Publications by authors named "Takeo Nakada"

42 Publications

Novel strategy to treat lung metastases: Hybrid therapy involving surgery and radiofrequency ablation.

Thorac Cancer 2021 Jun 9. Epub 2021 Jun 9.

Department of Diagnostic and Interventional Radiology, Aichi Cancer Center Hospital, Nagoya, Japan.

Background: This study was performed to evaluate the clinical outcomes of hybrid treatment involving surgical resection and percutaneous radiofrequency ablation for patients with multiple lung metastases.

Methods: Seventeen patients (6 men, 11 women; median age, 52 years; range, 16-78 years) underwent hybrid treatment involving surgery and radiofrequency ablation to treat multiple lung metastases (median number, 4; range, 2-26) between May 2014 and February 2020. The primary lesions were colorectal carcinoma (n = 9), uterine endometrial carcinoma (n = 3), osteosarcoma (n = 2), renal cell carcinoma (n = 1), glottic carcinoma (n = 1), and fibrolamellar hepatocellular carcinoma (n = 1). Twenty-four sessions each of surgery and radiofrequency ablation were performed. Safety, disease-free survival, and overall survival were evaluated. Safety was assessed according to the Clavien-Dindo Classification.

Results: A grade IVa adverse event of empyema developed in one patient (4%, 1/24) after surgery. A grade IIIa adverse event of pneumothorax and a grade II adverse event of lung abscess occurred in four (17%, 4/24) and one session (4%, 1/24) after radiofrequency ablation, respectively. During the median follow up of 34 months (range, 8-67 months), 10 patients (59%, 10/17) developed new metastases. The 5-year disease-free survival rate was 32%. Four or fewer lung metastases (p = 0.008) and metastases from colorectal carcinoma (p = 0.02) were factors significantly associated with longer disease-free survival. One patient (6%, 1/17) died of tumor progression 29 months after initial treatment. The 5-year overall survival rate was 88%.

Conclusions: The strategy of hybrid treatment involving surgery and radiofrequency ablation may offer good outcomes for patients with multiple lung metastases.
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http://dx.doi.org/10.1111/1759-7714.14041DOI Listing
June 2021

Clinical Guideline-Guided Outcome Consistency for Surgically Resected Stage III Non-Small Cell Lung Cancer: A Retrospective Study.

Cancers (Basel) 2021 May 21;13(11). Epub 2021 May 21.

Department of Thoracic Oncology, Aichi Cancer Center, Nagoya 464-8681, Japan.

Clinical guidelines can help reduce the use of inappropriate therapeutics due to localism and individual clinician perspectives. Nevertheless, despite the intention of clinical guidelines to achieve survival benefit or desirable outcomes, they cannot ensure a robust outcome. This retrospective study aimed to investigate whether guideline-consistency, including adjuvant treatments after surgical resection (ATSR) and guideline-matched first-line treatment for recurrence (GMT-R), according to the genomic profiles and immune status, could influence overall survival (OS). From 2006 to 2017, the clinical data of 308 patients with stage III non-small cell lung cancer (NSCLC) after surgical resection were evaluated. ATSR and GMT-R were allowed in 164 (53.2%) and 129 (62.3%) patients cases after surgical pulmonary resection, among which 207 (67.2%) recurrences were identified. The 5-year OS in guideline-consistent cases was significantly better than that in guideline-inconsistent cases ( < 0.01). Subgroup analyses further showed that the 5-year OS after propensity adjustment was significantly better in guideline-consistent than in guideline-inconsistent cases ( < 0.01), but not in either ATSR or GMT-R ( = 0.24). These data suggest that the guideline-consistent alternatives, which comprise ATSR or GMT-R, can contribute to survival benefits in pathological stage III NSCLC. However, only either ATSR or GMT-R has a potential survival benefit in these patients.
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http://dx.doi.org/10.3390/cancers13112531DOI Listing
May 2021

Robotic open-thoracotomy-view approach using vertical port placement and confronting monitor setting.

Interact Cardiovasc Thorac Surg 2021 May 11. Epub 2021 May 11.

Department of Thoracic Surgery, Aichi Cancer Center Hospital, Nagoya, Japan.

Objectives: Robotic lung resections (RLRs) are conventionally performed using look-up views of the thorax from the caudal side. To conduct RLR with views similar to those in open thoracotomy, we adopted a vertical port placement and confronting upside-down monitor setting, which we called robotic 'open-thoracotomy-view approach'. We herein present our experience of this procedure.

Methods: We retrospectively reviewed 58 patients who underwent RLR (43 with lobectomy; 15 with segmentectomy) with 3-arm open-thoracotomy-view approach using the da Vinci Surgical System between February 2019 and October 2020. The patient cart was rolled in from the left cranial side of the patient regardless of the side to be operated on. Robotic ports were vertically placed along the axillary line, and 2 confronting monitors and 2 assistants were positioned on each side of the patient. The right-side monitor, which was set up for the left-side assistant to view, projected the upside-down image of the console surgeon's view.

Results: All procedures were safely performed. The median duration of surgery and console operation was 215 and 164 min, respectively. Emergency conversion into thoracotomy and severe morbidities did not occur, and the median postoperative hospitalization duration was 3 days. In all procedures, the console surgeon and 2 assistants had direct 'bird-eye' views of the cranially located intrathoracic structures and instrument tips, which are sometimes undetectable with the conventional look-up view.

