Faculty Profiles - UENO Harushi

Real-world evidence of safety and influence for lung cancer surgery under COVID-19 pandemic in Japan

Kato, T; Katsuya, R; Okado, S; Sato, K; Noritake, O; Nakanishi, K; Noguchi, M; Kadomatsu, Y; Ueno, H; Ozeki, N; Nakamura, S; Fukumoto, K; Chen-Yoshikawa, TF

JOURNAL OF THORACIC DISEASE Vol. 15 ( 2 ) page： 542 - + 2023.2

Language：English Publisher：Journal of Thoracic Disease

Background: The COVID-19 pandemic has affected the clinical practice of lung cancer surgery in Japan, but few studies have revealed the real situation of surgical practice for lung cancer in this country. This latest information will help us to decide the future direction of lung cancer surgery under pandemic circumstances. Methods: We collected data from patients with primary lung cancer who underwent thoracic surgery between 2018 and 2021. To investigate the impact of the COVID-19 pandemic on lung cancer surgery, we compared between 2018–2019 (prepandemic group) and 2020–2021 (pandemic group) in the respect of patient characteristics, pathological findings, and short-term outcome after lung cancer resection by Mann-Whitney and Fisher’s exact tests. Moreover, the monthly number of surgeries for lung cancer in our institution during 2020–2021 was compared with the number of newly diagnosed COVID-19 patients in Japan by Spearman correlation analysis. Results: From 2018 through 2021, 936 patients with primary lung cancer underwent surgical intervention in our institute and were included in this study. The number of surgeries did not decrease in the pandemic group (n=443) compared with that in the prepandemic group (n=493). Tumor and invasive size in stage I which was measured by pathologist were significantly larger in the pandemic group than in the prepandemic group (tumor size: P=0.031, invasive size: P<0.001). In terms of postoperative short-term outcome, the median hospital stay was 6 days, 30-day mortality was 2, and morbidity was around 20% in both groups. Only one patient suffered from COVID-19 infection 5 months after right upper lobectomy. An increased ratio of newly diagnosed COVID-19 cases in Japan was negatively correlated with the number of surgeries for lung cancer in our institution in the next month (r=−0.393, P=0.007), although there was no correlation in the present or the month after next. Conclusions: Even during the COVID-19 pandemic period, lung cancer surgery could be performed safely and in a sustainable manner. However, pathological findings of lung cancer tended to be progressive in early-stage lung cancer.

DOI： 10.21037/jtd-22-1289

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

Fukumoto K, Ohara Y, Okado S, Watanabe H, Noritake O, Nakanishi K, Kadomatsu Y, Ueno H, Kato T, Nakamura S, Chen-Yoshikawa TF

Mediastinum (Hong Kong, China) Vol. 7 page： 40 2023

Language：English Publisher：Mediastinum

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

Open Access

ASO Visual Abstract: Impact of Pleural Thickness on the Occurrence of Postoperative Complications in Patients with Malignant Pleural Mesothelioma

Ito Toshinari, Nakamura Shota, Kadomatsu Yuka, Ueno Harushi, Kato Taketo, Ozeki Naoki, Fukumoto Koichi, Chen-Yoshikawa Toyofumi Fengshi

ANNALS OF SURGICAL ONCOLOGY Vol. 30 ( 3 ) page： 1586 2022.11

Impact of Pleural Thickness on Occurrence of Postoperative Complications in Patients with Malignant Pleural Mesothelioma

Ito Toshinari, Nakamura Shota, Kadomatsu Yuka, Ueno Harushi, Kato Taketo, Ozeki Naoki, Fukumoto Koichi, Chen-Yoshikawa Toyofumi Fengshi

