Nobuji Yokoyama

Pulmonary Function After Lobectomy: Video- Assisted Thoracic Surgery Versus Thoracotomy

BACKGROUND Whether video-assisted thoracic surgery (VATS) improves postoperative pulmonary function is still controversial. We compared postoperative pulmonary function after VATS lobectomy and standard lobectomy. METHODS Eleven patients who had undergone standard lobectomy and 10 patients who had undergone VATS lobectomy were studied. Arterial blood gas analyses were performed on the 4th, 7th, and 14th postoperative days. Pulmonary function, including forced vital capacity (FVC), forced expiratory volume in 1 second (FEV1.0), and peak flow rate (PFR) were measured on the 7th and 14th postoperative days (early phase), and approximately 1 year after surgery (late phase). RESULTS Pulmonary function, as assessed with arterial oxygen partial pressure (PaO2) (p = 0.054), arterial oxygen saturation (O2SAT) (p = 0.063), FVC (p = 0.10), and FEV1.0 (p = 0.08), was better after VATS lobectomy than after thoracotomy on the 7th postoperative day. PFR was significantly better after VATS on both the 7th and 14th postoperative days (p = 0.008 and p = 0.03, respectively). CONCLUSIONS VATS lobectomy had advantages on early postoperative pulmonary function. We conclude that VATS lobectomy is a beneficial alternative to standard thoracotomy, especially for patients with poor pulmonary reserve.

Port site recurrence of unexpected gallbladder carcinoma after a laparoscopic cholecystectomy: Report of a case

Unexpected gallbladder carcinoma was identified in a 71-year-old woman after she underwent a laparoscopic cholecystectomy (LC) for symptomatic cholelithiasis. A subsequent laparotomy for a resection of the liver bed and a dissection of the lymph nodes around the hepatoduodenal ligament was done. Two and a half years later, the patient developed subcutaneous metastasis at the epigastric trocar site through which the gallbladder was removed. A third operation was thus performed, revealing no evidence of peritoneal dissemination, liver metastasis, or lymph node metastasis, and the abdominal wall mass was resected. The histological findings confirmed the diagnosis of metastatic carcinoma of the gallbladder. We recommend that when planning LC, the possibility of malignancy should thus be kept in mind. However, if there is any sign which does not completely exclude malignancy, such as a contracture or wall thickness of the gallbladder, LC should be performed by the abdominal wall lifting method and using a protective bag for the removal of the gallbladder.

Strategy of the Treatment of Early Gastric Cancer at Matsuyama District.

松山市にある国立病院四国がんセンターにおける早期胃癌治療の現況について報告する. 陥凹主体のM癌では, 長径が10mm以下で潰瘍廏痕が無い分化型癌で内視鏡下粘膜切除 (以下EMR) を適応とし, それ以外のもの, 20mm以下の病巣に対して, 術中N (-), n (-) を条件に腹腔鏡下あるいは開腹下胃局所切除, それをこえるものに対してはpor以外でDO胃切除, porでD2胃切除を行っている. 隆起主体のM癌に対しては, 20mm以下でEMR, それをこえるものに対しては胃局所切除, 残胃の高度の変形をきたすようであればD0胃切除を行っている, 内視鏡部で施行したEMR 149例中5例に癌の遺残, 再発がみられた. 開腹下胃局所切除を17例に施行し, 術後に5例にsm層にわずかに癌浸潤が認められた. 腹腔鏡下胃局所切除を35例に施行, sm1が7例, sm2が3例, sm3が1例にみられた. 早期胃癌の術式の適応は流動的で議論の余地を残している.