Tatsuo Furuya

Risk Stratification According to the Prognostic Nutritional Index for Predicting Postoperative Complications After Lung Cancer Surgery

BackgroundThe prognostic nutritional index (PNI), an immune nutritional marker based on serum albumin levels and total lymphocyte count, predicts postoperative complications in various types of malignancies. However, the clinical significance of the PNI for postoperative complications following lung cancer surgery is uncertain.MethodsPatients with resected non-small cell lung cancer (nxa0=xa0515) were retrospectively analyzed and the relationship between the preoperative PNI and postoperative complications was evaluated.ResultsMultivariate logistic regression analysis revealed that a preoperative low PNI was a significant independent predictor of postoperative complications of Clavien–Dindo Gradexa0≥xa0II (odds ratio: 1.06 per unit decrease, 95.0% confidence interval 1.01–1.11). Patients were divided into three groups according to the preoperative PNI: normal (≥xa050; nxa0=xa0324), mildly low (<xa050,xa0≥xa045; nxa0=xa0134), and severely low (<xa045; nxa0=xa057). The incidence of postoperative complications of Gradexa0≥xa0II and Gradexa0≥xa0III in the normal, mildly low, and severely low PNI groups was 22.2, 39.6, and 42.1% and 7.1, 16.4, and 22.8%, respectively. The incidence of postoperative complications of Gradexa0≥xa0II and Gradexa0≥xa0III was significantly higher in the mildly low and severely low PNI groups than in the normal PNI group (pxa0<xa00.001 and pxa0<xa00.001, respectively). The incidence of air leak, pneumonia, and extrapulmonary infection, but not arrhythmia, was significantly higher in the mildly low and severely low PNI groups than in the normal PNI group.ConclusionsThe PNI could be a useful marker to predict the risk of postoperative complications after lung cancer surgery.

Spontaneous Regression of Primary Pulmonary Synovial Sarcoma

We report a rare case of primary pulmonary synovial sarcoma that underwent spontaneous regression after a transbronchial biopsy. A 38-year-old woman with a well-demarcated solitary mass shadow on chest roentgenogram was referred to us. A transbronchial biopsy was performed, and immunohistochemical results as well as detection of SYT-SSX1 (SYnovial sarcoma Translocation-Synovial Sarcoma X chromosome breakpoint) transcripts resulted in a diagnosis of synovial sarcoma. A right lower lobectomy was performed during video-assisted thoracoscopic surgery. Pathologic examination revealed widespread coagulative necrosis with feeding arterioles occluded by organized thrombi. To our knowledge, this is the first report of a case of spontaneous regression of primary pulmonary synovial sarcoma.

Clinical application of postoperative non-invasive positive pressure ventilation after lung cancer surgery

ObjectiveThe purpose of this study was to clarify the clinical efficacy of postoperative non-invasive positive pressure ventilation (PONIV) after pulmonary lobectomy in patients with lung cancer.MethodsFrom August 2010 and July 2015, 143 patients with lung cancer who underwent pulmonary lobectomy were retrospectively reviewed. PONIV was used immediately after surgery until the morning of postoperative day (POD) 1. Arterial blood gas was analyzed before and just after surgery (POD0) and on POD1. Oxygenation ability was perioperatively assessed by PaO2/FiO2 ratio, alveolar–arterial oxygen difference (A-aDO2), and respiratory index (A-aDO2/PaO2).Results112 patients received PONIV. From POD0 to POD1, the PaO2/FiO2 ratio significantly improved in all patients who received PONIV (333u2009±u200983 to 359u2009±u200947xa0mmHg, pu2009=u20090.004). Moreover, A-aDO2 and respiratory index significantly decreased following PONIV. PONIV significantly improved the PaO2/FiO2 ratio in patients with PaO2/FiO2 ratio of ≤u2009300 on POD0, older age (≥u200970xa0years), higher body mass index (≥u200925xa0kg/m2), and longer one-lung ventilation time (≥u2009180xa0min). There was no respiratory failure requiring mechanical ventilation and no mortality.ConclusionsPONIV effectively improved oxygenation in patients undergoing pulmonary lobectomy in patients with poor status, especially in patients with PaO2/FiO2 ratio of ≤u2009300 on POD0. PONIV could be an option of perioperative management for major thoracic surgery.

