Publications by authors named "Masanori Shimomura"

25 Publications

  • Page 1 of 1

Negative-pressure wound therapy in combination with bronchial occlusion to treat bronchopleural fistula: a case report.

Surg Case Rep 2021 Mar 2;7(1):61. Epub 2021 Mar 2.

Department of General Thoracic Surgery, Ayabe City Hospital, 20-1 Otsuka, Aono-cho, Ayabe, Kyoto, 623-0011, Japan.

Background: Bronchopleural fistula, which usually accompanies bronchial fistula and empyema, is a severe complication of lung cancer surgery. Negative-pressure wound therapy can enhance drainage and reduce the empyema cavity, potentially leading to early recovery. This therapy is not currently indicated for bronchopleural fistulas because of the risk of insufficient respiration due to air loss from the fistula.

Case Presentation: A 73-year-old man, who was malnourished because of peritoneal dialysis, was referred to our hospital for the treatment of lung cancer. Right lower lobectomy with mediastinal lymph node dissection was performed via posterolateral thoracotomy, and the bronchial stump was covered with the intercostal muscle flap. His postoperative course was uneventful and he was discharged. However, he was readmitted to our hospital because of respiratory failure and diagnosed as having bronchopleural fistula on the basis of the bronchoscopic finding of a 10-mm hole at the membranous portion of the inlet of the remnant lower lobe bronchus. Thus, thoracotomy debridement and open window thoracostomy were immediately performed. After achieving infection control, bronchial occlusion was performed using fibrin glue and a polyglycolic acid sheet was inserted through a fenestrated wound. Bronchial fistula closure was observed on bronchoscopy; therefore, a negative-pressure wound therapy system was applied to close the fenestrated wound. The collapsed lung was re-expanded and the granulation tissue around the wound increased; therefore, thoracic cavity size decreased and thoracoplasty using the latissimus dorsi was performed.

Conclusions: This bronchopleural fistula was treated successfully after a right lower lobectomy using an extra-pleural bronchial occlusion and negative-pressure wound therapy.
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http://dx.doi.org/10.1186/s40792-021-01144-4DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7922724PMC
March 2021

[Surgical Strategy for Multiple Synchronous Primary Lung Cancer Showing Ground Glass Opacities:Percutaneous Preoperative Computed Tomography-guided Lipiodol Marking Followed by Video-assisted Thoracic Surgery].

Kyobu Geka 2021 Jan;74(1):4-8

Department of Thoracic Surgery, Kyoto Yamashiro Medical Center, Kizugawa, Japan.

From May 2006 to March 2018, a total of 30 patients with multiple ground glass opacities( GGO) lessor equal to 2.0 cm underwent percutaneous preoperative computed tomography (CT)-guided Lipiodolmarking and subsequent video-assisted thoracic surgery( VATS). There were 22 patients with 2 GGOs,6 patients with 3 GGOs, 1 patient with 4 GGOs, and 1 patient with 5 GGOs. Of the 71 CT-guided Lipiodolmarking procedures were successfully completed. All 71 Lipiodol spots were detected with C-armshapedfluoroscopy and completely resected. Pneumothorax was the most common complication andoccurred in 22 (73.3%) of 30 cases. There were severe complications in two (6.7%) cases of pneumothoraxrequiring chest tube placement and three( 10.0%) cases of bloody sputum. Of 30 cases multipleGGOs revealed 24 synchronous lung cancer (19 patients with double lung cancer, 3 patients with triplelung cancer, 1 patient with quadruple lung cancer, and 1 patient with quintuple lung cancer). PreoperativeCT-guided lipiodol marking and VATS resection is a safe and reliable method for synchronous multiplelung cancer showing GGO.
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January 2021

Extra-thoracic SVC bypass with venous return cannulas in malignant mediastinal tumor surgery.

Ann Thorac Surg 2021 Jan 19. Epub 2021 Jan 19.

Division of Thoracic Surgery, Department of Surgery, Graduate School of Medical Science, Kyoto Prefectural University of Medicine. Electronic address:

Combined resection of the superior vena cava (SVC) is sometimes challenging during radical surgery for malignant mediastinal tumors. We report a case of a 21-year-old man with a malignant mediastinal germ cell tumor who underwent surgical resection with SVC reconstruction involving an extra-thoracic temporary bypass from the right brachiocephalic vein to the right atrium using venous return cannula because of left brachiocephalic vein occlusion. This is a convenient and safe optional technique providing an excellent intra-thoracic surgical view for temporary SVC bypass in patients with invasive malignant mediastinal tumor associated with venous return via the hemi-lateral brachiocephalic vein.
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http://dx.doi.org/10.1016/j.athoracsur.2020.11.056DOI Listing
January 2021

Prognostic significance of spread through air spaces in pulmonary metastases from colorectal cancer.

Lung Cancer 2020 11 20;149:61-67. Epub 2020 Sep 20.

