemotherapy for stage II-III Ns-NSCLC patients. This result supports a role for mandatory molecular diagnosis of early-stage Ns-NSCLC for precision oncology and signifies the importance of adjuvant for the 3rd generation tyrosine kinase inhibitor rather than platinum-based chemotherapy. This study is registered with the UMIN Clinical Trial Registry (UMIN 000012237).

DOI： 10.1111/cas.15171

Scopus

Challenges in left sleeve pneumonectomy in the left lateral decubitus position 査読有り

Nakamura S., Fukui T., Ito H., Goto M., Ozeki N., Chen-Yoshikawa T.F.

Nagoya Journal of Medical Science 84 巻 ( 3 ) 頁： 673 - 677 2022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：Nagoya Journal of Medical Science

We report the case of a 20-year-old woman with carinal adenoid cystic carcinoma who underwent left sleeve pneumonectomy in the left lateral decubitus position, during which severe desaturation was encountered. After transecting the left main bronchus, the left lung was selectively intubated and ventilated. However, oxygenation was inadequate. Hence, venoarterial extracorporeal membrane oxygenation (ECMO) was introduced. Initially, Barclay’s procedure was planned to preserve the left lung, but this plan was altered due to the extent of the tumor and unstable ventilation. After the lesion was removed, the trachea and right main bronchus were anastomosed end-to-end. During left pneumonectomy, the right lung was selectively ventilated, but oxygen saturation (SpO2) dropped to <70% despite ECMO. SpO2 improved on additionally ventilating the left lung using another breathing circuit. Temporary right chest closure was performed with ventilation of the left lung across the thoracotomy wound. The patient was turned to the semi-supine position, and tolerated selective right lung ventilation with ECMO. Subsequently, left thoracotomy and pneumonectomy were successfully performed. Careful management is required for desaturation in left sleeve pneumonectomy in the left lateral decubitus position.

DOI： 10.18999/nagjms.84.3.673

Scopus

脳死下肺摘出・搬送法標準化の現状

星川康, 芳川豊史

移植 57 巻 ( Supplement ) 頁： s145_2 - s145_2 2022年

記述言語：日本語出版者・発行元：一般社団法人日本移植学会

本学会ホームページ上で提示されている脳死下肺摘出術のオリジナル版は、2011年3〜5月当時の肺移植実施7施設に対してアンケート調査を行い、慎重なメール審議とコンセンサス形成を経て、全施設の相違点を包括するものが作成された。本邦の肺摘出術の初めての標準化プロセスであった。2021年4〜6月共同演者の芳川豊史先生（本学会脳死・心停止下リカバリー環境改善委員会委員）が中心となり、日本肺および心肺移植研究会を通じて、肺移植実施10施設に「臓器搬送における手順標準化に向けたアンケート調査」を行い、慎重なメール審議の上、改訂がなされた。特に逆行性灌流に関して、従来の摘出後バックテーブルで行うものから術野で行う形に変更した施設が増えていたため、従来法と併記する形で加筆がなされた。事前に腹部チームとコンセンサスを得ること、呼吸循環管理医・日本臓器移植ネットワークコーディネーターと情報共有することも強調されている。この他、現状に合致させるよう複数の意見が出され、この過程で多施設間相互の手技の再確認、標準化が改めてなされた。臓器摘出・搬送の互助制度に関しては、2018年1〜2月日本肺および心肺移植研究会による肺移植実施9施設に対するアンケート調査の結果、肺移植では時期尚早と判断し、腹部臓器の状況をオブザーブする方針となっている。脳死下肺摘出・搬送法標準化の現状を提示し、今後の課題を議論したい。