ANNALS OF SURGICAL ONCOLOGY Vol. 30 ( 3 ) page： 1574 - 1583 2022.11

Language：English Publisher：Annals of Surgical Oncology

Objectives: The rates of postoperative mortality and morbidity are high in patients with malignant pleural mesothelioma (MPM). Therefore, it is important to identify variables that increase the risk of postoperative complications. Pleural thickness has recently been identified as a prognostic indicator in patients with MPM. The aim of this study was to investigate clinical variables, including pleural thickness, that contribute to postoperative complications in patients with MPM. Patients and Methods: A total of 47 patients who underwent surgical excision of MPM between 2005 and 2021 were enrolled in this study. Correlations between postoperative complications within 90 days of surgery and preoperative clinical factors were investigated. Results: A total of 27 patients underwent extrapleural pneumonectomy (EPP), and the remaining 20 underwent pleurectomy/decortication (P/D). Macroscopic complete resections were obtained in all but three patients. Of the 47 patients, 23 (49%) experienced postoperative complications of grade 3 or worse. The major complication in patients with EPP was respiratory failure (n = 6), whereas the major complication in patients with P/D was prolonged air leakage (n = 7). Univariate logistic regression analysis found a correlation between postoperative complications and age, surgical side, and pleural thickness, while multivariate logistic regression analysis found surgical side (p = 0.04, 95% Cl 1.10–21.71, OR 4.90) and pleural thickness (p = 0.03, 95% Cl 1.21–23.00, OR 5.26) to significantly influence the occurrence of postoperative complications. Conclusions: Pleural thickness has a significant effect on the occurrence of postoperative complications. Patients with thick pleura on the right side are at greater risk of postoperative complications.

DOI： 10.1245/s10434-022-12790-9

Neoadjuvant Therapy for Patients With Non-small Cell Lung Cancer Complicated With Chest Wall Invasion

Sato, K; Nakamura, S; Kadomatsu, Y; Ueno, H; Kato, T; Ozeki, N; Fukumoto, K; Chen-Yoshikawa, TF

ANTICANCER RESEARCH Vol. 42 ( 11 ) page： 5539 - 5546 2022.11

Language：English Publisher：Anticancer Research

Background/Aim: Multidisciplinary treatment including anatomical pulmonary and chest wall resection is recommended for lung cancer complicated by chest wall invasion. The present study aimed to investigate the survival benefit and safety of preoperative therapy followed by surgery for non-small cell lung cancer with chest wall invasion. Patients and Methods: Sixty-five patients who underwent surgical excision of lung cancer complicated with chest wall invasion between 2009 and 2020 were enrolled in this study. Results: The median age was 65 (37-81) years old, with 59 males and 6 females. Histological types included squamous cell carcinoma (n=32) and adenocarcinoma (n=21). The median tumor diameter was 5.5 cm (2.3-12.5 cm). The clinical nodal status was N0 in 49 cases and N positive in 16 cases. Of the 65 eligible patients, 5- and 10-year overall survival (OS) rates were 58.4% and 46.0%, respectively, and 5- and 10-year progression-free survival (PFS) rates were 54.2% and 41.7%, respectively. For patients receiving preoperative therapy followed by surgery (Pre-Tx), 5- and 10-year OS survival rates were 69.2% and 62.9%, and among patients receiving up-front surgery (UFS) were 48.5% and 29.1%, respectively (p=0.03). The 5- and 10-year PFS rates for pre-Tx were 65.8% and 59.2%, respectively, and 44.7% and 26.8% for UFS, respectively (p=0.02). Cox regression analysis preoperative therapy was significantly associated with OS and PFS. Conclusion: We demonstrate the survival benefit of preoperative therapy followed by surgery for patients with lung cancer and chest wall invasion.

DOI： 10.21873/anticanres.16059

Prognostic Value of Uncertain Resection for Overall Survival in Non-small Cell Lung Cancer

Kadomatsu, Y; Nakamura, S; Ueno, H; Goto, M; Ozeki, N; Fukumoto, K; Fukui, T; Suzuki, Y; Chen-Yoshikawa, TF

ANNALS OF THORACIC SURGERY Vol. 114 ( 4 ) page： 1262 - 1268 2022.10

Language：English Publisher：Annals of Thoracic Surgery

Background: In this study we evaluated the R(un) category proposed by the International Association for the Study of Lung Cancer (IASLC) for non-small cell lung cancer (NSCLC). Methods: We retrospectively reviewed the medical records of patients with NSCLC who underwent segmentectomy or lobectomy between 2014 and 2015 at our institution. Residual tumor (R) status was reclassified from the Union for International Cancer Control designation to the IASLC-proposed R classification of R0 and R(un). The underlying reasons for the R(un) reclassification were analyzed according to pathologic stage, lymph node status, and resected lobe. A Cox proportional hazard model was used to evaluate the impacts of R(un) categorization on overall survival. Results: Of 355 patients, 44.5% were reclassified as R(un). The most common reason for the reclassification was insufficient number of harvested lymph nodes or no station 7 lymph nodes. When stratified by tumor location, the absence of station 7 lymph nodes was especially prominent in both the right and left upper lung resections. In the multivariate Cox regression model, the IASLC R classification was associated with poor overall survival in node-positive patients (hazard ratio, 2.657; P = .016). Conclusions: Various factors resulted in reclassification to R(un) because the R(un) group was highly heterogeneous. Careful consideration is required to determine whether the R(un) classification can be used as an indicator of lymph node dissection quality. For advanced cases, the R(un) definition may be useful in predicting poor prognosis.

