Daigo Kawano

Outcome of an Original Video-Assisted Thoracoscopic Extended Thymectomy for Thymoma

BACKGROUND Video-assisted thoracoscopic extended thymectomy (VATET) for a thymoma larger than 5 cm in size is still technically difficult. METHODS Thirty-five patients with clinical Masaoka stage I thymoma underwent an original VATET procedure between November 1998 and December 2009. RESULTS All patients successfully underwent VATET, and none required conversion to a median sternotomy. Two patients also underwent partial resection of the lung and pericardium. Although there were no perioperative deaths, 3 patients experienced minor complications. The average tumor size was 5.2 cm. Fifteen tumors were larger than 5 cm. Pathologically, 15 were Masaoka stage I, 19 were stage II, and one was stage III. There were no significant differences in the tumor size between stages I and II. There were two type A, eight type AB, 15 type B1, five type B2, and three type B3 tumors and two thymic carcinomas. Twenty tumors were located in the right side of the body, five were in the middle, and ten were on the left. There were no differences in tumor size or pathologic stage according to location. There were also no differences in pathologic stage according to tumor size. The average follow-up period was 65 months. One patient showed recurrence to the bilateral lung 3.5 years after the procedure. After resection, this patient was free of disease 5 years after the first procedure. There has been no recurrence in any of the other patients. CONCLUSIONS Our original VATET procedure may be indicated for patients with clinical Masaoka stages I and II thymoma and in those with tumors larger than 5 cm.

Prediction of the prognosis and surgical indications for pulmonary metastectomy from colorectal carcinoma in patients with combined hepatic metastases

BACKGROUND The value of surgical treatment for patients with pulmonary and hepatic metastases from colorectal carcinoma is controversial. The purpose of this study was to analyze our initial experience with this aggressive strategy, and to define the prognosis and the surgical indications. METHODS The records of 35 patients who underwent surgical treatments for both hepatic and pulmonary metastases from colorectal carcinoma, from January 1997 to December 2008, were retrospectively analyzed. RESULTS There were 18 females and 17 males with a median age was 62.0 years. The primary colorectal neoplasm was located at the colon in 23 patients (65.7%) and in the rectum in 12 patients (34.3%). The overall 5-year and 10-year survival rates were 65.3% and 31.5% from the date of primary colorectal resection, respectively. For patients who underwent metachronous hepatic and pulmonary surgical treatment, the 10-year survival rate was 40.9%, which was significantly better than that of those undergoing synchronous hepatic and pulmonary surgical treatment (p=0.0265). Patients who have pulmonary less than ten of metastasis thus seemed to have a better prognosis than those with more than ten, but the difference was quite significant (p=0.0719). In a multivariate Cox proportional hazards model, synchronous hepatic and pulmonary metastases was identified as an independent predictor of adverse survival (p=0.0073). CONCLUSIONS The results of our study suggest that hepatic and pulmonary surgical treatment can provide a better prognosis for patients with metachronous hepatic and pulmonary metastases from colorectal carcinoma. We believe that aggressive metastasectomy can be an option for selected patients, even if a patient has been previously treated for hepatic and pulmonary metastases from colorectal carcinoma.

Biological significance of the maximum standardized uptake values on positron emission tomography in non-small cell lung cancer

The 2‐[18F]‐fluoro‐2‐deoxy‐d‐glucose positron emission tomography (FDG‐PET) has recently become an important non‐invasive tool for the diagnosis and staging in several cancers. The standardized uptake value (SUV) of primary tumor has been reported to relate to cancer progression and prognosis, however, biological mechanism is still unclear.

Surgical treatment of stage IV non-small cell lung cancer

Most stage IV non-small-cell lung cancer (NSCLC) patients are not amenable to curative treatment. The purpose of this study was to analyse our initial experience with an aggressive surgical strategy for stage IV NSCLC, and to define which patients can benefit from this treatment. Forty-six stage IV NSCLC patients who underwent surgical resection of both primary lung cancer and metastatic sites from April 1989 to December 2010 were included in this study. The record of each patient was reviewed for age, gender, pN status, sites of metastasis, histology, surgical procedure and duration of survival. There were 13 females and 33 males. Their median age was 62.0 years (range, 44-82 years). The overall 5-year survival rate was 23.3% (median, 20.0 months), and the disease-free survival rate was 15.8% at 5 years (median, 16.1 months). Patients with the pN2 status had a significantly worse survival than patients with a pN0 or pN1 status (8.6 versus 33.1%, P = 0.0497). According to a multivariate Cox proportional hazards analysis, no independent predictor of survival was identified. The results of our study suggest that surgical treatment can extend the survival in stage IV NSCLC patients if the patients can tolerate surgery.

The prognostic impact of the amount of tobacco smoking in non-small cell lung cancer—Differences between adenocarcinoma and squamous cell carcinoma

BACKGROUNDS The purpose of this study was to investigate the relationship between the level of tobacco smoking and the clinicopathological features of non-small cell lung cancer (NSCLC) patients, individually for adenocarcinoma (Ad) and squamous cell carcinoma (Sq). PATIENTS AND METHODS We retrospectively reviewed the clinical records of 1825 consecutive lung cancer patients who underwent surgery in our department. Among these, the data sets of 750 Ad patients and 364 Sq patients who received lobectomy or more extensive resection were available. RESULTS In Ad patients, those who had never smoked (never-smokers) (n=309) were more likely to be female, to have less advanced stage tumors, and to have a significantly better prognosis than those who had ever smoked (ever-smokers) (n=441) (5-year OS: never-smokers, 67.9%; ever-smokers, 53.7%, p<0.0001). In Sq patients, the never-smokers (n=15) were more likely to be female than the ever-smokers (n=349). Among ever-smokers, the light-smokers (PY≤30; n=56) were associated with more female patients, more advanced stage tumors, and significantly worse prognoses than were the heavy smokers (PY>30; n=292) (p=0.0003). The multivariate survival analysis showed that light smoking was related to a worse prognosis compared with heavy smoking (HR=2.06, 95% CI 1.43-2.98, p=0.0001). CONCLUSIONS The never-smokers had a significantly better prognosis than ever-smokers among Ad patients, whereas the light-smokers had a significantly worse prognosis than heavy smokers among Sq patients. There may be factors other than tobacco carcinogens that influence the development of Sq in never and/or light smokers.

