Ryusuke Machino

Pulmonary resection for lung cancer in nonagenarians: a report of five cases.

Lung cancer surgery in octogenarians has already become common in Japan due to the high proportion of elderly people and the progress in perioperative management, including anesthesia and video-assisted thoracic surgery. However, there have been few reports about the surgical treatment of lung cancer in nonagenarians. Five cases (mean age: 91.2 years; 3 men, 2 women) of non-small cell lung cancer in nonagenarians in whom pulmonary resection was performed are reported. All were adenocarcinomas; three were clinical stage IA, and two were IB. Three patients underwent lobectomy, and two underwent wedge resection. Mediastinal lymph node dissection was omitted in all patients. There were no fatal postoperative complications. During follow-up, one patient died due to fatal arrhythmia, and one patient who underwent wedge resection had local recurrence, but the others are alive in good condition. Pulmonary resection of lung cancer is possible for highly selected, nonagenarian patients without lymph node metastasis.

Experience of Surgical Resection for Hilar Cholangiocarcinomas at a Japanese Single Cancer Institute

BACKGROUND/AIMS Surgical resection is a radical treatment option for hilar bile duct carcinoma (HBDC); however, it is still difficult to cure and postoperative morbidity is high at this stage. METHODOLOGY We examined the demographics, surgical records and outcome in 38 patients with hilar cholangiocarcinoma undergoing operation. RESULTS Five patients (13%) underwent probe laparotomy because of peritoneal dissemination or liver metastasis. Of 33 patients, extended hemi-hepatectomy was performed in 32 patients. Postoperative complications were observed in 46% including hepatic failure in 3 and hospital death was observed in 4 patients. Advanced tumor stage more than stage III was observed in 23 patients. Curability of operation was A in 5 patients, B in 17 and C in 11 and postoperative adjuvant chemotherapy was administered in 24% including photodynamic therapy in 3. Tumor recurrence was observed in 41% of HBDC patients. The 3- and 5-year tumor-free survival was 38% and 10%, respectively and 3- and 5-year overall survival was 48% and 32%, respectively. By comparison with tumor stage or final curability, survival rates were not significantly different between groups. CONCLUSIONS Surgical resection is still the only curative treatment option to improve patient survival even in advanced stage HBDC.

Scaffold-free trachea regeneration by tissue engineering with bio-3D printing

OBJECTIVES Currently, most of the artificial airway organs still require scaffolds; however, such scaffolds exhibit several limitations. Alternatively, the use of an autologous artificial trachea without foreign materials and immunosuppressants may solve these issues and constitute a preferred tool. The rationale of this study was to develop a new scaffold-free approach for an artificial trachea using bio-3D printing technology. Here, we assessed the circumferential tracheal replacement using scaffold-free trachea-like grafts generated from isolated cells in an inbred animal model. METHODS Chondrocytes and mesenchymal stem cells were isolated from F344 rats. Rat lung microvessel endothelial cells were purchased. Our bio-3D printer generates spheroids consisting of several types of cells to create 3D structures. The bio-3D-printed artificial trachea from spheroids was matured in a bioreactor and transplanted into F344 rats as a tracheal graft under general anaesthesia. The mechanical strength of the artificial trachea was measured, and histological and immunohistochemical examinations were performed. RESULTS Tracheal transplantation was performed in 9 rats, which were followed up postoperatively for 23 days. The average tensile strength of artificial tracheas before transplantation was 526.3 ± 125.7 mN. The bio-3D-printed scaffold-free artificial trachea had sufficient strength to transplant into the trachea with silicone stents that were used to prevent collapse of the artificial trachea and to support the graft until sufficient blood supply was obtained. Chondrogenesis and vasculogenesis were observed histologically. CONCLUSIONS The scaffold-free isogenic artificial tracheas produced by a bio-3D printer could be utilized as tracheal grafts in rats.

Initial Experience of Multivision Thoracoscopic Surgery With Two Cameras: Dual-Vision VATS.

Dear Editor, Performing thoracoscopic surgery for lung diseases has become common in the past decade. However, thoracic surgery is still riskier, particularly with respect to vascular injury that could lead to critical complications during the procedure, than endoscopic surgery for other organs. This leads to various approaches for thoracoscopic surgery, such as a 2-window approach, a mirror image endoscopic method, and a 3-dimensional system. Dangerous areas for thoracic surgery are behind the organs, out of the endoscope’s view, and there is a risk of interrupted camera view by bleeding or the mist of ultrasonic devices. To address these issues, we developed a system named “dual-vision thoracoscopic surgery” using 2 cameras. This report describes how to do this procedure and its advantages for general thoracic surgery. This technique has been used for complete videoassisted thoracic surgery (cVATS) lobectomy for lung cancer. We use a type of cVATS with 1 access window (3-4 cm) and 3 ports (5.5-11.5 mm). In dual-vision VATS, 2 cameras and 3 monitors are used. The cameras are a 30° rigid scope with a 10-mm diameter and a 0° rigid scope with a 5-mm diameter, which are inserted through different ports and fixed by a camera holder without extra port or extra surgeon. Three ports and 1 access window are also used in this procedure as our standard cVATS lobectomy for either side approach. By using the cameras from 2 different directions, such as ventrally or dorsally, wide-angle and different views from the main camera are available (Supplementary Figures 1 and 2, Video 1; available online at http://sri.sagepub.com/content/by/supplemental-data). Many reports have shown advantages of VATS in general thoracic surgery. However, Gopaldas et al reported that the rate of intraoperative complication was 1.6 times higher than that of open lobectomy, based on analysis of a huge data set from the Nationwide Inpatient Sample [3]. Fournel et al also reported precise data for intraoperative complications, which could be underestimated. Kawachi et al reported that the incidence of pulmonary vessel injury in the VATS group was 4.8 times that in the thoracotomy group. Various reasons can be found for these adverse events, and one countermeasure to prevent them is to have many people view the surgical site from different angles. We proposed another approach for cVATS using multiple cameras, which view the surgical site from different angles. The advantages of this procedure are viewing the surgical site from multiple angles, viewing the thoracic cavity from a distant perspective to have a wide-angle view, and continuing the operation during cleaning of the main camera without extra surgeon. This procedure would be helpful when staplers are inserted into tunnels of a fused fissure, pulmonary artery, and pulmonary vein for stapling. When changing devices and inserting them into the cavity, it helps to avoid injury to other organs. In addition, when the main camera view is obscured by mist, blood, or fog, surgeons can continue the procedure using the auxiliary camera. These advantages help ensure that the procedure is performed safely and confidently, and may shorten operation time. No special devices, no extra ports or no extra surgeons are needed, only another camera. This approach could also be helpful to improve the quality of the operation. However, extra cost and the necessity of more stuff could be disadvantages of this procedure. This system could reduce the risk of mistakes during thoracic surgery when the view is lost with the 1-camera method and be helpful to educate immature thoracic surgeons safely.

A Rare Case of Primary Pulmonary Glomus Tumor.

Glomus tumors are neoplasms originating from glomus bodies in the dermis or subcutis of the extremities. Extracutaneous presentations are rare, particularly in visceral organs where glomus bodies are sparse or even absent.1 Primary glomus tumors of the lung are extremely rare, and we have only been able to identify 12 reports from 1978 to 2008.1–4 We report a case of resected pulmonary glomus tumor and describe the clinicopathologic features with differential diagnoses on the basis of imaging findings.