Tatsuhiko Hirono

Pulmonary complications after surgical treatment of lung cancer in octogenarians

OBJECTIVE The purpose of this study was to analyze the risks associated with pulmonary resection for primary non-small cell lung cancer in octogenarians to help better management in these patients. METHODS We reviewed the outcome in our 35 patients aged 80 years and older who underwent pulmonary resection between 1981 and 1998. RESULTS The 5-year survival rate was 39.8%. The operative mortality rate was 0% and the morbidity 60%. There were ten major pulmonary complications, including respiratory insufficiency following bacterial pneumonia and sputum retention. Preoperative arterial pO(2) was significantly lower, A-aDO(2) was significantly higher, and operation time were significantly longer in patients with pulmonary complications after surgical treatment than in patients without complications (P<0.05). CONCLUSIONS Surgical treatment was not contraindicated for octogenarians with lung cancer. However, a relatively preoperative low arterial pO(2), high A-aDO(2), and long operation time may be risk factors for postoperative pulmonary complications in such patients. Surgeons must assess the preoperative data prudently to determine appropriate surgical strategy.

Surgical strategy for clinical stage I non-small cell lung cancer in octogenarians

OBJECTIVE The purpose of this study was to determine whether lobectomy without radical systematic mediastinal lymphadenectomy (LA) is a satisfactory alternative surgical treatment for octogenarians with clinical stage I non-small cell lung cancer (NSCLC). METHODS From April 1985 through December 2001, 49 patients aged 80 years and older who underwent surgical treatment for clinical stage I NSCLC were reviewed. Lobectomy without radical systematic mediastinal LA was performed for 27 patients (LA0 group) and lobectomy with radical systematic mediastinal LA was performed for 22 patients (LA group). RESULTS The mortality rate was 0% in the LA0 group and 4.5% in the LA group. Five-year survival rate according to the type of surgery was 44.8% in the LA0 group and 55.5% in the LA group, a difference that was not significant (P=0.88). Although there was no significant statistical difference, postoperative pulmonary complication was more frequent in the LA group than in the LA0 group (32% in the LA group versus 11% in the LA0 group P=0.07). Five-year survival rates according to serum carcinoembryonic antigen (CEA) levels were 0% for patients with elevated CEA levels (n=9) and 56.5% for patients with normal CEA levels (n=40) (P<0.01). CONCLUSION Lobectomy without radical systematic mediastinal LA appears to be a satisfactory surgical procedure for octogenarians with clinical stage I NSCLC. However, mediastinoscopy is necessary in such octogenarians if their serum CEA level is elevated so that the precise clinical stage can be determined and an accurate prognosis can be given.

Peripheral carcinoid tumor of the lung with focal melanin production

A case of carcinoid tumor of the lung with focal melanin production was encountered in a 56 year old Japanese woman. The tumor was found 16 years previously by mass survey chest X‐ray and had enlarged two‐fold in the intervening period. The tumor consisted of a variety of tumor cells showing a spindle, polygonal and pleomorphic appearance with abundant vasculature in the stroma. All tumor cells showed argyrophilia, together with a few showing argent‐affinity. Melanin‐containing tumor cells were also present in parts. Ultrastructurally, most tumor cells possessed various numbers of neurosecretory granules and a few of them contained granular type rnelanosomes. Tumor cells were connected with desmosomes and a few of them contained tonofilament‐like microfilaments. Only a few contained both neurosecretory granules and melanin. By immunohistochemistry, serotonin, metenkephalin and β‐endorphin positive cells were observed scattered throughout the tumor. A few tumor cells positive for tyrosine hydroxylase were also detected. Additionally, most tumor cells were positive for keratin. On the basis of these findings, the tumor of the current case is a pulmonary carcinoid tumor with focal melanin production.

Safety and prognosis of limited surgery for octogenarians with non-small-cell lung cancer

PurposeCurative lobectomy and systematic lymph node dissection for lung cancer in elderly patients are often associated with increased risk of postoperative morbidity and decreased quality of life. Conversely, avoiding surgery may mean not curing the cancer. We retrospectively examined data on surgery for octogenarians with clinical stage I non-small-cell lung cancer (NSCLC) to assess the safety and prognosis for patients who underwent radical or limited surgery.MethodsSubjects comprised 44 octogenarians who underwent surgery for clinical stage I NSCLC from 1996 to 2008. Preoperative co-morbidities, surgical procedures, postoperative morbidity, and prognoses were compared between radical and limited surgery.ResultsA total of 14 patients (32%) underwent complete lobectomy and systematic lymph node dissection (radical surgery), and 30 patients (68%) underwent segmentectomy or wedge resection or limited lymph node dissection (limited surgery). No significant differences in preoperative clinicopathological features were seen between groups except that significantly more clinical stage IA patients were in the limited surgery group than in the radical group. Surgical time was significantly shorter with limited surgery. Frequencies of postoperative morbidity and recurrence were similar for each type of surgery. Overall and disease-specific 5-year survival rates did not differ significantly between groups.ConclusionLimited surgery is less invasive and is associated with the same prognosis as radical surgery for octogenarians with NSCLC. Limited surgery for this cohort thus appears reasonable to prevent postoperative morbidity, particularly for patients with poor pulmonary reserve.

