[Show abstract][Hide abstract] ABSTRACT: Intrapericardial vessel management is one of the necessary techniques for respiratory surgeons. We collected cases that had undergone intrapericardial vessel management for lung cancer, and herein discuss the practical performance and safety of this treatment method. We identified 23 (5.6%) of 413 patients who had undergone lung cancer surgery during the 30-month period from January 2011 to June 2013 at our institution. Twenty cases had large sized tumors near the hilum. Three cases demonstrated severe adhesion in the intrathoracic region due to a previous operation. The lung cancer staging was stage ⅠA in 1 case, stage ⅠB in 4 cases, stage ⅡB in 5 cases, stage ⅢA in 11 cases, stage ⅢB in 1 case, and stage Ⅳ in 1 case. We performed lobectomy in 11 cases, bilobectomy in 6 cases, and pneumonectomy in 6 cases. The average operation time was 366 minutes (137-965). Post operative complications were observed in five cases, including two cases of air-leakage and three cases of arrhythmia. All cases were able to walk on foot at discharge. It is important to clearly understand intrapericardial anatomy in order to carry out successful intrapericadial vessel management.
Journal of UOEH 09/2015; 37(3):191-4. DOI:10.7888/juoeh.37.191
[Show abstract][Hide abstract] ABSTRACT: We herein report a very rare case of adenoid cystic carcinoma of the peripheral lungs. A 77-year-old female visited a family physician for aortitis syndrome, diabetes mellitus and hyperlipidemia. A follow-up chest computed tomography scan for aortitis syndrome revealed a nodule in the middle lobe of the right lung. Although a transbronchial lung biopsy was attempted, a definitive diagnosis could not be made. Because the possibility of lung malignancy could not be ruled out, thoracoscopic wedge resection of the middle lobe was performed. The intraoperative pathological diagnosis revealed carcinoma of the lungs and we performed middle lobectomy under complete video-assisted thoracoscopic surgery. A histopathological examination demonstrated an adenoid cystic carcinoma with a characteristic cribriform structure.
Journal of UOEH 06/2015; 37(2):121-5. DOI:10.7888/juoeh.37.121
[Show abstract][Hide abstract] ABSTRACT: Lung cancer is responsible for most cancer-related deaths. There are two broad types of lung tumors, usually classified as small cell lung cancer (SCLC) and non-small cell lung cancer (NSCLC). Current clinicopathological staging systems provide the advantage of standardized criteria for assessing tumor stage, and a relationship between advancing tumor stage and poor prognosis has been established for NSCLC. However, these staging systems have not led to clear criteria for selection of therapy for individual patients with NSCLC. The concept of therapy based on anatomical location, as used in staging systems, is poorly associated with the cancer stem cell (CSC) characteristics of individual tumor tissues. CSCs may have self-renewal and multipotent differentiation abilities and be responsible for tumor initiation, progression, and metastasis; they are highly resistant to chemoradiotherapy. Therefore, research into CSCs will provide the basis for developing of novel diagnostic and therapeutic strategies. We review aldehyde dehydrogenase isoform 1 (ALDH1), CD133, CD44 and CD166 as CSC markers, as weel as the Wnt/β-catenin pathway, KRAS, and the embryonic stem cell (ESC) signature.
[Show abstract][Hide abstract] ABSTRACT: Non-small cell lung cancer (NSCLC) accounts for 80-90 % of cases of primary lung cancer. Although surgery is recommended as the primary treatment for early-stage NSCLC, the prognosis is unsatisfactory even when complete resection is achieved. Recent clinical trials have shown that postoperative adjuvant chemotherapy with cytotoxic agents, namely uracil-tegafur (UFT) for stage IA (>2 cm in diameter)-IB patients or cisplatin-based regimens for stage II-IIIA patients, improves the prognosis, and adjuvant chemotherapy is recommended as the "standard treatment of care." However, adjuvant chemotherapy provides only a modest 5-year survival benefit of 4 % and may sometimes be fatal. To improve the risk-benefit balance of adjuvant chemotherapy, targeting agents such as antibodies against vascular endothelial growth factor (VEGF) and tyrosine-kinase inhibitors of epidermal growth factor receptor (EGFR-TKIs) are being evaluated in ongoing adjuvant trials. Another promising approach may be the individualization of adjuvant chemotherapy based on biomarkers that may predict the prognosis or benefits associated with adjuvant chemotherapy. The current status and future perspectives of adjuvant chemotherapy for NSCLC are reviewed and discussed.
