[Show abstract][Hide abstract] ABSTRACT: Background:
To avoid a pneumonectomy and preserve the lung parenchyma, a bronchovascular double-sleeve plasty including an extended sleeve lobectomy is a good choice for locally advanced lung cancer.
We describe a case with lung adenocarcinoma enrolled in our new protocol for ex situ auto-lung transplantation following an en bloc pneumonectomy and back table procedure for central lung cancer. Following completion of the pneumonectomy, the excised lung was irrigated with a cold extracellular phosphate-buffered solution to protect the lung graft from ischemia-reperfusion injury during preparation of the graft of a right basal segment as a back-table procedure.
Although auto-lung transplantation is a complicated procedure, an en bloc pneumonectomy following a back table procedure makes preparation of the graft easy, while simultaneous mediastinal lymph node dissection by another surgeon shortens operation time.
Preview · Article · Dec 2016 · Journal of Cardiothoracic Surgery
[Show abstract][Hide abstract] ABSTRACT: A 71-year-old woman was referred to our department for a nodular lesion in the left lung. She had been followed by urology department in our hospital for 6 years since right nephrectomy for ureter cancer. Chest X-ray and computed tomography(CT)scan demonstrated a small nodular shadow in the left lower lobe. The lung tumor was removed by wedge resection, and pathologically diagnosed during the operation as a metastasis from the ureter cancer. The lung tumor consisted of clear cells similar to the ureter cancer. However, the final pathological diagnosis changed to a primary lung cancer based on the findings of stratified differentiation and cancer cell nests in the tumor. Immunohistochemical staining for ureter epithelium-related antigens confirmed the diagnosis. Although we recommended left lower completion lobectomy, the patient refused additional surgery. She is suspected to have local recurrence in the left lower lobe 18 months after the surgery.
No preview · Article · May 2015 · Kyobu geka. The Japanese journal of thoracic surgery
[Show abstract][Hide abstract] ABSTRACT: Carinal resection and reconstruction for lung cancer, termed carinaplasty, is a rare operation, and the procedure remains challenging and few reports have been presented. We analyzed complications, local control, and manner of recurrence in patients who underwent a carinaplasty and compared the results to those who underwent an ordinary bronchoplasty. Among 766 patients who underwent surgery for primary lung cancer at our institutions, 82 bronchoplasty procedures were performed, while 6 of those who received a bronchoplasty underwent a carinaplasty. Three of 6 patients who received a carinaplasty underwent the montage method, and other 3 patients underwent the one-stoma method. There were no operative deaths in patients who underwent a carinaplasty, while there was 1 operative death in the group of patients who underwent an ordinary bronchoplasty. Complications in the anastomotic site were observed in 33% in the carinaplasty group and 5.3% in the ordinary bronchoplasty group . There was no significant difference in regard to local recurrence between the groups . In conclusion, our results show that a carinaplasty is a technically demanding but useful procedure to avoid a pneumonectomy in patients with locally advanced lung cancer.1. IntroductionCarinal resection and reconstruction for lung cancer, termed carinaplasty, is a rare operation in the field of thoracic surgery. In Japan, only about 10 carinaplasty procedures are performed each year, while over 30,000 surgeries have been done annually for lung cancer in the past decade [1, 2]. The first carinaplasty procedure was reported by Barclay et al.  in 1957 for a lung tumor using an end-to-side anastomosis technique, the so-called montage method. Thereafter in 1966, Mathey et al.  reported the double-barrel technique. Presently, carinaplasty procedures are performed using 3 different techniques, the montage, double-barrel, and one-stoma methods. However, the procedure remains challenging and few reports have been presented. In this study, we analyzed complications, local control, and manner of recurrence in patients who underwent a carinaplasty and compared the results to those who underwent an ordinary bronchoplasty.2. Subjects and Methods