DOI： 10.11386/jst.57.supplement_s145_2

CiNii Research

生体肺移植術後の健康関連QoLの実態調査　―脳死肺移植との比較―

大島洋平, 佐藤晋, 芳川豊史, 中島大輔, 吉岡佑二, 濱田涼太, 梶本泰志, 太田垣あゆみ, 伊達洋至, 松田秀一

移植 57 巻 ( Supplement ) 頁： s342_1 - s342_1 2022年

記述言語：日本語出版者・発行元：一般社団法人日本移植学会

【背景と目的】生体肺移植（LDLLT）は本邦を中心に行われており，生命予後は脳死肺移植（CLT）とほぼ同等とされるが，健康関連QoL（HRQoL）に関しては定かでは無い．移植後5年までのHRQoLについて検討を行った．【方法】当院の肺移植患者を対象とし，術前，術後3ヶ月，6ヶ月，1年，以後1年毎に5年までのSF-36を調査し，3コンポーネント・サマリースコア（PCS, MCS, RCS）を算出した．CLTは術前評価の欠測値が多く，LDLLTとの術前比較にはmMRCを用いた．術後経過の比較では，術前mMRC，QoL評価時の慢性移植肺機能不全合併の有無を共変量とし，線形混合モデルを用いて解析した．なお，有意水準は5%とした．【結果】LDLLT68例，CLT148例が解析対象となり，全体では中央値4.4年まで経過観察され，5年後観察を完遂したのは94例（44%）だった．術前のmMRCはLDLLTで有意に高値であった（p＜0.001）．PCSは術後3ヶ月でLDLLT36点 vs. CLT40点，術後5年で41点 vs. 39点と同等になった．MCSは術前からLDLLT56点と高値であり，術後はLDLLT，CLT共に50点を超えて推移した．RCSは術前LDLLT27点と低値であり，術後3ヶ月においても低値が持続したが，術後5年ではCLT46点に対し，LDLLTは50点を超えた．線形混合モデルによる評価では，LDLLTとCLTの経過に有意な差は認められなかった．【結論】LDLLT患者はCLTと比較して，術前の呼吸器症状はより重度であったが，少なくとも術後のHRQoLは同等，もしくは一部でLDLLTが上回ると考えられた．

DOI： 10.11386/jst.57.supplement_s342_1

CiNii Research

Setting a quality indicator for actual surgery time relative to scheduled surgery time in the context of increasing robotic-assisted thoracic surgery cases 査読有り

Ozeki N., Ueno H., Saeki J., Kadomatsu Y., Kato T., Nakamura S., Fukumoto K., Fukui T., Chen-Yoshikawa T.F.

General Thoracic and Cardiovascular Surgery 2022年

担当区分：最終著者記述言語：英語出版者・発行元：General Thoracic and Cardiovascular Surgery

Objective: This study aimed to demonstrate to the involved departments the goal of increasing the number of robotic-assisted thoracic surgery (RATS) cases/surgeons and acceptable surgery times. Methods: This retrospective study included 1572 patients who underwent thoracic surgery from fiscal year (FY) 2018 to FY 2021. The factors evaluated included the number of surgery cases and actual and scheduled surgery times. Results: The total number of RATS and total surgery cases increased after the quality indicator (QI) setting (n = 363, 360, 417, and 432 in FY 2018, 2019, 2020, and 2021, respectively). In FY 2020, 93.3% of the QI target was achieved, while in FY 2021, 88% was achieved. The number of RATS lobectomy/segmentectomy increased as the FY progressed (n = 31, 47, 58, and 116 in FY 2018, 2019, 2020, and 2021, respectively). The mean surgical time by RATS starters decreased in FY 2020 and 2021 (171.4 min.; 74 cases; seven RATS starters) compared with those in FY 2018 and 2019 (198.0 min.; 57 cases; six RATS starters) (P = 0.002). Conclusions: The goal of increasing the number of surgery cases and RATS cases/surgeons within the given framework was achieved by setting the QI.

DOI： 10.1007/s11748-022-01903-6

Scopus

Multicentre, prospective, observational study investigating the most appropriate surgical option that can prevent the recurrence of primary spontaneous pneumothorax after surgery: The PATCH study, protocol 査読有り

Kadomatsu Y., Yoshioka H., Shigemitsu K., Nomata Y., Mori S., Hijiya K., Motoyama H., Ichikawa Y., Sueyoshi K., Okasaka T., Miyamoto E., Kobayashi M., Takahashi M., Fujinaga T., Takechi H., Yamagishi H., Takuwa T., Kobayashi J., Sakamoto J., Taniguchi T., Hanaoka N., Kubo Y., Chen-Yoshikawa T.F.