Conclusions: The open-thoracotomy-view approach setting is a possible option for RLR. It offers natural thoracotomy views and can circumvent some of the known limitations of the conventional procedure.
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http://dx.doi.org/10.1093/icvts/ivab033DOI Listing
May 2021

Sarcopenia is poor risk for unfavorable short- and long-term outcomes in stage I non-small cell lung cancer.

Ann Transl Med 2021 Feb;9(4):325

Department of Thoracic Surgery, Aichi Cancer Center Hospital, Nagoya, Aichi, Japan.

Background: Sarcopenia characterized by skeletal muscle loss may influence postoperative outcomes through physical decline and weakened immunity. We aimed to investigate clinical significance of sarcopenia in resected early-stage non-small cell lung cancer (NSCLC).

Methods: We retrospectively reviewed 315 consecutive patients with pathologic stage I NSCLC who had undergone lobectomy with systematic nodal dissection. Sarcopenia was defined as the lowest quartile of psoas muscle area on the 3rd vertebra on the high-resolution computed tomography (HRCT) image. Clinicopathological variables were used to investigate the correlation to postoperative complications as well as overall and recurrence-free survival.

Results: Upon multivariable analysis, male sex [odds ratio (OR) =5.780, 95% confidence interval (CI): 2.681-12.500, P<0.001], and sarcopenia (OR =21.00, 95% CI: 10.30-42.80, P<0.001) were independently associated with postoperative complications. The sarcopenia group showed significantly lower 5-over all survival (84.4% 69.1%, P<0.001) and recurrence-free survival (77.2% 62.0%, P<0.001) comparing with the non-sarcopenia group. In a multivariable analysis, sarcopenia was an independent prognostic factor [hazard ratio (HR) =1.978, 95% CI: 1.177-3.326, P=0.010] together with age ≥70 years (HR =1.956, 95% CI: 1.141-3.351, P=0.015) and non-adenocarcinoma histology (HR =1.958, 95% CI: 1.159-3.301, P=0.016).

Conclusions: This is the first study which demonstrates that preoperative sarcopenia is significantly associated with unfavorable postoperative complications as well as long-term survival in pathologic stage I NSCLC. This readily available factor on HRCT may provide valuable information to consider possible choice of surgical procedure and perioperative management.
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http://dx.doi.org/10.21037/atm-20-4380DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7944314PMC
February 2021

Subsegmental resection preserves regional pulmonary function: A focus on thoracoscopy.

Thorac Cancer 2021 04 14;12(7):1033-1040. Epub 2021 Feb 14.

Department of Surgery, Division of Thoracic Surgery, The Teikyo University, Tokyo, Japan.

Background: The aim of this study was to evaluate regional postoperative preserved pulmonary function (PPPF) and three-dimensional (3D) volumetric changes according to the number of resected subsegments and investigate the factors that most affected pre-/post PPPF.

Methods: Patients who underwent thoracoscopic lobectomy (n = 73), and segmentectomy (n = 87) were eligible for inclusion in the study. They were classified according to the number of resected subsegments which ranged from 1 to 10. The percentage of pre-/postoperative forced expiratory volume in 1 s (FEV1) was used for comparison. Furthermore, lung volumetric changes were calculated using 3D computed tomography (CT) volumetry.

Results: The percentage of pre-/postoperative EFV1 between 4 and 5-7 and between 5-7 and 10 were significant (p = 0.03 and p < 0.01, respectively), but not between 1-2 to 4 (p = 0.99). The difference between volumetric changes in the left lower lobe of patients with a number of resected subsegments was significant (p < 0.01). On univariate and multivariate analyses, chronic inflammation was significant for decrease in recovery percentages. When the PPPF was compared among resected subsegments, it gradually decreased with an increase in the number of patients without a postoperative procrastination of inflammation (p < 0.01).

Conclusions: Segmentectomy is feasible and useful for PPPF. Even a relatively large-volume resection procedure where 5-7 subsegments are resected can preserve pulmonary function. Chronic inflammation was statistically identified as a risk factor for postoperative preserved pulmonary function.

Key Points: .
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http://dx.doi.org/10.1111/1759-7714.13841DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8017248PMC
April 2021

Comparison of surgical outcomes between thoracoscopic anatomical sublobar resection including and excluding subsegmentectomy.

Gen Thorac Cardiovasc Surg 2021 May 2;69(5):850-858. Epub 2021 Jan 2.

Department of Thoracic Surgery, Aichi Cancer Center, 1-1 Kanokoden Chikusa-ku, Nagoya, 464-8681, Japan.

Objectives: Despite the ubiquitous utilization of anatomical sublobar resection for malignant lung tumors, the effectiveness and feasibility of subsegmentectomy remains unclear. This study therefore compared the perioperative outcomes between anatomical sublobar resection including (IS) and excluding (ES) subsegmentectomy.

Methods: Patients who had undergone anatomical sublobar resection at our institution from January 2013 to March 2019 were retrospectively reviewed. Clinicopathologic characteristics and perioperative outcomes of the IS group (n = 58) were then analyzed the compared to those of the ES group (n = 203).