Surgery Today 04/2015; DOI:10.1007/s00595-015-1174-7 · 1.53 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: We herein present the pathological findings of a bulla covered using an absorbable polyglycolic acid sheet applied with fibrin glue. These findings indicated that the membrane of the bulla was reinforced. Covering the bulla with an absorbable polyglycolic acid sheet (Neoveil, Gunze Ltd, Kyoto, Japan) and applying fibrin glue was effective to prevent the recurrence of the pneumothorax. Moreover, this report is the first case report showing the pathological findings of a bulla which was covered with an absorbable polyglycolic acid sheet and fibrin glue.
General Thoracic and Cardiovascular Surgery 04/2015; DOI:10.1007/s11748-015-0545-8
[Show abstract][Hide abstract] ABSTRACT: The Japanese Association for Thoracic and Cardiovascular Surgery has conducted annual surveys of thoracic surgery throughout Japan.
The purpose of this study was to examine the 30-day mortality and hospital mortality after chest surgery per year to confirm the surgical outcomes of modern medical care in the area of respiratory surgery.
The mean of the 30-day mortality/hospital mortality over a period of 16 years for the patients with lung cancer, metastatic pulmonary tumors, mediastinal tumors, inflammatory pulmonary disease, empyema, and spontaneous pneumothorax was 0.60/1.20, 0.26/0.41, 0.26/0.45, 0.32/0.50, 1.77/4.15, and 0.07/0.10, respectively. Undergoing thoracic surgery is therefore relatively safe in Japan. The death rates associated with lung cancer and mediastinal tumors have gradually decreased owing to therapeutic improvements in recent years. However, this tendency was not true of empyema. The 30-day mortality/hospital mortality rates for empyema were particularly high.
These data suggest that the rates for empyema might have reached the limit for the current surgical techniques, and that there might be room for improvement by developing new techniques or management strategies. These data from the nationwide surveys can be useful for surgeons, because they can provide a better understanding of the present problems, as well as future prospects.
General Thoracic and Cardiovascular Surgery 02/2015; 63(5). DOI:10.1007/s11748-015-0524-0
[Show abstract][Hide abstract] ABSTRACT: EML4-ALK lung cancer accounts for approximately 3%–7% of non-small cell lung cancer cases. To investigate the molecular mechanism underlying tumor progression and targeted drug sensitivity/resistance in EML4-ALK lung cancer, clinically relevant animal models are indispensable. In this study, we found that the lung adenocarcinoma cell line A925L expresses an EML4-ALK gene fusion (variant 5a, E2:A20) and is sensitive to the ALK inhibitors crizotinib and alectinib. We further established highly tumorigenic A925LPE3 cells, which also have the EML4-ALK gene fusion (variant 5a) and are sensitive to ALK inhibitors. By using A925LPE3 cells with luciferase gene transfection, we established in vivo imaging models for pleural carcinomatosis, bone metastasis, and brain metastasis, all of which are significant clinical concerns of advanced EML4-ALK lung cancer. Interestingly, crizotinib caused tumors to shrink in the pleural carcinomatosis model, but not in bone and brain metastasis models, while alectinib showed remarkable efficacy in all three models, indicative of the clinical efficacy of these ALK inhibitors. Our in vivo imaging models of multiple organ sites may provide useful resources to analyze further the pathogenesis of EML4-ALK lung cancer and its response and resistance to ALK inhibitors in various organ microenvironments.This article is protected by copyright. All rights reserved.