Pulmonary myxoid leiomyosarcoma

A primary myxoid leiomyosarcoma arising from the peripheral bronchus of the right middle lobe was removed from a 20 year old man and examined by immunohistochemistry and electron microscopy. The tumor was well circumscribed, yellow‐whitish focal polypoid growth into the bronchial lumen and consisted of spindle cells with abundant myxoid substance in the stroma. Intrapulmonary metastasis, invasion to the bronchial wall and a few mitotic figures were found. Immunohistochemically, several, but not all, tumor cells were positive against anti‐vimentin, anti‐S‐100 protein, anti‐myosin and anti‐muscle specific actin. Ultrastructurally, tumor cells had thin filaments with dense bodies, pinocytic vesicles and discontinuous basal lamina. These findings indicate a myoxoid variant of leiomyosarcoma arising from mesenchyme in the peribronchial area.

Peripheral lung carcinomas associated with central fibrosis and mixed small cell and other histologic components

Three cases of peripheral small cell lung carcinoma (SCLC) with central fibrosis are presented. Central fibrosis is usually present in adenocarcinomas. Cases 1 and 2 are combined SCLCs with components of papillary adenocar‐cinoma, and case 3 is a mixed SCLC with a large cell component. Small cell Components showed intermediate cell type in ail cases. In cases 1 and 2, there was a gradual transition between small cell carcinoma and papillary ade‐nocarcinoma. Small cell components showed Grimelius argyrophilia, but other neuroendocrine markers such as neuronspecific enorase, chromogranin A, Leu‐7 and syn‐aptophysln were negative. The chest X‐ray examination of case 1 demonstrated rapid enlargement of a tumor shadow, which was present two years before, for a recent year. Central fibrosis, coexistence of small cell carcinoma and papillary adenocarcinoma, and a change of growth rate in the chest x‐ray may suggest that some SCLC derive from papillary adenocarcinomas.

Congenital bronchial atresia with partial anomalous pulmonary venous return

A 35-year-old woman with a high fever had a cystic lesion of the right lung including fluid and air. She was diagnosed with an infected bronchial cyst caused by congenital bronchial atresia with partial anomalous pulmonary venous return. She underwent a right upper lobectomy successfully. Patients with congenital bronchial atresia often have recurrent pulmonary infections with various imaging findings. The aberrant vein may relate to interruption of the bronchus in a patient with partial anomalous pulmonary venous return. Although segmental resection is recommended for this benign disease, lobar resection may be unavoidable because of adhesions or destruction of adjacent segments.

Reviews of corrective surgery in 126 csses of tetralogy of Fallot

One hundred and twenty-six cases , 68 male and 58 female, with tetralogy of Fallot (TF) were operated upon in this period, and 19 patients were less than 5 years of age, 52 being between 6 and 10 years of age, 37 being between 11 and 15 years of age and 18 being older than 16 years of age (Table 1). The Blalock-Taussigs systemic-pulmonary-artery anastomosis had been previously performed in 39 patients who were distributed in all age groups. Almost a l l patients but 12 showed cyanosis at rest and/or i n exercise. Of 126 cases, 17 demonstrated hemoglobin-levels were below 15 g/100 mL, 69 from 15 to 18 g/ 100 ml. and 40 more than 18 g/100 ml., respectively (Table 2). In all patients, a median sternotomy was used. A disc oxygenator was u~ed for the first 75 cases, but since 1969, cardiopulmonary bypass has been accomplished with a disposable bubble oxygenator and roller pumps utilizing the hemodilution technique. Flow rate was usually about 2.2 L/Min/M 2 and mild hypothermia from 33 to 29 degrees centigrade was applied. A transverse or a longitudinal right ventriculotomy was used according to the anatomical findings on t h e right ventricular outflow-tract, described later, and the course of the right coronary artery branches. Infundibular stenosis was removed by division and resection of the hypertrophied muscles and dilatation of the pulmonary annulus with a Tubbs-type dilator. Valvular stenosis was routinely corrected through the ventriculotomy by careful commissurotomy: However, the patients with a small pulmonary annulus and/or a hypoplastic pulmonary trunk received various types of the outflow patch, including the small Teflon fabric patch, the small or large pericardial patch and the valve retaining homoor heterologous pulmonary artery patch 2 (Fig. 1). A large ventricular septal defect was closed with a Teflon fabric patch fixed by interrupted and buttressed mattress-sutures and a specially designed clamp 5 was

A Case Report of Bronchial Cyst adenoma Associated with Lung Cancer

気管支粘液腺腫は, 気管支腺由来の良性の腫瘍である.69歳女性, 右S5の扁平上皮癌に合併した右B3起始部の気管支粘液腺腫に対し, 右上中葉切除術と縦隔リンパ節郭清術を施行した.気管支粘液部は5×5×3.5mmで, 右中葉扁平上皮癌とは連続性を認めなかった.本報告は, 欧米の報告を含め18例目, 本邦では2例目の非常に稀な腫瘍であるので報告する.