BMJ Open 11 巻 ( 12 ) 2021年12月

担当区分：最終著者記述言語：英語出版者・発行元：BMJ Open

Introduction Thoracoscopic surgery is performed for refractory or recurrent primary spontaneous pneumothorax (PSP). To reduce postoperative recurrence, additional treatment is occasionally adopted during surgery after bulla resection. However, the most effective method has not been fully elucidated. Furthermore, the preference for additional treatment varies among countries, and its efficacy in preventing recurrence must be evaluated based on settings tailored for the conditions of a specific country. The number of registries collecting detailed data about PSP surgery is limited. Therefore, to address this issue, a prospective multicentre observational study was performed. Methods and analysis This multicentre, prospective, observational study will enrol 450 participants aged between 16 and 40 years who initially underwent PSP surgery. Data about demographic characteristics, disease and family history, surgical details, and CT scan findings will be collected. Follow-up must be conducted until 3 years after surgery or in the event of recurrence, whichever came first. Patients without recurrence will undergo annual follow-up until 3 years after surgery. The primary outcome is the rate of recurrence within 2 years after surgery. A multivariate analysis will be performed to compare the efficacy of different surgical options. Then, adverse outcomes correlated with various treatments and the feasibility of treatment methods will be compared. Ethics and dissemination This study was approved by the local ethics committee of all participating centres. The findings will be available in 2025, and they can be used as a basis for clinical decision-making regarding appropriate options for the initial PSP surgery. Trial registration number NCT04758143.

DOI： 10.1136/bmjopen-2021-052045

Scopus

Updated long-term outcomes of salvage surgery after stereotactic body radiotherapy for early-stage non-small-cell lung cancer 査読有り

Yamanashi K., Hamaji M., Matsuo Y., Kishi N., Chen-Yoshikawa T.F., Mizowaki T., Date H.

Interactive Cardiovascular and Thoracic Surgery 31 巻 ( 6 ) 頁： 892 - 894 2021年12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：Interactive Cardiovascular and Thoracic Surgery

There is dearth of data regarding the long-term survival outcomes of salvage surgery after stereotactic body radiotherapy for early-stage non-small-cell lung cancer, as previous studies have included a short follow-up period. There is also scarce information on the management of re-relapse in previous studies. This study examined the long-term survival outcomes of patients who underwent salvage surgery for isolated local relapse (LR). We reviewed consecutive patients who underwent salvage surgery for isolated LR after stereotactic body radiotherapy for early-stage non-small-cell lung cancer between 1999 and 2015. All patients were followed up until death or at least 5 years from salvage surgery. Twelve patients were included for analysis. The median follow-up from isolated LR was 62.4 (range: 14.3-152.1) months. The 5-year overall survival rate was 58.3%, updated from 79.5% in our previous report. During the interim, new re-relapses did not occur, whereas there were 5 additional deaths. The median survival after re-relapse was 32.6 months. Our follow-up report confirmed that our patient selection for salvage surgery appeared to be appropriate and that long-term follow-up is required to assess the outcomes of patients undergoing salvage surgery. Long-term follow-up would provide detailed information on late re-relapses, treatment and outcomes of re-relapses and mortality from any causes.

DOI： 10.1093/icvts/ivaa194

Scopus

Diagnostic utility of metabolic parameters on FDG PET/CT for lymph node metastasis in patients with cN2 non-small cell lung cancer 査読有り

Nakanishi K., Nakamura S., Sugiyama T., Kadomatsu Y., Ueno H., Goto M., Ozeki N., Fukui T., Iwano S., Chen-Yoshikawa T.F.

