Nobumasa Takahashi

Survival After Surgery for Pathologic Stage IA Non-Small Cell Lung Cancer Associated With Idiopathic Pulmonary Fibrosis

BACKGROUND Many problems exist in regard to the treatment of lung cancer patients with idiopathic pulmonary fibrosis (IPF), but few reported studies have investigated the long-term prognosis after pulmonary resection in such patients. The purpose of the present study was to determine the postoperative survival of patients with pathologic stage IA non-small cell lung cancer (NSCLC) and IPF. METHODS We retrospectively reviewed 350 patients with pathologic stage IA NSCLC who underwent pulmonary resections at our institution between September 1994 and December 2007. We analyzed and compared 28 of these patients, who had simultaneous lung cancer and IPF, with the remaining 322 lung cancer patients without IPF. RESULTS The 5-year survival rates were 54.2% in pathologic stage IA lung cancer patients with IPF and 88.3% in those without IPF (p < 0.0001). Univariate analyses showed that age, sex, Brinkman Index, limited resection, operation time, adenocarcinoma, and IPF were significant prognostic factors for survival (p < 0.10). By multivariate analysis, however, only IPF was a significant prognostic factor for survival (p = 0.007). Propensity score-matching analysis confirmed that only IPF was significant prognostic factor (p = 0.043). CONCLUSIONS The 5-year survival rate of patients with pathologic stage IA NSCLC and IPF is 54.2%. IPF has independent, adverse effects on survival of pathologic stage IA NSCLC patients treated with pulmonary resection.

Use of silicone gel sheets for prevention of keloid scars after median sternotomy

PurposeA keloid scar often appears at the incision site of patients after median sternotomy. Use of silicone gel to treat hypertrophic burn scars and fresh incisions has yielded encouraging results. In this study, we report our experience with the preventive use of silicone gel sheets for keloid scars after median sternotomy.MethodsNine patients who underwent a median sternotomy were studied. A silicone gel sheet was kept directly on the surgical incision for 24 h starting 2 weeks after surgery. The treatment was repeated with a new sheet every 4 weeks for 24 weeks, at which times the subjective symptoms and the changes in keloid scars were determined.ResultsNone of the patients experienced an aggravation of any subjective symptoms during the 24-week study. After 24 weeks, all patients were free of a keloid scar that showed a rise and contraction of skin and causes discomfort. No adverse events were reported by any of the patients.ConclusionA silicone gel sheet is safe and effective for the preventing the formation of keloid scars after median sternotomy.

Postoperative complications and respiratory function following segmentectomy of the lung - comparison of the methods of making an inter-segmental plane.

Segmentectomy could be one of the standard modes of surgery for the treatment of early lung cancer. However, segmentectomy could be more difficult than lobectomy as to the management of inter-segmental plane. The relationship between methods of dividing an inter-segmental plane and postoperative complication/pulmonary function was investigated in this study. A retrospective study was conducted on 49 patients who underwent segmentectomy of the lung between February 2008 and April 2009 at our institute. Eighteen (36.7%) were male and 31 (63.3%) were female. The inter-segmental plane was divided with only a mechanical stapler in 18 patients, and electrocautery was used in the other 31 patients. There were no significant relationships between clinicopathological features and both procedures, except gender, operative time, and pleurodesis (P<0.05). Preserved forced expiratory volume in one second (FEV(1)) was not affected by the procedures. Patients who underwent left upper division segmentectomy had significantly more complications. On multivariate analysis, resected segment and intraoperative blood loss were found to be significant predictors for postoperative complications. There were no significant relationships between the methods of making inter-segmental planes and postoperative complications and/or lung functions. Resected segment and intraoperative blood loss were predictors for postoperative complication in segmental resection of the lung.