Results: No statistically significant differences in age, sex, comorbidities, tumor location, preoperative pulmonary function, or tumor size on imaging were found between both groups. The IS group had significantly higher preoperative computed tomography-guided marking rates (40% vs. 18%; p < 0.01) and used significantly more staplers for intersegmental dissection than the ES group [4, interquartile range (IQR): 3-4 vs. 3, IQR: 3-4; p = 0.03]. Both groups had comparable 30-day mortality (0% vs. 0%; p > 0.99), intraoperative complications (7% vs. 10%; p = 0.61), and postoperative complications (5% vs. 8%; p = 0.58). After propensity score matching, the IS group experienced significantly lesser blood loss than the ES group (5 mL, IQR: 1-10 vs. 5 mL, IQR: 5-20; p = 0.03). Both groups experienced no local recurrence and demonstrated similar postoperative pulmonary functions after surgery.

Conclusions: IS may be a feasible and acceptable therapeutic option for malignant lung tumors. Nonetheless, future investigations are required to further validate the current findings.
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http://dx.doi.org/10.1007/s11748-020-01556-3DOI Listing
May 2021

Covered Stent of the Left Common Carotid and Subclavian Arteries Assist the Invasive Tumor Resection.

Case Rep Pulmonol 2020 7;2020:8882080. Epub 2020 Dec 7.

Department of Surgery, The Jikei University School of Medicine, Nishishinbashi 3-19-18, Minatoku, Tokyo 105-8471, Japan.

Background: Some recent reports have described the usefulness of thoracic aortic stent grafts to facilitate en bloc resection of tumors invading the aortic wall. We report on malignant peripheral nerve sheath tumor resection in the left superior mediastinum of a 16-year-old man with neurofibromatosis type 1. The pathological margin was positive at the time of the first tumor resection, and radiation therapy was added to the same site. After that, a local recurrence occurred. The tumor was in wide contact with the left common carotid and subclavian arteries and was suspected of infiltration. After stent graft placement of these arteries to avoid fatal bleeding and cerebral ischemia by clamping these arteries and bypass procedure, we successfully resected the tumor without any complications.

Conclusion: s. Here, we report the usefulness of the prior covered stent placement to aortic branch vessels for the resection of invasive tumor.
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http://dx.doi.org/10.1155/2020/8882080DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7738784PMC
December 2020

Clinical adjustability of radiological tools in patients with surgically resected cT1N0-staged non-small-cell lung cancer from the long-term survival evaluation.

J Thorac Dis 2020 Nov;12(11):6655-6662

Department of Thoracic Surgery, Aichi Cancer Center Hospital, Nagoya, Japan.

Background: Various radiological tools have been introduced to determine the malignancy or prognosis of lung carcinomas. We retrospectively summarized the clinical outcomes to evaluate whether radiological tools such as consolidation-to-tumor ratio (CTR), tumor disappearance ratio (TDR), and mediastinal diameter (MD) are suitable for surgically resected non-small-cell lung cancer (NSCLC).

Methods: This retrospective study included 260 patients (128 men and 132 women; median age, 64 years) with cT1N0-staged NSCLC who underwent thoracotomy. Disease-free survival (DFS) and overall survival (OS) outcomes were analyzed using the Kaplan-Meier method and Cox proportional hazards model.

Results: When the adjusted hazard ratios (HRs) with reference to cT1a/1 mi were calculated, significant differences were observed in cT1b and cT1c for DFS (P=0.04 and P<0.01, respectively) and in cT1c for OS (P=0.01). For HRs with reference to CTR (≤0.5), a significant difference was only observed in CTR (>0.5) for DFS (P=0.01). For HRs with reference to TDR (≤25%), significant differences were observed in TDR (>75%) for DFS (P=0.02) and OS (P=0.02). For HRs with reference to MD (≤5 mm), significant differences were observed in 6-20 mm (P=0.04) and >20 mm (P=0.02) for DFS and in >20 mm (P=0.02) for OS.

Conclusions: All radiological tools revealed significant correlations with prognosis in the patients with cT1N0-staged NSCLCs. We recommend the use of MD in a clinical context. However, further investigation of this issue is needed.
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http://dx.doi.org/10.21037/jtd-20-1610DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7711385PMC
November 2020

Efficacy of Xenon Light With Indocyanine Green for Intersegmental Visibility in Thoracoscopic Segmentectomy.

J Surg Res 2021 03 3;259:39-46. Epub 2020 Dec 3.

Department of Thoracic Surgery, Aichi Cancer Center Hospital, Nagoya, Japan. Electronic address:

Background: We previously reported useful methods that can be implemented to identify intersegmental boundary lines (IBLs) by using an intravenous indocyanine green (ICG) fluorescence imaging system (ICG-FS) during a thoracoscopic anatomical segmentectomy (TAS). The aim of this study was to evaluate the recently released third-generation ICG-FS that features an emphasizing xenon-light source for IBL identification.

Methods: We prospectively studied cases involving 106 consecutive patients who underwent TAS. Intraoperatively, we used the third-generation ICG-FS, the conventional ICG methods (CIM) emphasizing xenon-light (CIM-X), and the spectra-A method (SAM) emphasizing xenon-light (SAM-X), for IBL identification. Furthermore, 16 of the 106 patients (15%) could be simultaneously evaluated using old-generation ICG-FSs, CIM, and SAM. All images were completely quantified for illuminance and for three colors, red, green, and blue.

