Shuichi Shinohara

The impact of covering the bulla with an absorbable polyglycolic acid (PGA) sheet during pneumothorax surgery

We herein present the pathological findings of a bulla covered using an absorbable polyglycolic acid sheet applied with fibrin glue. These findings indicated that the membrane of the bulla was reinforced. Covering the bulla with an absorbable polyglycolic acid sheet (Neoveil, Gunze Ltd, Kyoto, Japan) and applying fibrin glue was effective to prevent the recurrence of the pneumothorax. Moreover, this report is the first case report showing the pathological findings of a bulla which was covered with an absorbable polyglycolic acid sheet and fibrin glue.

Complete Resection of Thymic Sarcomatoid Carcinoma Through Total Aortic Arch Replacement.

Sarcomatoid carcinoma of the thymus is extremely rare. An operation remains the only effective treatment for this disease. We report a case of complete resection of thymic sarcomatoid carcinoma through a total aortic arch replacement and left upper lobectomy at our institution. Our aggressive operation was very effective, and the patient has experienced no recurrence in the 3 years since his operation.

Middle mediastinal thymic carcinoma with cystic findings in radiologic images: a case report

BackgroundThymic carcinomas are usually detected in the anterior mediastinum. Thymic carcinoma occurring in the middle mediastinum and showing an image of a cyst is extremely rare.Case presentationA 64-year-old man with a middle mediastinal tumor detected incidentally by a CT scan was referred. Chest CT showed an entirely cystic mass in the middle mediastinum between the bilateral brachiocephalic vein and trachea. We resected the tumor completely in the right recurrent nerve because it had invaded the nerve. Immunohistochemical features showed a thymic carcinoma pattern. The final diagnosis was thymic squamous cell carcinoma occurring in the middle mediastinum.ConclusionTo our best knowledge, this is the first report of a thymic carcinoma occurring in the middle mediastinum, as demonstrated by histopathological findings with immunohistochemical features.

Pulmonary artery reconstruction using autologous pulmonary vein for surgical treatment of locally advanced lung cancer: a case report

BackgroundResection and reconstruction of the pulmonary artery during lobectomy is a safe and effective procedure for centrally located lung cancer. We usually choose a pericardial conduit to repair a large defect of the pulmonary artery. The use of an autologous pulmonary vein conduit for reconstruction was first described in 2009.Case presentationA 64-year-old woman with left upper lung adenocarcinoma with mediastinal and hilar adenopathy was referred to our hospital. Hilar nodes had extensively infiltrated the pulmonary artery. We interposed an autologous superior pulmonary vein between the cut ends of the pulmonary artery. She was discharged without any complication on the ninth postoperative day.ConclusionsA pulmonary vein conduit is a good option for reconstruction of the pulmonary artery. We report the successful use of an autologous pulmonary vein conduit.

Total or partial vertebrectomy for lung cancer invading the spine

Background Surgery for lung cancer invading the spine remains challenging associated with high morbidity and mortality. However, recent advances in surgical techniques as well as in perioperative care may improve outcomes of lung cancer surgery with vertebrectomy. We describe our surgical approach and assess the outcome lung cancer invading the spine. Methods We retrospectively reviewed our recent experiences of lung cancer with vertebral invasion, in which we have performed total or partial vertebrectomy from January 2011 through April 2015. Results We experienced eight patients who were treated with partial or total vertebrectomy for lung cancer. Vertebral invasion was evaluated by chest CT and MRI findings. All cases were no distant metastasis. N factors were all patients N0 revealed by chest CT and PET-CT. Two patients were treated preoperative induction therapy (CDDP + TS-1, Radiation 50 Gy). For the surgery, total vertebrectomy was performed two patients, hemi vertebrectomy was two patients, transverse-process resection was four patients. In all of eight cases, complete resection were perfomed with total or partial vertebrectomy. Morbidity was observed in six patients (75%); no mortality occurred. Six patients (75%) were survived after surgery (range: 12–62 months) and four patients (50%) were no recurrence. Five years overall survival rate was 71.4%. Conclusions In our experience, Lung cancer surgery combined with vertebrectomy is highly aggressive surgery associated with high morbidity. But, this procedure is a promising treatment option for selected patients, for example N0M0 disease with lung cancer invading the spine.

Impact of Postoperative Pneumonia Developing After Discharge on Long-Term Follow-up for Resected Lung Cancer

BackgroundPostoperative nosocomial pneumonia is a common immediate complication following lung resection. However, the incidence and mortality of pneumonia developing after discharge (PDAD) for lung-resected patients during long-term observation remain unclear. The aim of this study was to investigate the clinical features of PDAD in patients with resected lung cancer.MethodsWe conducted a retrospective cohort study of 357 consecutive patients with lung cancer who had undergone lung resection at a single institution, between April 2007 and December 2016. The clinical characteristics, pathological features, and overall survival were analyzed. Propensity score matched analysis was used for the evaluation of overall survival between PDAD and non-PDAD groups with adjusted relevant confounding factors.ResultsPDAD was observed in 66 patients (18.5%). The cumulative incidence of PDAD was 14.9% at 3 years and 21.6% at 5 years. Mortality of PDAD was 30.3%. Multivariate analysis demonstrated that the risk factors for PDAD were age (OR 1.07; P = 0.005), oral steroid use (OR 5.62; P = 0.046), and lower-lobe resection (OR 1.87; P = 0.034). After propensity score matching, 52 patients with PDAD and 52 patients without it were compared. The incidence of PDAD resulted in a worse 5-year overall survival (56.1 vs. 69.3%; P = 0.024). The Cox proportional hazards model indicated that PDAD was associated with poor overall survival (HR 1.99, P = 0.027).ConclusionsOur findings revealed a high incidence and mortality of PDAD among patients who had undergone lung resection with long-term follow-up. Therefore, PDAD could be associated with poorer overall survival.

