T.F. Chen-Yoshikawa

Second malignancy versus recurrence after complete resection of thymoma

Background Patients undergoing complete resection of thymoma occasionally develop a recurrence of thymoma; they are also at risk of developing a second malignancy. The objective of our study was to compare the incidence and mortality of a second malignancy versus a recurrence of thymoma during the postoperative follow-up period after complete resection of thymoma. Methods A retrospective chart review was performed on our prospectively maintained database to identify patients undergoing complete resection of thymoma at our institution between 1991 and 2016. The incidence and related mortality of a second malignancy or recurrence of thymoma were recorded. Results One hundred and sixty-four patients were identified. Follow-up ranged from 1 to 239 months (median 54 months). During follow-up, 12 patients had a recurrence of thymoma and 14 developed a second malignancy. The mean risk ratio of recurrence to second malignancy was 0.58 (95% confidence interval: 0.48–0.69) at 5 years, 0.58 (95% confidence interval: 0.49–0.68) at 10 years, and 0.51 (95% confidence interval: 0.43–0.60) at 15 years. The mean risk ratio of recurrence versus second malignancy for related death was 0.59 (95% confidence interval: 0.50–0.70) at 5 years and 0.61 (95% confidence interval: 0.52–0.72) at 10 years. Conclusion It appears that patients undergoing complete resection of thymoma have a higher incidence of a second malignancy and a greater related mortality rate than a recurrence of thymoma. A multiinstitutional database is required to more rigorously evaluate both risks and to confirm our results.

Salvage video-assisted thoracoscopic lobectomy for isolated local relapse after stereotactic body radiotherapy for early stage non-small cell lung cancer: technical aspects and perioperative management

Limited data is available on salvage surgery for local relapse (LR) after stereotactic body radiotherapy (SBRT) for non-small cell lung cancer (NSCLC). We aimed to characterize treatment options and clarify long-term outcomes of isolated LR after SBRT for patients with clinical stage I NSCLC. Herein, we discuss technical aspects, perioperative management, and postoperative follow-up of two patients of the 12 patients undergoing salvage surgery for LR after SBRT at Kyoto University between 1999 and 2013. A 76-year-old male, 15 months after SBRT, underwent a salvage right upper lobectomy combined with adjacent right lower lobe wedge resection via video-assisted thoracoscopic surgery (VATS) for a 5.0-cm mass. Local recurrence was found 5 years after salvage surgery and treated with repeat SBRT, however he died from multiple distant metastases. An 85-year-old male, 14 months after SBRT, underwent a salvage left upper lobectomy via VATS for a 3.5-cm mass. Moderate intrapleural adhesion was noted and required careful dissection on the mediastinum. He is alive with no recurrence at 2 years from salvage surgery. Salvage VATS lobectomy was feasible after SBRT in two patients. Long-term follow-up and continued discussions at multidisciplinary conferences are required.

Salvage Pulmonary Metastasectomy for Local Relapse After Stereotactic Body Radiotherapy

Although several studies have evaluated the local control and survival outcomes in patients undergoing stereotactic body radiotherapy (SBRT) for pulmonary oligometastases, little data are available on the management of local relapse. Here, we present 3 patients who underwent lobectomy and mediastinal lymph node dissection as salvage pulmonary metastasectomy for local relapse after SBRT. The postoperative course has been uneventful for all 3 patients, with no evidence of disease at 40, 51, and 6 months from the salvage metastasectomy. Our experience suggests that salvage pulmonary metastasectomy may be associated with local control and long-term survival in carefully selected patients.

Protective Effect of a Hydrogen-Rich Preservation Solution During Cold Ischemia in Rat Lung Transplantation

・Anesthesia: pentobarbital 120mg/kg i.p. ・Ventilation setting: (O2 100%, Tidal volume (VT) 7ml/kg, RR 70/minutes, PEEP 2cmH2O) ・Preservation solution (perfadexR) flushed through the main pulmonary artery with 20 mL ・In the hydrogen group, hydrogen added to the preservation solution more than 1 ppm using hydrogen generation agent “水素水7.0 aquela”. ・Orthotopic left lung transplantation using cuff technic.

Thoracoscopic rebiopsy to detect the T790M mutation after postoperative recurrence

After pulmonary resection for non-small-cell lung cancer, some patients with postoperative recurrence and mutated epidermal growth factor receptor (EGFR) subsequently receive EGFR-tyrosine kinase inhibitors (EGFR-TKIs). Osimertinib may be efficacious if those patients become resistant to the 1st-line EGFR-TKI because of the T790M mutation. We recently performed thoracoscopic rebiopsy to detect the T790M mutation in 4 patients who became resistant to the 1st-line EGFR-TKI treatment for postoperative recurrence. Our limited experience suggests that thoracoscopic biopsy is associated with limited morbidity, can help detect the T790M mutation and may improve the management of select patients with acquired resistance to the 1st-line EGFR-TKIs.