Division of Thoracic Surgery, Department of Surgery, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan. Electronic address:

Objectives: Surgical resection for pulmonary metastases from colorectal cancer could provide long-term survival in selected patients, and it is commonly performed in practice. However, surgical margin relapse sometimes occurs and is a problematic issue to resolve. Spread through air spaces (STAS) is one of the invasion forms in primary lung cancer and is associated with local recurrence and a poor prognosis. The aim of this study was to evaluate the prognostic significance of STAS for pulmonary metastases from colorectal cancer and to assess the predictability of STAS with preoperative clinical information.

Methods: A total of 96 pulmonary metastatic lesions from colorectal cancer in 37 patients who underwent metastasectomy at our institution from January 2008 to December 2013 were retrospectively analyzed.

Results: STAS was identified in 41.6 % of the 96 lesions. Surgical margin relapse was found in 8 lesions (8.3 %) from 7 patients (18.9 %). The distance of STAS was identified as an independent risk factor for surgical margin relapse on multivariable analysis (p =  0.033). The patients with STAS showed significantly worse overall survival than those without (5-year overall survival rate: 30.3 % vs. 76.9 %; p =  0.002). On multivariable analysis, patients with STAS had a significantly higher risk of death than those without (p =  0.019). An elevated pre-metastasectomy serum carcinoembryonic antigen level was independently correlated with STAS on multivariable analysis (p =  0.049).

Conclusion: STAS was related to a poor prognosis and surgical margin relapse in pulmonary metastases from colorectal cancer.
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http://dx.doi.org/10.1016/j.lungcan.2020.09.010DOI Listing
November 2020

One-stage closure of large bronchopleural fistula with pedicled latissimus dorsi muscle flap after preemptive antibiotics: A case report.

Int J Surg Case Rep 2020 29;74:257-259. Epub 2020 Aug 29.

Division of Thoracic Surgery, Department of Surgery, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, 465 Kajii-cho, Kawaramachi-Hirokoji, Kamigyo-ku, Kyoto 602-8566, Japan.

Introduction: Bronchopleural fistula (BPF) after lung cancer surgery is a life-threatening complication and often needs two-stage closure after fenestration. Although one-stage closure of BPF is challenging, it would provide shorter treatment time and lower patient physical burden than two-stage closure. However, there have been few reports of one-stage closure of a large BPF.

Presentation Of Case: A 53-year-old man underwent robotic right lower lobectomy with systematic lymph node dissection. Postoperative bronchoscopy revealed an ischemic change in the bronchial stump, which progressed to a large BPF. However, under the preemptive antibiotic treatment without chest drainage, local infection was controlled within a limited pleural space. We successfully performed one-stage closure of a 3-cm sized BPF with pedicled latissimus dorsi (PLD) muscle flap.

Discussion: Early diagnosis of ischemic bronchitis and appropriate preceding antibiotic treatment could minimize the local infection around the fistula. To our knowledge, our case represented the largest BPF that was successfully treated by one-stage procedure using preemptive antibiotics and the PLD muscle flap.

Conclusion: One-stage closure using the PLD muscle flap may be a treatment option even for a 3-cm sized BPF, wherein infection is controlled and the relevant pleural cavity is limited.
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http://dx.doi.org/10.1016/j.ijscr.2020.08.035DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7486421PMC
August 2020

Prognostic Significance of Perioperative C-Reactive Protein in Resected Non-Small Cell Lung Cancer.

Semin Thorac Cardiovasc Surg 2020 Winter;32(4):1046-1055. Epub 2020 May 11.

Division of Thoracic Surgery, Department of Surgery, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kamigyo-ku, Kyoto, Japan. Electronic address:

Inflammation is reportedly associated with the development and progression of various malignancies. However, the clinical significance of preoperative and postoperative inflammation in lung cancer patients undergoing surgery is unknown. The relationship between preoperative and postoperative C-reactive protein (CRP), an indicator of inflammation, and survival was retrospectively analyzed in 356 patients who underwent complete resection of pathologic Stage I and II non-small cell lung cancers. Cutoffs for preoperative CRP (CRP), postoperative maximum levels of CRP (CRP), and postoperative CRP levels 30 days after surgery (CRP) were determined as 0.2 mg/dL, 6.4 mg/dL, and 0.2 mg/dL, respectively. Patients with CRP, CRP, or CRP status had significantly poorer overall survival (OS) and relapse-free survival (RFS) than those with CRP, CRP, or CRP. Patients were stratified into 4 groups according to perioperative CRP grades, combining CRP, CRP, and CRP statuses, yielding groups with grades 0, 1, 2, and 3. OS and RFS significantly worsened with increasing grade. After controlling for potential confounders, the multivariate Cox proportional hazard model revealed perioperative CRP grade as an independent poor prognostic factor for OS (grade 3 vs grade 0): adjusted hazard ratio, 5.05; 95% confidence interval, 1.59-19.6; P = 0.005), and RFS (adjusted hazard ratio, 3.62; 95% confidence interval, 1.50-9.33; P = 0.004). Perioperative inflammation was associated with a long-term negative prognostic impact after lobectomy for lung cancer. Further prospective analysis is required to identify whether control of perioperative inflammation may improve prognosis after lung cancer surgery.
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http://dx.doi.org/10.1053/j.semtcvs.2020.03.019DOI Listing
May 2020

Programmed death-ligand 1 expression profiling in thymic epithelial cell tumors: Clinicopathological features and quantitative digital image analyses.