BMC Cancer 21 巻 ( 1 ) 2021年12月

担当区分：最終著者記述言語：英語出版者・発行元：BMC Cancer

Background: The aim of this study was to assess the diagnostic utility of metabolic parameters on fluorine-18-fluoro-2-deoxy-D-glucose-positron emission tomography (FDG-PET)/computed tomography (CT) for predicting lymph node (LN) metastasis in patients with cN2 non-small cell lung cancer (NSCLC). Methods: We retrospectively reviewed patients who underwent surgery for cN2 NSCLC between 2007 and 2020. Those who had clinically diagnosed positive hilar and mediastinal LNs by routine CT and PET/CT imaging were investigated. To measure the metabolic parameters of LNs, the data according to maximum standardized uptake value (SUVmax), metabolic tumor volume (MTV), total lesion glycolysis (TLG), and LN-to-primary tumor ratio of SUVmax (LPR) were examined. The diagnosis of each retrieved LN was confirmed based on histopathological examination of surgical tissue specimens. Receiver operating characteristics (ROC) curves with area under the curve (AUC) calculations and multivariate analysis by logistic regression were performed. Results: Forty-five patients with 84 clinically diagnosed positive hilar or mediastinal LNs were enrolled in the present study. Of the 84 LNs, 63 LNs were pathologically proven as positive (75%). The SUVmax, MTV, TLG, and LPR of LN metastasis were significantly higher than those of benign nodes. In the ROC analysis, the AUC value of LPR [AUC, 0.776; 95% confidence interval (CI), 0.640–0.913] was higher than that of LN SUVmax (AUC, 0.753; 95% CI, 0.626–0.880) or LN TLG3.5 (AUC, 0.746; 95% CI, 0.607–0.885). Using the optimal LPR cutoff value of 0.47, the sensitivity, specificity, positive predictive value, negative predictive value, and accuracy were 84.1, 66.7, 88.3, 58.3, and 79.8%, respectively. Multivariate analysis by logistic regression showed that LPR was an independent predictor for LN metastasis (odds ratio, 6.45; 95% CI, 1.785–23.301; P = 0.004). In the subgroup analysis of adenocarcinoma patients (n = 18; 32 LNs), TLG3.5 was a better predictor (AUC, 0.816; 95% CI, 0.639–0.985) than LPR (AUC, 0.792; 95% CI, 0.599–0.986) or LN SUVmax (AUC, 0.792; 95% CI, 0.625–0.959). Conclusions: Our findings suggest that LPR on FDG-PET is a useful predictor for LN metastasis in patients with cN2 NSCLC. TLG can be a good predictor for LN metastasis in patients with adenocarcinoma.

DOI： 10.1186/s12885-021-08688-6

Scopus

Improved visualization of virtual-assisted lung mapping by indocyanine green 査読有り

Tokuno J., Chen-Yoshikawa T.F., Nakajima D., Aoyama A., Motoyama H., Sato M., Date H.

JTCVS Techniques 10 巻頁： 542 - 549 2021年12月

記述言語：英語出版者・発行元：JTCVS Techniques

Objectives: Virtual-assisted lung mapping (VAL-MAP) is a bronchoscopic marking method of dye application on the surface of the lungs before resecting nonpalpable nodules. However, in some cases, it can be difficult to identify the markings of VAL-MAP on computed tomography and intraoperative thoracoscopy. We developed and assessed the feasibility of indocyanine green VAL-MAP (ICG-VAL-MAP). Methods: A historical control trial was conducted to investigate the effectiveness of ICG-VAL-MAP for marking visualization compared with that of VAL-MAP. In ICG-VAL-MAP, instead of indigo carmine, ICG and computed tomography contrast agents were used for dye marking, and near-infrared fluorescence endoscopy was employed to visualize the ICG markings. The other processes in VAL-MAP were carried out. The marking visibility was assessed in 3 grades of easy, faint, or not identifiable. We compared the visibility of the markings on computed tomography images and during thoracoscopic operations between VAL-MAP (567 markings in 147 cases) and ICG-VAL-MAP (142 markings in 63 cases). Results: On the preoperative computed tomography images, ICG-VAL-MAP provided significantly better marking visualization than VAL-MAP (easy/faint/not identifiable = 142/0/0 vs 427/100/30; P <.0001). ICG-VAL-MAP provided significantly better intraoperative markings than VAL-MAP (easy/faint/not identifiable = 141/0/1, respectively, vs 475/50/42, respectively; P <.0001). Regarding complications, pneumothorax occurred in 8 (5.4%) cases of VAL-MAP and zero cases (0%) of ICG-VAL-MAP (P =.12); fever was observed in 7 (5.0%) cases of VAL-MAP and 2 (3.2%) cases of ICG-VAL-MAP (P =.72). Conclusions: ICG-VAL-MAP provided significantly better visibility of markings than VAL-MAP. It might be useful in the resection of nonpalpable small lung lesions.

