記述言語：英語   出版者・発行元：Annals of Thoracic and Cardiovascular Surgery 編集委員会  

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

Open Access

Web of Science

Scopus

PubMed

CiNii Research

Web of Science

Web of Science

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

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

DOI： 10.21037/jtd-23-892

Open Access

Web of Science

Scopus

PubMed

記述言語：英語   出版者・発行元：Quantitative Imaging in Medicine and Surgery  

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 threedimensional solid tumor volume, which is correlated with PIV, accurately predicted the postoperative outcome.

DOI： 10.21037/qims-23-36

Open Access

Web of Science

Scopus

PubMed

記述言語：日本語  

PubMed

記述言語：英語   出版者・発行元：Asian Journal of Endoscopic Surgery  

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

Web of Science

Scopus

PubMed

記述言語：英語   出版者・発行元：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

Open Access

Web of Science

Scopus

PubMed

Web of Science

記述言語：英語   出版者・発行元：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

Open Access

Web of Science

Scopus

PubMed

記述言語：英語   出版者・発行元：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

Open Access

Web of Science

Scopus

PubMed

記述言語：英語   出版者・発行元：Journal of Thoracic and Cardiovascular Surgery  

DOI： 10.1016/j.jtcvs.2021.01.030

Web of Science

Scopus

PubMed

DOI： 10.1245/s10434-021-10969-0

Web of Science

PubMed

記述言語：英語   出版者・発行元：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

Web of Science

Scopus

PubMed

記述言語：英語  

DOI： 10.1186/s40792-021-01323-3

Web of Science

PubMed

記述言語：英語   出版者・発行元：Annals of Thoracic Surgery  

Background: Invasive mucinous adenocarcinoma (IMA) is a rare subtype of invasive lung adenocarcinoma. However, the clinical course and prognostic outcomes following IMA resection, particularly postoperative recurrence, remain unclear. Methods: We pathologically reevaluated 1362 lung adenocarcinoma resections performed at our institution, categorizing cases into the IMA group (72 cases) and non-IMA group (1290 cases). The IMA group was further classified into pneumonia and nodular types based on preoperative computed tomography. Results: Overall, the IMA group had lower carcinoembryonic antigen levels (3 vs 8 ng/mL; P < .01), fewer lymph node metastasis (4% vs 24%; P < .01), and more KRAS mutations (56% vs 7%; P < .01) than the non-IMA group. Although postoperative recurrence rates did not differ between both groups (32% vs 27%; P = 0.35), lung recurrence occurred more frequently in the IMA group (83% vs 17%; P < .01). Propensity score-matched pair analysis showed that the IMA group had fewer lymph node metastasis (3% vs 35%; P < .01), more KRAS mutations (56% vs 9%; P < .01), and higher intrapulmonary recurrence rate (84% vs 31%; P < .01) than the non-IMA group. The 5-year overall survival rates did not differ between both groups (74% vs 81%; P = 0.26). However, among patients with intrapulmonary recurrence, those in the IMA group had significantly worse prognosis than those in the non-IMA group (35% vs 77%; P < .01). Conclusions: Intrapulmonary recurrence, which induced significantly worse prognosis, was more likely to occur in the IMA than non-IMA group.

