Takayuki Shirakusa

Early-stage lung adenocarcinomas with a micropapillary pattern, a distinct pathologic marker for a significantly poor prognosis.

Adenocarcinomas with a micropapillary pattern (MPP), featuring small papillary tufts lacking a central fibrovascular core, are thought to have a poor prognosis. To examine whether the MPP is a predictor of prognosis, clinicopathologic characteristics of adenocarcinomas were analyzed with particular reference to survival of early-stage patients. The subjects were 344 consecutive patients (female/male ratio 163:181) for whom complete surgical resection was undertaken at the Cancer Institute Hospital, Japan, during 1986–1995. Histologically, they were divided into two groups: MPP-positive (n = 139; 40%) and MPP-negative (n = 205; 60%). The following items were significantly more frequent in the MPP-positive group: metastasis to lymph nodes (p <0.001), pleural invasion (p = 0.02), intrapulmonary metastasis (p <0.001), and nonsmoking status (p = 0.002). In stage I patients (i.e., without lymph node metastasis, n = 154), 5-year survival of the MPP-positive group (n = 45) was 79%, significantly lower than the MPP-negative group (n = 109) of 93% (p = 0.004). In many cases of the c-stage I MPP-positive group, upstaging was necessary on the basis of pathologic findings for metastases, and the survival was between stage I and stage II. Our study clearly indicated that the MPP is a distinct prognostic marker for lung adenocarcinoma, particularly regarding apparent stage I diseases.

Surgical treatment of lung cancer in the octogenarian

The purpose of this study was to investigate the value of surgical treatment for lung cancer in the octogenarian. Thirty-three patients 80 years of age or older (mean age, 82.4; range, 80 to 92 years; 25 men, 8 women) underwent surgical resection in our units between 1974 and 1991. The operative mortality rate was 3%, and the 5-year survival rate was 32%. The relative 5-year survival rate (survival rate of our subjects/that of matched population) was 61%. The mortality and long-term survival rates were similar to those in younger patients. In this study, long-term survival had no significant dependence on stage of disease, histologic tumor type, or complete versus incomplete resection. It was dependent mainly on postoperative complications, in particular, cardiorespiratory complications (cardiac complications, p = 0.0005; respiratory complications, p < 0.05). These data suggest that the octogenarian who suffers from lung cancer deserves the opportunity for a cure and the long-term benefits of surgical treatment, on the condition that no postoperative major cardiorespiratory complications set in.

Micropapillary pattern: a distinct pathological marker to subclassify tumours with a significantly poor prognosis within small peripheral lung adenocarcinoma (≤20 mm) with mixed bronchioloalveolar and invasive subtypes (Noguchi's type C tumours)

Aims:  A micropapillary pattern (MPP) in lung adenocarcinoma, characterized by papillary structures with epithelial tufts lacking a central fibrovascular core, has been reported to be a new pathological marker of poor prognosis. However, its clinicopathological and prognostic significance in small lung adenocarcinomas (≤20 mm) remains undetermined. A new histological classification of small lung adenocarcinoma proposed by Noguchi et al. has been found to be useful since it has defined surgically curable bronchioloalveolar carcinoma (BAC)‐type tumours (Noguchis type A and B) based on the absence of active fibroblastic proliferation. However, BAC‐type tumours with active fibroblastic proliferation (Noguchis type C), which is adenocarcinoma with mixed subtypes including BAC and invasive carcinoma in the new World Health Organization (WHO) classification, account for most of the small adenocarcinomas and represent a heterogeneous group ranging from minimal to overtly invasive cancer with variable prognoses. Therefore, in this study the aim was to investigate whether MPP can be an additional histological marker(s) to subclassify this heterogeneous group in small lung adenocarcinoma.

Video-assisted thoracoscopic esophagectomy for esophageal cancer

AbstractBackground: The Ivor-Lewis procedure is a radical, invasive, and effective procedure for the resection of most esophageal cancers. To minimize invasiveness, we performed thoracoscopic and video-assisted esophagectomy and mediastinal dissection for esophageal cancer. Methods: From November 1995 to June 1997, 23 patients with intrathoracic esophageal cancer, excluding T4 cancers, underwent thoracoscopic and video-assisted esophagectomy. Bilateral cervical dissections were performed as well as preparation of the gastric tube and transhiatal dissection of the lower esophagus. The cervical esophagus was cut using a stapler knife, and esophageal reconstruction was performed through the retrosternal route or anterior chest wall. Next, thoracoscopic mediastinal dissection and esophagectomy were performed. Results: The mean volume of blood loss was 163 ± 122 ml; mean thoracoscopic surgery duration, 111 ± 24 min; mean postoperative day for patients to start eating, 8 ± 3 days; and mean hospital stay, 26 ± 8 days. No patient developed systemic inflammatory response syndrome postoperatively. Tracheal injury occurred and was repaired during the thoracoscopic approach in one patient. No patients died within 30 days after surgery. Postoperative complications included transient recurrent nerve palsy in five patients, pulmonary secretion retention requiring tracheotomy in two, and chylothorax in one. Five patients died of cancer recurrence within 1 year of surgery. Conclusions: Our surgical experience with thoracoscopic and video-assisted esophagectomy indicate that it is a feasible and useful procedure.

