記述言語：英語   掲載種別：研究論文（学術雑誌）  

OBJECTIVE: The use of limited anatomic resection for early-stage lung cancer is widely practiced worldwide. However, most studies have focused on standard segmentectomy or subsegmentectomy, and data on the short-term outcomes after anatomic sublobar resection in China are lacking. METHODS: In 2014, the use of anatomic partial lobectomy (APL), which is defined as lesion-centered resection of anatomical sublobular parts, was proposed by the National Cancer Center in China. We retrospectively evaluated all consecutive patients who underwent APL between November 2013 and October 2019 from our database, and the operative techniques and short-term outcomes were analyzed. RESULTS: A total of 3336 patients with a median age of 56 years underwent APL during the study period. Benign lesions were present in 8.5% of all patients and decreased across time. The mean total operation time was 127.3 minutes, the mean overall number of nodal sampling/dissections was 13, and the mean number of stations sampled was 4. Postoperative complications (grade ≥2) developed in 359 patients (10.8%), and no mortality occurred in the 30 days after surgery. Multivariate analysis showed that smoking, surgeon's early experience, thoracotomy or unplanned conversion to thoracotomy, and complex cases were risk factors for the occurrence of postoperative complications. CONCLUSIONS: Despite the increasing proportion of complex cases treated with APL, the incidence of postoperative complications decreased as our center accumulated surgical experience. APL procedures are safe and feasible when conducted in a specialized center.

DOI： 10.1016/j.jtcvs.2021.11.044

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記述言語：日本語   出版者・発行元：日本臨床外科学会  

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

18F-fluoro-2-deoxy-D-glucose positron emission tomography/computed tomography (FDG-PET/CT) has been widely used for preoperative staging of lung adenocarcinomas. The aim of this study was to determine whether a high maximum standardized uptake value (SUVmax) could correlate with pathological characteristics in those patients. We retrospectively reviewed patients with clinical stage 0-IA lung adenocarcinoma who underwent preoperative 18F-fluoro-2-deoxy-D-glucose positron emission tomography/computed tomography followed by curative anatomical resection. To identify more advanced disease and high-risk features, representing visceral pleural involvement, pulmonary metastasis, lymph node involvement, and lymphovascular involvement in resected surgical specimens, univariate and multivariate logistic regression analyses were performed. The optimal cutoff point for the SUVmax was determined by receiver operating characteristic analysis. In 2 groups divided according to the cutoff point, the disease-free survivals were calculated and compared using the Kaplan-Meier method and the log-rank test. More advanced disease and high-risk features were identified in 55 (18.9%) of the 291 patients. SUVmax was significantly correlated with more advanced disease and high-risk features, as did the consolidation/tumor ratio on computed tomography. Only 2 (1.2%) of the 169 patients with a SUVmax <3.20 showed more advanced disease and high-risk features, compared with 43.4% of patients with a SUVmax ≥3.20. The disease-free survival was significantly higher in patients with a SUVmax <3.20 than in those with a SUVmax ≥3.20 (P = 0.002). A high SUVmax correlates with more advanced disease and high-risk features in patients with clinical stage 0-IA lung adenocarcinoma. The SUVmax should be considered when deciding treatment strategy in early-stage lung adenocarcinoma.

DOI： 10.1053/j.semtcvs.2021.07.019

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：OXFORD UNIV PRESS  

OBJECTIVES: The optimal surgical approach for metachronous second primary lung cancer (MSPLC), especially ipsilateral MSPLC, remains unclear. This study aimed to review postoperative complications and examine surgical outcomes based on the extent of resection after surgery for ipsilateral MSPLC.METHODS: Clinical data from 61 consecutive patients who underwent pulmonary resection for ipsilateral MSPLC according to the Martini-Melamed criteria between January 2005 and December 2017 in 3 institutes were retrospectively reviewed.RESULTS: Postoperative complications were identified in 12 patients (19.7%). Regarding the combination of initial and second surgery, intraoperative bleeding was significantly greater in patients with anatomic-anatomic resection than in others (P < 0.001). Operation time was significantly longer in patients with anatomic-anatomic resection than in others (P <0.001). However, postoperative complications showed no significant differences based on the combination of surgeries. Five-year overall survival rates in patients with anatomic resection and wedge resection after second surgery were 75.8% and 75.8%, respectively (P= 0.738), and 5-year recurrence-free survival rates were 54.2% and 67.6%, respectively (P = 0.368). Cox multivariate analysis identified ever-smoker status (P = 0.029), poor performance status (P = 0.011) and tumour size >20 mm (P = 0.001) as independent predictors of poor overall survival, while ever-smoker status (P = 0.040) and tumour size >20 mm (P = 0.007) were considered independent predictors of poor recurrence-free survival.CONCLUSIONS: Regarding postoperative and long-term outcomes for patients with ipsilateral MSPLC, surgical intervention is safe and offers good long-term survival. Wedge resection is an acceptable provided tumours <= 2 cm and ground-glass opacity-predominant as a second surgery for early-stage ipsilateral MSPLC.

DOI： 10.1093/icvts/ivab025

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：SPRINGER  

PURPOSE: The best surgical approach for second primary lung cancer remains a subject of debate. The purpose of this study was to review the postoperative complications after second surgery for second primary lung cancer and to investigate the outcomes based on these complications. METHODS: The clinical data of 105 consecutive patients who underwent pulmonary resection for multiple primary lung cancers between January, 1996 and December, 2017, were reviewed according to the Martini-Melamed criteria. RESULTS: After the second surgery, low body mass index (BMI) (< 18.5 kg/m2) (P = 0.004) and high Charlson comorbidity index (CCI) (P = 0.002) were independent predictors of postoperative complications. Survival analysis revealed the 5-year overall survival rates of 74.5% and 61.4% for patients without postoperative complications and those with postoperative complications (P = 0.044), respectively, but the 5-year cancer-specific survival rates of 82.5% and 80.0% (P = 0.926), respectively. During this period, there were significantly more respiratory-related deaths of patients with complications than of those without complications (P = 0.011). CONCLUSION: Surgical intervention is feasible and potentially effective for second primary lung cancer but may not achieve positive perioperative and long-term outcomes for patients with a low BMI or a high CCI. Treatment options should be considered carefully for these patients.