Patients with primary lung cancer who underwent a carinaplasty or ordinary bronchoplasty at our institutions from June 2002 to December 2012 were retrospectively investigated. Each one provided the consent to undergo the respective procedure. An affiliated ethics committee approved this retrospective study and waived the need for patient consent for analysis of the results.All patients who met the indications provided by cardiopulmonary function tests underwent surgery. In this series, patient selection for a carinaplasty was dependent on the balance between the extent of cancer and technical difficulty. Patients considered able to tolerate a sleeve pneumonectomy were also considered to be candidates for a carinaplasty.An end-to-end anastomosis was performed in both the carinaplasty and ordinary bronchoplasty cases with a telescope technique using interrupted sutures with full-thickness bites and 3-0 or 4-0 monofilament absorbable materials. In addition, an appropriately sized ostium for the anastomosis was created on the right sidewall of the trachea or left main bronchus by a scalpel. When necessary, an angioplasty was performed using continuous sutures with 4-0 or 5-0 monofilament materials. We used an interposition of vascularized soft tissue to separate and protect the suture line between the bronchoplasty and angioplasty in some cases. One week after the operation, a bronchoscopic examination was conducted to observe the status of the anastomosis. When ischemic change at the site was observed, 120 μg of prostaglandin E1 was intravenously infused daily for 2 weeks to induce angiogenesis in the ischemic tissue .Complications, local control, and recurrence were retrospectively analyzed. Statistical analysis was performed using a chi-square test for comparison of variables and differences were considered significant at .3. ResultsAmong 766 patients who underwent surgery for primary lung cancer at our institutions, 82 bronchoplasty procedures were performed, while 6 of those who received a bronchoplasty underwent a carinal resection and reconstruction (Table 1). Two of 3 patients who underwent the montage method had the right upper bronchus anastomosed to the trachea, while the other underwent an anastomosis of the right basal bronchus to the left main bronchus (Figure 1). All 3 of those patients underwent a pulmonary arterioplasty, and 2 needed a pulmonary venoplasty and/or left atrial resection. Three patients who underwent the one-stoma method received a right upper sleeve lobectomy and carina resection, with the bronchus intermedius anastomosed to the carina. One of those patients who underwent an angioplasty and all 3 received a U-shaped incision in the pericardium to release the inferior pulmonary vein for distension of the anastomosis.
[Show abstract][Hide abstract] ABSTRACT: (18)F-fluorodeoxyglucose positron emission tomography (FDG-PET) plays an important role in many oncological settings. In this study, we assessed the utility of (18)F-FDG-PET for predicting the histological classification, stage and survival of thymic epithelial tumors.
We retrospectively analyzed 37 patients with thymic epithelial tumors who underwent PET before surgical resection and investigated the relationship between the maximum of standardized uptake value (SUVmax) of each tumor and the WHO classification, recurrence-free survival, and tumor-related gene expressions.
The study included 15 males and 22 females, ranging in age from 22 to 81 years (mean 64 years). The tumor histology of 31 tumors was thymoma and that of the remaining tumors was thymic carcinoma. The Masaoka tumor stage was as follows: stage I in 18, II in 9, III in 5 and IV in 5 patients. The patients were divided into three groups according to a simplified histologic classification: low-risk thymoma (types A, AB and B1, n = 21), high-risk thymoma (types B2 and B3, n = 10) and thymic carcinoma (n = 6). The SUVmax of low-risk group (SUVmax ≤4.27) was significantly lower than that of high-risk group (p = 0.0114) and that of thymic carcinomas (SUVmax >4.27) was also significantly higher than that of thymomas (p < 0.0001). The group of high SUVmax (SUVmax >4.27) had significantly inferior recurrence-free survival to that of less value (SUVmax ≤4.27) (p = 0.0009). The SUVmax were not correlated with tumor-related gene expressions.
The SUVmax of (18)F-FDG-PET reflects WHO classification of thymic epithelial tumors. High SUVmax predicts lower recurrence-free survival of the tumors.