Lung Cancer 2020 07 6;145:40-47. Epub 2020 May 6.

Division of Thoracic Surgery, Department of Surgery, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, 465 Kajii-cho, Kamigyo-ku, Kyoto 602-8566, Japan. Electronic address:

Objectives: Whether the extent of expression of programmed death-ligand 1 (PD-L1) is clinically significant remains uncertain, although immuno-oncological features have been studied in thymic epithelial cell tumors (TETs). We investigated the histological features of PD-L1 expression in TETs, and assessed PD-L1 expression using digital image analysis.

Materials And Methods: Participants comprised 66 patients with TET who underwent surgical resection between 2001 and 2016. We calculated tumor cell-positive ratio as total proportion score (TPS) with immunohistochemistry using SP263 anti-PD-L1 monoclonal antibody. PD-L1 expression was also quantified using digital image analysis of whole-slide images. We evaluated the relationship between conventional visual TPS using optical microscopy (TPS-V) and TPS from digital image analysis (TPS-IA). We further classified all TETs into high or low PD-L1 expression groups and assessed the clinical significance of PD-L1 expression level using TPS-V and TPS-IA.

Results: WHO histological types were Type A (n = 8), AB (n = 18), B1 (n = 5), B2 (n = 16), B3 (n = 6), metaplastic thymoma (n = 2), and thymic carcinoma (TC) (n = 11). Median TPS-Vs were 2%, 2%, 10 %, 65 %, 90 %, 1%, and 20 %, respectively. TPS-IAs correlated with TPS-Vs in TETs overall and in thymomas, but not in TCs. PD-L1 expression levels in TETs differed significantly among histological types. Whether TPS-V or TPS-IA were used, the PD-L1 group included more cases of the more aggressive histological types. Recurrence-free survival (RFS) was shorter in the PD-L1 group than in the PD-L1 group in thymoma using TPS-IA, whereas RFS of the PD-L1 group was shorter in all TETs using TPS-V.

Conclusion: PD-L1 expression levels depended on the histological type of TET. Extensive PD-L1 expression in TETs was associated with poor prognosis. Digital image analysis is feasible for evaluating PD-L1 expression in TETs and might offer clinically relevant features of thymomas.
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http://dx.doi.org/10.1016/j.lungcan.2020.04.038DOI Listing
July 2020

The clinical significance of ground glass opacities in lung adenocarcinoma in the era of UICC-TNM classification ver.8.

J Thorac Dis 2019 Dec;11(12):5680-5681

Division of Thoracic Surgery, Department of Surgery, Kyoto Prefectural University of Medicine, Kyoto, Japan.

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http://dx.doi.org/10.21037/jtd.2019.12.58DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6988044PMC
December 2019

High Neutrophil Count as a Negative Prognostic Factor for Relapse in Patients with Thymic Epithelial Tumor.

Ann Surg Oncol 2020 Jul 28;27(7):2438-2447. Epub 2020 Jan 28.

Division of Thoracic Surgery, Department of Surgery, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan.

Purpose: Preoperative neutrophil count is reportedly associated with poor prognosis in cancer patients. This study aimed to investigate the clinical significance of pre-treatment peripheral blood cell counts in patients with thymic epithelial tumors (TETs).

Methods: A retrospective review of 71 patients with completely resected TETs [64 thymoma, 6 thymic carcinoma, and 1 thymic neuroendocrine tumor] between 2000 and 2018 was conducted. Associations between tumor recurrence and pre-treatment peripheral blood cell counts of leukocytes (WBC), neutrophils (Neut), lymphocytes (Lymph), monocytes (Mono), and platelets (Plt) were analyzed. Optimal cut-off points were selected using receiver operating characteristic curve analysis to predict tumor recurrence.

Results: High WBC (≥ 7000), Neut (≥ 4450), and Plt (≥ 226 × 10) counts had significantly poor relapse-free survival (RFS), but high Lymph (≥ 1950) and Mono (≥ 400) did not. High Neut had the strongest correlation with recurrence (area under curve, 0.800); we focused on the analysis between high-Neut and low-Neut groups. High Neut count significantly correlated with smoking history, pre-treatment C-reactive protein level, and advanced stage; high Neut count and aggressive histology tended to show correlations. RFS was significantly poorer in the high-Neut group than in the low-Neut group (p = 0.003), with 5-year RFS rates of 63.8% and 96.8%, respectively. High Neut count was a significant adverse predictor for RFS and cumulative incidence of recurrence (p = 0.005 and p < 0.001, respectively). The risk scoring system comprising high Neut count, advanced stage, and aggressive histology demonstrated better prognostic ability than any prognostic factors alone.