DOI： 10.1007/s00595-020-02038-y

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記述言語：英語   出版者・発行元：AME PUBL CO  

DOI： 10.21037/jtd-20-1582

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：SPRINGER JAPAN KK  

OBJECTIVE: Although lobectomy is the standard surgical procedure for small-sized non-small cell lung cancer (NSCLC), segmentectomy has been performed for various reasons. The aim of this study was to investigate the characteristics of and risk factors for recurrence in early-stage NSCLC patients undergoing segmentectomy. METHODS: We retrospectively reviewed 179 patients with clinical stage I NSCLC who underwent segmentectomy. Preoperative factors were analyzed using the log-rank test for univariate analyses. Multivariate analyses were performed using a Cox proportional hazards regression model to identify independent risk factors for recurrence. For the significant factors, optimal cutoff points were determined by receiver operating characteristic (ROC) analysis. RESULTS: During the follow-up period of 51 months, 18 patients developed recurrence; 5 had locoregional (including 2 with margin recurrences only), 9 had distant, and 4 had both locoregional and distant recurrence. Multivariate and ROC analysis identified radiologic solid tumor size with a cutoff point of 1.5 cm as an independent risk factor for recurrence. Three patients in the solid size < 1.5 cm group (n = 119) developed recurrence, 2 of whom had surgical margin recurrence, compared to 15 patients in the solid size ≥ 1.5 cm group (n = 60). CONCLUSIONS: The indication for segmentectomy should be decided upon with caution, and the segments to be resected should be carefully considered to secure an appropriate surgical margin in this low-risk subgroup of patients because they may have a relatively higher risk of surgical margin recurrence, despite being at decreased risk.

DOI： 10.1007/s11748-020-01338-x

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記述言語：英語   出版者・発行元：AME PUBL CO  

DOI： 10.21037/atm.2020.03.35

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：AME PUBL CO  

Background: The management of the intersegmental plane (ISP) is challenging during uniport video-assisted thoracoscopic (VATS) pulmonary segmentectomy. Staplers and electrocautery have been used extensively in ISP management. However, both of them have their respective drawbacks. Currently, we have provided a revised technique termed as "Combined Dimensional Reduction Method" (CDR method), for managing the ISP with combined application of ultrasonic scalpel and staplers. The study aimed to review the outcomes of patients who underwent uniport VATS segmentectomy with or without the CDR method in our institute and assess the feasibility and safety of the CDR method. Methods: From March 2017 to February 2018, 220 patients who underwent uniport VATS segmentectomy were retrospectively reviewed. By using IQQA software, pulmonary structures were reconstructed as three-dimensional (3D) images, making the targeted structures could be identified preoperatively. For the management of the ISP, in the CDR group, we firstly used the ultrasonic scalpel to trim the 3D pulmonary structure along the intersegmental demarcation, making the remaining targeted parenchyma both sufficiently thin enough and located on a 2D plane; thus, enabling easy use of staplers in managing ISP. Whereas, in the non-CDR group, we only use the staplers to manage the ISPs. The clinical characteristics, complications, and postoperative pulmonary functions were compared between the two groups. Results: Propensity score analysis generated 2 well-matched pairs of 71 patients in CDR and non-CDR groups. There was no 30-day postoperative death or readmission in either group. The CDR group was significantly associated with the shorter operative time (178.3±35.8 vs. 209.2±28.7 min) (P=0.031) and postoperative stay (4.5±2.3 vs. 5.7±4.2 days) (P=0.041), compared to the non-CDR group. Moreover, no significant difference was observed in blood loss, a period of chest tube drainage, a period of ultrafine tube drainage, and postoperative pulmonary complications between the two groups. Moreover, the recovery rate of postoperative forced expiratory volume in 1 second (FEV1) or vital capacity (VC) at 1 and 3 months after segmentectomy was comparable between them. Conclusions: The CDR method could make segmentectomy easier and more accurate, and therefore has the potential to be a viable and effective technique for uniport VATS pulmonary segmentectomy.

DOI： 10.21037/tlcr.2019.09.12

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記述言語：日本語   掲載種別：研究論文（学術雑誌）  

Associated with an increase of small-sized lung cancer or metachronous second primary lung cancer, we have more opportunities to perform sublobar resection. Difficulties of identifying tumor location and appropriate surgical margin for small-sized ground-glass opacity (GGO) dominant lesions in thoracoscopic surgery is the big issue of sublobar resection. Virtual-assisted lung mapping (VAL-MAP) that makes markings on the lung surface through some peripheral bronchi by bronchoscopically projects intrapulmonary anatomy on the lung surface and literally draw a map. We report a case of thoracoscopic left upper division segmentectomy for multiple ground-glass nodules (GGNs) using preoperative VAL-MAP. A 65-year-old women who had undergone right upper lobectomy for primary lung cancer, and had multiple GGNs in the bilateral lungs was followed up as an outpatient. Eleven years after initial pulmonary resection, 2 lesions in the left upper division became bigger, and we decided to perform surgery for 4 GGNs in the left upper division including these 2 lesions. We preoperatively made bronchoscopic dye markings through B1+2c, B3a and B4a for in the left upper lobe. The 3 markings were intraoperatively identified. We decided the resection line based on the markings and performed thoracoscopic left upper division segmentectomy. The pathological diagnosis was minimally invasive adenocarcinoma, adenocarcinoma in situ and pneumonitis. Surgical margins were negative. VAL-MAP will assume an important role as an intraoperative navigation system for sublobar resection.

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記述言語：日本語   出版者・発行元：(株)南江堂  

65歳女。胸部CT異常影を主訴とした。右肺上葉切除術後の多発スリガラス結節(GGN)症例であり、胸部CTでは左肺S1+2a末梢に2ヵ所、左肺S3c末梢とS3aにそれぞれGGNを認め、いずれも肺癌の可能性があったため、全ての病変を含むよう区域切除を選択した。また、S3aの病変は術中触知困難が予想され、左肺S4+5との区域間に近接していたため、切離ラインの設定補助目的でvirtual-assisted lung mapping(VAL-MAP)を用い、胸腔鏡下左上区切除を行った結果、病変からのマージンを確保しつつ、残存区域の損失を最小限にするよう胸腔鏡下に完全切除できた。術後5年で再発はなく、残存するGGN病変も著変なく経過している。VAL-MAPは触知困難病変に対する胸腔鏡下区域切除において、特に有用であった。

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その他リンク： https://search-tp.jamas.or.jp/index.php?module=Default&action=Link&pub_year=2019&ichushi_jid=J00349&link_issn=&doc_id=20190701230011&doc_link_id=1573950786545221248&url=https%3A%2F%2Fcir.nii.ac.jp%2Fcrid%2F1573950786545221248&type=CiNii&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00003_1.gif

記述言語：日本語   出版者・発行元：真興交易(株)医書出版部  

非常に稀な自然気管破裂の1症例を経験した。症例は85歳の女性で、高度肥満、閉塞性睡眠時無呼吸症候群、関節リウマチの現病歴があり、ステロイド治療中であった。外傷などの誘因なく背部痛、呼吸困難が出現し、気管支鏡で分岐部直上の気管破裂を認めた。手術のために挿管された二腔チューブが、気管裂傷部に迷入し、換気困難になった。体外式膜型人工肺を使用して、手術を完遂し、治療を継続したが死亡した。(著者抄録)