No preview · Article · Jan 2014 · Annals of Nuclear Medicine
[Show abstract][Hide abstract] ABSTRACT: A 68-year-old woman was referred to our hospital due to a left chest abnormal shadow on chest film. She had a history of occupational exposure to organic solvent for about 30 years until 10 years ago. Computed tomography (CT) scan demonstrated a nodular shadow 12 mm in diameter in the left lower lobe. As a lung cancer was suspected, partial resection of the lobe including the small lesion was performed. Since mucosa-associated lymphoid tissue(MALT) lymphoma was diagnosed by intraoperative pathological examination, we finished the operation without any more lung resection. The diagnosis was finally confirmed by histological finding of small lymphoid cell proliferation and positive staining for CD20. Chronic inflammation, such as Helicobacter pylori infection, is considered to be a cause of MALT lymphoma. We speculate that the long term exposure to organic solvent may develop the disease by continuous chemical stimulation to bronchus.
No preview · Article · Sep 2013 · Kyobu geka. The Japanese journal of thoracic surgery
[Show abstract][Hide abstract] ABSTRACT: Objective: Intraoperative diagnosis of lymph node (LN) metastasis is critical in lung cancer patients. The one-step nucleic acid amplification (OSNA) assay is a novel technique using a loop-mediated isothermal amplification method of gene amplification. The objective of this study was to investigate whether the OSNA assay provides sufficient diagnosis of LN metastasis in lung cancer patients.Methods: A total of 40 LN stations were dissected from the 20 patients, who had curative lobectomy for lung cancer. The cut halves of LNs were used for pathological diagnosis, and other halves were for the OSNA assay. The OSNA assay used cytokeratin (CK) 19 mRNA as a marker. The CK19 mRNA copy number was detected using RD-100i (Sysmex Corp., Hyogo, Japan). One formalin-fixed section with the largest cutting surface of the other halves of LNs was used for pathological examination. When discordance was observed between OSNA assay and usual pathological examination, an additional examination using 1-mm interval sections was performed.Results: In the forty LN stations, three stations were diagnosed as LN metastasis positive pathologically. In these three, the OSNA assays showed extremely high numbers of CK19 mRNA copies. When the cutoff value was set to 250 copies/μl, 4 stations with relatively low copy numbers were found to be discordant. Of the 4 discordant cases, one was shown to be micro-metastasis positive in the additional pathological assessment. The sensitivity of the OSNA assay was 100.0%, and its specificity was 91.7%.Conclusions: This method could be applied to intraoperative assessment LNs metastasis.
[Show abstract][Hide abstract] ABSTRACT: Because pulmonary metastasis is considered to be systemic spread of hepatocellular carcinoma( HCC),indication of pulmonary resection as a treatment for it is not well-described. We retrospectively reviewed clinical records of the patients who underwent pulmonary resection for metastases from HCC in our hospital. Seven patients, 6 men, 1 woman, and the mean-age 65.4 year-old, underwent pulmonary resection from April in 2001 to March in 2010. During the same period, we carried out pulmonary resection for 122 patients with metastases from other malignant diseases. Therefore, pulmonary resection for HCC metastases accounted for 5.4% of the total pulmonary metastasectomy. One of the 7 patients, a 70 year-old man, survives for 69 months after right middle lobectomy for solitary HCC metastasis. Other 6 patients with multiple pulmonary metastases or with increased level of alpha-fetoprotein (AFP) before pulmonary resection died of systemic recurrence. The mean survival time of 7 patients was 20 months and was 11.8 months except the long-time survivor. From our results, patients with multiple pulmonary metastases from HCC or with increased serum level of AFP before surgery should be carefully selected as candidates for pulmonary metastasectomy.