DOI： 10.1016/j.xjtc.2021.07.019

Scopus

Patient-reported dyspnea and health predict waitlist mortality in patients waiting for lung transplantation in Japan 査読有り

Ikeda M., Oga T., Chen-Yoshikawa T.F., Tokuno J., Oto T., Okawa T., Okada Y., Akiba M., Tanaka S., Yamada Y., Yutaka Y., Ohsumi A., Nakajima D., Hamaji M., Isomi M., Chin K., Date H.

Respiratory Research 22 巻 ( 1 ) 2021年12月

記述言語：英語出版者・発行元：Respiratory Research

Background: Waitlist mortality due to donor shortage for lung transplantation is a serious problem worldwide. Currently, the selection of recipients in Japan is mainly based on the registration order. Hence, scientific evidence for risk stratification regarding waitlist mortality is urgently needed. We hypothesized that patient-reported dyspnea and health would predict mortality in patients waitlisted for lung transplantation. Methods: We analyzed factors related to waitlist mortality using data of 203 patients who were registered as candidates for lung transplantation from deceased donors. Dyspnea was evaluated using the modified Medical Research Council (mMRC) dyspnea scale, and the health status was determined with St. George’s Respiratory Questionnaire (SGRQ). Results: Among 197 patients who met the inclusion criteria, the main underlying disease was interstitial lung disease (99 patients). During the median follow-up period of 572 days, 72 patients died and 96 received lung transplantation (69 from deceased donors). Univariable competing risk analyses revealed that both mMRC dyspnea and SGRQ Total score were significantly associated with waitlist mortality (p = 0.003 and p < 0.001, respectively) as well as age, interstitial lung disease, arterial partial pressure of carbon dioxide, and forced vital capacity. Multivariable competing risk analyses revealed that the mMRC and SGRQ score were associated with waitlist mortality in addition to age and interstitial lung disease. Conclusions: Both mMRC dyspnea and SGRQ score were significantly associated with waitlist mortality, in addition to other clinical variables such as patients’ background, underlying disease, and pulmonary function. Patient-reported dyspnea and health may be measured through multi-dimensional analysis (including subjective perceptions) and for risk stratification regarding waitlist mortality.

DOI： 10.1186/s12931-021-01715-x

Scopus

Polyglycolic acid sheet covering to prevent recurrence after surgery for spontaneous pneumothorax: a meta-analysis 査読有り

Kadomatsu Y., Fukui T., Mori S., Chen-Yoshikawa T.F., Wakai K.

Scientific Reports 11 巻 ( 1 ) 2021年12月

記述言語：英語出版者・発行元：Scientific Reports

The coverage technique using absorbable mesh was first described in a European guideline published in 2015 as a preventive method for the recurrence of spontaneous pneumothorax. We performed a meta-analysis based on a literature search of primary studies that compared the postoperative recurrence rate of primary spontaneous pneumothorax between the use and nonuse of polyglycolic acid sheet coverage. Two reviewers independently selected and evaluated the quality of the relevant studies. The risk ratio in each study was calculated in a random-effect meta-analysis. Statistical heterogeneity among the included studies was quantitatively evaluated using the I2 index, and publication bias was assessed using a funnel plot. A total of 19 retrospective cohort studies were analyzed: 1524 patients who underwent wedge resection alone (the control group) and 1579 who received additional sheet coverage. Polyglycolic acid sheet coverage was associated with a lower recurrence rate than that in the control group (risk ratio: 0.27, 95% confidence interval 0.20–0.37, P < 0.001; I2 0%). The funnel plot suggested possible publication bias. The covering technique reduced the recurrence rate of pneumothorax after thoracoscopic surgery to one-fourth.

DOI： 10.1038/s41598-021-83103-5

Scopus

Commentary: Paving the way with visualization of the invisible craftsmanship 招待有り査読有り

Nakamura S., Chen-Yoshikawa T.F.

