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ABSTRACT: PURPOSE: Chemoradiation therapy (CRT) is recommended as standard care for stage III non-small cell lung cancer (NSCLC), but some patients experience local recurrence after the treatment. Surgical resection after CRT involves high surgical risk, but is expected to increase the curability. This study was performed to investigate the impact of presurgical CRT on the postoperative outcome, focusing especially on the effect of radiation therapy. METHODS: Twenty-six patients with stage III (N2 or T3-4) NSCLC underwent pulmonary resection after CRT. A radiation dose up to 40-70 Gy was given with concurrent chemotherapy. The morbidity, mortality and survival after surgical resection were examined. RESULTS: Lung resection was performed as lobectomy (73 %) or pneumonectomy (19 %). Postoperative complications occurred in 12 patients (morbidity 46.1 %). The overall 5-year survival of the entire cohort was 69.7 %. The factors associated with favorable long-term survival included a pathological complete response (CR) and mediastinal node negative condition after CRT, and microscopic complete resection. CONCLUSION: Surgical resection for stage III patients after CRT may provide a survival benefit with acceptable morbidity. The surgical morbidity may be increased by prior radiation therapy, thus, surgeons should be familiar with the available countermeasures to reduce the surgical risk.
Surgery Today 02/2013; · 1.22 Impact Factor
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Shin-Ichi Yamashita,
Keita Tokuishi,
Toshihiko Moroga,
Sosei Abe,
Kozo Yamamoto,
So Miyahara,
Yasuhiro Yoshida,
Jun Yanagisawa,
Daisuke Hamatake, Masafumi Hiratsuka,
Yasuteru Yoshinaga,
Satoshi Yamamoto,
Takeshi Shiraishi,
Katsunobu Kawahara,
Akinori Iwasakai
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ABSTRACT: BACKGROUND: Although accumulating data support the feasibility and efficacy of video-assisted thoracic surgery anatomic resection, few studies have reported on intraoperative complications, such as vessel injury. The purpose of this study was to evaluate intraoperative vessel injury and to analyze troubleshooting. METHODS: Twenty-six of 557 patients with non-small cell lung cancer who underwent thoracoscopic anatomic lung resection were identified as having intraoperative vessel injury between January 2004 and December 2011. The injured portion, devices used, recovery approach, and hemostatic procedure were analyzed. The perioperative outcomes in patients with and without vessel injury were compared. RESULTS: The most commonly used devices were ultrasonic coagulation shears in 9 cases, followed by scissors in 5 and an endostapler in 4. Seventeen of the 26 cases were injured at the branches of the pulmonary artery, and the others were at major vessels. Half of the patients were converted to thoracotomy, and 6 were treated by minithoracotomy. Hemostatic procedures were primary closure in 17 and sealant in 7. The perioperative outcomes, including operative time and blood loss, were significantly different between the two groups, but duration of chest tube drainage, length of hospital stay, and morbidity rate were not. No mortality was identified in the patients with vessel injury. CONCLUSIONS: Video-assisted thoracic surgery anatomic resection was feasible and safe, regardless of the intraoperative vessel injury. Although surgeons should pay attention to avoid unexpected bleeding, the magnitude of injury and effectual step-by-step management should lead to a safe operation.
The Annals of thoracic surgery 01/2013; · 3.74 Impact Factor
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Kyobu geka. The Japanese journal of thoracic surgery 07/2012; 65(7):570-3.
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ABSTRACT: Recently, the greater utilization of computed tomography (CT) has led to an increasing proportion of small-sized stage I A lung cancer in less than 1 cm in diameter. However, a treatment strategy for these small-sized lung cancers has not yet been defined. The aim of this study was to investigate surgical outcomes regarding these lung cancers. A total of 123 patients who underwent complete surgical resection for lung cancer in less than 1 cm between January 1995 and March 2010 were retrospectively evaluated. The 123 study subjects consisted of 54 male and 69 female patients. The mean age was 64.0 (43~82) years. The mean tumor size was 0.9( 0.3~1.0) cm. In this study, 70 patients underwent lobectomy (56.9%). Segmentectomy and wedge resection were underwent 23( 18.7%) and 30 patients( 24.4%), respectively. The 3-, 5- and 10-year survival rates were 95.7, 92.3 and 85.7%, respectively, after the operation for lung cancer in less than 1 cm. There were no significant difference between sublobar resection and lobectomy. However, 2 patients( 1.6%) had recurrent cancer and 7 patients (5.7%) had lymph node metastasis. We suggested surgical procedure for patients with lung cancers in less than 1 cm should be selected with the greatest care, because recurrent cancer and lymph node metastasis can occur in patients.