No preview · Article · Apr 2013 · Kyobu geka. The Japanese journal of thoracic surgery
[Show abstract][Hide abstract] ABSTRACT: Purpose: Several small studies have reported that acute exacerbation (AE) of idiopathic interstitial pneumonia (IIP) can occur after lung resection for patients with non-small cell lung cancer, though the incidence rate is unclear. Methods: We examined our institutional data and performed a search of the MEDLINE database for publications regarding AE of IIP following surgery for lung cancer. Studies reporting the incidence rates of IIP and AE were included. Results: Eleven studies including our institutional data were determined to be eligible. Seven studies designated the incidence of IIP. Of 4749 patients (from 7 studies) who underwent lung resection for NSCLC, 277 had IIP, for an incidence rate of 5.8% (range 1.1%-11.7%). Eleven studies designated the incidence of AE from IIP patient, 67 (15.8%) of 424 IIP patients (from 11 studies) developed AE after surgery, of whom 38 (56.7%) died during the postoperative course. Conclusion: Coexistent IIP in patients with lung cancer increases the risk of lung cancer surgery. Furthermore, AE of IIP may be a major cause of operation-related death.
[Show abstract][Hide abstract] ABSTRACT: A mediastinal Mullerian cyst was initially reported as a new category of congenital cyst by Hattori, et al. in 2005. We treated a 53-year-old female referred to us with a posterior mediastinal tumor found at the Th5 prevertebral level by chest-computed tomography during a medical check-up. She had a history of mediastinal teratoma, which was removed at the age of 35. Chest magnetic resonance imaging revealed homogenous, high-intensity signals in T2-weighted images. The lesion was resected using a thoracoscopic procedure, and histologic and immunohistochemical staining revealed a ciliated cyst of Mullerian origin. The newly established mediastinal Mullerian cyst should be included in the differential diagnosis of posterior mediastinal cysts.
[Show abstract][Hide abstract] ABSTRACT: We report a case of metastatic diaphragm tumor from uterine corpus cancer. A 72-year-old female had a tumor on right diaphragm 4-years after operation for uterine corpus cancer. After chemotherapy, tumor resection was performed by right lung basal segmentectomy, partial liver resection, and partial diaphragm resection. The pathological examination revealed adenocarcinoma, compatible with uterine corpus cancer, metastasizing in diaphragm and involving lung and liver. After the operation, a local recurrence occurred at parasternal lymph node, which is considered to be present on the efferent route of lymph flow from diaphragm.
No preview · Article · Aug 2011 · Kyobu geka. The Japanese journal of thoracic surgery
[Show abstract][Hide abstract] ABSTRACT: An 85-year-old male with superior sulcus tumor was referred to our hospital complaining right brachial pain and omalgia. Chest computed tomography showed right apical lung tumor involving the 1st rib, and bronchoscopy established a diagnosis of squamous cell carcinoma, cT3NOM0. After concurrent chemoradiotherapy [cisplatin (CDDP) + 60 Gy], functional examination indicated him to be tolerable to lobectomy, and he underwent right upper lobectomy + chest wall resection (1st-3rd ribs) + lymph-node dissection. Pathological examination revealed that the effect of chemoradiotherapy was Ef. 3. The postoperative course was uneventful. He is free from recurrence for 7 years after the surgery.
No preview · Article · Jun 2011 · Kyobu geka. The Japanese journal of thoracic surgery
[Show abstract][Hide abstract] ABSTRACT: We report a rare case of nodular lymphoid hyperplasia in the lung. An 18-year-old woman had an abnormal shadow found on chest radiography images. Positron-emission tomography showed an uptake of (18)F-fluorodeoxyglucose in the mass lesion, with a maximum standardized uptake value of 2.4. The lesion gradually enlarged, and surgical removal was performed. Histopathological examination of the resected lung revealed polyclonal proliferation of lymphoid tissue, leading to a diagnosis of nodular lymphoid hyperplasia.
No preview · Article · Jul 2009 · General Thoracic and Cardiovascular Surgery
[Show abstract][Hide abstract] ABSTRACT: A recent meta-analysis study showed that post-operative adjuvant chemotherapy with UFT, an oral combination drug composed of tegafur [prodrug of 5-fluorouracil (5-FU)] and uracil [inhibitor of dihydropyrimidine dehydrogenase (DPD)] was associated with improved survival in patients with lung adenocarcinomas, but not in those with lung squamous cell carcinomas.