Microthymoma and microscopic thymomas associated with a thymic cyst without solid component

A 75-year-old asymptomatic man presented with an anterior mediastinal cyst without a solid component on computed tomography. Pathologic examination of the specimens obtained by thoracoscopic resection showed a thymic cyst with a 1.6-mm type A microthymoma in the surrounding thymic tissue. In addition, there were multiple hyperplastic nodules smaller than 1xa0mm histologically corresponded to microscopic thymomas. The patient underwent completion thymectomy through median sternotomy; thereafter, there was no residual thymic neoplasm detected. This was the first case report of a type A microthymoma. Microthymoma or microscopic thymoma could be present concomitantly with a thymic cyst without a solid component.

Surgical outcome of wide wedge resection in poor-risk patients with clinical-N0 non-small cell lung cancer

ObjectiveSublobar resection is practically indicated in poor-risk patients compromised cardiopulmonary reserve or for small ground-glass opacity-dominant adenocarcinomas. The aim of this study was to clarify the surgical outcomes of wide wedge resection in poor-risk patients with clinical-N0 non-small cell lung cancers.MethodsSixty-two poor-risk patients, who underwent wedge resection for clinical-N0 lung cancer, were retrospectively reviewed. We defined the ratio of the maximum diameter of the consolidation to the maximum tumour diameter as the consolidation-to-tumour ratio using high-resolution computed tomography.ResultsThe 5-year overall, recurrence-free, and lung cancer specific survivals of all patients were 56.4, 46.6, and 81.1%, respectively, while other malignancies were frequently found as causes of death. Overall and recurrence-free survivals were favourable in patients with tumour size ≤3xa0cm, consolidation-to-tumour ratio ≤0.50, solid tumour size ≤1.2xa0cm, carcinoembryonic antigen level <5.0xa0ng/mL and adenocarcinoma. Multivariate Cox proportional hazard model revealed that solid tumour size ≤1.2xa0cm and consolidation-to-tumour ratio ≤0.50 were independent prognostic factors. CT-guided lipiodol marking was applied in 20 patients to identify the tumour location had no recurrence.ConclusionsWide wedge resection could be radical treatment option in poor-risk patients with clinical-N0 non-small cell lung cancer, though careful follow-up might be necessary for other malignancies. Patients with solid tumour ≤1.2xa0cm or ground-glass-dominant lesion are good candidates for wedge resection. CT-guided lipiodol marking is a useful option to identify the location and safe surgical tumour margin in wedge resection.

Successful treatment with afatinib for pancreatic metastasis of lung adenocarcinoma: a case report

Metastatic lung cancer of the pancreas is rare and optimal treatment protocols have not been determined. An asymptomatic 53-year-old man with primary lung cancer underwent a right lower lobectomy and was diagnosed with acinar adenocarcinoma, pT2bN2M0 stage IIIA. An epidermal growth factor receptor (EGFR) mutation (exon 19 deletion L747-A750insP) was detected in the primary tumor. Adjuvant platinum-based chemotherapy was administered. The patients serum carcinoembryonic antigen (CEA) level had increased to 38.6 ng/mL 32 months after surgery, and positron emission tomography-computed tomography (PET-CT) revealed a 2.5-cm, hypermetabolic nodule in the pancreatic body. Using endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA), the nodule was pathologically diagnosed as a pancreatic metastasis of lung adenocarcinoma. The EGFR status of the pancreatic metastasis was confirmed to be the same as that of the primary lung tumor. The patient started afatinib therapy and his serum CEA level immediately decreased and remained at approximately the reference limit. On a follow-up PET-CT scan after 10 months of treatment with afatinib, the metastatic nodule in the pancreas had disappeared and no accumulation of fluorine-18-deoxyglucose (FDG) was detected. To the best of our knowledge, this is the first reported case of a complete response of pancreatic metastatic lung adenocarcinoma to EGFR-tyrosine kinase inhibitors (TKIs).