DOI： 10.1016/j.athoracsur.2020.09.042

Web of Science

Scopus

PubMed

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

Open Access

Web of Science

Scopus

PubMed

記述言語：英語   出版者・発行元：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

Web of Science

Scopus

PubMed

記述言語：英語   出版者・発行元：Interactive Cardiovascular and Thoracic Surgery  

OBJECTIVES: Robotic lung resections (RLRs) are conventionally performed using look-up views of the thorax from the caudal side. To conduct RLR with views similar to those in open thoracotomy, we adopted a vertical port placement and confronting upside-down monitor setting, which we called robotic 'open-thoracotomy-view approach'. We herein present our experience of this procedure. METHODS: We retrospectively reviewed 58 patients who underwent RLR (43 with lobectomy; 15 with segmentectomy) with 3-arm open-thoracotomy-view approach using the da Vinci Surgical System between February 2019 and October 2020. The patient cart was rolled in from the left cranial side of the patient regardless of the side to be operated on. Robotic ports were vertically placed along the axillary line, and 2 confronting monitors and 2 assistants were positioned on each side of the patient. The right-side monitor, which was set up for the left-side assistant to view, projected the upside-down image of the console surgeon's view. RESULTS: All procedures were safely performed. The median duration of surgery and console operation was 215 and 164 min, respectively. Emergency conversion into thoracotomy and severe morbidities did not occur, and the median postoperative hospitalization duration was 3 days. In all procedures, the console surgeon and 2 assistants had direct 'bird-eye' views of the cranially located intrathoracic structures and instrument tips, which are sometimes undetectable with the conventional look-up view. CONCLUSIONS: The open-thoracotomy-view approach setting is a possible option for RLR. It offers natural thoracotomy views and can circumvent some of the known limitations of the conventional procedure.

DOI： 10.1093/icvts/ivab033

Web of Science

Scopus

PubMed

出版者・発行元：General Thoracic and Cardiovascular Surgery  

Objectives: Despite the ubiquitous utilization of anatomical sublobar resection for malignant lung tumors, the effectiveness and feasibility of subsegmentectomy remains unclear. This study therefore compared the perioperative outcomes between anatomical sublobar resection including (IS) and excluding (ES) subsegmentectomy. Methods: Patients who had undergone anatomical sublobar resection at our institution from January 2013 to March 2019 were retrospectively reviewed. Clinicopathologic characteristics and perioperative outcomes of the IS group (n = 58) were then analyzed the compared to those of the ES group (n = 203). Results: No statistically significant differences in age, sex, comorbidities, tumor location, preoperative pulmonary function, or tumor size on imaging were found between both groups. The IS group had significantly higher preoperative computed tomography-guided marking rates (40% vs. 18%; p < 0.01) and used significantly more staplers for intersegmental dissection than the ES group [4, interquartile range (IQR): 3–4 vs. 3, IQR: 3–4; p = 0.03]. Both groups had comparable 30-day mortality (0% vs. 0%; p > 0.99), intraoperative complications (7% vs. 10%; p = 0.61), and postoperative complications (5% vs. 8%; p = 0.58). After propensity score matching, the IS group experienced significantly lesser blood loss than the ES group (5 mL, IQR: 1–10 vs. 5 mL, IQR: 5–20; p = 0.03). Both groups experienced no local recurrence and demonstrated similar postoperative pulmonary functions after surgery. Conclusions: IS may be a feasible and acceptable therapeutic option for malignant lung tumors. Nonetheless, future investigations are required to further validate the current findings.

DOI： 10.1007/s11748-020-01556-3

Scopus

記述言語：英語  

DOI： 10.1186/s40792-021-01148-0

Web of Science

PubMed

記述言語：英語   出版者・発行元：General Thoracic and Cardiovascular Surgery  

Objective: According to the tumor-node-metastasis classification for thymic malignancies, the proportion of patients diagnosed with stage I is expected to increase significantly. However, whether those patients have homogenous clinicopathological features and survival has not been fully evaluated. Methods: We reviewed 153 consecutive patients with stage I thymic epithelial tumors (133 thymomas, 15 thymic carcinomas, and 5 neuroendocrine tumors) who underwent complete resection at our institution between 2001 and 2016 and evaluated the prognostic significance of their clinicopathological factors. Results: The stage I patients accounted for 78% of all thymic epithelial tumors. The 5-year overall survival and recurrence-free survival rates of the 153 patients were 94% and 80%, respectively. The patients with the histology of thymic carcinoma or neuroendocrine tumor and with a tumor larger than 5.0 cm showed significantly worse recurrence-free survival in multivariate analysis (p = 0.027 and 0.038, respectively). Only the tumor size was revealed as a significant prognostic factor for recurrence-free survival when limited in the 133 cases of thymoma (p = 0.048). Conclusions: Patients with large tumors showed significantly worse recurrence-free survival than those with small tumors both in stage I thymic epithelial tumors and thymomas.