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：BMC  

BACKGROUND: The presence of emphysema on computed tomography (CT) is associated with an increased frequency of lung cancer, but the postoperative outcomes of patients with pulmonary emphysema are not well known. The objective of this study was to investigate the association between the extent of emphysema and long-term outcomes, as well as mortality and postoperative complications, in early-stage lung cancer patients after pulmonary resection. METHODS: The clinical records of 566 consecutive lung cancer patients who underwent pulmonary resection in our department were retrospectively reviewed. Among these, the data sets of 364 pathological stage I patients were available. The associations between the extent of lung emphysema and long-term outcomes and postoperative complications were investigated. Emphysema was assessed on the basis of semiquantitative CT. Surgery-related complications of Grade ≥ II according to the Clavien-Dindo classification were included in this study. RESULTS: Emphysema was present in 63 patients. The overall survival and relapse-free survival of the non-emphysema and emphysema groups at 5 years were 89.0 and 61.3% (P < 0.001), respectively, and 81.0 and 51.7%, respectively (P < 0.001). On multivariate analysis, significant prognostic factors were emphysema, higher smoking index, and higher histologic grade (p < 0.05). Significant risk factors for poor recurrence-free survival were emphysema, higher smoking index, higher histologic grade, and presence of pleural invasion (P < 0.05). Regarding Grade ≥ II postoperative complications, pneumonia and supraventricular tachycardia were more frequent in the emphysema group than in the non-emphysema group (P = 0.003 and P = 0.021, respectively). CONCLUSION: The presence of emphysema affects the long-term outcomes and the development of postoperative complications in early-stage lung cancer patients.

DOI： 10.1186/s12890-019-0839-1

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：SPRINGER JAPAN KK  

OBJECTIVES: To aim of this study was to clarify the safety of simultaneous thoracic aortic endografting and combined resection of the aortic wall and thoracic malignancy in a one-stage procedure over the early and mid-term periods. METHODS: From March 2013 to December 2017, 6 patients underwent aortic endografting followed by one-stage en bloc resection of the tumor and aortic wall. Thoracic surgeons and cardiovascular surgeons discussed predicted tumor invasion range and resection site, stent placement position, stent length and size, and the surgical procedure, taking into account the safe margin. RESULTS: The proximal site of aortic endografting was the: aortic arch in 2 cases (subclavian artery (SCA) occlusion in one, and SCA fenestration in one); distal arch just beneath the SCA in 2; descending aorta in 2. Pulmonary resection involved lobectomy in 2 patients, pneumonectomy in 2, and completion pneumonectomy in 1. Aortic resection was limited to the adventitia in 2 cases, extended to the media in 3, and extended to the intima in 1. An endograft-related complication, external iliac artery intimal damage requiring vessel repair, was observed in one case. No complications associated with aortic resection were observed. Two postoperative complications of atrial fibrillation and chylothorax developed. There were no surgery-related deaths. During follow-up, no late endograft-related complications such as migration or endoleaks occurred. CONCLUSIONS: Early and mid-term outcomes of stent graft-related complications are acceptable. Simultaneous thoracic aortic endografting and combined resection of the aortic wall and thoracic malignancies are feasible in one stage on the same day.

DOI： 10.1007/s11748-018-1003-1

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記述言語：日本語   出版者・発行元：(NPO)日本呼吸器外科学会  

【対象と方法】2009年2月〜2015年3月の新潟呼吸器外科研究グループでの特発性肺線維症(IPF)合併肺癌手術例において、術後及び遠隔期の急性増悪(AE)の発生と予後を前向きに検討した。【結果】対象は48例で、男/女47/1例、平均年齢70歳。術後AEは3例(6%)に認め、その内1例が再AEで、2例が再々AEで死亡していた。単変量解析で、術後AEに対する予測因子はなく、遠隔期AEに関しては術後AE発症が予測因子であった。遠隔期AEは、平均16ヵ月で14例(29%)に発症し、8例がAEにより死亡していた。術後AE発症群と非発症群の3年全生存率(OS)は0%、70.6%で(p<0.001)、遠隔期AE発症群と非発症群の3年OSは35.7%、80.3%であった(p=0.001)。【結語】術後AE発症のみが遠隔期AE発症の予測因子であった。遠隔期AEを念頭に置いた注意深い経過観察が必要である。(著者抄録)

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記述言語：英語   出版者・発行元：SPRINGER  

DOI： 10.1007/s00270-018-1958-4

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：BMC  

BACKGROUND: Patients with idiopathic pulmonary fibrosis (IPF) have a high risk of developing lung cancer, but few studies have investigated the long-term outcomes of repeated surgery in such patients. The purpose of this study was to evaluate the surgical outcomes of repeated lung cancer surgery in patients with IPF. METHODS: From January 2001 to December 2015, 108 lung cancer patients with IPF underwent pulmonary resection at two institutions; 13 of these patients underwent repeated surgery for lung cancer, and their data were reviewed. RESULTS: The initial procedures of the 13 patients were lobectomy in 8, segmentectomy in 2, and wedge resection in 3. The subsequent procedures were wedge resection in 10 and segmentectomy in 3. The clinical stage of the second tumor was stage IA in 12 and stage IB in 1. Postoperatively, 3 patients (23.1%) developed acute exacerbation (AE) of IPF and died. The rate of decrease in percent vital capacity was significantly higher in patients with AE than in those without AE (p = 0.011). The 3-year overall survival rate was 34.6%. The causes of death were cancer-related in 7, AE of IPF in 3, and metachronous lung cancer in 1. CONCLUSIONS: Despite limited resection, a high incidence of AE was identified. The early and long-term outcomes of repeated surgery in lung cancer patients with IPF were poor because of the high risk of AE of IPF and lung cancer recurrence. Long-term intensive surveillance will be required to determine whether surgical intervention is justified in patients with multiple primary lung cancers and IPF.

DOI： 10.1186/s12890-018-0703-8

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：AME PUBL CO  

DOI： 10.21037/jtd.2018.05.79

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：SPRINGER  

BACKGROUND: Lung squamous cell carcinoma (LSCC) is a major histological subtype of lung cancer. In this study, we investigated genomic alterations in LSCC and evaluated the clinical implications of mutation burden (MB) in LSCC. METHODS: Genomic alterations were determined in Japanese patients with LSCC (N = 67) using next-generation sequencing of 415 known cancer genes. MB was defined as the number of non-synonymous mutations per 1 Mbp. Programmed death-ligand 1 (PD-L1) protein expression in cancer cells was evaluated by immunohistochemical analysis. RESULTS: TP53 gene mutations were the most common alteration (n = 51/67, 76.1%), followed by gene alterations in cyclin-dependent kinase inhibitor 2B (CDKN2B; 35.8%), CDKN2A (31.3%), phosphatase and tensin homolog (30.0%), and sex-determining region Y-box 2 (SOX2, 28.3%). Histological differentiation was significantly poorer in tumors with high MB (greater than or equal to the median MB) compared with that in tumors with low MB (less than the median MB; p = 0.0446). The high MB group had more tumors located in the upper or middle lobe than tumors located in the lower lobe (p = 0.0019). Moreover, cancers in the upper or middle lobes had significantly higher MB than cancers in the lower lobes (p = 0.0005), and tended to show higher PD-L1 protein expression (p = 0.0573). SOX2 and tyrosine kinase non-receptor 2 amplifications were associated with high MB (p = 0.0065 and p = 0.0010, respectively). CONCLUSIONS: The MB level differed according to the tumor location in LSCC, suggesting that the location of cancer development may influence the genomic background of the tumor.

