Masaya Kawada

Reevaluation of the indications for radical pancreatectomy to treat pancreatic carcinoma: Is portal vein infiltration a contraindication?

Abstract.Abstract.Purpose: Portal vein resection (PVR) has become more widely performed owing to improvements in the perioperative mortality rate. The present study was performed to determine whether portal vein infiltration is a contraindication against radical pancreatectomy for patients with pancreatic carcinoma.Methods: Between 1990 and 1997, a total of 66 patients with invasive ductal carcinoma of the pancreas underwent surgical resection at the Department of Surgery II, Hokkaido University Hospital. After the exclusion of those who underwent distal pancreatectomy, the remaining 43 patients were divided into a PVR(+) group (n= 28) and a PVR(−) group (n= 15). The clinicopathological characteristics, morbidity, and mortality were statistically compared between the two groups.Results: The overall survival rate of the patients who required PVR was not significantly different from that of those who underwent pancreatic resection without PVR.Conclusion: These findings suggest that combined PVR should not be a contraindication to radical pancreatectomy for pancreatic carcinoma with positive vascular invasion.

Vaccination of fusion cells of rat dendritic and carcinoma cells prevents tumor growth in vivo

Several reports on immunotherapy using dendritic cells‐based vaccine have been published. We investigated findings using fusion cells (FCs) generated from rat dendritic cells and a syngeneic hepatic cancer cell line with regard to inducing anti‐tumor immunity. Vaccination of rats using FCs protected against growth of the subcutaneously implanted tumor in vivo and induced infiltration of CD8+ T cells into the tumor. At the site of CD8+ T cell infiltration, there were apoptotic tumor cells. T cells from spleen of FCs‐vaccinated rats with protective ability against tumor growth included tumor specific cytotoxic CD8+ T cells restricted to major histocompatibility complex Class I. In addition, adaptive transfer of in vitro re‐stimulated splenic T cells with FCs was effective in preventing tumor growth and in vivo vaccinations of rats with FCs after resection of the subcutaneous implanted tumor inhibited local tumor recurrences. Immunotherapy using FCs appears to be an effective method if used in combination with surgical or other anti‐cancer therapies.

A new marking technique for peripheral lung nodules avoiding pleural puncture: the intrathoracic stamping method

While performing thoracoscopic wedge resection of the lung, the location of the lesion is generally identified by visual inspection or palpation. When difficulty in identification of the lesion by thoracoscopy is anticipated, preoperative marking is performed. However, complications and technical difficulties plague current marking techniques. To overcome this problem, we designed a new, safe and easy marking technique that avoids pleural puncture, called the intrathoracic stamping method.

Simultaneous Resection of Bilateral Intralobar and Extralobar Pulmonary Sequestrations With Video-Assisted Thoracoscopic Surgery

The term pulmonary sequestration is applied to a pulmonary lobe or portion of a lobe that is supplied by an anomalous systemic artery and drain either into the systemic or pulmonary veins. The conditions are divided into intralobar pulmonary sequestration, in which the sequestration is situated inside the visceral pleura of a normal lobe, and extralobar sequestration, in which the sequestration is surrounded by its own pleura. Most sequestrations are unilateral; bilateral sequestrations are rare. We report the case of a synchronous bilateral intralobar and extralobar pulmonary sequestrations resected simultaneously with video-assisted thoracoscopic surgery.

Immunoglobulin G4‐related disease presenting as a pulmonary nodule with an irregular margin

We report a case of immunoglobulin G4 (IgG4)‐related lung disease presenting as a solitary pulmonary nodule with an irregular margin on computed tomography. The nodule showed a high standardized uptake value on positron emission tomography. A malignant pulmonary tumour could not be excluded. Middle lobectomy was performed. Histological analysis revealed marked lymphoplasmacytic infiltration and storiform fibrosis. Immunostaining indicated the presence of IgG4‐positive plasma cells. A definitive diagnosis of IgG4‐related disease was confirmed.

Clinical evaluation of the feasibility of minimally invasive surgery in esophageal cancer.

Open thoracotomy laparotomy with extended dissection for esophageal cancer is associated with problems such as delayed postoperative recovery and decreased quality of life. In contrast, in minimally invasive surgery, these problems can be improved. In the present study, we investigated the feasibility of minimally invasive surgery in esophageal cancer.

Extrapleural hematoma as a complication following thoracotomy for pulmonary lobectomy

Extrapleural hematoma as a complication following thoracic surgery is rare. We report a case of an extrapleural hematoma following pleural lobectomy that resolved completely with nonsurgical treatment. A 63-year-old woman underwent left lower lobectomy for lung cancer through a left posterolateral thoracotomy. She had been prescribed the anticoagulant cilostazol to increase her heart rate for atrioventricular dissociation. Preoperatively, it was stopped, and a temporary pacemaker was placed to counteract bradycardia via the right jugular vein without complication. The chest tube was removed, and cilostazol was resumed on the third postoperative day. On day 7, she suddenly experienced left shoulder pain followed by hypotension, tachycardia, and anemia. Enhanced computed tomography (CT) revealed an extrapleural hematoma rather than a hemothorax. She became symptomatic after rapid infusion. The hematoma resolved without an invasive intervention. The CT results 189 days after the onset showed almost complete regression of the hematoma.

Resection of mediastinal goiter extending to the carina with use of artificial pneumothorax, two-lung ventilation, and thoracoscopy, with the patient in a prone position

A 67-year-old woman was presented with a mediastinal tumor extending from the left lobe of the thyroid and passing through the posterior trachea, causing displacement of the esophagus to the left side of the patient and then descending into the right side of the mediastinum to below the carina. Surgery was performed under two-lung ventilation with the patient in a prone position; general anesthesia was performed with a single-lumen tube combined with artificial pneumothorax. In thoracoscopic surgery, we were able to confirm and preserve anatomical structures. After detachment of the tumor at the level of the left and right subclavian arteries, the patient was placed supine, a cervical incision was added, and the tumor was extracted. The tumor was diagnosed as a nonmalignant mediastinal goiter (MG). No such surgical report was found in the literature, and one would be useful for this new approach to MG removal.