Eisaku Komori

Evaluation of lesions corresponding to ground-glass opacities that were resected after computed tomography follow-up examination

BACKGROUND Ground-glass opacity (GGO), which is closely related with bronchioloalveolar carcinoma (BAC), is being detected more frequently. BAC is considered to be a relatively less aggressive tumor, and immediate resection at the time of detection might not be necessary. Therefore, when GGO is detected, a CT follow-up examination is often performed. If growth is detected during the follow-up CT examination, resection is usually considered. However, the possible treatment delay caused by the scheduling of a CT follow-up examination is an issue that must be clarified. Since the cancer might progress during the follow-up period, such follow-up periods might have a negative influence on the patients prognosis. This study attempted to clarify whether CT follow-up causes treatment delay. METHODS A total of 113 lung cancer patients with pure or mixed GGO findings who underwent a resection after a CT follow-up examination between 1999 and 2005 were retrospectively examined. The CT findings at the initial detection, the changes in the CT findings during the CT follow-up period, the histology, the pathological stage and the outcomes after resection were reviewed and evaluated. RESULTS The CT finding at the time of the initial detection showed pure GGO in 63 patients and mixed GGO in 50 patients. Histology revealed that adenocarcinoma was found in all 113 patients; squamous cell carcinoma was not found in any of the patients. One-hundred twelve patients were diagnosed as having Stage IA, and a singe patient with visceral pleura invasion was diagnosed as having Stage IB. Complete resections were performed in all the patients. The median postoperative follow-up period was 45.0 months. No recurrences or deaths were observed during the study period. CONCLUSIONS No treatment delays or negative influences on patient outcome resulted from the CT follow-up period. A future prospective study should be conducted to establish the optimal CT follow-up program.

Comparison in prognosis after VATS lobectomy and open lobectomy for stage I lung cancer: retrospective analysis focused on a histological subgroup.

BackgroundVideo-assisted thoracoscopic surgery (VATS) has become an attractive surgical procedure, but several issues remain to be resolved. Prognosis after VATS lobectomy is important to evaluate the adequacy of VATS lobectomy as a cancer operation. Interestingly, several investigators, including us, have reported that prognosis after VATS lobectomy was superior to that after open lobectomy in early non-small-cell lung cancer (NSCLC). One of the possible reasons is the low invasiveness of VATS lobectomy. But we considered that patient bias might have some influence favoring VATS lobectomy. To evaluate our hypothesis, we reviewed medical records of stage I NSCLC patients undergoing operation between 1993 and 2002. We compared and evaluated the relationship between patient characteristics and prognosis after VATS and open lobectomy. We focused particularly on histological type, classifying it into four subgroups; (1) bronchioloalveolar carcinoma (BAC), (2) mixed BAC + papillary adenocarcinoma (BAC + Pap), (3) other adenocarcinoma (Other adeno), (4) squamous cell carcinoma + others (Sq +others).ResultsA total of 165 patients underwent VATS lobectomy, and 123 patients underwent open lobectomy. The 5-year survival rate of the VATS lobectomy group was 94.5% and that of the open lobectomy group was 81.5%. Univariate Cox regression of survival revealed that male, CEA > 5, Other adeno, Sq + others, open lobectomy, and tumor size > 3 cm were significant negative prognostic variables. Multivariate Cox regression of survival revealed that histological subtype and tumor size were independent prognostic factors, but surgical procedure was not an independent prognostic factor.CommentsPrognosis after VATS lobectomy was superior to that after open lobectomy, but patient bias influenced the prognosis in favor of VATS lobectomy, and the surgical procedure itself was not a prognostic factor.

Variance analysis of a clinical pathway of video-assisted single lobectomy for lung cancer

PurposeClinical pathways have contributed to standardized postoperative management, but analyzing variance is also important to maintain quality control. To evaluate the validity of our own clinical pathway for managing video-assisted lobectomy for lung cancer, we analyzed the variances influencing postoperative recovery.MethodsBetween April 2003 and April 2004, 62 consecutive patients with lung cancer underwent video-assisted single anatomic lobectomy with lymph node dissection. We evaluated 61 of these patients after the exclusion of one, who deviated from the clinical pathway management immediately as a result of serious complications.ResultsThere were 29 men and 32 women, with an average age of 65.7 years. Complications developed in 29 patients, but there was no operative mortality. The occurrence of variance ranged from 1.6% to 34.4% for each activity and included prolonged supplemental oxygen therapy, out-of routine examination, prolonged epidural anesthesia, and delayed bathing frequently. Complications and an abnormal body mass index were significant and independent clinical factors affecting the increase in variance.ConclusionsOur original clinical pathway management was tolerable for lung cancer patients undergoing a video-assisted lobectomy. Complications and an abnormal body mass index were significant predictive factors for an increase in variance of our clinical pathway.