DOI： 10.1245/s10434-018-6401-1

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記述言語：英語   出版者・発行元：AME PUBL CO  

DOI： 10.21037/jtd.2018.05.41

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：AME PUBL CO  

Background: Virtual-assisted lung mapping (VAL-MAP), a bronchoscopic multi-spot dye-marking technique, was tested for its ability to resect ground glass nodules (GGNs) in sublobar lung resections. Methods: All patients were prospectively registered in the multi-institutional lung mapping (MIL-MAP) study using VAL-MAP. The data were retrospectively analyzed, focusing on GGNs. GGN characteristics, pathological findings, operation type, and the surgical contribution of VAL-MAP were evaluated. Results: The 370 GGNs in 299 patients included 257 pure and 113 mixed GGNs. There were 146 wedge resections (43.6%), 99 simple segmentectomies (29.6%), and 60 complex segmentectomies (18.0%). The largest number of marks were used in complex segmentectomy (4.05±0.74), followed by simple segmentectomy (3.35±0.97) and wedge resection (2.96±0.80). The overall successful resection rate was 98.6%. Multiple [2-5] GGNs were concurrently targeted by VAL-MAP in 53 patients (17.7%) with 123 GGNs. Two concurrent resections were conducted in 36 patients (12.1%), most commonly wedge resection and segmentectomies (21 patients). Among 190 sub-centimeter GGNs, 24 out of 51 GGNs ≤5 mm in diameter (47.1%) and 113 of 139 GGNs >5 mm in diameter (81.3%) were primary lung cancer (P<0.0001). Regarding the contribution of VAL-MAP to successful resection, wedge resection and pure GGNs were graded higher than both other resection types and mixed GGNs. Conclusions: VAL-MAP enabled thoracoscopic limited resection of GGNs. Its multiple marks facilitated resections of multi-centric GGNs. Resected suspicious GGNs >5 mm in diameter are likely to be lung cancer. VAL-MAP may impact decision-making regarding the indications and type of surgery for suspicious small GGNs.

DOI： 10.21037/jtd.2018.05.13

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記述言語：日本語   出版者・発行元：(NPO)日本呼吸器外科学会  

症例は64歳女性。子宮体癌の破裂により当院を受診した。緊急で子宮切除が行われたが、その際のCTで深部静脈血栓と右肺動脈血栓、左肺動脈内の塞栓子を認めた。子宮体癌術後下大静脈フィルターと抗凝固薬にて治療が行われた。抗凝固療法により右肺動脈内の血栓は消失したが、左肺動脈の塞栓子は消失しなかった。その後塞栓子は徐々に増大を認めた。PET/CTでは同病変に集積を認め、心臓カテーテル検査での腫瘍生検により血管肉腫と診断された。胸骨正中切開で体外循環を併用し、左主肺動脈切除と左肺全摘、右主肺動脈再建を行った。病理では血管内膜由来の肉腫であることが判明した。術後8ヵ月目に再発を認め、9ヵ月後に肺炎による呼吸不全で死亡した。肺動脈肉腫は稀な疾患であり、文献的考察を加え報告する。(著者抄録)

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その他リンク： https://search-tp.jamas.or.jp/index.php?module=Default&action=Link&pub_year=2018&ichushi_jid=J02256&link_issn=&doc_id=20180523320010&doc_link_id=10.2995%2Fjacsurg.32.492&url=https%3A%2F%2Fdoi.org%2F10.2995%2Fjacsurg.32.492&type=J-STAGE&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00007_3.gif

記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：NATURE PUBLISHING GROUP  

Next-generation sequencing (NGS) has enabled comprehensive detection of genomic alterations in lung cancer. Ethnic differences may play a critical role in the efficacy of targeted therapies. The aim of this study was to identify and compare genomic alterations of lung adenocarcinoma between Japanese patients and the Cancer Genome Atlas (TCGA), which majority of patients are from the US. We also aimed to examine prognostic impact of additional genomic alterations in patients harboring EGFR mutations. Genomic alterations were determined in Japanese patients with lung adenocarcinoma (N = 100) using NGS-based sequencing of 415 known cancer genes, and correlated with clinical outcome. EGFR active mutations, i.e., those involving exon 19 deletion or an L858R point mutation, were seen in 43% of patients. Some differences in driver gene mutation prevalence were observed between the Japanese cohort described in the present study and the TCGA. Japanese cohort had significantly more genomic alterations in cell cycle pathway, i.e., CDKN2B and RB1 than TCGA. Concurrent mutations, in genes such as CDKN2B or RB1, were associated with worse clinical outcome in patients with EGFR active mutations. Our data support the utility of comprehensive sequencing to detect concurrent genomic variations that may affect clinical outcomes in this disease.

DOI： 10.1038/s41598-017-18560-y

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：SPRINGER  

PURPOSE: To establish the most effective methods of postoperative surveillance to detect early recurrence of lung adenocarcinoma. METHODS: The subjects of this retrospective study were 485 patients with p-stage I-III lung adenocarcinoma, who underwent postoperative surveillance. We examined the sites and detection modes of recurrence and calculated the recurrence-free probabilities. Patients with stage I disease were divided into low- and high-risk recurrence groups using a risk score calculated by assigning points proportional to risk factor regression coefficients. RESULTS: Of the 112 patients with recurrence, 86 had intrathoracic recurrence. Routine computed tomography (CT) revealed recurrence in 60 patients. The recurrence-free probability curves showed that 95% of recurrences were identified within the first 4 years after resection in patients with stage II/III disease. In patients with stage I disease, the predictors of recurrence included male sex, positive pleural lavage cytology, moderate-to-poor differentiation, and visceral pleural invasion. Postoperative recurrences were detected throughout the follow-up period in the high-risk group. CONCLUSIONS: Routine chest CT plays an important role in the postoperative surveillance of lung adenocarcinoma. We recommend intensive follow-up during the early post-resection period for patients with advanced stage disease and long-term follow-up for high-risk patients with stage I disease.

DOI： 10.1007/s00595-017-1537-3

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：AME PUBL CO  

A novel strategy of one-stage surgery in combination with thoracic endovascular grafting and resection for T4 lung cancer invading the thoracic aorta and spine is described. A 56-year-old man with locally advanced lung cancer infiltrating the aortic wall and spine underwent neoadjuvant chemotherapy and thoracic irradiation, followed by en bloc resection of the aortic wall and spine with thoracic endovascular grafting. He developed postoperative chylothorax, but there were no stent graft-related events. After 3 months, computed tomography (CT) did not show aortic stent graft stenosis, migration, or deformation.