JTCVS Open 8 巻頁： 664 - 665 2021年12月

Kernel-based framework to estimate deformations of pneumothorax lung using relative position of anatomical landmarks 査読有り

Yamamoto U., Nakao M., Ohzeki M., Tokuno J., Chen-Yoshikawa T.F., Matsuda T.

Expert Systems with Applications 183 巻 2021年11月

記述言語：英語出版者・発行元：Expert Systems with Applications

In video-assisted thoracoscopic surgeries, successful procedures of nodule resection are highly dependent on the precise estimation of lung deformation between the inflated lung in the computed tomography (CT) images during preoperative planning and the deflated lung in the treatment views during surgery. Lungs in the pneumothorax state during surgery have a large volume change from normal lungs, making it difficult to build a mechanical model.The purpose of this study is to develop a deformation estimation method of 3D surface of a deflated lung from a few partial observations. To estimate deformations for a largely deformed lung, a kernel regression-based solution was introduced. The proposed method used a few landmarks to capture the partial deformation between the 3D surface mesh obtained from preoperative CT and the intraoperative anatomical positions. The deformation for each vertex of the entire mesh model was estimated per-vertex as a relative position from the landmarks. The landmarks were placed in the anatomical position of the lung's outer contour. The method was applied on nine datasets of the left lungs of live beagle dogs. Contrast-enhanced CT images of the lungs were acquired.The proposed method achieved a local positional error of vertices of 2.74 mm, Hausdorff distance of 6.11 mm, and Dice similarity coefficient of 0.94. Moreover, the proposed method achieved the estimation lung deformations from a small number of training cases and a small observation area.This study contributes to data-driven modeling of pneumothorax deformation of the lung.

DOI： 10.1016/j.eswa.2021.115288

Scopus

Removal of hematoma due to massive hemoptysis after transbronchial biopsy: a case report. 査読有り国際誌

Harushi Ueno, Hideki Tsubouchi, Keita Nakanishi, Tomoshi Sugiyama, Yuka Kadomatsu, Masaki Goto, Naoki Ozeki, Shota Nakamura, Takayuki Fukui, Toyofumi Fengshi Chen-Yoshikawa

Surgical case reports 7 巻 ( 1 ) 頁： 237 - 237 2021年11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）

BACKGROUND: Massive hemoptysis is a life-threatening complication after transbronchial biopsy (TBB). Reports on massive hemoptysis occurring several days after TBB are scarce. CASE PRESENTATION: A 62-year-old man presented with massive hemoptysis and was admitted to hospital as an emergency on the eighth day after TBB. On the 12th day after TBB, computed tomography showed complete atelectasis of the right middle and lower lobes. The patient underwent emergent right upper lobectomy. The right upper lobe bronchus was separated with a scalpel, the hematoma was pulled out with forceps, and the bronchus subsequently sutured shut. The patient was discharged from the hospital uneventfully. CONCLUSIONS: We experienced a case of massive hemoptysis on the eighth day after TBB, which required emergency surgery due to persistent bleeding into the airway and airway obstruction during follow-up. Postoperative pneumonia and atelectasis could be prevented by manual removal of the residual hematoma.

DOI： 10.1186/s40792-021-01323-3

PubMed

Morphological and functional reserves of the right middle lobe: Radiological analysis of changes after right lower lobectomy in healthy individuals 査読有り

Yamagishi H., Chen-Yoshikawa T.F., Oguma T., Hirai T., Date H.

Journal of Thoracic and Cardiovascular Surgery 162 巻 ( 5 ) 頁： 1417 - 1423.e2 2021年11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：Journal of Thoracic and Cardiovascular Surgery