Results: IBLs were successfully identified in all the patients (100%) with no adverse events. The SAM-X significantly increased the illuminance, especially in the resecting segments, compared to the CIM (39.0 versus 22.2, P < 0.01) and SAM (39.0 versus 29.3, P < 0.01), with enhanced red color compared to the CIM (33.1 versus 21.9, P < 0.01) and SAM (33.1 versus 14.0, P < 0.01). Furthermore, the SAM-X significantly increased the illuminance contrast compared to the CIM-X (34.1 versus 15.3, P < 0.01).

Conclusions: The present study suggests that the SAM-X potentially provided images with the highest visibility and colorfulness compared to the older generation ICG-FSs or CIM-X. Secure IBL identification can be more easily and safely performed using the SAM-X.
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http://dx.doi.org/10.1016/j.jss.2020.11.028DOI Listing
March 2021

The impact of same-day chest drain removal on pulmonary function after thoracoscopic lobectomy.

Gen Thorac Cardiovasc Surg 2021 Apr 29;69(4):690-696. Epub 2020 Oct 29.

Department of Thoracic Surgery, Aichi Cancer Center Hospital, 1-1 Kanokoden, Chikusa-ku, Nagoya, 464-8681, Japan.

Objectives: This study aims to assess the feasibility and impact on long-term pulmonary function of chest drain removal on the operation day following thoracoscopic right upper lobectomy for clinical stage I non-small cell lung cancer.

Methods: We retrospectively evaluated the data of 116 patients between May 2013 and March 2019. We evaluated the correlations of clinical parameters of chest drain removal and medium- and long-term pulmonary function by comparing removal on operation day (R group) and retainment (D group).

Results: The R group comprised 64 patients, and the D group had 52 patients. Fifty patients (96.2%) in the D group had chest drain removed within 3 postoperative days. Since February 2016, chest drain removal on operation day was performed in 64 of 74 patients (86.5%) according to our chest drain removal protocol. Removal of chest drains on operation day was associated with shorter postoperative hospitalization (p < 0.01) and lower postoperative complications ≧ grade II of the Clavien-Dindo classification (p = 0.026). Only one patient in the R group needed reinsertion. The R group had greater spirometry results at 3- and 12-postoperative months (POM). R group patients had statistically improved pulmonary functions from 3 to 12POM, while those in the D Group were stagnated at 6POM.

Conclusions: Removal of chest drains on operation day using our protocol is safe and feasible for thoracoscopic right upper lobectomy. This protocol was statistically associated with slightly better long-term pulmonary function, which could not bring clinically meaningful medium- and long-term benefit.
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http://dx.doi.org/10.1007/s11748-020-01516-xDOI Listing
April 2021

Four Hours Postoperative Mobilization is Feasible After Thoracoscopic Anatomical Pulmonary Resection.

World J Surg 2021 Feb 23;45(2):631-637. Epub 2020 Oct 23.

Department of Thoracic Surgery, Aichi Cancer Center Hospital, 1-1 Kanokoden, Chikusa-ku, Nagoya, 464-8681, Japan.

Background: We aimed to analyze the feasibility and risk factors associated with early mobilization (EM) within 4 h after thoracoscopic lobectomy and segmentectomy.

Methods: This study retrospectively evaluated 214 consecutive patients who underwent thoracoscopic anatomical pulmonary resection using our EM protocol between October 2017 and February 2019. We compared the correlations of the patients' characteristics including the total number of drugs and perioperative parameters such as air leak, and orthostatic hypotension (OH) between the EM (E group) and failed EM (F group) groups. Second, we evaluated risk factors for OH, which often causes critical complications.

Results: A total of 198 patients (92.5%: E group) completed the EM protocol, whereas 16 patients did not (7.5%: F group). The primary causes of failure were severe pain, air leak, postoperative nausea and vomiting, and OH (n = 1, 3, 8, and 4). Upon univariate analysis, air leakage, OH, and non-hypertension were identified as risk factors for failed EM (all p <0.05). EM was associated with a shortened chest tube drainage period (p <0.01). Thirty patients (14%) experienced OH, and 20% of them failed EM. A total number of drugs ≥5 (p = 0.015) was an independent risk factor for OH. Operative and anesthetic variables were not associated with EM or OH.

Conclusions: The EM protocol was safe and useful for tubeless management. Surgeons should be advised to actively prevent air leak. Our EM protocol achieved a low frequency of OH in mobilization. Due to its versatility, our mobilization protocol may be promising, especially in patients without severe comorbidities. Clinical registration number: The study protocol was approved by the Review Board of Aichi Cancer Center (approval number: 2020-1-067).
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http://dx.doi.org/10.1007/s00268-020-05836-0DOI Listing
February 2021

Efficacy of Immune Checkpoint Inhibitor Monotherapy for Advanced Non-Small-Cell Lung Cancer with Rearrangement.

Int J Mol Sci 2020 Apr 9;21(7). Epub 2020 Apr 9.

Department of Thoracic Oncology, Aichi Cancer Center Hospital, 1-1 Kanokoden, Chikusa-ku, Nagoya, Aichi 464-8681, Japan.