Kyobu geka. The Japanese journal of thoracic surgery 01/2012; 65(1):25-8.
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ABSTRACT: Bronchial complications owing to airway anastomosis still remain a cause of morbidity and mortality following lung transplantation, and bronchial stenosis is the most common manifestation. Current treatment strategies include endoscopic balloon dilation, laser ablation, and stent insertion. Although a variety of stent types are currently available, it is unclear as to which type of prosthesis is most suitable for post-transplant bronchial complications with regard to the primary effects and long-term outcomes. We herein discuss a case of stenosis of the right bronchial anastomosis in a patient who underwent right single lung transplantation for idiopathic pulmonary fibrosis. This complication was successfully treated with the placement of a modified Dumon Y-stent. The stent was removed 2 months after insertion, and the patient has subsequently maintained an adequate airway caliber. Computed tomography, especially the sagittal section through the chest, is useful for detecting bronchial stenosis and monitoring the healing of this condition.
Surgery Today 09/2011; 41(9):1302-5. · 1.22 Impact Factor
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ABSTRACT: Tracheal surgery is an established treatment for various diseases; however, it is still a potentially challenging procedure. We herein discuss the safety of this procedure with regard to the coordination with airway interventional and anesthetic support.
A tracheal resection was performed on 18 patients. The dyspnea due to pre-existing severe airway stenosis, which was considered to be a risk factor for the safe induction of general anesthesia, was present in 12 (66.7%) cases.
Seven of the 12 patients with pre-existing airway obstruction required interventional airway treatment before surgery. One case with a polyp-like tracheal tumor required venoarterial percutaneous cardiopulmonary support to establish adequate oxygenation before surgery. All 18 cases underwent a segmental resection of the trachea, with the average length of 3.6 rings. Postoperative recovery was uneventful for all but one patient with postintubation tracheal stenosis, who died 17 days after surgery due to a methicillin-resistant Staphylococcus aureus infection. Complications in the other patients included four cases of laryngeal nerve palsy, three of aspiration, and one patient with Horner syndrome, with a total morbidity of 27.7%.
A tracheal resection is currently a safe procedure; however, cooperation with sophisticated airway interventional treatment teams, cardiopulmonary bypass support, or a well-trained anesthesiologist is essential for obtaining a successful outcome, especially for the cases with pre-existing severe airway obstruction.
Surgery Today 04/2011; 41(4):490-5. · 1.22 Impact Factor
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ABSTRACT: We report a long-term outcome of extremely oversized lung allograft. A left lower lobe transplantation from an adult donor was performed on a four-year-old recipient after left pneumonectomy. Lobar lung allograft volume was calculated to be approximately 180% of the recipient's predicted left thoracic capacity. Accordingly, the lung allograft was compressed to 47% of its original size immediately after transplantation. Initial postoperative functional recovery of the allograft was excellent despite this severe compression. As the patient grew physically, both his forced expiratory volume in 1 s (FEV(1)) and his left lung volume increased slowly but steadily during an observation period of two years and four months after transplantation.
Interactive cardiovascular and thoracic surgery 03/2011; 13(1):114-6.
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Takeshi Shiraishi, Masafumi Hiratsuka,
Mitsuteru Munakata,
Takao Higuchi,
Satoshi Makihata,
Yasuteru Yoshinaga,
Satoshi Yamamoto,
Akinori Iwasaki,
Masanobu Yasumoto,
Takamitsu Hamada,
Kazuo Higa,
Takashige Kuraki,
Kentaro Watanabe,
Noritsugu Morishige,
Tadashi Tashiro,
Kazuki Nabeshima,
Katsunobu Kawahara,
Kan Okabayashi,
Hiroshi Yasunaga,
Takayuki Shirakusa
The Journal of thoracic and cardiovascular surgery 11/2007; 134(4):1092-3. · 3.41 Impact Factor
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ABSTRACT: The outcomes of a video-assisted thoracoscopic surgery lobectomy for lung cancer, with a special focus on its locoregional control, were compared with a conventional lobectomy.
We performed a retrospective review of 160 patients who had undergone a lobectomy either by means of thoracoscopic surgery (n = 81) or a standard thoracotomy (n = 79) for clinical T1N0M0 nonsmall-cell lung cancer. The overall, disease-free, and locoregional recurrence-free survival were compared. In a separate multivariate analysis, the ability of numerous clinical and surgical factors, including the surgical approach, to predict locoregional recurrence was investigated.