Conclusions: High Neut count significantly correlated with TET recurrence, suggesting a negative prognostic effect of latent inflammation in TET patients.
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http://dx.doi.org/10.1245/s10434-020-08228-9DOI Listing
July 2020

Prediction models for the viability of pulmonary metastatic lesions after chemotherapy in nonseminomatous germ cell tumors.

Int J Urol 2020 Mar 8;27(3):206-212. Epub 2020 Jan 8.

Division of Thoracic Surgery, Department of Surgery, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan.

Objectives: To analyze predictors associated with viable cells in pulmonary residual lesions after chemotherapy for metastatic testicular nonseminomatous germ cell tumors and to develop models to prioritize pulmonary resection.

Methods: Between 2008 and 2017, 40 patients underwent pulmonary metastasectomy after chemotherapy for nonseminomatous germ cell tumors. We evaluated these patients, and 326 pulmonary residual lesions were confirmed using computed tomography and pathological evaluations. Relationships with outcomes were analyzed using logistic regression analyses. Risk prediction models were developed, and predictive probabilities for the risk of viable cells were estimated.

Results: Histological examinations showed that 73 (22%) pulmonary residual lesions contained viable cells: teratomas, 46 (14%); and cancer cells, 37 (11%). Multivariate analyses showed that the predictors associated with cancer cells in the residual lesions were elevated tumor marker levels, multiregimen chemotherapy, increased tumor size 6 months before surgery and the histological composition of the primary lesion, including yolk sac tumors. Additional predictors associated with teratomas were aspect ratio and histological composition of the primary lesion, including teratomas.

Conclusions: Intratumoral heterogeneity contributes to nonseminomatous germ cell tumor chemoresistance, and primary lesion site yolk sac tumors and teratomas are associated with greater risks of viable cells. Increased residual lesion size during chemotherapy could also be a predictor. Our simple model can predict the presence of viable cells in residual lesions after chemotherapy, and it might assist in decision-making and prioritizing pulmonary residual lesion resection.
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http://dx.doi.org/10.1111/iju.14162DOI Listing
March 2020

Safety and reliability of computed tomography-guided lipiodol marking for undetectable pulmonary lesions.

Interact Cardiovasc Thorac Surg 2020 04;30(4):546-551

Division of Thoracic Surgery, Department of Surgery, Kyoto Prefectural University of Medicine, Kyoto, Japan.

Objectives: This study aimed to evaluate the safety and reliability of percutaneous computed tomography (CT)-guided lipiodol marking for undetectable pulmonary lesions before video-assisted thoracic surgery (VATS).

Methods: We retrospectively analysed the cases of CT-guided lipiodol marking followed by VATS in 9 institutes from May 2006 to March 2018. Lipiodol (0.2-0.5 ml) was percutaneously injected closely adjacent to undetectable pulmonary lesions with computed-tomography guidance. Lipiodol spots were identified using C-arm-shaped fluoroscopy during VATS. We grasped the lipiodol spots, including the target lesions, with ring-shaped forceps and resected them.

Results: Of 1182 lesions, 1181 (99.9%) were successfully marked. In 1 case, the injected lipiodol diffused, and no spot was created. Of the 1181 lesions, 1179 (99.8%) were successfully resected with intraoperative fluoroscopy. Two lipiodol spots were not detected because of the lipiodol distribution during the division of pleural adhesions. The mean lesion size was 9.1 mm (range 1-48 mm). The mean distance from the pleural surface was 10.2 mm (range 0-43 mm). Lipiodol marking-induced pneumothorax occurred in 495 (57.1%) of 867 cases. Of these, chest drainage was required in 59 patients (6.8%). The other complications were 19 (2.2%) cases of bloody sputum, 3 (0.35%) cases of intravascular air, 1 (0.12%) case of pneumonia and 1 (0.12%) case of cerebral infarction. There were no lipiodol marking-induced deaths or sequelae.

Conclusions: Preoperative CT-guided lipiodol marking followed by VATS resection was shown to be a safe and reliable procedure with a high success rate and acceptably low severe complication rate.
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http://dx.doi.org/10.1093/icvts/ivz304DOI Listing
April 2020

Trousseau's syndrome associated with pulmonary pleomorphic carcinoma exhibiting aggressive features: A case report.

Mol Clin Oncol 2020 Jan 11;12(1):36-40. Epub 2019 Nov 11.

Division of Thoracic Surgery, Department of Surgery, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto 602-8566, Japan.