We investigated the 5-FU-related gene expression levels of thymidylate synthase (TS), DPD, thymidine phosphorylase (TP) and orotate phosphoribosyl transferase (OPRT) in resected tumor specimens from 51 patients with adenocarcinomas and 47 with squamous cell carcinomas using quantitative reverse transcription-PCR, and compared those levels between the two histological types.
The relative gene expression values of TS, TP and OPRT were significantly lower in adenocarcinomas compared with squamous cell carcinomas, 1.60 +/- 0.86 versus 4.33 +/- 3.40 (P < 0.001), 0.84 +/- 0.52 versus 2.27 +/- 1.16 (P = 0.006) and 9.59 +/- 6.30 versus 16.94 +/- 12.04 (P < 0.001), respectively. The relative gene expression value of DPD was significantly greater in adenocarcinomas than those in squamous cell carcinomas, 2.33 +/- 1.22 versus 1.50 +/- 1.20 (P = 0.01). Lower expressions of TS and TP were observed more in adenocarcinomas (89.8%) than in squamous cell carcinomas (48.9%) (P < 0.001).
These data may explain that post-operative adjuvant chemotherapy with UFT was associated with improved survival in stage I patients with adenocarcinoma, but less with squamous cell carcinoma.
Preview · Article · Nov 2008 · Japanese Journal of Clinical Oncology
[Show abstract][Hide abstract] ABSTRACT: We evaluated the effects of mediastinal lymph-node dissection on outcomes in octogenarians with primary lung cancer. Outcomes and postoperative complications were retrospectively investigated in 48 octogenarians with anatomically resected lung cancer, of whom 23 underwent a mediastinal lymph-node dissection (ND2 group) and 25 a limited lymphadenectomy (ND0-1 group). Forty-three patients underwent a lobectomy, two a pneumonectomy, and three a segmentectomy. The five-year survival rate for all was 35%, while that for those in pathological stage I was 43.3% and for those in stage II+III was 21.2%. As for lymph node dissection, the five-year survival rate for the ND0-1 group (54.3%) was superior to that for the ND2 group (21.7%) (P=0.022). For patients in pathological stage I, those rated ND0-1 had a better five-year survival than those rated ND2 (61.9% vs. 28.6%) (P=0.041). In addition, mediastinal lymph-node dissection increased the incidence of postoperative cardiac complications (P=0.004). Our results indicate that major pulmonary resection with mediastinal lymph-node dissection is associated with a higher rate of mortality in octogenarians with lung cancer.
Full-text · Article · Nov 2008 · Interactive Cardiovascular and Thoracic Surgery
[Show abstract][Hide abstract] ABSTRACT: The prognostic value of p21 protein expression in lung cancer patients has been assessed. However, its significance in those with pulmonary squamous cell carcinoma following induction chemotherapy (IC) remains unclear. We studied on patients who did or did not undergo IC (NIC) to elucidate the prognostic value of p21 protein expression.
p21 protein expression was assessed immunohistochemically and samples with greater than 10% positive tumor cells were considered positive. We then analyzed clinical-pathological features, including p53 protein expression and prognosis, in 43 patients who underwent IC group and 40 who did not IC (NIC) group.
Positive nuclear p21 samples were obtained from 17 (41.5%) patients in the in IC group and 22 (55.0%) in the NIC group. In the IC group, there was no significant correlation between the histological effectiveness of chemotherapy and p53 protein expression, whereas a significant correlation was observed between that and p21 protein expression (p=0.048). Further, the prognosis for p21-positive patients tended to be better (p=0.0506) than for p21-negative patients, and was significant (p=0.048) in patients with pathological stage (p-stage) II or III disease.
Our findings suggest that p21 protein expression is a prognostic factor for primary patients with pulmonary squamous cell carcinoma following IC.
Full-text · Article · Mar 2007 · Annals of thoracic and cardiovascular surgery: official journal of the Association of Thoracic and Cardiovascular Surgeons of Asia