DOI： 10.21037/jtd.2017.10.101

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記述言語：英語   出版者・発行元：AME PUBL CO  

DOI： 10.21037/jtd.2017.09.101

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記述言語：日本語   掲載種別：研究論文（学術雑誌）  

For general thoracic surgeons, perioperative management for prevention of cardiac complications is important because patients undergoing general thoracic surgery often have risk factors for cardiac disease. Sever cardiac failure should be detected and treated prior to surgery, and coronary artery may be examined in patients with risk factors for ischemic heart disease. Pulmonary resection sometimes causes right-sided heart failure due to reducing pulmonary vascular bed. In high-risk patients for rightsided heart failure, pulmonary artery pressure monitoring by right heart catheterization should be considered in addition to blood pressure and central venous pressure monitoring, and precise fluid management is required. Because perioperatively occurred myocardial infarction is sometimes lethal, patients with preoperatively identified significant coronary artery stenosis, percutaneous coronary intervention or coronary artery bypass grafting should be considered although surgeons need to be careful for the timing of surgery and anticoagulant therapy. Even if patients have no typical symptoms, perioperative myocardial infarction can be diagnosed 12-lead electrocardiogram and serum biomarkers. Cooperation with cardiologists is necessary for the treatment of perioperative myocardial infarction. Although arrhythmia is one of the major complications after general thoracic surgery, arrhythmia with hemodynamic instability should be immediately treated. Early diagnosis and management of cardiovascular events can minimize the consequences of these complications.

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：OXFORD UNIV PRESS INC  

OBJECTIVES: Virtual-assisted lung mapping (VAL-MAP) is a preoperative bronchoscopic multispot dye-marking technique using virtual images. The purpose of this study was to evaluate the safety, efficacy and reproducibility of VAL-MAP among multiple centres. METHODS: Selection criteria included patients with pulmonary lesions anticipated to be difficult to identify at thoracoscopy and/or those undergoing sub-lobar lung resections requiring careful determination of resection margins. Data were collected prospectively and, if needed, compared between the centre that originally developed VAL-MAP and 16 other centres. RESULTS: Five hundred patients underwent VAL-MAP with 1781 markings (3.6 ± 1.2 marks/patient). Complications associated with VAL-MAP necessitating additional management occurred in four patients (0.8%) including pneumonia, fever and temporary exacerbation of pre-existing cerebral ischaemia. Minor complications included pneumothorax (3.6%), pneumomediastinum (1.2%) and alveolar haemorrhage (1.2%), with similar incidences between the original centre and other centres. Marks were identifiable during operation in approximately 90%, whereas the successful resection rate was approximately 99% in both groups, partly due to the mutually complementary marks. The contribution of VAL-MAP to surgical success was highly rated by surgeons resecting pure ground glass nodules ( P  < 0.0001), tumours ≤ 5 mm ( P  = 0.0016), and performing complex segmentectomy and wedge resection ( P  = 0.0072). CONCLUSIONS: VAL-MAP was found to be safe and reproducible among multiple centres with variable settings. Patients with pure ground glass nodules, small tumours and resections beyond conventional anatomical boundaries are considered the best candidates for VAL-MAP. Clinical Trial Registration Number: UMIN 000008031. University Hospital Medical Information Network Clinical Trial Registry ( http://www.umin.ac.jp/ctr/ ).

DOI： 10.1093/ejcts/ezw395

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記述言語：日本語   出版者・発行元：新潟医学会  

画像診断機器の進歩、検診の普及などにより早期の小型肺癌症例は増加し、それに伴い肺癌手術例も年々増加している。肺癌外科治療に関連し、主に胸腔鏡補助下手術、縮小手術について述べる。胸腔鏡補助下手術(Video-assisted Thoracic Surgery、VATS)は、内視鏡を胸腔内に挿入しモニターを見ながら行う胸部手術の総称で、肺癌に対しても広く用いられている。標準開胸手術と比しVATSは、手術創が小さく美容面で優れ、また、身体的な負担が少なく、手術後疼痛の軽減、合併症頻度の減少、早期回復などの点で効果が期待できる。しかし、VATSでは、モニター視による立体把握が困難な点、操作角度や器具の制限により、進行癌症例や比較的難度の高い手術手技の遂行が困難な点などいくつか欠点があり、現時点では、癌の根治性、安全性を優先した上で、アプローチ方法として標準開胸手術とVATSとの選択を行うように位置づけられている。肺癌外科治療において、腫瘍の存在する肺葉を切除する術式を肺葉切除、1つあるいは数区域を切除するものを区域切除、腫瘍の存在する部位のみを切除する術式を部分切除と呼んでおり、区域切除と部分切除からなる縮小切除は肺切除範囲を減じ、残存肺容量、呼吸機能をより温存するための術式である。現行のガイドラインにおいては肺癌の標準術式は肺葉切除であり、種々の理由で肺葉切除が困難と考えられる患者に対しては縮小手術が許容される。また、一部の早期小型肺癌症例では、肺葉切除が可能な呼吸機能、全身状態であっても肺葉切除と同等の治療効果を期待し積極的に縮小手術が選択されることもある。現在、日本および北米で小型肺癌症例に対する肺葉切除と縮小手術の大規模多施設ランダム化比較試験が進行中であり、今後これらの試験の結果によっては、一部の小型肺癌に対して縮小手術が標準治療となり得る。しかし、胸腔鏡補助下手術はモニター上で肺内の腫瘍を視認することができず、また、小切開創から手術を行うため、肺深部の小型肺病変や、すりガラス陰影を主体とする病変の位置を手術中に同定するのが非常に困難である。したがって、いずれも低侵襲を目指したVATSと縮小手術の両立は困難であり、さらなる手技の習熟、新たな手技、機器の開発が望まれる。(著者抄録)

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その他リンク： https://search-tp.jamas.or.jp/index.php?module=Default&action=Link&pub_year=2016&ichushi_jid=J00990&link_issn=&doc_id=20170410150004&doc_link_id=%2Fdg3nigta%2F2016%2F013012%2F004%2F0675-0678%26dl%3D0&url=https%3A%2F%2Fwww.medicalonline.jp%2Fjamas.php%3FGoodsID%3D%2Fdg3nigta%2F2016%2F013012%2F004%2F0675-0678%26dl%3D0&type=MedicalOnline&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00004_2.gif

記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：PIONEER BIOSCIENCE PUBL CO  