Programmed death-ligand 1 (PD-L1) expression is a predictor of immune checkpoint inhibitor (ICI) treatment efficacy. The clinical efficacy of ICIs for non-small-cell lung cancer (NSCLC) patients harboring major mutations, such as or mutations, is limited. We genotyped 190 patients with advanced lung adenocarcinomas who received nivolumab or pembrolizumab monotherapy, and examined the efficacy in NSCLC patients with or without major mutations. Among the patients enrolled in the genotyping study, 47 patients harbored mutations, 25 patients had mutations, 5 patients had a mutation, 6 patients had a mutation, and 7 patients had rearrangement. The status of PD-L1 expression was evaluated in 151 patients, and the rate of high PD-L1 expression (≥50%) was significantly higher in patients with mutations. The progression-free survival was 0.6 (95% CI: 0.2-2.1) months for -positive patients and 1.8 (95% CI: 1.2-2.1) months for -positive patients. All patients with rearrangement showed disease progression within three months from the initiation of anti-PD-1 treatment. Our data suggested that ICI treatment was significantly less efficacious in patients with rearrangement than in patients with mutations, and PD-L1 expression was not a critical biomarker for ICI treatment for patients with one of these mutations.
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http://dx.doi.org/10.3390/ijms21072623DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7178012PMC
April 2020

Is skeletal muscle mass an optimal marker for postoperative outcomes in lung cancer patients?

J Thorac Dis 2019 Dec;11(12):5643-5645

Department of Thoracic Surgery, Aichi Cancer Center Hospital, Nagoya, Japan.

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http://dx.doi.org/10.21037/jtd.2019.11.21DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6988079PMC
December 2019

Simultaneous Two-Dimensional and Three-Dimensional Simulation of Thoracoscopic Sleeve Lobectomy: A Quick Understanding of Pitfalls.

Ann Thorac Surg 2020 05 22;109(5):e383-e385. Epub 2020 Jan 22.

Department of Surgery, Division of Thoracic Surgery, The Jikei University School of Medicine, Minatoku, Tokyo, Japan.

Thoracoscopic sleeve lobectomy is challenging, considering the technical difficulty in controlling the needle angle and thread through the port. However, effective simulation of the procedure remains to be established. Here, we describe our first experience with thoracoscopic sleeve lobectomy simulation using a three-dimensional printed thoracic model and a handmade rolled sponge. Owing to the transparent structure, we could simultaneously confirm the suturing technique through the monitor (two-dimensional) and direct vision (three-dimensional). We are certain that our realistic and easily repeatable simulation will assist in developing better technique and conduct feasible thoracoscopic sleeve lobectomy.
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http://dx.doi.org/10.1016/j.athoracsur.2019.11.055DOI Listing
May 2020

Recovery of pulmonary function after lung wedge resection.

J Thorac Dis 2019 Sep;11(9):3738-3745

Department of Surgery, Division of Thoracic Surgery, Jikei University School of Medicine, Tokyo, Japan.

Background: Pulmonary function following lung wedge resection is not fully understood. This study aimed to assess the influence of wedge resection upon postoperative pulmonary function.

Methods: We retrospectively evaluated pulmonary function at 3, 6, and 12 months postoperatively in 29 patients who underwent lung wedge resection. The values of the pulmonary function tests (PFTs) were compared among the time points using a paired -test.

Results: The vital capacity (VC) values before surgery and at 3, 6 and 12 months postoperatively were 2,994±793, 2,845±799, 2,941±801, and 2,964±839 mL, respectively. The VC decreased at 3 months postoperatively (P=0.002) and recovered by 6 and 12 months postoperatively (P=0.003 and 0.003, respectively). The VC values at 6 and 12 months postoperatively did not significantly differ from that before surgery (P=0.152 and 0.361, respectively). The forced expiratory volume in one second (FEV) values before surgery and at 3, 6, and 12 months postoperatively were 2,156±661, 2,034±660, 2,091±672 and 2,100±666 mL, respectively. The values decreased at 3 months postoperatively (P<0.001) and recovered; however, they remained lower than the preoperative value (P=0.036).

Conclusions: The postoperative VC decreased temporarily but recovered to near the preoperative level after 12 months. We concluded that the loss of VC following lung wedge resection is minimal. These findings are beneficial for planning surgery and explaining the procedure to patients who are undergoing lung wedge resection.
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http://dx.doi.org/10.21037/jtd.2019.09.32DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6790438PMC
September 2019

Clinicopathological Features, Surgical Outcomes, Oncogenic Status and PD-L1 Expression of Pulmonary Pleomorphic Carcinoma.

Anticancer Res 2019 Oct;39(10):5789-5795

Department of Thoracic Surgery, Aichi Cancer Center Hospital, Nagoya, Japan.

Background/aim: Pulmonary pleomorphic carcinoma (PPC) is rare, and few studies have reported its features. We assessed the clinicopathological features, surgical outcomes, oncogenic status and programmed death-ligand 1 (PD-L1) expression of PPC.

Patients And Methods: We retrospectively reviewed data from 22 consecutive patients who underwent resection of PPC between 2007 and 2017.

Results: The predominant tissue type of the epithelial component was adenocarcinoma in 15 patients (68%) and the others in 7 patients (32%), and the 3-year disease-free survival rate tended to be better in patients with an adenocarcinoma component compared to patients with another component (40.0% vs. 17.1%, p=0.059). PD-L1 expression was observed in all eight tumors whose PD-L1 status could be examined and high PD-L1 expression (≥50%) was frequent (5/8, 63%).

Conclusion: A predominant adenocarcinoma epithelial component in PPC might be associated with better survival outcomes and high PD-L1 expression might be frequent in PPC.
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http://dx.doi.org/10.21873/anticanres.13782DOI Listing
October 2019

Risk factors and cancer recurrence associated with postoperative complications after thoracoscopic lobectomy for clinical stage I non-small cell lung cancer.