Objectives: Remaining lung tissue after pulmonary resection can expand without decline in structural complexity and compensate for functional loss, showing morphological and functional reserves. However, the distribution of these reserves is unknown. This study examined the heterogeneity of morphological and functional reserves of the remaining lung tissue. Methods: We retrospectively analyzed 53 donors who underwent right lower lobectomy for living-donor lobar lung transplantation. We examined morphometric changes in computed tomography images from 3 to 12 months after lobectomy. We assessed lung volume and structural complexity expressed as the fractal dimension. We also assessed effective lung volume (the volume of the lung with intermediate density) and volumetric fluctuation during respiration. Changes were compared between the right upper lobe, middle lobe, and left lung. Results: The expansion of lung tissue was greater in the middle lobe (130.9% ± 19.7%) than in the upper lobe (109.7% ± 9.2%; P < .001). The fractal dimension declined in the upper lobe (P < .001) but was maintained in the middle lobe (P = .39). The increase in effective lung volume was larger in the middle lobe (97.2 ± 73.5 mL) than in the upper lobe (62.7 ± 87.1 mL; P < .001), but not significantly different from that of the left lung (55.8 ± 186.3 mL; P = .052). A similar pattern was seen in respiratory fluctuation. Conclusions: Morphological and functional changes in lung tissue remaining after pulmonary resection were heterogeneous. The right middle lobe demonstrated morphological and functional reserves after right lower lobectomy.

DOI： 10.1016/j.jtcvs.2020.08.017

Scopus

Impacts of single nucleotide polymorphisms in Fc gamma receptor IIA (rs1801274) on lung transplant outcomes among Japanese lung transplant recipients 査読有り

Kayawake H., Chen-Yoshikawa T.F., Tanaka S., Tanaka Y., Ohdan H., Yutaka Y., Yamada Y., Ohsumi A., Nakajima D., Hamaji M., Egawa H., Date H.

Transplant International 34 巻 ( 11 ) 頁： 2192 - 2204 2021年11月

記述言語：英語出版者・発行元：Transplant International

This study aimed to analyze the influences of single nucleotide polymorphisms (SNPs) in Fc gamma receptor IIA (FCGR2A) on postoperative outcomes after lung transplantation (LTx). We enrolled 191 lung transplant recipients [80 undergoing living-donor lobar lung transplants (LDLLTs) and 111 undergoing deceased-donor lung transplants (DDLTs)] in this study. We identified SNPs in FCGR2A (131 histidine [H] or arginine [R]; rs1801274) and reviewed the infectious complication-free survival after ICU discharge. The SNPs in FCGR2A comprised H/H (n = 53), H/R (n = 24), and R/R (n = 3) in LDLLT and H/H (n = 67), H/R (n = 42), and R/R (n = 2) in DDLT. Recipients with H/H (H/H group) and those with H/R or R/R (R group) were compared in the analyses of infectious complications. In multivariate analyses, the R group of SNPs in FCGR2A was associated with pneumonia-free survival {HR: 2.52 [95% confidence interval (CI): 1.35–4.71], P = 0.004}, fungal infection-free survival [HR: 2.50 (95% CI: 1.07–5.84), P = 0.035], and cytomegalovirus infection-free survival [HR: 2.24 (95% CI: 1.07–4.69), P = 0.032] in LDLLT, but it was not associated with infectious complication-free survival in DDLT. Therefore, in LDLLT, more attention to infectious complications might need to be paid for LTx recipients with H/R or R/R than for those with H/H.

DOI： 10.1111/tri.13974

Scopus

Left Upper Lobe Trisegmentectomy After Pulmonary Endarterectomy 査読有り

Tsubouchi H., Goto M., Terazawa S., Adachi S., Suzuki Y., Usui A., Kondo T., Chen-Yoshikawa T.F.

Annals of Thoracic Surgery 112 巻 ( 5 ) 頁： e361 - e363 2021年11月

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 Surgery

Major pulmonary resection has been successfully performed after pulmonary endarterectomy for chronic thromboembolic pulmonary hypertension in a few cases. A pulmonary nodule was detected in a 68-year-old man with a diagnosis of chronic thromboembolic pulmonary hypertension. After pulmonary hypertension was resolved with pulmonary endarterectomy, left upper lobe trisegmentectomy was performed for small lung cancer. Dissection of the pulmonary artery was carefully performed with a possibility of a fragile state on the arterial wall due to previous pulmonary endarterectomy. Pathologically, the arterial media with an uneven thickness was exposed to the vascular lumen in the resected pulmonary artery.