Trousseau's syndrome is characterized as an unexpected, cancer-related thrombotic event, such as a cerebral infarction or a deep vein thrombosis/pulmonary embolism. We describe the first reported case of Trousseau's syndrome with pulmonary pleomorphic carcinoma and aggressive features. A 74 year-old man presenting with a pulmonary mass, which was identified as pleomorphic carcinoma with extensive lymph node involvement, in the left lower lobe, underwent a left lower lobectomy. Immunohistochemical analysis revealed that neoplastic cells exhibited an extensive expression of tissue factors with a mucin-producing adenocarcinoma component. Three months postoperatively, diffuse infiltration rapidly appeared in the left lung, which was identified as lymphangitic carcinomatosis via bronchoscopy. Prior to treatment for cancer recurrence, the patient presented with a left hemiplegia due to a cerebral infarction via multiple thromboses, with no evidence of atherosclerotic or cardiogenic thrombi. Elevated D-dimer and carbohydrate antigen 125 levels and the presence of a fibrin thrombus retrieved from the occluded vessel suggested Trousseau's syndrome as the etiology of the brain infarction. A hypercoagulable state associated with the aggressive recurrence of pulmonary pleomorphic carcinoma, accompanied by cancer cell production of mucin and tissue factors may be a potential mechanism for cancer-related thrombosis.
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http://dx.doi.org/10.3892/mco.2019.1947DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6888249PMC
January 2020

Extended latissimus dorsi chimeric thoracoplasty with a vascular supercharge for Aspergillus empyema.

Interact Cardiovasc Thorac Surg 2020 03;30(3):491-492

Division of Thoracic Surgery, Department of Surgery, Kyoto Prefectural University of Medicine, Kyoto, Japan.

The latissimus dorsi and serratus anterior muscles are available for reconstruction coverage of thoracic defects. We performed extended latissimus dorsi-serratus anterior chimeric thoraco-myoplasty with a vascular supercharge to maintain sufficient blood supply to the flaps because of a deficiency in the distal blood flow to the flap revealed by an intravenous injection of indocyanine green and simultaneous endobronchial embolization for refractory Aspergillus empyema.
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http://dx.doi.org/10.1093/icvts/ivz280DOI Listing
March 2020

A rare case of pulmonary typical carcinoid with prominent acinic cell differentiation, resembling acinic cell carcinoma.

Pathol Int 2019 Dec 14;69(12):721-726. Epub 2019 Nov 14.

Departments of Surgical Pathology, Kyoto Prefectural University of Medicine, Kyoto, Japan.

We herein describe a rare case of low-grade endobronchial tumor that exhibited two distinct features of typical carcinoid and acinic cell carcinoma (ACC) by immunohistochemical and ultrastructure study. ACC was suspected on transbronchial biopsy. The resected specimen showed that the tumor surface comprised an acinic cell component (40% of the tumor), and the central area comprised typical carcinoid (60% of the tumor). The acinic cell component was positive for chromogranin A, synaptophysin and alpha-1-antichymotrypsin. Additionally, this component showed focal apical membranous staining for DOG1 and weak positivity for BCL10 and SOX10. Conversely, the carcinoid component was negative for all proteins except for chromogranin A and synaptophysin. Electron microscopy indicated zymogen-type granules (600-800 nm in diameter) in the acinic cell component, whereas neuroendocrine-type granules (200-300 nm in diameter) were observed in the carcinoid component. Nuclear NR4A3 immunostaining, which is highly specific for ACC of the salivary gland, was negative in this case. We conclude that the pulmonary carcinoid tumor with true zymogen-type granules could be seen but showed superficial similarities to ACC based on negative nuclear staining for NR4A3. Pulmonary carcinoids encompass a wide morphological spectrum and may exhibit prominent acinic cell differentiation.
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http://dx.doi.org/10.1111/pin.12869DOI Listing
December 2019

Successful thoracoscopic evacuation of an extrapleural hematoma with delayed symptomatic pleural effusion: a case report.

Surg Case Rep 2019 Aug 14;5(1):133. Epub 2019 Aug 14.

Division of Thoracic Surgery, Department of Surgery, Kyoto Prefectural University of Medicine, Kyoto, 602-8566, Japan.

Background: Traumatic extrapleural hematoma is a rare condition and is usually managed conservatively until spontaneous resolution unless active bleeding or expansion is found.

Case Presentation: An 80-year-old man taking an anticoagulant medication was referred to our hospital after accidentally falling in a street ditch while riding a bike. Chest X-ray and computed tomography (CT) scan showed multiple fractures on ribs 7-9, hemothorax, and extrapleural hematoma in the posterior chest wall. Though the patient's hemothorax was improved by chest tube drainage, the extrapleural hematoma still remained. He was transferred to another hospital for rehabilitation, but he was readmitted to our hospital because of dyspnea with accumulation of left pleural effusion, including a subpopulation of neutrophils, but without bacterial infection. We performed thoracoscopic evacuation of the hematoma on day 57 after the initial blunt chest trauma. The patient has had no recurrence of pleuritis for 6 months after surgery.