The Impact of Cigarette Smoking on Prognosis in Small Adenocarcinomas of the Lung: The Association Between Histologic Subtype and Smoking Status

Objective: In this retrospective study, we clarified the impact of smoking on prognosis and the association of clinicopathological factors, particularly histologic subtype, in patients with small adenocarcinoma of the lung. Methods: Between 1996 and December 2006, 121 patients presenting with adenocarcinomas that had a diameter ≤2 cm were analyzed. The clinicopathological records of the patients were examined for age, gender, nodal status (c-N and p-N), tumor size, serum carcinoembryonic antigen level, histologic subtype, and smoking history. A histologic subtype was defined using a modified World Health Organization classification. These subtypes are bronchioloalveolar carcinoma (BAC), adenocarcinoma with little or no BAC component (Non or min BAC), and mixed bronchioloalveolar carcinoma with other adenocarcinoma components. Results: The overall 5-year survival rates were 94.4% for never-smokers (N = 55) and 79.2% for smokers (N = 66) (p = 0.05). Cancer-specific 5-year survival rates were 98.0% for never-smokers and 80.4% for smokers (p = 0.03). Gender, serum carcinoembryonic antigen level, and histologic subtype were significantly associated with smoking status. Histologic subtype (Non or min BAC) was the only significant prognostic factor in multivariate analyses. The prevalence of smoking by histologic subtype was 27.3% for BAC, 43.2% for mixed bronchioloalveolar carcinoma, and 74.6% for Non or min BAC. The prevalence was significantly higher in Non or min BAC than in the others. Furthermore, the smoking index (daily cigarette consumption times years of smoking) was significantly higher in Non or min BAC than in the other two subtypes. In addition, patients with a high smoking index showed a greater percentage of Non or min BAC subtypes. Finally, male gender was associated with Non or min BAC independent of smoking status (p = 0.03). Conclusions: When adenocarcinomas were small (diameter ≤2 cm) cigarette smoking and male gender were associated with Non or min BAC histologic subtypes, which are thought to have more aggressive biologic features resulting in poorer outcome compared with other subtypes.

Experience of silicone gel sheets for patients with keloid scars after median sternotomy

PurposeIt is often difficult to control hypertrophic scars and keloids with drug therapy, steroid injection, surgery, radiation therapy, laser, or wound pressing. Use of silicone gel to treat hypertrophic burn scars and fresh incisions has yielded encouraging results. We report our experience of silicone gel sheets for patients with keloids following median sternotomy.MethodsNine patients underwent a median sternotomy and received other therapies before participating in this treatment. A silicone gel sheet was placed directly on the keloid scar and maintained at all times. Sheets were replaced every 4 weeks for a total treatment duration of 24 weeks. The scar area was measured, and subjective symptoms were determined prior to therapy and after completion of therapy.ResultsThere were three men and six women, with a mean age of 45.2 years (range 22–69 years). Progression of protuberance and rub was seen in one patient. Scar redness and cramping were either diminished or unchanged in all patients. Itching progressed in two patients. After 6 months, the area of the scar relative to its initial area was 0.98 (range 0.78–1.27). Harmful events did not occur.ConclusionA silicone gel sheet is effective for treating keloid scars following median sternotomy. Silicone gel sheets are safe and easy to use and do not aggravate any subjective symptoms.

Clinicopathological Factors Associated with Unexpected N3 in Patients with Mediastinal Lymph Node Involvement

Introduction: We have already shown that postoperative survival was poor in p-N3 patients from the experience of extended radical nodal dissection (ERD: cervical and bilateral mediastinal nodal dissection) for lung cancer. In this retrospective study, we aimed to clarify the clinicopathological factors associated with p-N3 in patients with mediastinal lymph node involvement (excluding c-N3) who underwent ERD, and we studied their impact on prognosis. Methods: Between 1996 and April 2006, in patients with lung cancer in the right upper lobe, we performed ERD after obtaining informed consent from the patients. The study comprised 8 females and 29 males (median age of 60 years), with 15/7/15 cases of c-N0/c-N1/c-N2, respectively. The clinicopathological records of each patient were examined for prognostic factors associated with p-N3, including age, gender, histology, c-N number, preoperative serum CEA level, number of metastatic stations, and distribution of metastatic nodes according to the system of Naruke et al. Because c-N3 cases were excluded from the study, we defined p-N3 as unexpected N3. Results: Of the 37 study subjects, 19 (51.4%) had one or more metastases to the mediastinal lymph nodes. Of these 19 patients, 10 (52.6%) had metastases to cervical and/or contralateral mediastinal lymph nodes (unexpected N3; 5-year survival was 0%). C-N factor (c-N2), nonskip N2, multistation mediastinal lymph node metastasis, highest mediastinal nodal involvement, and pT status were significantly associated with unexpected N3. In particular, multistation mediastinal lymph node metastasis and highest mediastinal nodal involvement were significant prognostic factors in multivariate analyses. Conclusions: Because unexpected N3 patients showed a poor prognosis after ERD, treatment modalities other than surgery should be considered. On the other hand, because true N2 patients showed a good outcome after surgery, surgical resection may be considered an important therapeutic modality even for N2 patients, given that they show single-station mediastinal nodal involvement or c-N0-1.