DOI： 10.1016/j.athoracsur.2021.07.087

Computer-Aided Volumetry by Multidetector Computed Tomography is Efficient for Prognostic Prediction of Early-Stage Solid Lung Cancers

A novel system applying artificial intelligence in the identification of air leak sites Open Access

Kadomatsu, Y; Nakao, M; Ueno, H; Nakamura, S; Chen-Yoshikawa, TF

JTCVS TECHNIQUES Vol. 15 page： 181 - 191 2022.10

Language：English Publisher：JTCVS Techniques

Objective: Prolonged air leak is the most common complication of thoracic surgery. Intraoperative leak site detection is the first step in decreasing the risk of leak-related postoperative complications. Methods: We retrospectively reviewed the surgical videos of patients who underwent lung resection at our institution. In the training phase, deep learning-based air leak detection software was developed using leak-positive endoscopic images. In the testing phase, a different data set was used to evaluate our proposed application for each predicted box. Results: A total of 110 originally captured and labeled images obtained from 70 surgeries were preprocessed for the training data set. The testing data set contained 64 leak-positive and 45 leak-negative sites. The testing data set was obtained from 93 operations, including 58 patients in whom an air leak was present and 35 patients in whom an air leak was absent. In the testing phase, our software detected leak sites with a sensitivity and specificity of 81.3% and 68.9%, respectively. Conclusions: We have successfully developed a deep learning-based leak site detection application, which can be used in deflated lungs. Although the current version is still a prototype with a limited training data set, it is a novel concept of leak detection based entirely on visual information.

DOI： 10.1016/j.xjtc.2022.06.011

Kato, T; Iwano, S; Katsuya, R; Okado, S; Ito, T; Sato, K; Nakanishi, K; Kadomatsu, Y; Ueno, H; Ozeki, N; Nakamura, S; Fukumoto, K; Chen-Yoshikawa, TF

JOURNAL OF THORACIC ONCOLOGY Vol. 17 ( 9 ) page： S206 - S207 2022.9

Skeletal muscle and related protein expression as prognostic factors in thymic squamous cell carcinoma

Nakanishi, K; Ozeki, N; Tateyama, H; Kadomatsu, Y; Ueno, H; Goto, M; Nakamura, S; Fukumoto, K; Chen-Yoshikawa, TF

JOURNAL OF THORACIC DISEASE Vol. 14 ( 9 ) page： 3245 - 3254 2022.9

Language：English Publisher：Journal of Thoracic Disease

Background: Sarcopenia and its marker, the psoas muscle index (PMI), have attracted attention as prognostic factors for various types of cancers. The fragile X-related 1 (FXR1) gene is highly expressed in myocytes, and FXR1 overexpression is a candidate biomarker for poor survival in several types of cancers. Thymic squamous cell carcinoma (TSQCC) is rare, and no studies assessing its prognostic factors, particularly in terms of skeletal muscle mass and FXR1 expression, are available. Methods: We retrospectively investigated the prognostic significance of PMI in 34 patients who underwent TSQCC resection, considering the status of FXR1 and tumor programmed death-ligand 1 (PD-L1). PMI was calculated from the bilateral psoas muscle using preoperative computed tomography (CT). Patients were divided into two groups: low PMI (<58.2%, n=17) and normal PMI (≥58.2%, n=17). Immunohistochemical analysis was performed to determine the FXR1 and PD-L1 expression levels. Results: Low PMI was significantly associated with worse overall survival (OS) (5-year survival rate; 86% vs. 100%; P=0.026) and marginally associated with worse disease-free survival (DFS) (5-year survival rate; 39% vs. 66%; P=0.090) compared with normal PMI. The immunohistochemical analysis revealed that the FXR1 intensity score (0–1+: 6% vs. 0%; 2+–3+: 94% vs. 100%; P=0.31), median FXR1 distribution (95% vs. 90%; P=0.63), and PD-L1 status (high: 47% vs. 59%; P=0.49) were not significantly different between the two groups. Conclusions: Our findings suggest that PMI might be considered as a potential prognostic factor in TSQCC and that FXR1 is widely expressed regardless of the PMI status. Skeletal muscle mass may play a role in the prognosis of TSQCC.