DOI： 10.1016/j.athoracsur.2021.02.022

Scopus

Virtual-assisted lung mapping in sublobar resection of small pulmonary nodules, long-term results. 査読有り国際誌

Hirokazu Yamaguchi, Masaaki Sato, Kazumichi Yamamoto, Keiko Ueda, Hiroshi Date, Toyofumi Chen-Yoshikawa, Yoshito Yamada, Junko Tokuno, Masahiro Yanagiya, Fumitsugu Kojima, Nobuyuki Yoshiyasu, Masashi Kobayashi, Yasuhiro Nakashima, Terumoto Koike, Jin Sakamoto, Shinji Kosaka, Ryuta Fukai, Tomoki Nishida, Hiroaki Sakai, Shinji Shinohara, Masaru Takenaka, Fumihiro Tanaka, Kenji Misawa, Jun Nakajima

European journal of cardio-thoracic surgery 61 巻 ( 4 ) 頁： 761 - 768 2021年10月

記述言語：英語掲載種別：研究論文（学術雑誌）

OBJECTIVES: The short-term efficacy of virtual-assisted lung mapping (VAL-MAP), a preoperative bronchoscopic multi-spot lung-marking technique, has been confirmed in 2 prospective multicentre studies. The objectives of this study were to analyse the local recurrence and survival of patients enrolled in these studies, long-term. METHODS: Of the 663 patients enrolled in the 2 studies, 559 patients' follow-up data were collected. After excluding those who did not undergo VAL-MAP, whose resection was not for curative intent, who underwent concurrent resection without VAL-MAP, or who eventually underwent lobectomy instead of sublobar resection (i.e. wedge resection or segmentectomy), 422 patients were further analysed. RESULTS: Among 264 patients with primary lung cancer, the 5-year local recurrence-free rate was 98.4%, and the 5-year overall survival (OS) rate was 94.5%. Limited to stage IA2 or less (≤2 cm in diameter; n = 238, 90.1%), the 5-year local recurrence-free and OS rates were 98.7% and 94.8%, respectively. Among 102 patients with metastatic lung tumours, the 5-year local recurrence-free rate was 93.8% and the 5-year OS rate was 81.8%. Limited to the most common (colorectal) cancer (n = 53), the 5-year local recurrence-free and OS rates were 94.9% and 82.3%, respectively. CONCLUSIONS: VAL-MAP, which is beneficial in localizing small barely palpable pulmonary lesions and determining the appropriate resection lines, was associated with reasonable long-term outcomes. SUBJ COLLECTION: 152, 1542.

DOI： 10.1093/ejcts/ezab421

PubMed

綜説小児肺移植の現状

芳川豊史

小児科 62 巻 ( 11 ) 頁： 1364 - 1373 2021年10月

Deformation analysis of surface and bronchial structures in intraoperative pneumothorax using deformable mesh registration 査読有り

Nakao M., Kobayashi K., Tokuno J., Chen-Yoshikawa T., Date H., Matsuda T.

Medical Image Analysis 73 巻 2021年10月

記述言語：英語出版者・発行元：Medical Image Analysis

The positions of nodules can change because of intraoperative lung deflation, and the modeling of pneumothorax-associated deformation remains a challenging issue for intraoperative tumor localization. In this study, we introduce spatial and geometric analysis methods for inflated/deflated lungs and discuss heterogeneity in pneumothorax-associated lung deformation. Contrast-enhanced CT images simulating intraoperative conditions were acquired from live Beagle dogs. The images contain the overall shape of the lungs, including all lobes and internal bronchial structures, and were analyzed to provide a statistical deformation model that could be used as prior knowledge to predict pneumothorax. To address the difficulties of mapping pneumothorax CT images with topological changes and CT intensity shifts, we designed deformable mesh registration techniques for mixed data structures including the lobe surfaces and the bronchial centerlines. Three global-to-local registration steps were performed under the constraint that the deformation was spatially continuous and smooth, while matching visible bronchial tree structures as much as possible. The developed framework achieved stable registration with a Hausdorff distance of less than 1 mm and a target registration error of less than 5 mm, and visualized deformation fields that demonstrate per-lobe contractions and rotations with high variability between subjects. The deformation analysis results show that the strain of lung parenchyma was 35% higher than that of bronchi, and that deformation in the deflated lung is heterogeneous.

DOI： 10.1016/j.media.2021.102181

Scopus

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