Shinsuke Kitazawa

Video-Assisted Thoracoscopic Conservative Repair of Postoperative Lobar Torsion

Postoperative lobar torsion is a rare and life-threatening complication. Several previous cases have been treated with completion lobectomy. We report successful surgical repair of middle lobar torsion after upper lobectomy. On postoperative day 4, the middle lobe was rotated approximately 150 degrees counterclockwise. The surface of the middle lobe appeared congestive, but its surface color, elasticity, and compliance improved 1 h after detorsion. We preserved the middle lobar function and prescribed warfarin for pulmonary vein thrombosis. When preserving a twisted lobe, it is important to consider the damage to the twisted lung, risk of thrombosis, and residual pulmonary function.

Early-stage thymic carcinoma: is adjuvant therapy required?

Although the prognosis of advanced thymic carconoma remains poor, previous reports have shown survival rates of 70% to 100% in patients with Masaoka stage I or stage II of the disease who were treated with surgery followed by adjuvant therapy. However, the role of adjuvant therapy in these stages is controversial. We retrospectively evaluated the outcome of 4 patients with Masaoka stage II thymic carcinoma who were treated with surgery alone between 1992 and 2008. No patient had stage I of the disease. Primary tumors were preoperatively evaluated by chest X-ray and computed tomography. Needle biopsy was not performed because the tumors were clinically diagnosed as noninvasive thymomas. The largest diameter of the primary tumor was 65 mm. Mediastinal lymphadenopathy was not detected by computed tomography. All patients underwent transsternal thymectomy. Mediastinal lymph node dissection was not performed. None of the patients received adjuvant chemotherapy and/or irradiation. Histopathologic examination revealed squamous cell carcinoma in 3 patients and undifferentiated carcinoma in one. Pathologic invasion to the adjacent organs or lymph node metastasis was not detected. All patients were alive and free from relapse at a follow-up of 72 months (range, 12-167 months). Radical resection without adjuvant therapy could be a treatment option for early Masaoka stage thymic carcinoma with low-grade histology.

Three-dimensional computed tomographic volumetry precisely predicts the postoperative pulmonary function

PurposeIt is important to accurately predict the patient’s postoperative pulmonary function. The aim of this study was to compare the accuracy of predictions of the postoperative residual pulmonary function obtained with three-dimensional computed tomographic (3D-CT) volumetry with that of predictions obtained with the conventional segment-counting method.MethodsFifty-three patients scheduled to undergo lung cancer resection, pulmonary function tests, and computed tomography were enrolled in this study. The postoperative residual pulmonary function was predicted based on the segment-counting and 3D-CT volumetry methods. The predicted postoperative values were compared with the results of postoperative pulmonary function tests.ResultsRegarding the linear correlation coefficients between the predicted postoperative values and the measured values, those obtained using the 3D-CT volumetry method tended to be higher than those acquired using the segment-counting method. In addition, the variations between the predicted and measured values were smaller with the 3D-CT volumetry method than with the segment-counting method. These results were more obvious in COPD patients than in non-COPD patients.ConclusionsOur findings suggested that the 3D-CT volumetry was able to predict the residual pulmonary function more accurately than the segment-counting method, especially in patients with COPD. This method might lead to the selection of appropriate candidates for surgery among patients with a marginal pulmonary function.

Surgical resection for bilateral giant emphysematous bullae

Surgical resection is an accepted procedure for the treatment of giant emphysematous bullae. However, few studies have reported for bilateral cases. We report a case in which we unexpectedly had to perform a one-stage surgical resection of the bilateral giant bullae. A 46-year-old male presented with bilateral emphysematous giant bullae. Initially, two-stage surgery was planned in order to operate on each lung separately. Immediately following the left bullectomy, a chest radiograph showed enlargement of the contralateral giant bulla and the patient’s hemodynamic status became unstable due to compression of the mediastinum by the enlarged bulla. As urgent decompression was required, a right bullectomy was promptly performed. His postoperative course was uneventful and the clinical and functional conditions were improved. On the occasion of surgical treatment of bilateral giant bullae, careful attention should be paid to the possibility of an enlargement of the contralateral bullae. Correspondence to: Shinsuke Kitazawa, Department of Thoracic Surgery, Faculty of Medicine, University of Tsukuba, 1-1-1 Tennnodai, Tsukuba, Ibaraki 305-8575, Japan. Tel: +81-29-853-3900; Fax: +81-29-853-3904; E-mail: s1630418@u.tsukuba.ac.jp