DOI： 10.21037/jtd-22-385

Relationship of smoking cessation period with the incidence of complications in lung cancer surgery

Kadomatsu, Y; Sugiyama, T; Sato, K; Nakanishi, K; Ueno, H; Goto, M; Ozeki, N; Nakamura, S; Fukumoto, K; Chen-Yoshikawa, TF

EUROPEAN JOURNAL OF CARDIO-THORACIC SURGERY Vol. 62 ( 3 ) 2022.8

Language：English Publisher：European Journal of Cardio-thoracic Surgery

OBJECTIVES: The incidence of postoperative complications is relatively high in smokers. Although 4-week smoking cessation before surgery is generally recommended, it has not been sufficiently studied in lung cancer surgery. This study investigated whether smoking cessation for a short period of time significantly reduced complications after lung cancer surgery. METHODS: This was a retrospective, observational study that investigated the relationship between the smoking cessation period and the incidence of complications in lung cancer surgery. Patients who underwent curative-intent surgery for lung cancer at our institution between January 2014 and December 2017 were included. The smokers were classified into the following 4 categories of smoking cessation period before surgery: current (<4 weeks), recent (4 weeks to 12 months), distant (12 months to 5 years) and ex-smokers (>5 years). RESULTS: A total of 911 patients were included in this study. The incidence of pulmonary complications was 5 times higher in the smoker group than in the never smoker group (12.9% vs 2.5%, P < 0.001). On multivariable analysis in both models, the odds ratio for complications was significantly higher in distant smokers than in recent smokers and never smokers. Across all models, low lung function significantly predicted the development of postoperative complications. CONCLUSIONS: The evidence-based smoking cessation duration that reduces the incidence of complications after thoracic surgery remains unclear. The incidence of postoperative complications was more strongly affected by low pulmonary function than by the duration of preoperative smoking cessation. For patients with marginal indications for surgery, postponing surgery to accommodate a smoking cessation period seemed unnecessary.

DOI： 10.1093/ejcts/ezac163

Postoperative empyema complicated with descending necrotizing fasciitis: a case report

Kadomatsu, Y; Ueno, H; Goto, M; Ozeki, N; Nakamura, S; Chen-Yoshikawa, TF

SURGICAL CASE REPORTS Vol. 8 ( 1 ) page： 133 2022.7

ASO Visual Abstract: Pleural Invasion Depth of Disseminated Nodules in Patients with Stage IVa or Recurrent Thymoma: Assessment, Curative Impact, and Surgical Outcomes

Nakamura, S; Tateyama, H; Nakanishi, K; Sugiyama, T; Kadomatsu, Y; Ueno, H; Goto, M; Ozeki, N; Fukui, T; Yokoi, K; Chen-Yoshikawa, TF

ANNALS OF SURGICAL ONCOLOGY Vol. 29 ( 3 ) page： 1838 - 1838 2022.3

Pleural Invasion Depth of Disseminated Nodules in Patients with Stage IVa or Recurrent Thymoma: Assessment, Curative Impact, and Surgical Outcomes

Nakamura, S; Tateyama, H; Nakanishi, K; Sugiyama, T; Kadomatsu, Y; Ueno, H; Goto, M; Ozeki, N; Fukui, T; Yokoi, K; Chen-Yoshikawa, TF

ANNALS OF SURGICAL ONCOLOGY Vol. 29 ( 3 ) page： 1829 - 1837 2022.3

Language：English Publisher：Annals of Surgical Oncology

Background: Thymoma patients with pleural dissemination are difficult to manage, and their treatment strategy remains undefined. This study aimed to investigate the clinicopathologic features of these patients, focusing on the association between the depth of pleural invasion and prognosis. Methods: Between 2003 and 2019, the study identified 120 disseminated lesions in 20 thymoma patients. Seven patients had de novo stage IVa thymoma and 13 were recurrent cases. Extrapleural pneumonectomy was performed for 8 patients and debulking surgery for 12 patients. Invasion depth of pleural tumors was classified into two groups: when the disseminated tumors invaded the pleura beneath the elastic layer, the tumor was diagnosed as Da, and when the disseminated tumors invaded the pleura beyond the elastic layer, the tumor was diagnosed as Db. Results: Of 120 nodules, 31 (26%), found in eight patients with recurrent malignancies, were classified as Db. The pathologic status of the surgical margin (PSM) was positive in eight patients, seven of whom had Db nodules. The 5-year overall survival (OS) rate was 100% in the Da group and 75% in the Db group (P = 0.02). The 5-year progression-free survival (PFS) rate was 66.7% in the Da group and 25% in the Db group (P = 0.02). Cox univariate analysis showed that PFS was significantly influenced by the depth of invasion (P = 0.04) and PSM (P = 0.03). Conclusion: Depth of pleural invasion may influence survival outcomes for thymoma patients with pleural dissemination. The patients in this study with Da-disseminated nodules had an increased probability of a longer OS and PFS and tended to achieve negative PSM compared with the patients with Db.