DOI： 10.1007/s11748-020-01427-x

Web of Science

Scopus

PubMed

出版者・発行元：Mediastinum  

This report presents an unusual case of life-threatening massive bleeding in the pulmonary trunk adjacent to the right ventricular outflow tract during resection of a large primary mediastinal nonseminomatous germ cell tumor (PMNSGCT) in the absence of cardiovascular surgeons. The patient was a 21-year-old male whose large mediastinal tumor was diagnosed as an extragonadal PMNSGCT, which was a mixture of a yolk sac tumor and an immature teratoma. Generally, chemotherapy causes extensive peripheral tumor necrosis of PMNSGCTs, thus enabling their complete resection. In this case, surgeons considered the resection as possible by dissecting the peripheral necrotic tissue, and cardiovascular surgeons were thus not consulted. Enlarged modified left hemi-clamshell thoracotomy (HCST) was applied. While dissecting around the pulmonary trunk, the assistant-held forceps accidentally touched the tensed pulmonary trunk, which caused bleeding. We immediately contacted the collaborating cardiac surgery department at another hospital for assistance. Meanwhile, massive bleeding occurred, leading to hemorrhagic shock, and thus direct cardiac massage was required. Our team managed to establish a venoarterial (VA) extracorporeal membrane oxygenation (ECMO). After the arrival of cardiac surgeons, a suction circuit was added, and bleeding was stopped using sutures. Finally, complete resection of the tumor was achieved, and the patient awoke the following day without any brain dysfunction. After discussions with all the members involved in the surgery, we developed an in-hospital consensus on how to perform surgeries for large thoracic tumors safely at our cancer center without the cardiovascular surgery department. We herein present the case and consensus and discuss the relevant issues.

DOI： 10.21037/med-20-66

Scopus

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  

<p>【背景】脳死ドナー臓器摘出では、外科医だけでなく臨床工学技士（ME）・看護師・コーディネーター等多職種が関わる医療で、実際の手技を知っていればよりよい連携が可能かもしれない。献体されたご遺体の固定方法は進化しており、特殊な保存液で固定された状態は生体と類似しているため、手術トレーニングに用いることが可能となった。肺移植実施施設でない当院での実施施設へのとり組みの一貫として、心臓外科医・ME・医学生と合同で臓器摘出トレーニングを実行したので報告する。</p><p>【トレーニング概要】開胸・心嚢切開し臓器評価方法を全員で確認した後、心灌流液注入用と肺灌流液ドレナージ用のカテーテルを各留置し、大血管を遮断し心臓摘出、続いて肺摘出を行った。続いてバックテーブルにて肺の植え込みができる状態にまで処理を行いトレーニング終了とした。心肺摘出に際して重要となる左房の処理については、操作を止め指導医にポイントを解説してもらいつつ、心臓外科・呼吸器外科の双方の考えを伝え、解剖を確認しながら行った。また、MEと肺灌流液ドレナージ経路の方法や肺灌流のタイミングなど細やかな部分まで共有できた。</p><p>【結語】本トレーニングは多職種での手技と順序の確認に有用で、臓器摘出の際互いに心がけているポイントや考えも共有・理解できた。今後はプログラムを定型化し、実践に対応できるレベルに質を高めつつ、看護師やコーディネーターも含めて行う予定である。</p>

