Yusuke Nabe

Successful surgical treatment with tracheal resection for a symptomatic vascular ring in an adult

Vascular rings are congenital anomalies of the aortic arch, which may cause compression of the trachea and esophagus. Compression symptoms usually present in infants and children. Adult presentations are quite rare, and compression symptoms may not be relieved by surgical correction due to tracheal remodeling and malacia caused by a long-standing compression. Here, we present an adult case of symptomatic vascular ring formed by the right aortic arch and persistent left ligamentum arteriosus. Respiratory symptoms were predominantly due to severe tracheal stenosis caused by tracheal wall thickening through remodeling during long-standing compression, and were relieved by surgery with transection of the persistent followed by resection and reconstruction of the trachea.

Squamous cell carcinoma transformation from adenocarcinoma as an acquired resistance after the EGFR TKI therapy in (EGFR-mutated) non-small cell lung cancer

Lung cancer remains the leading cause of cancer mortality worldwide. The incidence of recurrence or distant metastasis after complete resection of primary tumors is reported to be 37%, even in patients with stage I non-small cell lung carcinoma (NSCLC) (1).

Outcomes of patients undergoing surgery for thymic carcinoma: a single-center experience

Background Thymic carcinoma is uncommon, presents locally at an advanced stage, and behaves aggressively. The optimum treatment for advanced thymic carcinoma is controversial. We retrospectively reviewed our institutional experience with patients with thymic carcinoma. Methods We analyzed the clinical data of six patients who underwent total thymectomy for thymic carcinoma at our institution from 2006 to 2016. Variables analyzed included sex, age, histological classification, Masaoka staging, postoperative treatment, and recurrence. Results The clinical characteristics of the six patients with thymic carcinoma (median age, 56 years; five men and one woman) were as follows: squamous cell carcinoma (n=5); sarcomatoid carcinoma (n=1); Masaoka stages II (n=1), III (n=2), IVa (n=1), and IVb (n=2). Four patients underwent combined pulmonary resection (66.7%) as a component of en bloc resection due to suspicion of pulmonary invasion. Four patients (66.7%) received postoperative therapy, and complete resection was achieved for four patients. There were no perioperative deaths. One patient experienced a recurrence. Conclusions Complete resection for thymic cancer improved the prognosis of our patients, indicating that robust studies will be required to confirm our findings.

Extremely Didactic Experience About the Postoperative Recurrence of Lung Cancer: a Case Report

We often encounter the postoperative recurrence of lung cancer. It is generally diagnosed based on the clinical course and the results of imaging studies, such as computed tomography (CT) and positron emission tomography (PET). The organization diagnosis is often not done. We present the case of a patient who was treated for the postoperative recurrence of lung cancer that was later proven by biopsy to be a second lung cancer. It is possible that cases of a second cancer, like ours, are overlooked because they are incorrectly classified as postoperative recurrences of lung cancer based on the clinical course and imaging findings. However, when we encounter a case of suspected postoperative recurrence, we should also consider that it could be a second lung cancer.

Complete Resection of an Anterior Mediastinal Tumor by Total Arch Replacement and Pulmonary Artery Trunk Pasty with a Pericardial Patch: A case report

Introduction Patients with undiagnosed anterior mediastinal tumors commonly undergo surgery for diagnosis and treatment. However, determining the optimal therapeutic strategy is difficult for tumors with substantial invasion, such as lesions touching the aortic arch (AA). Case presentation A 76-year-old man of Asian descent presented to our hospital because chest computed tomography (CT) revealed an anterior mediastinal tumor. This tumor surrounded the left subclavian vein and touched the AA. We suspected the tumor to be malignant. We therefore decided to resect the tumor with preparation for total arch replacement (TAR). The operation was performed in three steps. First, we performed a mediastinal sternotomy. However, the tumor had invaded the subclavian vein, so we resected this vein after adding a transmanubrial approach. However, because of invading the AA we needed next step. Second, we shifted the patient to the right lateral decubitus position. We performed partial resection of the left upper lobe and exfoliated the distal AA. Third, we shifted the patient to the dorsal position and implanted an artificial cardiopulmonary device, after which we performed TAR, and pulmonary artery (PA) trunk plasty with a pericardial patch. The operation was successful, with no major adverse events. Pathologically, the tumor was diagnosed as diffuse large B-cell lymphoma. Discussion If oncologically complete resection is preferable for tumors with substantial invasion, complete resection should be attempted even if the surgery is difficult. Conclusion We performed complete resection of an anterior mediastinal tumor with TAR and PA trunk plasty using a pericardial patch.

Successful lung-sparing resection of synchronous pleural mesothelioma and contralateral lung cancer

BackgroundMalignant pleural mesothelioma (MPM) is an uncommon malignant tumor, and its synchronous occurrence with primary lung cancer is extremely rare. Here, we report the first surgical case of synchronous MPM and contralateral lung adenocarcinoma. Extrapleural pneumonectomy (EPP) combined with surgery for contralateral lung cancer may not be tolerated, and a lung-sparing procedure including pleurectomy/decortication (P/D) can be an alternative to achieve complete resection.Case presentationA 69-year-old male with right MPM and lung adenocarcinoma in the left upper lobe presented. Two lesions were judged to be synchronous MPM and lung cancer that were both potentially resectable clinical stage I diseases, and complete resection of both tumors was successfully achieved with right P/D following left upper division segmentectomy.ConclusionsP/D, not EPP, is a less invasive surgical procedure for MPM with curative intent and can be performed in combination with contralateral lung resection.

Mediastinal Tracheostoma for Treatment of Tracheostenosis after Tracheostomy in a Patient with Mucopolysaccharidosis-Induced Tracheomalacia

Background Treatment of tracheostenosis after tracheostomy in pediatric patients is often difficult. Mucopolysaccharidosis is a lysosomal storage disease that may induce obstruction of the airways. Case Presentation A 16-year-old male patient underwent long-term follow-up after postnatal diagnosis of type II mucopolysaccharidosis. At 11 years of age, tracheostomy was performed for mucopolysaccharidosis-induced laryngeal stenosis. One week prior to presentation, he was admitted to another hospital on an emergency basis for major dyspnea. He was diagnosed with tracheostenosis caused by granulation. The patient was then referred to our institution. The peripheral view of his airway was difficult because of mucopolysaccharidosis-induced tracheomalacia. For airway management, a mediastinal tracheostoma was created with extracorporeal membrane oxygenation. To maintain the blood flow, the skin incision for the mediastinal tracheal hole was sharply cut without an electrotome. The postoperative course was uneventful, and the patient was weaned from the ventilator on postoperative day 19. He was discharged 1.5 months postoperatively. Although he was referred to another institution because of respiratory failure caused by his primary disease 6 months postoperatively, his airway management remained successful for 1.5 years postoperatively. Conclusion Mediastinal tracheostomy was useful for treatment of tracheostenosis caused by granulation tissue formation after a tracheostomy.