Solitary fibrous tumor of the mediastinum

An 18-year-old man was referred to our hospital for further evaluation of a right anterior mediastinal tumor that measured 6 cm in diameter. Computed tomography-guided transcutaneous aspiration biopsy was performed, but no definitive diagnosis could be obtained. Because the tumor did not appear to be a high-grade malignant tumor, we undertook resection of the tumor to obtain a definitive diagnosis and provide appropriate treatment. Total thymectomy with tumor resection was performed through a median sternotomy. The tumor was solid, measuring 5.2 × 4.2 × 3.5 cm. The histological diagnosis was solitary fibrous tumor (SFT) arising from the mediastinum. Most extrathoracic SFTs appear to pursue a benign course, although careful long-term follow-up of these patients is necessary because the tumors have been reported to recur or metastasize in some cases.

Pulmonary angioplastic procedure for lung cancer surgery.

PurposeAlthough bronchoplasty for the treatment of lung cancer is widely accepted as a reliable, safe procedure for the preservation of lung function, there have been only a few reports on pulmonary artery (PA) resection and reconstruction.MethodsRetrospectively, we reviewed our medical records of pulmonary angioplastic procedures and assessed the results.ResultsA total of 25 patients (5 women, 20 men) with a mean age of 68 years (range 44–85 years) underwent a pulmonary angioplastic procedure for lung cancer surgery. Altogether, 13 patients had adenocarcinoma, and 11 had squamous cell carcinoma. The cancers were located in the left lung in 15 cases and in the right lung in 10 cases. The PA reconstructions comprised 4 circumferential resections and anastomoses, 18 wedge resections and end-to-end anastomoses, 2 tangential resections with direct suturing, and 1 wide wedge resection and autologous pericardial patch repair. Six patients underwent concomitant bronchoplasty with pulmonary artery reconstruction. Prior to surgical treatment, seven patients had received neoadjuvant therapy. Although early postoperative complications occurred in eight patients (32%), no operative or in-hospital deaths occurred. All the patients in this series were discharged from hospital and went home. The overall 5-year survival rate was 45%, with a mean 27 months of follow-up.ConclusionMost operative complications after PA reconstruction were controllable despite the high morbidity rate. Pulmonary angioplastic procedures for the surgical treatment of lung cancer are both useful and feasible with good intermediate-term results.

Approach to treatment of acute respiratory failure with liquid ventilation

Liquid ventilation using Perflubron has been investigated for more than 30 years. Many investigators demonstrated beneficial effects of liquid ventilation in the setting of respiratory failure in animals. It is thought that liquid ventilation could be a new treatment for acute respiratory distress syndrome (ARDS). There are two methods in liquid ventilation. One is total liquid ventilation (TLV), in which the lungs are filled with Perflubron. The other one is, so to speak, partial liquid ventilation (PLV), in which the lungs are partially filled with Perflubron. Nowadays, partial liquid ventilation is applied in many animal studies and clinical trials, although total liquid ventilation is applied only in animal studies. Liquid ventilation using Perflubron has beneficial effects on gas exchange and a lung lavage effect in ARDS. In the rabbit model of respiratory failure induced by lung lavage, PLV produced significant improvement in blood gas compared with gas ventilation (GV) (PaO2 50±8 mmHg in GV, 225±91 mmHg in PLV; PaCO2 68±7 mmHg in GV, 44±5 mmHg in PLV). PLV also caused a decrease in myeloperoxidase (MPO) activity in a lung transplantation study in dogs (0.77±0.5 in GV, 0.38±0.25 in PLV). It is suggested that liquid ventilation might have an anti-inflammatory and lung protective effect. It is likely that liquid ventilation is a reasonable alternative. However, details of liquid ventilation, such as indications, management technique, and interaction with current therapy, are still unclear.