Conclusion: Since posttraumatic extrapleural hematoma may result in delayed secondary intractable pleural effusion causing dyspnea, careful observation is necessary when considering indications of surgical intervention.
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http://dx.doi.org/10.1186/s40792-019-0691-9DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6694359PMC
August 2019

Volume-Based Consolidation-to-Tumor Ratio Is a Useful Predictor for Postoperative Upstaging in Stage I and II Lung Adenocarcinomas.

Thorac Cardiovasc Surg 2019 Aug 8. Epub 2019 Aug 8.

Division of Thoracic Surgery, Department of Surgery, Kyoto Prefectural University of Medicine, Kyoto, Japan.

Background:  We investigated the postoperative upstaging of stage I and II lung adenocarcinoma patients to identify useful predictors for accurate staging.

Methods:  We retrospectively reviewed data from 80 consecutive patients undergoing lobectomy and mediastinal lymph node dissection for clinical stage I and II lung adenocarcinomas. We evaluated clinical variables, including the preoperative serum carcinoembryonic antigen (CEA), tumor diameter, consolidation-to-tumor ratio (CTR), maximum standardized uptake value (SUVmax) on FDG- PET, expression of epithelial growth factor receptor mutations, and pathological invasion to the pleura (pl), lymph duct (ly), and vein (v).

Results:  Eleven patients (13.8%) showed postoperative upstaging. Three cases had pN1 migrating from cN0, four cases had pN2 from cN0, and four cases showed malignant pleural effusion. The CEA level and CTR were significantly higher in the upstaging group. The tumors in the upstaging group showed more frequent pathological invasion to the visceral pleura and vein. In patients with 3 cm or smaller consolidation, two-dimensional (2D)-CTR and volume-based CTR were independent predictors of upstaging.

Conclusions:  Volume-based CTR could be a useful predictor for accurate clinical staging in stage I and II adenocarcinoma patients in addition to consolidation size, serum CEA level, and 2D-CTR. Both volume-based and 2D-CTRs might be especially useful in T1 diseases.
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http://dx.doi.org/10.1055/s-0039-1694061DOI Listing
August 2019

Suppressive Effects of Aspirin for Postthoracotomy Pleural Adhesion in Rats.

Int J Med Sci 2019 25;16(4):593-601. Epub 2019 Apr 25.

Division of Thoracic Surgery, Department of Surgery, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, 465 Kajii-cho, Kamigyo-ku, Kyoto 602-8566, Japan.

Background: Postoperative adhesion is one of major concerns at re-thoracotomy. Aspirin has both the anti-platelet and anti-inflammatory effects, and decreases several cytokines production.

Objective: We investigated that aspirin could reduce postoperative adhesion formation in a rat model.

Methods: We cauterised the lung visceral pleural to make postoperative adhesion in rats. The animals were allocated to a control group and an aspirin administration group (100 mg/kg/day for 14 days). We performed re-thoracotomy and evaluated the adhesion lengths on day 14. We also investigated the cytokine expression in the adhesion region and the peripheral tissue with platelet-derived growth factor (PDGF), platelet-derived growth factor receptor (PDGFR), alpha smooth muscle actin (α-SMA), transforming growth factor beta 1 (TGF-β1), and vascular endothelial growth factor-A (VEGF-A), sequentially.

Results: The adhesion lengths were significantly shorter in the aspirin group than that in the control group (8.7±2.0 mm vs 11.2±1.1 mm, =0.024). The expressions of PDGF and PDGFR were lower in the aspirin group than that in the control group on day 3. The expression of α-SMA on fibroblasts decreased in the aspirin group on day 3. There was no significant difference in the expressions of TGF-β1 and VEGF-A with administration of aspirin.

Conclusions: Aspirin could reduce postoperative pleural adhesion by inhibiting the expression of PDGF.
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http://dx.doi.org/10.7150/ijms.32632DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6535663PMC
December 2019

Intractable pneumothorax due to rupture of subpleural rheumatoid nodules: a case report.

Surg Case Rep 2018 Aug 8;4(1):89. Epub 2018 Aug 8.

Department of General Thoracic Surgery, Ayabe City Hospital, 20-1 Otsuka, Aono-cho, Ayabe, Kyoto, 623-0011, Japan.

Background: In rare cases, rheumatoid pleural nodules can rupture into the pleural cavity to cause pneumothorax or empyema. We report successful surgical treatment of a patient with an intractable secondary pneumothorax due to rupture of a subpleural rheumatoid nodule into the pleural cavity.