DOI： 10.11386/jst.56.supplement_s105

CiNii Research

出版者・発行元：Video-Assisted Thoracic Surgery  

Background: Little is known about the relative superiority of existing lobectomy approaches. We retrospectively summarized the clinical outcomes of four-port (i.e., multiple-port) thoracoscopic surgery (TS) lobectomy with lymph node dissection (LND) in patients with stage cN0 non-small cell lung cancer (NSCLC). Methods: This retrospective study included 245 patients (119 men and 126 women; median age, 65 years) with stage cN0 NSCLC according to both computed tomography (CT) and positron emission tomography (PET) scans. Two patients (0.8%) who underwent thoracotomy conversion were excluded. Regarding prognostic implications, disease-free survival (DFS) and overall survival (OS) outcomes were analyzed according to the mediastinal size (MD) category using the Kaplan-Meier method. Results: Overall, 10 cases (4.1%) of mediastinal nodal upstaging (cN0pN2) and 9 (3.7%) cases of hilar or peribronchial nodal upstaging (cN0pN1) were observed. The 5-year DFS and OS rates after TS lobectomy with LND were 90.5% and 97.9%, respectively. In a subgroup analysis by MD, a significant difference in DFS was only observed between the groups with a MD ≤5 mm and 1 mm (P=0.04). No significant differences in OS were observed between the subgroups. Conclusions: The clinical outcomes after TS lobectomy via the four-port, upside-down monitor approach appears to contribute to a favorable prognosis. However, MD was not identified as an independent prognostic factor for survival in patients with stage cN0 NSCLC.

DOI： 10.21037/vats.2020.04.01

Open Access

Web of Science

Scopus

記述言語：英語   出版者・発行元：Anticancer Research  

Background/Aim: Pulmonary pleomorphic carcinoma (PPC) is rare, and few studies have reported its features. We assessed the clinicopathological features, surgical outcomes, oncogenic status and programmed death-ligand 1 (PD-L1) expression of PPC. Patients and Methods: We retrospectively reviewed data from 22 consecutive patients who underwent resection of PPC between 2007 and 2017. Results: The predominant tissue type of the epithelial component was adenocarcinoma in 15 patients (68%) and the others in 7 patients (32%), and the 3-year disease-free survival rate tended to be better in patients with an adenocarcinoma component compared to patients with another component (40.0% vs. 17.1%, p=0.059). PD-L1 expression was observed in all eight tumors whose PD-L1 status could be examined and high PDL1 expression (≥50%) was frequent (5/8, 63%). Conclusion: A predominant adenocarcinoma epithelial component in PPC might be associated with better survival outcomes and high PD-L1 expression might be frequent in PPC.

DOI： 10.21873/anticanres.13782

Web of Science

Scopus

PubMed

DOI： 10.1016/j.jtho.2019.08.1344

Web of Science

記述言語：英語   出版者・発行元：World Journal of Surgery  

Background: Calcified lymph nodes (LNs) on computed tomography (CT) in patients with lung cancer are generally considered to be a benign feature. However, few studies have evaluated the pathological status of such calcified LNs. We investigated the clinicopathological findings of patients with calcified LNs on preoperative CT who underwent operation for lung cancer and assessed the frequency of metastasis to calcified LNs as well as the risk factors associated with such metastases. Methods: This was a retrospective study of 72 consecutive patients with calcified LNs detected on preoperative CT who underwent pulmonary resection for primary lung cancer between 2011 and 2013. A total of 354 LN stations including 101 LN stations with calcified LNs were evaluated. Results: The frequency of metastasis to calcified LNs was 19.4% (14 of 72 patients) on a per-person basis and 18.8% (19 of 101 stations) on a per-nodal station basis. When the size of calcification was major (>5 mm), the frequency of metastasis to such calcified LNs was significantly lower than when it was minor (≦5 mm) on a per-nodal station basis (11.1% vs 27.7%, P = 0.043). Furthermore, when the size of calcification was major and the status of LN stations with calcified LNs was single, there was no metastasis to such LN stations (0 of 26 stations). Conclusions: The frequency of metastasis to calcified LNs was about 20% on both a per-person and a per-nodal station basis. Although calcified LNs as well as non-calcified LNs should be dissected during operation, dissection of a single LN station with calcification, particularly major calcification, can be omitted.