Thorac Cancer 2019 10 21;10(10):1945-1952. Epub 2019 Aug 21.

The Jikei University School of Medicine, Department of Surgery, Division of Thoracic Surgery, Tokyo, Japan.

Background: Minimally invasive thoracoscopic lobectomy is the recommended surgery for clinical stage I non-small cell lung cancer (NSCLC). The purpose of this study was to identify the risk factors, including sarcopenia, for postoperative complications in patients undergoing a complete single-lobe thoracoscopic lobectomy for clinical stage I NSCLC, as well as the impact of complications on disease-free survival.

Methods: We retrospectively investigated 173 patients with pathologically-diagnosed NSCLC who underwent curative thoracoscopic lobectomies between April 2013 and March 2018. Sarcopenia was assessed using the psoas muscle index calculated from preoperative computed tomography images at the third lumbar vertebral level.

Results: Complications developed in 38 (22%) patients, including 21 with prolonged air leak. In univariate analysis, the significant risk factors for complications were advanced age, male sex, higher Charlson Comorbidity Index (CCI) score, lower cholinesterase, lower albumin, higher creatinine level, pleural adhesion, operative time ≥ five hours, nonadenocarcinoma cancer, and larger tumor size. Multivariate analysis showed that age ≥ 75 years (P = 0.002) and pleural adhesion (P = 0.026) were significant independent risk factors for complications. Compared with the patient group without complications, postoperative complications were independently associated with shorter disease-free survival (P = 0.01).

Conclusions: Advanced age and pleural adhesion were independent risk factors for complications after complete single-lobe thoracoscopic lobectomies for clinical stage I NSCLC, and postoperative complications were statistically associated with poor prognosis. Surgical teams should ensure an experienced surgeon leads the operation for patients at higher risk to avoid prolonged postoperative hospitalization and a possible poor prognosis.
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http://dx.doi.org/10.1111/1759-7714.13173DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6775224PMC
October 2019

Risk factors for recurrence of primary spontaneous pneumothorax after thoracoscopic surgery.

J Thorac Dis 2019 May;11(5):1940-1944

Division of Thoracic Surgery, Department of Surgery, The Jikei University School of Medicine, Tokyo, Japan.

Background: Recurrence of pneumothorax after thoracoscopic surgery is a concerning issue for thoracic surgeons. In this study, we aimed to determine the risk factors for recurrence of spontaneous pneumothorax after thoracoscopic surgery.

Methods: A total of 192 patients with spontaneous pneumothorax aged <50 years who underwent thoracoscopic surgery from January 2010 to December 2016 were included in this study. Pre- and post-operative characteristics were obtained from medical records, and recurrent and non-recurrent cases were compared.

Results: Fourteen patients (7.3%) experienced pneumothorax recurrence. Pneumothorax recurrence was observed more frequently in patients aged <20 years (P=0.041) and those in whom bullae were not identified on preoperative computed tomography (CT) (P=0.049). The use of polyglycolic acid (PGA) sheets during surgery significantly decreased the recurrence rate (P=0.031). A history of ipsilateral pneumothorax before surgery was a significant risk factor for recurrence after thoracoscopic surgery (P=0.001). In the multivariate analysis, a history of ipsilateral pneumothorax and identification of bullae on CT were identified as significant risk factors for recurrence.

Conclusions: A history of ipsilateral pneumothorax, and inability to identify bullae on preoperative CT were risk factors for postoperative recurrence of pneumothorax.
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http://dx.doi.org/10.21037/jtd.2019.04.105DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6588783PMC
May 2019

Thoracoscopic lobectomy using indocyanine green fluorescence to detect the interlobar fissure in a patient with displaced B3 and absence of fissure: A case report.

Thorac Cancer 2019 07 19;10(7):1654-1656. Epub 2019 Jun 19.

Department of Thoracic Surgery, Aichi Cancer Center Hospital, Nagoya, Japan.

A 90-year-old woman was admitted to our hospital with suspected lung adenocarcinoma. Preoperative three-dimensional reconstructed computed tomography revealed displacement of the anterior segmental bronchus (B3) arising from the right middle lobe bronchus with absence of the fissure between the right upper and middle lobes. A complete thoracoscopic right upper lobectomy was successfully performed. It is crucial to identify such anomalies prior to lung resection to avoid intraoperative complications during thoracoscopic lobectomy or segmentectomy. Additionally, intravenous indocyanine green with a fluorescence system was useful to identify the proper interlobar fissure boundary intraoperatively. To the best of our knowledge, this is the first reported case of thoracoscopic lobectomy for lung cancer with displaced B3 and absence of the interlobar fissure to be performed by applying the intravenous indocyanine green method.
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http://dx.doi.org/10.1111/1759-7714.13104DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6610257PMC
July 2019

Right Upper Lobe Torsion after Right Lower Lobectomy: A Rare and Potentially Life-Threatening Complication.

Case Rep Pulmonol 2018 23;2018:2146458. Epub 2018 Dec 23.

Department of Surgery, The Jikei University School of Medicine, Nishishinbashi 3-19-18, Minatoku, Tokyo 105-8471, Japan.