Resection of synchronous bilateral multiple lung adenocarcinomas using virtual-assisted lung mapping

BackgroundVirtual-assisted lung mapping (VAL-MAP) is a novel marking technique to assist sub-lobar resection of small hardly palpable lung tumors. Here, we present the first case of synchronous bilateral multiple lung adenocarcinomas that were successfully resected with VAL-MAP navigation.Case presentationA 73-year-old female with multiple nodules (1 in the right upper lobe, 2 in the right lower lobe, 1 in the left upper lobe, and 1 in the left lower lobe) was referred. Complete resection was achieved with left lower lobectomy in combination with sub-lobar resections (wedge resection for a lesion in the left upper lobe, segmentectomy for a lesion in the right upper lobe, and complex segmentectomy for lesions in the right lower lobe) in which resection lines with securing adequate margins were determined with VAL-MAP navigation.ConclusionsVAL-MAP is useful in sub-lobar resections including complex segmentectomy for multiple lung adenocarcinomas.

Virtual-assisted lung mapping (VAL-MAP) shortened surgical time of wedge resection

Background The detection of extremely small lung tumors has increased with the development of computed tomography. Resection of such tumors by thoracoscopy is often hindered due to the unclear location of the tumor. Various methods of preoperative determination of such lesions have been attempted, but without marked success. Here we used virtual-assisted lung mapping (VAL-MAP) to perform surgical resection of small lung lesions. Methods We selected patients with pulmonary tumors that we anticipated to be difficult to identify during thoracoscopy and/or decide the resection line for sub-lobar lung resection. The wedge resections in the VAL-MAP group were compared to a group of patients who underwent wedge resection without VAL-MAP in 2013. Results Surgery duration was significantly shorter in the VAL-MAP group (average: 76.4 min) than in the 2013 group (average: 108.6 min; P=0.000451), although the VAL-MAP group (average major axis: 9.6 mm) had smaller tumors (P=0.000032) and more pure ground-glass opacities (GGOs) (P=0.0000919) than the 2013 group (average major axis: 16.6 mm). Conclusions The findings of this study indicate that VAL-MAP is efficacious. In particular, VAL-MAP resulted in a shorter surgery duration and has expanded the indications of resectable lesions.

Impact of the favorable prognosis of patients with lung cancer adjoining bullae

Background Lung cancer adjoining bullae (LC-AB) is an uncommon manifestation. The clinical characteristics and prognosis of LC-AB remain unclear. The aim of this study is to investigate the clinical features and overall survival (OS) of patients with LC-AB following lung resection compared to non-LC-AB group. Methods We retrospectively investigated 291 consecutive patients with lung cancer who underwent curative resection in a single institution between April 2007 and March 2015. A total of LC-AB was 52 patients. LC-AB was determined using thin slice computed tomography (CT) imaging and pathological findings. Survival analysis was calculated using the Kaplan-Meier method. We used a Cox proportional hazards model for the univariate and multivariate analysis to identify prognostic factors. Results The LC-AB group showed a higher frequency of younger patients (P=0.017), former or current smokers (P=0.011), men (P=0.021), tumor location in the upper lobe (P=0.031), moderately or poorly differentiated tumor histology (P<0.001), pleural indentation (P=0.007), and non-adenocarcinoma histology (P=0.016) than the non-LC-AB group. The 5-year survival and recurrence-free survival (RFS) rates were significantly higher in the LC-AB group than the non-LC-AB group (88.5% vs. 74.9%, P=0.010, 75.4% vs. 61.3%, P=0.030, respectively). Multivariate analysis using a Cox proportional hazard model of OS showed that LC-AB was an independent prognostic factor [hazard ratio (HR): 0.30, 95% confidence interval (CI): 0.12-0.77, P=0.012]. Conclusions Patients with LC-AB had better OS than those with non-LC-AB. Thus, LC-AB may be an independent favorable prognostic factor following curative resection.

Extremely Didactic Experience About the Postoperative Recurrence of Lung Cancer: a Case Report

We often encounter the postoperative recurrence of lung cancer. It is generally diagnosed based on the clinical course and the results of imaging studies, such as computed tomography (CT) and positron emission tomography (PET). The organization diagnosis is often not done. We present the case of a patient who was treated for the postoperative recurrence of lung cancer that was later proven by biopsy to be a second lung cancer. It is possible that cases of a second cancer, like ours, are overlooked because they are incorrectly classified as postoperative recurrences of lung cancer based on the clinical course and imaging findings. However, when we encounter a case of suspected postoperative recurrence, we should also consider that it could be a second lung cancer.