BACKGROUND: Although lobectomy is the standard surgical procedure for non-small cell lung cancer (NSCLC), recent studies show favorable outcomes after limited resection in patients with small-sized peripheral tumors. We conducted a randomized controlled trial of such patients to estimate postoperative outcomes and pulmonary function following these surgical techniques. METHODS: Between 2005 and 2008, eligible patients with tumors of 2 cm or less were randomly assigned 1:1 to undergo lobectomy or limited resection; 32 and 33 NSCLC patients in each group, respectively, were analyzed. The primary end points were 5-year overall survival (OS) and disease-free survival (DFS), while the secondary end points were postoperative pulmonary function including forced vital capacity (FVC) and forced expiratory volume in 1 second (FEV1). RESULTS: The 5-year OS rates were 93.8% and 90.9% in the lobectomy and limited resection groups, respectively (P=0.921). The 5-year DFS rates were 93.8% and 90.9% in the lobectomy and limited resection groups, respectively (P=0.714). These rates did not differ significantly between the two resection groups. The median postoperative/preoperative FVC ratios were 84.1% and 90.0% in the lobectomy and limited resection groups, respectively, while the median postoperative/preoperative FEV1 ratios were 81.9% and 89.1%, respectively. Both ratios were significantly higher in the limited resection group (P=0.032 and P=0.005 for FVC and FEV1 ratios, respectively). CONCLUSIONS: A similar outcome, with more preserved postoperative pulmonary function, was observed in patients who underwent limited resection compared to those who underwent lobectomy. Ongoing large-scale multi-institutional prospective randomized trials of lobar versus sublobar resection in patients with small peripheral NSCLCs will hopefully provide definitive information about intentional limited resection of small peripheral tumors.

DOI： 10.21037/jtd.2016.11.106

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：SPRINGER  

OBJECTIVE: A precise preoperative diagnosis of in situ or minimally invasive carcinoma may identify patients who can be treated by limited resection. Although some clinical trials of limited resection for lung cancer have started, it will take a long time before the results will be published. We have already reported a large-scale study of limited resection. We herein report the data for a subclass analysis according to differences in pathology. METHODS: Data from multiple institutions were collected on 1710 patients who had undergone limited resection (segmentectomy or wedge resection) for cT1N0M0 non-small cell carcinoma. The disease-free survival (DFS) and recurrence-free proportion (RFP) were analyzed. Small cell carcinomas and carcinoid tumors were excluded from this analysis. Adenocarcinomas were sub-classified into four groups using two factors, the ratio of consolidation to the tumor diameter (C/T) and the tumor diameter alone. RESULTS: The median patient age was 64 (20-75) years old. The mean maximal diameter of the tumors was 1.5 ± 0.5 cm. The DFS and RFP at 5 years based on the pathology were 92.2 and 94.7 % in adenocarcinoma (n = 1575), 76.3 and 82.4 % in squamous cell carcinoma (SqCC) (n = 100), and 73.6 and 75.9 % in patients with other tumors (n = 35). The prognosis of adenocarcinoma in both groups A (C/T ≤0.25 and tumor diameter ≤2.0 cm) and B (C/T ≤0.25 and tumor diameter >2.0 cm) was good. In SqCC, only segmentectomy was a favorable prognostic factor. In the groups with other pathologies, large cell carcinomas were worse in prognosis (the both DFS and RFP: 46.3 %). CONCLUSION: Knowing the pathological diagnosis is important to determine the indications for limited resection. Measurement of the tumor diameter and C/T was useful to determine the indications for limited resection for adenocarcinoma. Limited resection for adenocarcinomas is similar with a larger resection, while the technique should be performed with caution in squamous cell carcinoma and other pathologies.

DOI： 10.1007/s00268-016-3596-9

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記述言語：日本語   掲載種別：研究論文（学術雑誌）  

We report here a case of fatal respiratory failure developed during chemotherapy for diffuse large B cell lymphoma that occurred late after lung transplantation. 25-year- old man underwent lung transplantation from brain death donor for respiratory failure due to interstitial pneumonia at the age of 16 years old. Two years after transplantation, his respiratory function decreased gradually. Chronic lung allograft dysfunction including bronchiolitis obliterans( BOS) and restrictive allograft syndrome was suspected and immunosuppression was enhanced. Nine years after transplantation, he had abdominal pain and physical examination suggested intestinal obstruction. Small intestine endoscopy revealed an ulcer at jejunum and diffuse large B cell lymphoma( DLBCL) was finally diagnosed by biopsy. Chemotherapy was planned for lymphoma, but respiratory failure progressed just before chemotherapy. Chest computed tomography showed infiltrative shadow in right lung, so we suspected presence of lymphoma and chemotherapy was carried out. After chemotherapy, abnormal shadow in the right lung disappeared. Although chemotherapy was effective, respiratory failure progressed and he died. Pathological examination from autopsy showed mixture of BOS, diffuse alveolar damage, invasion of aspergillus and acute fibrinoid organizing pneumonia but no residual DLBCL was found in the lung.

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記述言語：日本語   出版者・発行元：(株)南江堂  

25歳男。幼少期より間質性肺炎にて加療されるも呼吸不全が進行し、16歳時に海外で脳死両側肺移植を受けていた。その後、閉塞性細気管支炎とrestrictive allograft syndromeの混在した慢性期移植肺機能不全の状態となり、免疫抑制剤の投与にて経過観察されていた。今回、腹痛、嘔吐が出現し、小腸内視鏡で空腸に潰瘍性病変を認めた。生検の結果、びまん性大細胞型B細胞リンパ腫と診断され、化学療法待機中に呼吸不全の進行を認めた。胸部CTでは右肺門部を中心とした浸潤影を認め、臨床経過よりリンパ腫の肺病変と判断し、化学療法を行う方針とした。化学療法直前に呼吸不全が進行したため、人工呼吸器管理下に抗真菌薬を併用して化学療法を開始した。1コース目終了時に右肺門部浸潤影はほぼ消失したが、その後、真菌感染症と呼吸不全を来たし43日目(両側肺移植後9年8ヵ月目)に死亡した。

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その他リンク： https://search-tp.jamas.or.jp/index.php?module=Default&action=Link&pub_year=2016&ichushi_jid=J00349&link_issn=&doc_id=20161011120016&doc_link_id=1390002209966314112&url=https%3A%2F%2Fcir.nii.ac.jp%2Fcrid%2F1390002209966314112&type=CiNii&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00003_2.gif

記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：OXFORD UNIV PRESS  

OBJECTIVES: In 2015, we reported the outcomes of patients undergoing intentional limited resection (ILR) for non-small-cell lung cancer (NSCLC) from a retrospective, multi-institutional large database in Japan. Here, we analyse the clinicopathological characteristics of the patients extracted from this database with late recurrence and compare them with those with early recurrence. METHODS: Of 1538 patients in the database with cT1aN0M0 NSCLC, 92 (6%) had recurrence. In this study, early recurrence was defined as recurrence within 5 years and late recurrence as recurrence beyond 5 years after surgery. We compared the clinicopathological characteristics and post-recurrence survival (PRS) between patients with early and late recurrence. RESULTS: Of the 92 patients with recurrence, 21 (23%) had late recurrence. Compared with the early recurrence group, there were significantly more adenocarcinomas and local recurrences in the late recurrence group (P = 0.04 for both). The 3- and 5-year PRS rates were 53 and 24%, respectively, and the median PRS period was 38 months. There were no significant differences in the PRS curves between patients with early and late recurrence (P = 0.12). Only 3 patients (0.2%) had recurrence more than 10 years after ILR. Of the 21 late-recurrence patients, 17 (81%) had tumours with a consolidation/tumour ratio (CTR) >0.25. CONCLUSIONS: Late recurrence occurred in 21 (23%) of 92 patients with recurrence after ILR for cT1aN0M0 NSCLC. Late recurrence was more likely to involve adenocarcinoma and local recurrence. It is thus considered reasonable to follow patients with a CTR >0.25 for 10 years after ILR.