DOI： 10.1007/s00268-019-04937-9

Scopus

PubMed

記述言語：英語   出版者・発行元：Thoracic Cancer  

A 90-year-old woman was admitted to our hospital with suspected lung adenocarcinoma. Preoperative three-dimensional reconstructed computed tomography revealed displacement of the anterior segmental bronchus (B3) arising from the right middle lobe bronchus with absence of the fissure between the right upper and middle lobes. A complete thoracoscopic right upper lobectomy was successfully performed. It is crucial to identify such anomalies prior to lung resection to avoid intraoperative complications during thoracoscopic lobectomy or segmentectomy. Additionally, intravenous indocyanine green with a fluorescence system was useful to identify the proper interlobar fissure boundary intraoperatively. To the best of our knowledge, this is the first reported case of thoracoscopic lobectomy for lung cancer with displaced B3 and absence of the interlobar fissure to be performed by applying the intravenous indocyanine green method.

DOI： 10.1111/1759-7714.13104

Open Access

Web of Science

Scopus

PubMed

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

Background: We previously reported the clinical application of powered vascular staple (PVS) for closure of subsegmental or segmental bronchus (SSB). This study aimed to measure breakdown pressure in experiment and to investigate bronchopleural fistula (BPF) after thoracoscopic segmentectomy (TS). Methods: Part 1: a total of 30 cadaveric pigs were used, and bronchi were categorized into the following four groups: small [S, bronchial outer diameter (BOD) of 4–8 mm, n=8], medium (M, 9–10 mm, n=9), and large (L, >10 mm, n=13). We additionally added a single additional suture to compensate for weak sites with large BOD (group R, n=6). The pressure was slowly increased, and stump breakdown was observed. Part 2: we investigated the morbidity of BPF formation at follow-up of at least 6 months in a total of 217 patients. Results: Part 1: the mean leak pressure was the highest in M, followed by groups S, R and L’. However, the significant difference was not found between S and R. Part 2: no BPF was observed, clinically. Conclusions: Based on experimental results and clinical experience, the proper selection of PVS should contribute to the safety, feasibility, and success as SSB closure.

DOI： 10.21037/jtd.2019.06.18

Open Access

Web of Science

Scopus

PubMed

記述言語：英語   出版者・発行元：General Thoracic and Cardiovascular Surgery  

Objective: There is no consensus concerning whether the residual stomach should be preserved after esophagectomy for thoracic esophageal cancer patients with previous distal or segmental gastrectomy. The purpose of this retrospective study was to assess the efficacy of preserving the residual stomach after esophagectomy in patients with previous gastrectomy. Methods: Between 2000 and 2015, 45 consecutive thoracic esophageal cancer patients with previous distal or segmental gastrectomy underwent esophagectomy followed by colon reconstruction. Patients were assigned to two groups according to how the residual stomach was treated (preservation group, n = 11; resection group, n = 34). We compared surgical outcomes and alterations of nutrition status, including the skeletal muscle area, between the two groups. In addition, we investigated the distribution of abdominal lymph node metastases in the resection group. Results: Operative time and blood loss tended to be lower in the preservation group compared to the resection group. However, the difference did not reach statistical significance. The rate of patients decreasing skeletal muscle area after surgery was significantly higher in the resection group (88% vs 50%, P = 0.03). There were no patients with metastatic abdominal lymph nodes when the previous gastrectomy had been performed for gastric cancer and the esophageal cancer was located at the upper or middle esophagus in the resection group. Conclusions: Preservation of the residual stomach after esophagectomy in esophageal cancer patients with previous gastrectomy may influence the postoperative nutrition status and can be selectively approved.