The total recurrence of the primary disease occurred in 28 cases (12 locoregional and 14 distant). In the 12 documented local recurrences, 8 belonged to the thoracoscopic surgery group and 4 were in the standard thoracotomy group, without significant differences (p = 0.229). The overall 5-year survival rates associated with the thoracoscopic and standard procedure were 89.1% and 77.7%, respectively (p = 0.149). No significant differences in the disease-free or locoregional recurrence-free survivals were observed between the groups. The results of a multivariate analysis for the incidence of total and locoregional recurrence demonstrated that two covariates, lymph node metastasis and the surgical side (right or left lung), were significant factors for both total and locoregional recurrence. No significant relationship was found between thoracoscopic surgery or standard thoracotomy, and the incidence of locoregional recurrence.
Our findings suggest that thoracoscopic surgery is not inferior regarding its ability to achieve locoregional control in comparison with the standard procedure.
The Annals of thoracic surgery 10/2006; 82(3):1021-6. · 3.74 Impact Factor
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ABSTRACT: Airway stenting for severe central airway stenosis is inherently a dangerous procedure. There is the risk of critical airway obstruction due to bleeding, tumor debris, and airway perforation during the procedure. Once such situations occur, percutaneous cardiopulmonary support (PCPS) can be one of the most valuable rescue options to prevent critical hypoxic complications. At our institute, four of 49 patients who received stenting or other airway intervention required PCPS support (8%). Two of these cases required PCPS to be performed in an emergency setting during the procedure while the procedure was elective in the other 2. All procedures were performed effectively and safely without any complications caused by PCPS, including massive airway bleeding due to anticoagulant treatment. Patients were able to be weaned off PCPS uneventfully. PCPS is considered to be a valuable procedure in remedying critical hypoxic situations during airway intervention.
The Japanese Journal of Thoracic and Cardiovascular Surgery 01/2005; 52(12):592-6.
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Journal of Thoracic and Cardiovascular Surgery 07/2004; 127(6):1845-7. · 3.41 Impact Factor
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ABSTRACT: Because elderly breast cancer patients differ in various biological characteristics from younger patients, it is important to clarify the clinical characteristics and treatment results of elderly patients with this disease. A total of 332 breast cancer cases (327 patients) who received surgery were divided into three groups, consisting of a premenopause group younger than 50 years of age (group A, N = 144), a postmenopause group younger than 70 years of age (group B, N = 140), and elderly cases 70 years of age or older (group C, N = 48). A positive node involvement was seen in about 40% of all cases, but the lymph node positivity of group C was significantly lower than that of group A or B. The postoperative 5-year survival rates of groups A, B, and C were 88.9%, 87.5%, and 89.4% at all stages, and 90.2%, 86.2%, and 91.4% at stages I and II, respectively. Only in group C did survival rates show no significant difference between node status. We conclude that both radical and cosmetic surgical treatments performed in elderly breast cancer patients aged 70 years or older are as effective as in younger breast cancer patients.
International surgery 88(3):169-74. · 0.36 Impact Factor
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ABSTRACT: The role of video-assisted thoracic surgery (VATS) thymectomy is still being studied, and many surgeons remain skeptical of the value of this recent option. We made a retrospective evaluation to ascertain whether VATS-extended thymectomy is as reliable as standard median sternotomy in the treatment of myasthenia gravis (MG) and whether the endoscopic procedure presents any advantages for patients. Eighteen consecutive patients requiring extended thymectomy for MG were treated between April 1997 and September 2003 at our hospital. Nine patients received VATS-extended thymectomy, and the remaining nine patients received standard extended thymectomy by sternotomy. In the VATS group, the anterior mediastinal space was well visualized by sternal lifting. The mean operative time was 268.3 +/- 51.1 minutes in the VATS group and 177.3 +/- 92.5 minutes in the sternotomy group. Operative time was significant longer in the VATS group than in the sternotomy group (P < 0.05). The mean operative bleeding was 68.6 +/- 47.8 ml in the VATS group and 154.1 +/- 109.0 ml in the sternotomy group. Operative bleeding was significantly less in the VATS group than in the sternotomy group (P < 0.05). There was no significant difference between the two groups with regard to postoperative duration of chest tube or the level of serum C-reactive protein on the first operative day. There was a downward trend in nicotinic acetylcholine receptors antibody levels after thymectomy compared with before thymectomy in both groups. VATS thymectomy should be considered a valid alternative to the established approaches aimed at achieving a "curative thymectomy" in patients with MG.
International surgery 91(1):44-51. · 0.36 Impact Factor
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ABSTRACT: Thoracoscopic operations for benign mediastinal tumors have been useful. However, it is difficult to remove cystic mediastinal tumors completely because of their cystic structure. We herein describe a useful technique of tumor cannulation that allows for the simple and safe removal of these tumors.
The Annals of Thoracic Surgery.