Prognosis of surgically resected lung cancer with extremely high preoperative serum carcinoembryonic antigen level

PurposeThe aim of this study was to investigate the prognosis of resected lung cancer patients with extremely high carcinoembryonic antigen (CEA) levels. Several reports have indicated that increased preoperative serum CEA levels are associated with a dismal outcome after surgery, whereas others have reported long-term survival among patients with extremely high preoperative CEA levels. We investigated whether preoperative serum CEA levels, especially extremely high levels, were related to the prognosis of non-small-cell lung cancer (NSCLC) after surgery.MethodsFrom September 1996 to January 2008, a total of 649 patients underwent surgical treatment for NSCLC at Juntendo University Hospital. We conducted a retrospective review to investigate the prognostic significance of the preoperative CEA level in these patients. We also investigated the prognosis of patients with an extremely high preoperative CEA level (>30 ng/ml).ResultsThe 5-year survival rates were 78.4% and 63.0% for patients with normal and abnormal preoperative CEA levels, respectively. The survival rate was significantly worse for patients with abnormal preoperative CEA levels (P = 0.0002). In all, 28 patients had preoperative CEA levels >30 ng/ml. Although most of these patients showed a poor prognosis, 7 (25.0%) were longterm survivors (>4 years).ConclusionAn abnormal preoperative CEA level suggests a poor prognosis for patients with NSCLC after surgery. Nevertheless, a few patients with an extremely high preoperative CEA level had long-term survival. Even if the preoperative CEA is extremely high, we perform a careful survey for distant or intrathoracic metastases and should not overlook operable cases.

Spontaneous hemorrhage of a thymic cyst in an adult: Report of a case

Mediastinal cysts account for about 19% of all mediastinal masses, and thymic cysts represent only about 1.5% of anterior mediastinal masses. Thymic cysts do not usually cause symptoms and are often found incidentally on routine chest radiography. We report the case of a thymic cyst that hemorrhaged into the mediastinum and the right pleural cavity, causing chest pain. The patient, a 55-year-old man, underwent emergency surgical resection and recovered uneventfully.

Usefulness of suplatast tosilate for chronic cough following lung cancer surgery

ObjectiveChronic dry cough is reported to occur in about 25% of patients following lung cancer surgery. Experimental data suggest that it may be caused mainly by stimulation of C-fibers, which are widely distributed to the lower trachea and bronchi. We assessed the clinical usefulness of suplatast tosilate (IPD) for chronic dry cough after lung cancer surgery.MethodsThe subjects were patients with stage I lung cancer who had undergone lobectomy combined with mediastinal lymph node dissection. IPD was administered orally at 400 mg daily, and its efficacy was evaluated by patient interview 1, 2, and 3 months after the start of treatment. The subjects were 19 patients, and the duration of cough before entering the study was 393.2 days.ResultsThe response rate was 84.2% (16/19) 1 month after the start of treatment. It seems that IPD inhibits cough resulting from stimulation of the bifurcated trachea with a high content of C-fibers.ConclusionThe present study suggested the efficacy of IPD for controlling chronic dry cough after lung cancer surgery.

Validating margin status in lung wedge resection for clinical stage I non-small cell lung cancer

Stage I non-small cell lung cancer (NSCLC) is a localized disease without metastasis; therefore, it can be treated effectively with local therapies. Pulmonary resection is the most frequent treatment, performed as pulmonary wedge resection, segmentectomy, lobectomy, or pneumonectomy. Some retrospective clinical studies of pulmonary wedge resection suggest that its outcome may be inferior to that of anatomical pulmonary resection, whereas other recent studies, which assess surgical margin status, leveled acceptable outcomes. Since the outcome of pulmonary wedge resection for lung cancer may depend on tumor size, distance from the surgical margin to the tumor, tumor size/margin distance ratio, and margin cytology results, a prospective study assessing these parameters is ongoing. This will allow us to identify the clinical implications of these factors and predict which patients are likely to have a good outcome.