DOI： 10.1093/icvts/ivw125

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：MEDICAL TRIBUNE INC  

OBJECTIVES: Combined pulmonary fibrosis and emphysema (CPFE) is a unique disorder. The aim of this study was to compare the surgical outcomes of lung cancer patients with CPFE and those with idiopathic pulmonary fibrosis (IPF) without emphysema. METHODS: A total of 1548 patients who underwent surgery for primary lung cancer between January 2001 and December 2012 were retrospectively reviewed. RESULTS: Of the 1548 patients, 55 (3.6%) had CPFE on computed tomography (CT), and 45 (2.9%) had IPF without emphysema. The overall and disease-free 5-year survival rates for patients with CPFE were not significantly worse than those for patients with IPF without emphysema (24.9% vs. 36.8%, p = 0.814; 39.8% vs. 39.3%, p = 0.653, respectively). Overall, 21 (38.1%) patients with CPFE and nine patients (20.0%) with IPF without emphysema developed postoperative cardiopulmonary complications. Patients with CPFE had significantly more postoperative cardiopulmonary complications involving pulmonary air leakage for >6 days, hypoxemia, and arrhythmia than patients with IPF without emphysema (p = 0.048). CONCLUSIONS: There was no significant difference in survival after surgical treatment between CPFE patients and IPF patients without emphysema, but CPFE patients had significantly higher morbidity than IPF patients without emphysema.

DOI： 10.5761/atcs.oa.15-00315

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：ELSEVIER SCIENCE INC  

Six years after primary surgical treatment for gastric cancer, fluoro-deoxy-glucose positron emission tomography/computed tomography was performed in a 72-year-old man, and demonstrated an increased fluoro-deoxy-glucose uptake in the apex of the left ventricle. Magnetic resonance imaging also revealed a solitary small myocardial tumor. Under cardiopulmonary bypass, tumorectomy was performed with a macroscopically sufficient margin. Histopathologic examination showed adenocarcinoma with poor differentiation developed in the myocardium and pericardial fat; these findings were compatible with the previously resected gastric cancer. The postoperative course was uneventful; the patient has been alive for 29 months without any evidence of local recurrence or cardiac events.

DOI： 10.1016/j.athoracsur.2015.06.108

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：ELSEVIER SCIENCE INC  

BACKGROUND: The indication for limited resection of radiologically pure solid non-small cell lung cancer (NSCLC) is controversial owing to its invasive pathologic characteristics. This study was performed to compare the outcomes after lobectomy and segmentectomy in these NSCLC patients. METHODS: We retrospectively reviewed 251 patients with radiologically pure solid cT1a N0 M0 NSCLC who underwent lobectomy or segmentectomy, and the preoperative characteristics of the patients treated with the two operative techniques were matched using propensity score methods. Overall survival (OS) and disease-free survival (DFS) curves were compared using the log rank test, and differences in survival were also evaluated by the McNemar test. The preoperative factors and surgical procedure were analyzed with the multivariate Cox proportional hazards regression model to identify independent predictors of poor OS and DFS. RESULTS: In the propensity score matched lobectomy and segmentectomy groups (87 patients per group), the 5-year and 10-year OS rates were 85% versus 84% and 66% versus 63%, respectively; and the 5-year and 10-year DFS rates were 80% versus 77% and 64% versus 58%, respectively. There were no significant differences between the two groups in OS or DFS by the log rank test, and also no significant differences in 3-year, 5-year, or 7-year OS or DFS by the McNemar test. Although age, smoking status, pulmonary function, and carcinoembryonic antigen were identified as significant predictors of both OS and DFS, the surgical procedure was not identified. CONCLUSIONS: Similar oncologic outcomes after lobectomy and segmentectomy were indicated among patients with radiologically pure solid small-sized NSCLC.

DOI： 10.1016/j.athoracsur.2015.10.048

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：SAGE PUBLICATIONS INC  

Ectopic adrenocorticotrophic hormone (ACTH)-producing bronchopulmonary carcinoid arising in a bronchopulmonary sequestration is extremely rare. The case of a 67-year-old woman with a 1.7-cm nodule in the mediastinal side of the left lower lobe is presented. At 52 years of age, she was diagnosed as having ACTH-dependent Cushing's syndrome (CS). However, no ectopic source of ACTH-secretion was detected. Seven years later, she underwent a bilateral adrenalectomy because of aggravation of her health condition. This time, tumor excision was performed by thoracoscopic surgery. The tumor adhered sparsely to the mediastinal pleura and the left lower lobe and was bluntly separated from these tissues. Pathologically, the tumor was a typical carcinoid arising in an extralobar pulmonary sequestration. Immunohistochemical staining confirmed the secretion of ACTH by bronchopulmonary carcinoid tumor cells. After surgery, the serum ACTH level was almost normalized, and the dexamethasone (1 mg) suppression test showed significant suppression of ACTH.

DOI： 10.1177/1066896915605615

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：ELSEVIER SCI LTD  

INTRODUCTION: Parathyroid adenomas are the most common cause of primary hyperparathyroidism. However, cases of parathyroid adenomas greater than 4cm with osteitis fibrosa cystica are extremely rare. Herein, we report a case of resection of a large ectopic mediastinal parathyroid adenoma. CASE PRESENTATIONS: A 46-year-old female with chief complaints of bone pain and gait disturbance was referred to our hospital. Physical examination revealed many mobile teeth in her oral cavity, distortion of the vertebral body, and bowlegs. Laboratory tests showed hypercalcemia, hypophosphatemia, and elevated serum levels of intact parathyroid hormone. Chest CT revealed a 42-mm well-defined, enhancing mass in front of the left-sided tracheal bifurcation. Her findings were diagnosed as primary hyperparathyroidism due to an ectopic mediastinal parathyroid tumor. We performed a median sternotomy and resected the tumor. The tumor was a solid, yellowish-brown mass measuring 42×42 mm. Pathologically, the tumor consisted mainly of chief cells with some oxyphil cells; there were no necrotic areas or nuclear atypia, and few mitotic figures. We diagnosed the tumor as an ectopic mediastinal parathyroid adenoma. Eight months after the resection, her serum calcium, phosphorus, and intact PTH levels were normal. DISCUSSION AND CONCLUSIONS: Parathyroid adenomas and parathyroid carcinomas have disparate natural histories, but they can be difficult to differentiate on the basis of preoperative clinical characteristics. We believe that long-term follow-up of these cases is required because there have been few reports on the postoperative natural history of large parathyroid adenomas.