Effectiveness of erlotinib against recurrent pulmonary adenocarcinoma unresponsive to gefitinib: report of a case.

We report a case of recurrent pulmonary adenocarcinoma, found 2 years after resection, which responded extremely well to erlotinib, after gefitinib treatment had failed to evoke any response. This case report provides useful information for thoracic oncologists and shows that we should consider giving erlotinib after gefitinib for recurrent pulmonary adenocarcinoma, even if the gefitinib treatment is ineffective.

Dedifferentiated Chondrosarcoma of the Lung : Report of a Case

This report presents a rare case of pulmonary sarcoma with regional anaplastic changes. A 73-year-old Japanese man with a hamartoma-like nodule of the left lung accompanied by interstitial pneumonia was followed up for 30 months. He underwent a surgical resection due to the rapid growth of the lung nodule. A pathological examination revealed a dedifferentiated sarcoma arising from the chondrosarcoma.

The influence of intracellular epidermal growth factor receptor (EGFR) signal activation on the outcome of EGFR tyrosine kinase inhibitor treatment for pulmonary adenocarcinoma

PurposeThe epidermal growth factor receptor tyrosine kinase inhibitors (EGFR-TKIs), such as gefitinib, exhibit up to a 70% response rate against non-small cell lung cancer (NSCLC) harboring somatic activating mutations of the EGFR gene (EGFR). The mechanism of intrinsic resistance of EGFR mutation-positive NSCLC against EGFR-TKIs is not known. The current study assesses the relationship between the molecular expression of EGFR signals and the response to gefitinib treatment in patients with pulmonary adenocarcinoma to elucidate the mechanism of intrinsic resistance to gefitinib.MethodsThe present study included 30 patients with pulmonary adenocarcinoma who were treated with gefitinib for a postoperative recurrence. The correlation between the response to gefitinib treatment and various clinical and molecular features was evaluated.ResultsEGFR mutations were detected in 20 (66.7%) of the 30 patients. The response to gefitinib treatment was a complete response in 1 case, partial response in 12 cases, stable disease in 4 cases, and progressive disease in 13 cases. Both univariate and multivariate analyses showed the presence of an EGFR mutation, and the expression of phospho-EGFR (p-EGFR) significantly correlated with a better response to gefitinib treatment. Ten of the 16 p-EGFR positive patients were disease controlled, but all 4 p-EGFR negative patients were intrinsically resistant to EGFR-TKIs (P = 0.025). Other factors including sex, smoking status, serum carcinoembryonic antigen and cytokeratin-19 fragment levels, EGFR, Met proto-oncogene, phospho-Met, and hepatocyte growth factor expression were not associated with the response to gefitinib treatment.ConclusionThese results suggest that, even if EGFR mutations were observed, a p-EGFR negative state might be a cause of intrinsic resistance to EGFR-TKIs.

Synovial sarcoma of the chest wall.

We here report a rare case of synovial sarcoma of the chest wall. A 71-year-old Japanese woman noticed a left anterior chest wall mass after twice having had surgery for lung cancer. An aspiration biopsy diagnosed synovial sarcoma. She then underwent a surgical resection. Pathology examination revealed a biphasic-type synovial sarcoma. When the prepared RNA from the tumor was subjected to a polymerase chain reaction, SYT-SSX1 fusion gene transcripts were demonstrated. Patients with the SYT-SSX1 fusion gene have a worse clinical outcome than patients with SYT-SSX2-positive tumors. After a second surgery, performed in 1 year later, there was no evidence of recurrence for 30 months; however, careful observation may be required.

Surgical Resection of Pulmonary Malignant Tumors After Living Donor Liver Transplantation

BACKGROUND The aim of this study is to report on patients who developed tumor recurrence of the lung or de novo pulmonary malignancies after living donor liver transplantation (LDLT) and to show the benefit of a surgical resection for these pulmonary malignant tumors. METHODS A total 246 patients who underwent LDLT were investigated. RESULTS Pulmonary malignant tumors after LDLT were observed in 12 (4.9%) of 246 patients studied. These patients included 9 tumor recurrences and 3 de novo malignancies. The frequency of pulmonary recurrence was 9.4% (9 of 96 patients) and that of pulmonary de novo malignancies including 2 primary lung cancer and 1 mucosa-associated lymphoid tissue (MALT) lymphoma, was 1.2% (3 of 246 patients). Four of 9 recurrent patients could undergo surgical resections and the survival range in patients who received surgery was 17 to 56 months with a mean of 36 months after LDLT; on the other hand, the survival range in patients that could not undergo a surgical resection was 4 to 26 months with a mean of 18 months. Among the de novo malignancies, only the MALT lymphoma patient could undergo a surgical resection. Repeated surgical resections of pulmonary malignant tumors could be performed in 3 patients and all these patients have been long-term survivors. CONCLUSIONS These results suggest a surgical resection of pulmonary malignancies including tumor recurrences or de novo malignancies after LDLT is a feasible procedure and may prolong survival in selected patients, even under immunosuppressive conditions.