DOI： 10.1245/s10434-021-10888-0

Removal of hematoma due to massive hemoptysis after transbronchial biopsy: a case report

Ueno, H; Tsubouchi, H; Nakanishi, K; Sugiyama, T; Kadomatsu, Y; Goto, M; Ozeki, N; Nakamura, S; Fukui, T; Chen-Yoshikawa, TF

SURGICAL CASE REPORTS Vol. 7 ( 1 ) page： 237 2021.11

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

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

BMC CANCER Vol. 21 ( 1 ) page： 983 2021.9

Language：English Publisher：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

Differential impacts of postoperative complications on patients' survival in completely resected non-small-cell lung cancer

Kadomatsu, Y; Tsubouchi, H; Nakanishi, K; Sugiyama, T; Ueno, H; Goto, M; Ozeki, N; Nakamura, S; Fukui, T; Chen-Yoshikawa, TF

GENERAL THORACIC AND CARDIOVASCULAR SURGERY Vol. 69 ( 9 ) page： 1283 - 1290 2021.9

Language：English Publisher：General Thoracic and Cardiovascular Surgery

Objective: The aim of this study was to investigate the effects of inflammatory respiratory complications on long-term survival in patients with resected non-small cell lung cancer. We defined inflammatory respiratory complications to include the following six conditions: pneumonia, empyema, bronchial fistula, respiratory dysfunction, acute interstitial pneumonia, and atelectasis. Methods: Part of the National Clinical Database was linked to our prospective database from 2014 to 2017. Linkage was achieved for 866 patients. The Kaplan–Meier method was used to evaluate the overall, relapse-free, and cancer-related survival. The Cox proportional hazard model was used to analyze the impact of each complication. Results: Of the 736 patients included in the study, 149 had complications. The 5-year overall and cancer-specific survival rates were significantly lower in patients with inflammatory respiratory complications. The Cox proportional hazard model showed that the inflammatory respiratory complications had a significant impact on overall survival (hazard ratio 2.48, 95% confidence interval 1.41–4.38) but not air leak (hazard ratio 1.38, 95% confidence interval 0.70–2.70). Conclusions: Our study shows the differential impact of each complication on the survival of patients with non-small cell lung cancer. The presence of inflammatory respiratory complications was the only predictor of poor overall survival.

DOI： 10.1007/s11748-021-01619-z

Learning curve of robotic lobectomy for lung malignancies by certified thoracic surgeons

Robotic open-thoracotomy-view approach using vertical port placement and confronting monitor setting.

Sakakura N, Nakada T, Shirai S, Takahara H, Nakanishi K, Matsui T, Ueno H, Takahashi Y, Kuroda H

Interactive cardiovascular and thoracic surgery Vol. 33 ( 1 ) page： 60 - 67 2021.6

Fukui, T; Kawaguchi, K; Tsubouchi, H; Ueno, H; Sugiyama, T; Mori, S; Goto, M; Ozeki, N; Hakiri, S; Nakamura, S; Chen-Yoshikawa, TF

NAGOYA JOURNAL OF MEDICAL SCIENCE Vol. 83 ( 2 ) page： 227 - 237 2021.5

Language：English Publisher：Nagoya Journal of Medical Science

Video-assisted thoracic surgery (VATS) has become widespread in the last 20 years, followed by robot-assisted thoracic surgery (RATS). Few studies compared the learning curve between RATS lobectomy and conventional VATS. This study included 79 RATS lobectomy cases performed in our hospital from November 2015 to October 2019. To estimate the required number for learning, the cumulative sum method, which is to plot a value obtained by sequentially accumulating a difference from a mean value was applied. As a result, the median total operative time and the median console time for all cases were 167 minutes and 138 minutes, respectively. Firstly, for our team, 28 cases were estimated to be required for learning curve for RATS lobectomy. For individual, each surgeon might be learned in only 5 to 6 cases. By contrast, the number of cases for learning VATS lobectomy which was underwent by a ‘single' surgeon from 2009 was estimated to be 35 cases. The time to dock from start operation (median 14 minutes) reached plateau in 18 cases, but the time after rollout was median of 18 minutes and there was no significant change from the beginning. In conclusion, RATS lobectomy might be a technique that could be learned in a small number of cases compared to VATS. The results of this study might be helpful for certified surgeons who tried to get started with RATS and for establishing a learning program.

DOI： 10.18999/nagjms.83.2.227