DOI： 10.1007/s11748-019-01070-1

Scopus

PubMed

記述言語：英語   出版者・発行元：Mediastinum  

DOI： 10.21037/med.2019.04.04

Open Access

Scopus

PubMed

記述言語：英語   出版者・発行元：Japanese Journal of Clinical Oncology  

There are few reports on the use of salvage surgery for small cell lung cancer (SCLC). Five patients who underwent resection of post-chemoradiotherapy residual lesion/local reprogression of SCLC between 2005 and 2017 were included in the study. We retrospectively reviewed their surgical outcomes and prognosis to assess the feasibility and potential efficacy of salvage surgery. Indications for salvage surgery were local reprogression (four patients) and residual lesion (one patient) with ycN0 disease. Complete pathological resection was achieved in four patients; however, malignant pleural effusion was diagnosed in one patient after the surgery. Morbidity and mortality rates were 0%. Estimated 5-year survival rate was 67%. Recurrence and death after surgery occurred only in the patient with malignant pleural effusion. We demonstrate the feasibility of salvage surgery in SCLC. In carefully-selected patients, especially those without lymph node involvement, salvage surgery may provide effective local control and favorable survival outcomes.

DOI： 10.1093/jjco/hyz010

Web of Science

Scopus

PubMed

記述言語：英語   出版者・発行元：Cancer Management and Research  

Background: Enhanced recovery after surgery (ERAS) protocols are well known for reducing post-operative complications, facilitating early recovery and reducing hospitalization. In this study, we developed ERAS protocols involving immediate ice cream intake for checking postoperative chylothorax and subsequent early ambulation in order to investigate whether these methods have postoperative benefits. Methods: We retrospectively evaluated 500 patients who underwent thoracoscopic segmentectomy and/or lobectomy (TSL) between January 2014 and September 2017. The patients were divided into two groups: 271 patients for Phase I and 229 for Phase II. Ice cream intake commenced during Phase I. Phase I patients were made to walk on the following day, whereas Phase II ambulate within 4 hrs after immediate ice-cream intake. Results: The mean ice cream intake was significantly higher in Phase II than in Phase I (81.6% vs 56.1%). In Phase II, 91.2% and 94.0% were able to ambulate within 4 and 6 hrs, respectively. Minor postoperative complications (Clavien-Dindo I-II classification) were lower in Phase II (3.1%) than in Phase I (10.4%); however, we found no statistical significance (p=0.08). Multivariate analysis showed that ice cream intake and removal of chest drainage tube within 4-6 hrs significantly contributed to the reduction of hospitalization to ≥3 postoperative days (p=0.03 and p<0.01). Conclusions: The results of this study suggested that our ERAS protocol represented by immediate ice cream intake, and early ambulation is feasible and can help in reducing postoperative complications, chest drainage duration, and hospitalization after TSL.

DOI： 10.2147/CMAR.S195219

Open Access

Web of Science

Scopus

PubMed

記述言語：英語   出版者・発行元：Esophagus  

Background: This study aimed to compare the extent of lateral thermal spread of surrounding tissues after the use of advanced bipolar and ultrasonic coagulation and shearing devices. Association between recurrent laryngeal nerve paralysis (RLNP) and such devices was assessed in patients who underwent minimally invasive esophagectomy (MIE). Methods: LigaSure™ (LS) and Sonicision™ (SONIC) were used. In ex vivo experiments using the porcine muscle, blade temperature and tissue temperature were measured using a thermometer after the activation of both devices. For the clinical assessment, 46 consecutive patients who received MIE were retrospectively assessed. Results: The temperature generated at the blade of both devices increased with the activation time. The blade temperature of LS was significantly lower than that of SONIC (P < 0.001). The blade temperature of SONIC exceeded 100 °C after 3-s activation. The temperature of surrounding tissues after a single activation of the devices decreased with the tissue distance from activation blade. The temperatures of tissues at 1 and 2 mm away from the blade side of LS were significantly lower than those of SONIC (P = 0.001 and P < 0.001, respectively). The temperature of tissue 2 mm away from the blade side of LS increased 6.4 °C from the baseline temperature. Furthermore, the incidence of RLNP in the LS group was lower than that in the SONIC group (P = 0.044). Conclusion: This study highlights the necessity of spatial and temporal recognition of the thermal spread of coagulation and shearing devices to reduce the thermal injuries following MIE.

DOI： 10.1007/s10388-018-0621-0

Scopus

PubMed

DOI： 10.1016/j.jtho.2018.08.1011

Web of Science