Yoshinori Nagamatsu

Surgical treatment for patients with pulmonary metastases after resection of primary colorectal carcinoma.

Background. The optimum treatment for patients with pulmonary metastases from colorectal carcinoma is still controversial.

Preoperative spirometry versus expired gas analysis during exercise testing as predictors of cardiopulmonary complications after lung resection.

PurposeAs cardiopulmonary load increases with the amount of lung resected, to perform surgery safely it is important to be able to predict cardiopulmonary insufficiency. However, lung function testing with spirometry and blood gas analysis does not accurately measure cardiopulmonary reserve. We conducted this study to evaluate expired gas analysis during exercise testing for predicting postoperative complications after lung resection.MethodsExpired gas analysis during exercise and spirometry were done 1 week preoperatively in 211 patients who underwent pulmonary resection for lung cancer. Patients were divided postoperatively according to whether cardiopulmonary complications were absent (group A) or present (group B).ResultsIn group B there were more men than women (P < 0.01), and the mean age was greater (P < 0.05). There was no difference in disease stage, but more patients underwent pneumonectomy in group B than in group A (P < 0.005). The results of expired gas analysis during exercise testing and of spirometry showed that maximum oxygen uptake/m2 (P < 0.0005), anaerobic threshold/m2 (P < 0.01), vital capacity (VC)/m2 (P < 0.005), %VC (P < 0.0001), forced expiratory volume in 1 s (FEV1.0)/m2 (P < 0.0001), and FEV1.0% (P < 0.05) were lower in group B than in group A.ConclusionsThe combination of expired gas analysis during exercise and conventional pulmonary function tests identified patients at risk for postoperative cardiopulmonary complications following pulmonary resection.

Left partial anomalous pulmonary venous connection found during a lobectomy for lung cancer : report of a case

We report herein the case of a 68-year-old man in whom a partial anomalous pulmonary venous connection (PAPVC) was found during an operation for primary lung cancer. The preoperative clinical findings did not suggest a vascular shunt, and intraoperatively the anomalous vein was seen to drain only from the left upper lobe into the left innominate vein. The lower pulmonary vein connected normally, and there was no atrial septal defect nor any other anomalous condition. A left upper lobectomy with ligation of the anomalous connected vein was performed uneventfully. This type of PAPVC is extremely rare, and is especially noteworthy because there were no clinical signs.

Selection of Pulmonary Resection Procedures to Reduce Postoperative Complications in 200 Patients

PurposeWe previously demonstrated in a pilot study that postoperative cardiopulmonary complications could be reduced by selecting pulmonary resection procedures based on the results of a combination of specific preoperative cardiopulmonary function tests. The present study reports a re-examination of the criteria for preoperative screening and prospectively assessed whether the selected surgical procedures were appropriate in 200 patients who underwent the planned extent of pulmonary resection.MethodsIn 200 patients requiring lung tumor resection, five preoperative parameters (forced expiratory volume in 1 s on the intact side, maximal oxygen uptake, ejection fraction, occluded pulmonary artery pressure, and occluded total pulmonary vascular resistance index) were used to assign each patient to one of five risk categories in order to select the optimal resection procedure. Thereafter, the postoperative course was investigated to determine the value of this selection method.ResultsThoracotomy was performed in 195 of the 200 patients (97.5%). Two patients (1%) died; one patient succumbed to acute exacerbation of interstitial pneumonia and the other patient died from pulmonary embolism. Six patients (3.1%) developed major complications after surgery and 12 patients (6.2%) had mild complications, while 175 (89.7%) showed a good postoperative course.ConclusionThe use of five preoperative parameters to select the pulmonary resection procedure minimized postoperative death and major complications.

Factors Related to an Early Restoration of Exercise Capacity After Major Lung Resection

PurposeWe attempted to identify the factors related to an early restoration of the exercise capacity after lung resection.MethodsMajor lung resection was performed in 164 patients. Exercise testing and spirometry were performed before surgery, and 2 weeks and 1 month afterward. During exercise, the maximum oxygen uptake per minute per m2 of body surface area (V̇o2max/m2) was measured. The percent change of V̇o2max/m2 at 2 weeks and 1 month after surgery was calculated by setting the preoperative V̇o2max/m2 value as 100%. Patients were then assigned to the early restoration group or late restoration group according to their V̇o2max/m2 measured 2 weeks after surgery. Preoperative cardiopulmonary function, as well as various preoperative and intraoperative factors were compared between the two groups.ResultsAt 2 weeks after surgery, the mean V̇o2max/m2 was 80.9% compared with that before surgery, and was 88.1% at 1 month. A multivariate analysis showed that the surgical method used (thoracotomy and mediastinal lymph node dissection) had a significant effect on the postoperative restoration of the V̇o2max/m2.ConclusionAn early restoration of exercise capacity after lung resection is possible in patients without mediastinal lymph node dissection and in those who have a small thoracotomy wound.