Case Presentation: A 75-year-old man with a medical history of rheumatoid arthritis, acute coronary syndrome, and diabetes was admitted to our hospital because of left chest pain and dyspnea. A chest X-ray and chest computed tomography (CT) scan showed a left pneumothorax and several small subpleural nodules with cavitation. Repeated pleurodesis via a chest tube failed to improve the pneumothorax, so we decided to perform thoracoscopic surgery. Air leakage was detected in the left upper lobe where the subpleural nodule was visible on chest CT. Resection of the lesion successfully resulted in resolution of the air leakage. The final pathological diagnosis of the subpleural nodule was a pulmonary rheumatoid nodule. The patient has had no evidence of recurrence of pneumothorax after surgery.

Conclusions: We obtained a final pathological diagnosis of a rheumatoid nodule that caused an intractable pneumothorax. Pneumothorax associated with rupture of rheumatoid nodules in the subpleural cavitary is difficult to treat with thoracoscopic surgery as a second-line treatment.
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http://dx.doi.org/10.1186/s40792-018-0502-8DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6082747PMC
August 2018

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

Gen Thorac Cardiovasc Surg 2018 Oct 27;66(10):565-572. Epub 2018 Jun 27.

Division of Thoracic Surgery, Department of Surgery, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, 465 Kajii-cho, Kawaramachi-Hirokoji, Kamigyo-ku, Kyoto, 602-8566, Japan.

Objective: The 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.

Methods: From 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 PaO/FiO ratio, alveolar-arterial oxygen difference (A-aDO), and respiratory index (A-aDO/PaO).

Results: 112 patients received PONIV. From POD0 to POD1, the PaO/FiO ratio significantly improved in all patients who received PONIV (333 ± 83 to 359 ± 47 mmHg, p = 0.004). Moreover, A-aDO and respiratory index significantly decreased following PONIV. PONIV significantly improved the PaO/FiO ratio in patients with PaO/FiO ratio of ≤ 300 on POD0, older age (≥ 70 years), higher body mass index (≥ 25 kg/m), and longer one-lung ventilation time (≥ 180 min). There was no respiratory failure requiring mechanical ventilation and no mortality.

Conclusions: PONIV effectively improved oxygenation in patients undergoing pulmonary lobectomy in patients with poor status, especially in patients with PaO/FiO ratio of ≤ 300 on POD0. PONIV could be an option of perioperative management for major thoracic surgery.
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http://dx.doi.org/10.1007/s11748-018-0963-5DOI Listing
October 2018

Improvements in thoracic surgery outcomes: a multi-institutional collaboration study.

J Cardiothorac Surg 2015 Mar 6;10:30. Epub 2015 Mar 6.

Division of Chest Surgery, Department of Surgery, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan.

Background: Treatment protocols (including those for thoracic surgery) tend to be customized for individual hospitals. Procedural standardization is required to improve surgical tasks and patient outcomes. This study aimed to evaluate the effects of an initiative to standardize surgical tasks for efficient and safe performance.

Methods: Hospitals associated with the Division of Chest Surgery of the Kyoto Prefectural University of Medicine held joint meetings involving their thoracic surgeons and operating room nurses between February 2011 and November 2012 to standardize surgical tasks. Operation times and blood loss were compared before and after standardization.

Results: The implementation rate of standardized surgical tasks was 97%. The pre-operative (from entry to the operating room until commencement of surgery) and post-operative (from conclusion of surgery until departure from the operating room) times were significantly decreased after the standardization. When compared according to operative group (all thoracic surgery, lung lobectomy, and partial lung resection), operation times were shorter for all three groups; in addition, the amount of blood loss was lower in all three groups after standardization. A post-standardization survey showed improved morale among the meeting participants.

Conclusions: Interdisciplinary standardization of surgical tasks across institutions improved thoracic surgery tasks and surgical outcomes.
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http://dx.doi.org/10.1186/s13019-015-0228-7DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4356109PMC
March 2015

The OIDE hook: a retractor for video-assisted thoracic surgery.

J Thorac Cardiovasc Surg 2013 Apr 9;145(4):1139-1140. Epub 2013 Jan 9.

Division of Chest Surgery, Department of Surgery, Kyoto Prefectural University of Medicine, Japan.

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http://dx.doi.org/10.1016/j.jtcvs.2012.12.040DOI Listing
April 2013

Chondromyxoid fibroma with secondary aneurysmal bone cyst of the rib.

Ann Thorac Cardiovasc Surg 2013 20;19(3):250-2. Epub 2012 Aug 20.

Department of General Thoracic Surgery, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Kyoto, Japan.

Chondromyxoid fibroma (CMF) is a rare, benign cartilaginous tumor, comprising less than 1% of primary bone tumors, and usually occurs in the metaphysis of a long tubular bone around the knee. We report a rare case of CMF of the rib. The patient was a 25-year-old man who visited the hospital for left upper back pain. Roentgenography revealed an 8-cm mass in the left upper lung field; computed tomography revealed a large multicystic tumor with aneurysmal bone cyst (ABC)-like features in the posterior mediastinum. ABCs are also a rare benign tumor representing 2.5% of primary bone tumors, and most of ABCs are located in the metaphysis of long bones and vertebrae. To the best of my knowledge, there is no report of CMF with secondary ABC of the rib. We performed total resection of the tumor. Complete tumor resection may be the best treatment option for a cure.
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http://dx.doi.org/10.5761/atcs.cr.12.01931DOI Listing
October 2013

Drug resistance to paclitaxel is not only associated with ABCB1 mRNA expression but also with drug accumulation in intracellular compartments in human lung cancer cell lines.