Cancer Science 01/2015; 106(3). DOI:10.1111/cas.12600 · 3.52 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: A total of 437 primary lung cancer patients underwent curative surgery from 2006 to 2010. Twenty-two patients (5.0%) had collagen disease. Sixteen (72.7%) patients had rheumatism, 3 (13.7%) patients had systemic sclerosis, 2 (9.1%) had systemic lupus erythematosus, and 1 (4.5%) had adult Still's disease. Sixteen (72.7%) patients were pathological stage IA, 4 (18.2%) were stage IB, and 2 (9.1%) were IIIA. Eighteen (81.8%) patients had adenocarcinoma, 2 (9.1%) had squamous cell carcinoma, 1 (4.5%) had large cell neuro-endocrine carcinoma, and 1 (4.5%) had pleomorphic carcinoma. Sixteen (72.7%) patients underwent lobectomy, 2 (9.1%) patients received segmentectomy, and 4 (18.2%) patients underwent partial resection. Only postoperative pneumothorax occurred after surgery as a complication, and there was no significant difference between patients with and without collagen disease (P=0.539). The only significant difference was in preoperative interstitial pneumonitis (P=0.001). Therefore, we were able to perform surgery with the careful observation of patients with collagen disease.
The Journal of the Japanese Associtation for Chest Surgery 01/2015; 29(1):2-5. DOI:10.2995/jacsurg.29.2
[Show abstract][Hide abstract] ABSTRACT: We report a resected case of advanced right lung cancer invading the entrance of the right upper bronchus, with inflammatory stenosis of the middle bronchus in a 74-year-old man. We performed right upper and middle sleeve lobectomy. Computed tomography revealed a mass of 52×37 mm invading the ascending pulmonary artery. Transbronchial lung biopsy was performed, but a preoperative diagnosis was not obtained. A bronchofiber could not be passed through the middle bronchus because of the severe inflammatory stenosis. The preoperative diagnosis was lung cancer, and the clinical stage was T2bN0M0, IIA. We performed right upper and middle sleeve lobectomy and combined resection of the azygos arch. We anastomosed the right main bronchus and peripheral part of the intermedius, and then covered it with a pedicled pericardial fat pad. We resected the pulmonary ligament to reduce the tension of anastomosis. The pathological diagnosis was small cell lung cancer, and the final stage was T3N1M0, IIIA. Four courses of adjuvant chemotherapy (CDDP/CPT-11) were administered. No recurrence has occurred to date.
The Journal of the Japanese Associtation for Chest Surgery 01/2015; 29(4):491-494. DOI:10.2995/jacsurg.29.491
[Show abstract][Hide abstract] ABSTRACT: Video-assisted thoracic surgery (VATS) has become popular in the field of chest surgery. Recently, there has been a gradual reduction in the number of surgeons in Japan, which thus increases concerns regarding a potential shortage in the number of surgeons in the future. In this study, we evaluated the efficacy of using a surgical simulator with an endoscopic simulator to provide practical training for 245 medical students. Three different tests were performed with a one-week interval between each test, and the task completion time between the 1st and 2nd training sessions was then analyzed. A reduction in the time required to perform the tasks was observed. In addition, 95% of the subjects had a positive opinion regarding the application of the device for practical training, while 85% reported an increased interest in surgery. No significant relationships were observed between the task completion time and the degree of proficiency in performing the task or between the results of students choosing to become surgeons and those not choosing to become surgeons in the future according to a follow-up study. The students who later decided to become surgeons tended to express a positive opinion on the questionnaire compared with the non-departmental staff. As a result, providing student education using a training simulator for endoscopic surgery is therefore considered to have a beneficial effect in increasing the number of medical school students who later decide to become surgeons.
Kyobu geka. The Japanese journal of thoracic surgery 11/2014; 67(12):1047-50.
[Show abstract][Hide abstract] ABSTRACT: Erratum to: Gen Thorac Cardiovasc Surg (2014) 62:734-764 DOI 10.1007/s11748-014-0464-0The following errors appeared in the above-cited article.In 2012 Final report, (A) Cardiovascular surgery section, on the seventh line in the third paragraph, “14,944 cases in thoracic aortic aneurysm” should read “15,058 cases in thoracic aortic aneurysm”.Also in (A) Cardiovascular surgery section, the title for Table 3, “Thoracic aortic aneurysm (total; 14,944)” should read “Thoracic aortic aneurysm (total; 15,058)”. (1) “Dissection (total; 6,266”) should read (1) “Dissection (total; 6,380”). Additionally, some column totals were incorrect. The corrected table is given below.In (B) General thoracic surgery section, Table 22, on the eighth line of the table body, “Cardinal reconstruction” should read “Carinal reconstruction”.
General Thoracic and Cardiovascular Surgery 10/2014; 63(2). DOI:10.1007/s11748-014-0464-0