Selection of Pulmonary Resection Procedures to Avoid Postoperative Complications

PurposeWe previously found a potential predictive value in a retrospective analysis of spirometry and an expired gas analysis during the exercise. We sought to reduce postoperative cardiopulmonary complications by selecting lung tumor resection procedures based on a combination of specific preoperative cardiopulmonary function test results.MethodsOut of the 53 patients requiring a lung tumor resection, five preoperative parameters (forced expiratory volume in 1 s for intact-side, maximal oxygen uptake, ejection fraction, occluded pulmonary artery pressure, and occluded total pulmonary vascular resistant index) were used to assign patients to one of five risk categories in order to select the optimal pulmonary resection procedure. The patients were later grouped according to their postoperative course to test the value of this procedure selection method.ResultsNo patient died or developed severe complications after surgery. Five patients had mild complications, while 46 had a good postoperative course; the 13 deaths, in the cancer cases, included 11 from primary or metastatic cancer and 2 from other causes. The overall five-year survival was 61.4%.ConclusionThis method for determining a pulmonary resection procedure avoided postoperative deaths and severe cardiopulmonary complications, while achieving a good outcome.

Expired gas analysis during exercise testing pre-pneumonectomy.

PurposeExpired gas analysis has enabled the successful prediction of postoperative complications in patients undergoing thoracic esophagectomy. We conducted this study to determine whether preoperative expired gas analysis during exercise testing can help identify patients at high risk of postoperative complications after pneumonectomy.MethodsWe measured the vital capacity, percent vital capacity, forced expiratory volume in 1.0 s, percent forced expiratory volume in 1.0 s, maximum oxygen uptake per minute, anaerobic threshold, arterial partial pressure of oxygen, and arterial partial pressure of carbon dioxide in 27 patients scheduled to undergo pneumonectomy. Group A consisted of 18 patients without postoperative cardiopulmonary complications and group B consisted of 9 patients with postoperative cardiopulmonary complications. We compared preoperative cardiopulmonary data between these two groups.ResultsPostoperative cardiopulmonary complications developed in 9 of the 27 patients (33.3%), 3 (11%) of whom died. The maximum oxygen uptake and the anaerobic threshold were significantly higher in group A than in group B (P < 0.05), whereas spirometric pulmonary function testing and arterial blood gas analysis showed no intergroup differences.ConclusionExpired gas analysis during exercise testing can help identify patients at high risk of postoperative cardiopulmonary complications after pneumonectomy.

Surgical treatment of lower rectal cancer with sphincter preservation using handsewn coloanal anastomosis.

The present study was designed to evaluate the technical feasibility and oncologic results of performing handsewn coloanal anastomosis (CAA). A total of 46 patients treated for lower rectal cancer using CAA were retrospectively studied, and the oncologic results were compared with those of 105 patients treated with abdominoperineal resection (APR). CAA was performed in patients who had both good mobility of the tumor and a distal clearance margin of more than 1.0 cm. No significant difference was noted in the mortality rates following the two operations (CAA 2.2% vs APR 1.9%). Pelvic recurrence was detected in two patients (4.5%) after CAA and in six patients (7.2%) after APR. The 5-year survival rate after CAA was 79.2% and that after APR was 72.6%. No significant difference was noted in the incidence of pelvic recurrence or the survival rates between the two operations. These results show that CAA could be an excellent reconstructive option in the treatment of lower rectal carcinoma for selected patients.

Dumbbell-shaped thoracic hibernoma: computed tomography and magnetic resonance imaging findings

Hibernoma is an uncommon, benign soft tissue tumor that arises in brown adipose tissue. The computed tomography (CT) and magnetic resonance imaging (MRI) findings of hibernomas are similar to those of well-differentiated liposarcoma or angiolipoma. We report the unique appearance of a rare thoracic wall hibernoma, which appeared as a dumbbell-shaped lipomatous tumor across an intercostal region. A dynamic contrast-enhanced study on MRI revealed early enhancement, which corresponded to the branching low-signal intensity on T2-weighted images of the mass.

A case of resected synchronous multiple primary lung cancer comprising adenocarcinoma and carcinoid (cancer-in-cancer)

We performed surgical resection of synchronous multiple primary lung cancer, comprising adenocarcinoma and carcinoid components. The latter tumor was located within the central scar tissue formed by the adenocarcinoma (cancer-in-cancer). The patient was a 67-year-old Japanese woman who had a nodular lesion in the right S1 on chest computed tomography. Lung cancer was diagnosed intraoperatively by rapid needle aspiration cytology, and right upper lobectomy with mediastinal lymph node dissection was performed. Histological examination of the resected specimen revealed cancer-in-cancer, consisting of adenocarcinoma and a carcinoid tumor. The carcinoid component was localized within the central fibrous scar of the dominant adenocarcinoma component.