Int J Oncol 2012 Apr 13;40(4):995-1004. Epub 2011 Dec 13.

Department of General Thoracic Surgery, Kyoto Prefectural University of Medicine, 465 Kajii-cho, Kawaramachi-Hirokoji, Kamigyo-ku, Kyoto 602-8566, Japan.

In order to clarify the mechanisms of resistance to paclitaxel in lung cancer, three human lung cancer cell lines which exhibit different sensitivity to paclitaxel were investigated from the following viewpoints: overexpression of ATP-binding cassette, sub-family B, member 1 (ABCB1), mutations on paclitaxel binding site of β-tubulin genes, quantity of polymerized tubulin and the intracellular localization of paclitaxel. ABCB1 expression was evaluated by real-time RT-PCR. No correlations were noted between the ABCB1 expression in the sensitive and resistant cell lines at the mRNA level. No mutations on the paclitaxel binding site of the β-tubulin genes were detected in either the resistant or sensitive cells. Live cell images obtained by confocal laser microscopy revealed that the resistant cell line, RERF-LC-KJ, had more accumulation of Oregon Green® 488 conjugated paclitaxel in the lysosomal and extra-lysosomal compartments of cytoplasm than other cell lines. The results obtained in this study indicated that the changes in the subcellular localization could contribute to the production of paclitaxel resistance in lung cancer cell lines. Further studies should be conducted to elucidate the molecular mechanisms that differentiate the intracellular localization of paclitaxel.
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http://dx.doi.org/10.3892/ijo.2011.1297DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3584812PMC
April 2012

Analysis of surgeon's line of sight using an optical tracking system with a multifaceted marker device.

Int J Comput Assist Radiol Surg 2011 Nov 22;6(6):803-9. Epub 2011 Apr 22.

Department of General Thoracic Surgery, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, 465 Kajii-cho, Kawaramachi-Hirokoji, Kamigyo-ku, Kyoto 602-8566, Japan.

Purpose: Video-assisted thoracoscopic surgery (VATS) is a widely used technique where operating surgeons alternate between direct vision through minithoracotomy and monitor-aided vision as required. We analyzed surgeons' line of sight to assess their proficiency at using an optical tracking system with a multifaceted marker device.

Methods: An infrared optical tracking system was developed that is capable of integrating information from a multifaceted marker device and analyzing three-dimensional (3D) dynamic movements including flexion and rotation. Using this system, we analyzed multiple aspects of surgeons' head poses, thereby indirectly identifying their visual line of sight. A multifaceted device comprising 4 surfaces and 4 markers was constructed and attached to surgeons' heads. The surgeons' head motions were tracked using this multifaceted device and videotaped their face while they performed wedge resection. Both data sets were compared.

Results: The system could document 98.5% of surgeons' head motions, with a high correlation ( = 0.935) between data acquired using the multifaceted device and video analysis. An inverse correlation was observed between tumor size and the monitor-viewing time ratio by surgeons in pulmonary wedge resection (R(2) = 0.728).

Conclusion: An optical tracking system with a multifaceted device was able to measure 3D dynamic movements of thoracic surgeons. The associated problems of reflection angle and marker shielding were solved. The utility of this device for analyzing surgeons' visual line of sight during VATS was established.
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http://dx.doi.org/10.1007/s11548-011-0565-5DOI Listing
November 2011

[Severe bone marrow suppression during adjuvant chemotherapy for gastric cancer by S-1 and its possible relationship to dihydropyrimidine dehydrogenase deficiency].

Gan To Kagaku Ryoho 2010 Jan;37(1):131-3

Department of Surgery, Aiseikai Yamashina Hospital, Japan.

The patient was a 70-year-old woman, who had undergone total gastrectomy and splenectomy with D2 lymph node dissection, for stage II gastric cancer. We admitted S-1 of 80 mg/day in adjuvant chemotherapy on postoperative day 28. There were no adverse events for one week, and she was discharged. Severe diarrhea occurred 6 days following discharge, but she continued to take S-1. Two weeks after discharge, she visited our hospital, suffering from severe dehydration (grade 4), leucopenia (grade 4)and thrombocytopenia (grade 3). Unfortunately, she died of lung edema and multiple organ failure 28 days after chemotherapy. We measured the mRNA expression level of dihydropyrimidine dehydrogenase (DPD) of the patient's liver by the Dannenberg Tumor Profile method. The expression level of DPD was significantly low, so we suggested that the severe bone marrow suppression might have been caused by the disordered metabolism of 5-FU.
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January 2010