Lymphomatous polyposis of the gastrointestinal tract, including mantle cell lymphoma, follicular lymphoma and mucosa-associated lymphoid tissue lymphoma

Aims:  Lymphomatous polyposis (LP) is considered to represent mantle cell lymphoma (MCL) of the gastrointestinal (GI) tract. However, a few reports have suggested that some are follicular lymphoma (FL) or mucosa‐associated lymphoid tissue (MALT) lymphomas. In this study, we analysed 35 patients and clarified the clinicopathological features of LP.

Results of resection for bronchogenic carcinoma in patients over the age of 80.

Thirty three patients aged over 80 years underwent resection for bronchogenic carcinoma. The operations performed were: lobectomy (21), segmentectomy (4), wedge resection (2), pneumonectomy (3), carinal resection (1). In two patients no resection was feasible. Three patients died within two months of surgery. The cumulative five year survival rate was 55%, 79% for patients with stage I carcinoma and 31% for stage III. It is considered that resection has an acceptable outcome in patients over 80 years.

Surgical treatment of pulmonary aspergilloma and Aspergillus empyema

Twenty-four patients, 16 male and 8 female, underwent a total of 35 operations for pulmonary aspergillosis. Intrapulmonary aspergilloma was detected in 19, and Aspergillus empyema was present in 5. The major operative procedures performed were pneumonectomy in 2 patients, lobectomy in 8, segmentectomy in 1, cavernostomy in 4, and open-window thoracostomy in 5. The surgical results in 5 patients 70 years old or older were excellent. Empyema developed postoperatively in 2 patients who had undergone wedge resection of the lung or segmentectomy. Although resection involving the minimum extent possible is desirable in the treatment of intrapulmonary aspergilloma so as not to decrease lung function, it is dangerous to perform a limited procedure in the case of aspergilloma with an invasive character. In patients in poor general condition, cavernostomy followed by muscle flap plombage is recommended. For Aspergillus empyema, the primary procedure was open-window thoracostomy followed by plombage using chest wall muscle or omentum. We consider omental flap plombage to be superior to thoracoplasty in some respects for mycotic empyema, especially because it is a less extensive surgical procedure.

The number of lymph node metastases influences survival in esophageal cancer

Background and Objectives: Lymph node involvement adversely affects the survival of patients with esophageal cancer. We retrospectively investigated whether the number of involved lymph nodes and the degree of lymph node dissection affect survival.

Omentopexy for tracheal autografts

An effective method of vascularization is required in tracheal transplantation, as tracheal vessels are too find to be anastomosed easily. A series of experiments, including postmortem injection study, were conducted to assess the usefulness of omentopexy for tracheal autografts in 17 dogs. In group I (n = 4) a six-ring tracheal autograft was implanted in the greater omentum for 28 days. The structural integrity of all the autografts was maintained. In group II (n = 3) a six-ring cervical trachea was excised and reimplanted as an autograft without omental wrapping. All three autografts dissolved or transformed. No neovascularity from the recipient trachea or surrounding tissue was seen in the autografts by postoperative day 11. In group III (n = 10) omentopexy was added to the same experiment as group II. All the autografts were nourished adequately by the omental circulation as demonstrated by injection study, and remained viable early after transplantation. We conclude that the omentopexy is an effective method to facilitate neovascularization in tracheal autografts.

Sonodynamic therapy of cancer using a novel porphyrin derivative, DCPH-P-Na(I), which is devoid of photosensitivity.

To improve the efficacy of sonodynamic therapy of cancer using photosensitizers, we developed a novel porphyrin derivative designated DCPH‐P‐Na(I) and investigated its photochemical characteristics and sonotoxicity on tumor cells. DCPH‐P‐Na(I) exhibited a minimum fluorescent emission by excitation with light, compared with a strong emission from ATX‐70, which is known to reveal both photo‐ and sonotoxicity. According to this observation, when human tumor cells were exposed to light in the presence of DCPH‐P‐Na(I) in vitro, the least phototoxicity was observed, in contrast to the strong phototoxicity of ATX‐70. However, DCPH‐P‐Na(I) exhibited a potent sonotoxicity on tumor cells by irradiation with ultrasound in vitro. This sonotoxicity was reduced by the addition of L‐histidine, but not D‐mannitol, thus suggesting that singlet oxygen may be responsible for the sonotoxicity of DCPH‐P‐Na(I). DCPH‐P‐Na(I) demonstrated significant sonotoxicity against a variety of cancer cell lines derived from different tissues. In addition, in a mouse xenograft model, a potent growth inhibition of the tumor was observed using sonication after the administration of DCPH‐P‐Na(I) to the mouse. These results suggest that sonodynamic therapy with DCPH‐P‐Na(I) may therefore be a useful clinical treatment for cancers located deep in the human body without inducing skin sensitivity, which tends to be a major side‐effect of photosensitizers. (Cancer Sci 2007; 98: 916–920)