An 84-year-old woman was referred to our institution with suspected right lung cancer. Subsequently, she underwent thoracoscopic right lower lobectomy without mediastinal lymph node dissection. Postoperatively, she complained of dyspnea and developed arterial oxygen desaturation after 12 h and acute respiratory failure (ARF). An emergency chest computed tomography revealed the right upper bronchial stenosis with hilar peribronchovascular soft tissue edema because the middle lung lobe had been pushed upward and forward and the right upper lung lobe had twisted dorsally. Emergency bronchoscopy revealed severe right upper bronchial stenosis with an eccentric rotation and severe edema. The bronchia stenosis was successfully treated with glucocorticoids and noninvasive positive pressure ventilation for ARF.
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http://dx.doi.org/10.1155/2018/2146458DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6323478PMC
December 2018

Vitamin D Supplementation and Survival of Patients with Non-small Cell Lung Cancer: A Randomized, Double-Blind, Placebo-Controlled Trial.

Clin Cancer Res 2018 09 17;24(17):4089-4097. Epub 2018 Jul 17.

Division of Molecular Epidemiology, the Jikei University School of Medicine, Tokyo, Japan.

Higher serum 25-hydroxyvitamin D (25(OH)D) levels are reportedly associated with better survival in early-stage non-small cell lung cancer (NSCLC). Therefore, whether vitamin D supplementation can improve the prognosis of patients with NSCLC was examined (UMIN000001869). A randomized, double-blind trial comparing vitamin D supplements (1,200 IU/day) with placebo for 1 year after operation was conducted. The primary and secondary outcomes were relapse-free survival (RFS) and overall survival (OS), respectively. Prespecified subgroup analyses were performed with stratification by stage (early vs. advanced), pathology (adenocarcinoma vs. others), and 25(OH)D levels (low, <20 ng/mL vs. high, ≥20 ng/mL). Polymorphisms of vitamin D receptor (VDR) and vitamin D-binding protein (DBP) and survival were also examined. Patients with NSCLC ( = 155) were randomly assigned to receive vitamin D ( = 77) or placebo ( = 78) and followed for a median of 3.3 years. Relapse and death occurred in 40 (28%) and 24 (17%) patients, respectively. In the total study population, no significant difference in either RFS or OS was seen with vitamin D compared with the placebo group. However, by restricting the analysis to the subgroup with early-stage adenocarcinoma with low 25(OH)D, the vitamin D group showed significantly better 5-year RFS (86% vs. 50%, = 0.04) and OS (91% vs. 48%, = 0.02) than the placebo group. Among the examined polymorphisms, DBP1 (rs7041) TT and CDX2 (rs11568820) AA/AG genotypes were markers of better prognosis, even with multivariate adjustment. In patients with NSCLC, vitamin D supplementation may improve survival of patients with early-stage lung adenocarcinoma with lower 25(OH)D levels. .
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http://dx.doi.org/10.1158/1078-0432.CCR-18-0483DOI Listing
September 2018

Clinicopathological Features of Thymoma with Ring Calcification: Case Reports.

Ann Thorac Cardiovasc Surg 2017 Oct 1;23(5):256-261. Epub 2017 May 1.

Department of Surgery, Jikei University Hospital, Tokyo, Japan.

Thymomas with ring calcifications are very rare and quaint style. Herein, we presented our three cases of thymomas with ring calcifications and reviewed totally 10 cases including 7 cases of previous English literatures. The median age was 53 years. Myasthenia gravis was a complication in 40%. The median maximal diameter was 50 mm. They were diagnosed as pathological type B or had type B component. Based on World Health Organization (WHO) classification, 20%, 60%, and 20% cases were stage I, stage II, and stage III, respectively. Seven ring calcifications were within tumors (inner type) and two cases were outside tumors (outer type). The other had a thymoma arising in the calcic wall of a calcified thymic cyst (miscellaneous type). Four other anterior mediastinal tumors with ring calcification had been reported. We need pathological examinations for a definitive diagnosis. Surgeons should plan surgery because of the possibility of invasive thymomas, or other malignant tumors.
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http://dx.doi.org/10.5761/atcs.cr.16-00247DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5655338PMC
October 2017

Thymic Cavernous Hemangioma With a Left Innominate Vein Aneurysm.

Ann Thorac Surg 2015 Jul;100(1):320-2

Department of Surgery, Jikei University Hospital, Minatoku, Tokyo, Japan.

Here we report a case of thymic cavernous haemangioma with the left innominate vein aneurysm. A 43-year-old man presented with chest pain. Enhanced chest computed tomography revealed an anterior mediastinal tumor measuring 60 × 52 × 38 mm with multiple venous lakes and focal specks of calcification, composed of a low-density soft tissue mass along with a left innominate vein aneurysm. We preoperatively diagnosed the mass as a thymic hemangioma and subsequently performed surgical resection. Pathologic diagnosis was a thymic cavernous hemangioma with a left innominate vein aneurysm, which is very rare.
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http://dx.doi.org/10.1016/j.athoracsur.2014.08.057DOI Listing
July 2015

Pulmonary pleomorphic carcinoma detected as a result of pneumothorax and the subsequent occurrence of multiple cystic metastases.

Case Rep Med 2014 20;2014:219273. Epub 2014 Aug 20.

Department of Internal Medicine, Division of Respiratory Medicine, Jikei University School of Medicine, Tokyo, Japan.

