Ryuichi Suemitsu

Persistent and aggressive treatment for thymic carcinoma : Results of a single-institute experience with 25 patients

Objectives: The aim of this study is to retrospectively evaluate the role of several therapies, mainly chemotherapy, for thymic carcinoma (TC). Methods: From July 1973 to July 2005, 25 patients (15 males and 10 females) with histologically proven TC were treated at our department. The median age of the patients was 59 years, with a range of from 30 to 78 years. According to Masaoka’s staging system, there was 1 stage I patient, 3 stage II, 7 stage III, 6 stage IVa, and 8 stage IVb patients. The histological subtype was in all cases squamous cell carcinoma, nonkeratinizing type. Results: There were 6 complete surgical resections, 1 incomplete resection followed by chemoradiotherapy, 6 with radiotherapy alone, 3 with radiotherapy plus chemotherapy, and 9 with chemotherapy alone as the initial treatment. Eighteen patients were administered second-line therapy. The regimen obtaining the best response rate was doublet chemotherapy consisting of carboplatin (CBDCA) and paclitaxel. The median survival time and survival rate at 5 years for the patients excluding surgical cases with stage I/II disease were 32 months and 31%, respectively. Conclusion: The doublet of CBDCA and paclitaxel thus appears to be a promising regimen for TC and further investigation in a multi-institutional phase II trial is, therefore, strongly called for.

Results of a pulmonary metastasectomy in patients with colorectal cancer

PurposeThe lung is one of the key sites of hematogenous metastasis in patients with colorectal cancer. A metastasectomy of the lung is reported to improve the prognosis of colorectal cancer. We reviewed our experience in evaluating the surgical outcomes in colorectal cancer patients who have undergone a pulmonary metastasectomy.MethodsA single-center retrospective evaluation of clinical prognostic factors (1996–2008) related to a pulmonary metastasectomy of patients with colorectal cancer was conducted. Fifty-seven consecutive patients in our hospital who had undergone a resection of pulmonary metastasis from colorectal cancer were retrospectively investigated.ResultsThe mean age of the patients who underwent an initial pulmonary metastasectomy was 63.8 years. The average number of pulmonary metastases was 3.8. Pulmonary metastasectomy was performed an average of 1.6 times per head. A total of 32 patients had undergone a liver metastasectomy, and the 5-year survival of these 32 patients was 43.1%. The 5-year survival of the time from first pulmonary metastasectomy was 53.9%. There were no statistical differences with regard to the disease-free interval, interval from primary resection, or the number of pulmonary metastasectomies.ConclusionsA pulmonary resection for colorectal pulmonary metastases is therefore considered to be a favorable treatment for long-term survival even in the presence of liver metastases. Thoracic surgeons should therefore aggressively perform a pulmonary metastasectomy of colorectal cancer.

Serum Tissue Inhibitors of Metalloproteinase-1 and -2 in Patients with Non-Small Cell Lung Cancer

PurposeIn view of the increasing number of patients diagnosed with lung cancer every year worldwide, there is an urgent need for an effective screening marker to improve its early detection.MethodsWe quantified the level of immunoreactive proteins for the tissue inhibitors of metalloproteinase (TIMP)-1 and TIMP-2 in the sera of 54 patients with non-small cell lung cancer (NSCLC) and 25 healthy control subjects, by using enzyme-linked immunosorbent assays with specific monoclonal antibodies.ResultsThe TIMP-1 level was significantly higher, and the TIMP-2 level was significantly lower in the patients with NSCLC than in the controls. Furthermore, both TIMP-1 and TIMP-2 were significantly higher in patients with squamous cell carcinoma than in those with adenocarcinoma. The TIMP-1 level in patients with stage III/IV disease was significantly higher than that in those with stage I/II disease. The TIMP-1/TIMP-2 ratio was significantly higher in the patients with NSCLC, and the receiver-operating characteristic curves analysis revealed that the TIMP-1/2 ratio, but not TIMP-1 or -2 alone, was a better screening marker for NSCLC than carcinoembryonic antigen (P < 0.0001). Patients with a high TIMP-1 value had significantly shorter disease-free survival (P = 0.0479), but those with a high TIMP-1/2 ratio did not.ConclusionThe TIMP-1/2 ratio may be a good screening marker of NSCLC; however, it was less effective than TIMP-1 as a prognostic factor.

The Perioperative Complications for Elderly Patients with Lung Cancer Associated with a Pulmonary Resection Under General Anesthesia

Background: Surgery for elderly patients with lung cancer is relatively common due to the increasing elderly population. This study evaluated the perioperative complications associated with surgery in patients over 70 years of age with lung cancer. Patients and Methods: A single-center retrospective evaluation was conducted of perioperative complications (1996-2006) in lung cancer surgical patients. We reviewed and analyzed the clinical records of 364 consecutive patients over 70 years of age and 392 control patients. Results: The mean age of the elderly group was 75.5 years old and that of the control group was 59.4 years. A segmental or wedge resection was performed more frequently for the elderly group than in the control group, whereas pneumonectomies and lobectomies were performed more frequently in the control group. Preoperative comorbidities such as cardiac and thoracic diseases were more frequently recognized in the elderly group than in the control group. The quantity of propofol used as induction anesthesia in the elderly group was significantly smaller than that of the control group, furthermore, the operation time and operation room stay time of the elderly group were significantly shorter than that of the control group, however, extubation time was significantly prolonged. The ratio of thoracic complications in the elderly group was higher than that in the control group. The ratio of pulmonary leakage in the elderly group was higher than in the control group; however, there was no significant difference in length of stay in the hospital, the ratio of operative death and hospital death between the two groups. Conclusions: Elderly patients more frequently have perioperative complications than younger patients; however, there was no statistical difference in mortality. A pulmonary resection for elderly patients may therefore be as feasible as in younger patients.

Elective video-assisted thoracoscopic lung biopsy for interstitial lung disease.

Lung biopsy is often required for the definitive subtype classification of interstitial lung disease. The video-assisted thoracoscopic approach has been advocated as an alternative to standard open lung biopsy because it is less invasive; however, whether it makes a positive contribution to treatment strategy remains contentious. We investigated the safety and efficacy of the video-assisted approach in a retrospective review of 30 consecutive patients who underwent the procedure in an elective setting after being diagnosed with interstitial lung disease by chest radiography and computed tomography. The mean age of the patients was 56.7 years. The preoperative vital capacity and forced expiratory volume in 1 second were 80.0% and 83.6%, respectively. There was no operative mortality, but 2 cases of respiratory failure and 1 of prolonged air leak occurred. The diagnostic yield was 100%, and treatment was changed in 57% of the cases as a result of the histological diagnosis. The rate of treatment change was higher for patients with nonspecific interstitial pneumonia than for those with idiopathic pulmonary fibrosis. We conclude that video-assisted biopsy is effective in the subtyping of interstitial lung disease and is a safe procedure when performed electively at the early stage of the disease.

Effect of Body Mass Index on Perioperative Complications in Thoracic Surgery

Obesity is perceived as a risk factor in general thoracic surgery. We conducted a single-center retrospective evaluation of perioperative complications in 822 patients who underwent thoracic surgery between 2000 and 2005. According to body mass index, 82 were underweight (< 18.5 kg·m−2), 568 were normal (18.5–24.9 kg·m−2), 155 were overweight (25.0–29.9 kg·m−2), and 17 were obese (≥30 kg·m−2). A significant increase in preoperative comorbidity (hypertension and ischemic heart disease) was observed with increasing body mass index. There was no significant difference in operation time or length of stay in the operating room, but extubation time was significantly different among the 4 groups. Of the intraoperative complications, alveolar-arterial oxygen difference increased significantly with increasing obesity, and hypoxia was least common in the normal group. Postoperatively, there was more pulmonary leakage in the underweight group and less pneumonia in the normal group. Both the underweight and the obese are at increased risk of perioperative complications and need to be carefully observed and managed intraoperatively and postoperatively.

Unique minithoracotomy assisted by videothoracoscopy facilitates a maximal view even with a minimal wound for resection of primary lung cancer

Resection for primary lung cancer with an unique minithoracotomy and use of videothoracoscopy is described. Through an incision of approximately 10 cm at an ausculatory triangle, the 5th intercostal thoracotomy is done following dissection of muscles. At the anterior and posterior portion of the 6th rib, the 6th intercostal vessels and nerve were dissected and the rib was resected. This approach makes feasible opening of a thoracic window without injury to the nerve and removal of the rib. Thoracoscopy is introduced through a midaxillary wound of 2 cm. We report nine patients in whom we achieved resection for primary lung cancer by using this approach. This technique facilitates a standard operation for lung cancer and an almost painless postoperative state.

The results of surgery under general anesthesia in patients with lung cancer

PurposeThere are few reports of surgical complications for underweight patients. This study evaluated the complications associated with lung cancer surgery and anesthesia in underweight patients in a comparison with obese ones.MethodsA single-center retrospective evaluation of perioperative complications was conducted in 756 patients who underwent thoracic surgery under general anesthesia between 1996 and 2006. The body mass index showed that 39 were extremely underweight (<17.2 kg/m2), 45 were underweight (17.2–18.4 kg/m2), 513 were normal (18.5–24.9 kg/m2), and 159 were obese (>24.9 kg/m2).ResultsExtremely underweight patients had the most preoperative thoracic disease such as emphysema, whereas obese patients had the most preoperative cardiovascular disease such as hypertension. The postresection-predicted pulmonary function showed no difference among the four groups. Extremely underweight patients had an increased incidence of intraoperative hypotension and arrhythmia in comparison to underweight patients. On the other hand, obese patients had the majority of intraoperative thoracic complications such as hypoxia. Extremely underweight patients had more postoperative thoracic complications, especially pneumonia and pulmonary air leakage, than other patients.ConclusionsExtremely underweight patients as well as obese patients had a high risk of perioperative complications, especially postoperative thoracic complications. Extremely underweight patients should therefore be carefully observed with regard to respiratory management.

Complication of bovine pericardial buttress: pulmonary pseudotumor.

A 38-year-old man reported progressive back pain 4 years after undergoing partial resection of the lung for spontaneous pneumothorax, using staples buttressed with bovine pericardium. Chest computed tomography detected a mass near the staple line. Resection of the mass was performed successfully and the pain was relieved. The excised material was identified as an inflammatory pulmonary pseudotumor caused by the buttressing material.

Thyroid Cancer With a Cystic Mediastinal Tumor Invading the Right Main Bronchus

A 55-year-old woman presented with hemosputum. She had noted thyroid swelling and computed tomography was performed by her family physician. The computed tomographic scan revealed a thyroid tumor and a mediastinal cyst connecting to the thyroid tumor. Fiberoptic bronchoscopy showed direct invasion to the right main bronchus. She was preoperatively diagnosed with thyroid cancer combined with a mediastinal tumor and underwent a thyroidectomy and mediastinal tumor resection. These tumors were adherent to the esophagus, trachea, superior vena cava, and azygos vein; however, the mediastinal cyst, despite the fact that it directly invaded the right main bronchus, showed no malignant cells.