A 39-year-old man was admitted for spontaneous pneumothorax. He underwent pulmonary resection to correct the lesion causing the air leakage, and a pathological diagnosis of pulmonary pleomorphic carcinoma was made because we thought that the pneumothorax developed due to the direct rupture of necrotic neoplastic tissue into the pleural cavity. After the operation, the patient received chemotherapy, during which multiple cystic metastases gradually developed in the lung that caused repeated occurrences of pneumothorax. Clinicians must be careful to recognize that pneumothorax can also be a complication of primary and various metastatic pulmonary malignancies.
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http://dx.doi.org/10.1155/2014/219273DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4158116PMC
September 2014

Thoracoscopic anatomical subsegmentectomy of the right S2b + S3 using a 3D printing model with rapid prototyping.

Interact Cardiovasc Thorac Surg 2014 Oct 6;19(4):696-8. Epub 2014 Jul 6.

Department of Surgery, The Jikei University Hospital, Minatoku, Tokyo, Japan.

Thoracoscopic segmentectomies and subsegmentectomies are more difficult than lobectomy because of the complexity of the procedure; therefore, preoperative decision-making and surgical procedure planning are essential. In the literature, we could successfully perform thoracoscopic anatomical subsegmentectomy of the right S2b + S3 using a 3D printing model with rapid prototyping. This innovative surgical support model is extremely useful for planning a surgical procedure and identifying the surgical margin.
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http://dx.doi.org/10.1093/icvts/ivu174DOI Listing
October 2014

Simplified cavernostomy using wound protector for complex pulmonary aspergilloma.

Ann Thorac Surg 2014 Jul;98(1):360-1

Department of Surgery, Jikei University Hospital, Minatoku, Tokyo, Japan.

A 64-year-old man presented with dyspnea, chest pain, cough, expectoration, and continuous low-grade fever. Chest radiography and computed tomography revealed a right-sided, thick-walled cavity with diseased lung parenchyma, and sputum microscopy confirmed fungal forms of aspergillus. He subsequently developed a left-sided pneumonia caused by aspiration of the right-sided abscess. Because lung resection was considered too invasive, we performed simplified cavernostomy using the Alexis Wound Protector (XXS) using local anesthesia. In addition to the excellent drainage outcomes, this procedure was both simple and efficient. Moreover, the procedure was associated with less pain and physical limitation for the patient.
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http://dx.doi.org/10.1016/j.athoracsur.2013.11.087DOI Listing
July 2014

Imaging Characteristics in ALK Fusion-Positive Lung Adenocarcinomas by Using HRCT.

Ann Thorac Cardiovasc Surg 2015 3;21(2):102-8. Epub 2014 Jun 3.

Department of Thoracic Surgical Oncology, Thoracic Center, The Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo, Japan.

Objectives: We aimed to identify high-resolution computed tomography (HRCT) features useful to distinguish the anaplastic lymphoma kinase gene (ALK) fusion-positive and negative lung adenocarcinomas.

Methods: We included 236 surgically resected adenocarcinoma lesions, which included 27 consecutive ALK fusion-positive (AP) lesions, 115 epidermal growth factor receptor mutation-positive lesions, and 94 double-negative lesions. HRCT parameters including size, air bronchograms, pleural indentation, spiculation, and tumor disappearance rate (TDR) were compared. In addition, prevalence of small lesions (≤20 mm) and solid lesions (TDR ≤20%) were compared.

Results: AP lesions were significantly smaller and had lower TDR (%) than ALK fusion-negative (AN) lesions (tumor diameter: 20.7 mm ± 14.1 mm vs. 27.4 mm ± 13.8 mm, respectively, p <0.01; TDR: 22.8% ± 24.8% vs. 44.8% ± 33.2%, respectively, p <0.01). All AP lesions >20 mm (n = 7, 25.9%) showed a solid pattern. Among all small lesions, AP lesions had lower TDR and more frequent spiculation than AN lesions (p <0.01). Among solid lesions, AP lesions were smaller than AN lesions (p = 0.01).

Conclusion: AP lung lesions were significantly smaller and had a lower TDR than AN lesions. Spiculation was more frequent in small lesions. Non-solid >20 mm lesions may be ALK fusion-negative.
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http://dx.doi.org/10.5761/atcs.oa.14-00093DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4990087PMC
January 2016

A three-dimensional mediastinal model created with rapid prototyping in a patient with ectopic thymoma.

Ann Thorac Cardiovasc Surg 2015 15;21(1):87-9. Epub 2014 Mar 15.

Department of Surgery, The Jikei University Kashiwa Hospital, Kashiwa, Chiba, Japan.

Preoperative three-dimensional (3D) imaging of a mediastinal tumor using two-dimensional (2D) axial computed tomography is sometimes difficult, and an unexpected appearance of the tumor may be encountered during surgery. In order to evaluate the preoperative feasibility of a 3D mediastinal model that used the rapid prototyping technique, we created a model and report its results. The 2D image showed some of the relationship between the tumor and the pericardium, but the 3D mediastinal model that was created using the rapid prototyping technique showed the 3D lesion in the outer side of the extrapericardium. The patient underwent a thoracoscopic resection of the tumor, and the pathological examination showed a rare middle mediastinal ectopic thymoma. We believe that the construction of mediastinal models is useful for thoracoscopic surgery and other complicated surgeries of the chest diseases.
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http://dx.doi.org/10.5761/atcs.nm.13-00342DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4989994PMC
December 2015