DOI： 10.1016/j.ijscr.2016.04.007

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記述言語：日本語   出版者・発行元：新潟医学会  

甲状腺癌のうち乳頭癌(papillary carcinoma)の頻度は90%と大部分を占め、頸部リンパ節転移の頻度が高く、高齢者では未分化癌に転化することもある。今回、結腸癌術後の全身検索で発見され、胸骨縦切開を追加して切除可能であった無症候性進行甲状腺癌の1例を経験したので文献的考察を加えて報告する。症例は76歳、女性。上行結腸癌手術後7年目にCA19-9値の上昇傾向を指摘され、CT検査では上縦隔へ進展した7cm大の甲状腺腫瘤と1.5cm大の右頸部リンパ節腫大を認めた。穿刺吸引細胞診ではclass IIIであったが甲状腺癌が強く疑われたため、手術目的に当科入院となった。術前の頸部CTおよびMRI検査では、甲状腺腫瘍は上縦隔まで進展していたが、明らかな血管への浸潤所見は認めず、気管支鏡検査では明らかな気管浸潤は認めなかった。手術を施行し、右頸部リンパ節を摘出し術中迅速病理診断に提出したところ乳頭癌の診断が得られたため、甲状腺全摘術および頸部リンパ節郭清の方針となった。術中所見では、上縦隔内の無名静脈および右頸動脈への浸潤が疑われ、切除可能か否かの判定が困難であった。視野を確保し、血管等への浸潤の有無を判定するために胸骨縦切開を追加した。その結果、良好な視野が得られ、無名静脈、右左総頸動脈への直接浸潤を認めず、腫瘍の切離が可能となり、甲状腺全摘術および頸部リンパ節郭清を施行した。甲状腺癌、特に乳頭癌は10年生存率が80〜90%と良好であり、また、放置した場合に気管浸潤、血管浸潤を伴うと、生命予後のみならず、患者QOLも著しく損なわれるので、可能であるならば積極的に切除を行うことが望ましい。(著者抄録)

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その他リンク： https://search-tp.jamas.or.jp/index.php?module=Default&action=Link&pub_year=2015&ichushi_jid=J00990&link_issn=&doc_id=20150811080007&doc_link_id=%2Fdg3nigta%2F2015%2F012905%2F007%2F0281-0286%26dl%3D0&url=https%3A%2F%2Fwww.medicalonline.jp%2Fjamas.php%3FGoodsID%3D%2Fdg3nigta%2F2015%2F012905%2F007%2F0281-0286%26dl%3D0&type=MedicalOnline&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00004_2.gif

記述言語：日本語   掲載種別：研究論文（学術雑誌）   出版者・発行元：(株)南江堂  

動脈瘤合併肺癌例に対するステントグラフト内挿術・肺切除同時手術の2例を経験した。症例1は74歳男で、腹部CTにて腎動脈分岐部以下に最大短径50.cmの腹部大動脈瘤1を指摘された。右胸水貯溜を指摘され、気管支鏡下細胞診で悪性細胞を検出し、右原発性肺癌、腹部大動脈瘤と診断した。肺切除、ステントグラフト内挿術の同時手術の方針となった。第12病日に軽快退院となった。症例2は72歳男で、胸部CTで右肺の異常陰影を指摘された。精査の胸腹部CTで右上葉に肺野弓リンパ節と一塊となった腫瘤性病変、右腎に腫瘍性病変、左内腸骨動脈瘤を指摘された。経皮的冠状動脈形成術後に、ステントグラフト内挿術と同時手術で肺癌外科治療を先行、その後腎細胞癌の外科治療を行う方針となった。第11病日に軽快退院となった。

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その他リンク： https://search-tp.jamas.or.jp/index.php?module=Default&action=Link&pub_year=2015&ichushi_jid=J00349&link_issn=&doc_id=20150330060012&doc_link_id=1390845713010031104&url=https%3A%2F%2Fcir.nii.ac.jp%2Fcrid%2F1390845713010031104&type=CiNii&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00003_2.gif

記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：OXFORD UNIV PRESS INC  

OBJECTIVES: A precise preoperative diagnosis of 'very early' lung carcinoma may identify patients who can undergo curative surgery with limited resections. METHODS: Data from a multi-institutional project were collected on 1737 patients who had undergone limited resections (segmentectomy or wedge resection) for T1N0M0 non-small-cell carcinomas. As it was expected, this study was predominantly including ground glass nodules. Computed tomography was used to obtain the ratio of consolidation to the maximal tumour diameter to determine invasive potential of the tumours. Overall and disease-free survivals and recurrence-free proportions were analysed. RESULTS: Median age was 64 years. Mean maximal diameter of the tumours was 1.4±0.5 cm. Overall and recurrence-free survivals after limited lung resection were 94.0 and 91.1% at 5 years, respectively. Recurrence-free proportions were 93.7% at 5 years. Unfavourable prognostic factors in overall survival were lymph node metastasis, interstitial pneumonia, male gender, older age, comorbidities (cardiac disease, diabetes etc.) and consolidation/tumour ratio (C/T)≤0.25. C/T≤0.25 predicted good outcomes especially in cT1aN0M0 disease. In a subclass analysis of cT1N0M0 squamous cell carcinomas, wedge resection was the only unfavourable prognostic factor in both overall and disease-free survivals. CONCLUSIONS: If the patient was 75 years old or younger and was judged fit for lobectomy, limited resection for cStage I non-small-cell lung cancer (NSCLC) showed excellent outcomes and was not inferior to the reported results of lobectomy for small-sized NSCLC. The carcinomas with C/T≤0.25 rarely recur and are especially good candidates for limited resection.

DOI： 10.1093/ejcts/ezu138

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：HINDAWI LTD  

Few reports have described surgical resection for second primary lung cancers originating close to the initial surgical margin for lung cancer. A 64-year-old man had undergone left segmentectomy with lymph node dissection for small peripheral squamous cell lung cancer using video-assisted thoracic surgery, with pathology confirming a small tumor 12 mm in diameter identified about 3 cm from the surgical margin. Eighteen months after initial surgery, computed tomography revealed a 30 mm pulmonary nodule close to the initial surgical margin in the residual left upper lobe and the serum level of carcinoembryonic antigen was found to be increased. Local recurrence on the staple-line of the surgical margin was suspected, and completion left upper lobectomy was performed. Histological examination identified not only a squamous cell carcinoma component but also a small cell carcinoma component. The immunohistochemical staining pattern of the second tumor differed from that of the initial resected lung squamous cell carcinoma. The final pathological diagnosis was a second primary tumor with mixed small cell carcinoma and squamous cell carcinoma histology.

DOI： 10.1155/2015/462193

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記述言語：日本語   掲載種別：研究論文（学術雑誌）   出版者・発行元：(株)南江堂  

症例は65歳男性で、IgA腎症により慢性腎不全となり、持続腹膜透析(CAPD)が導入され、3週間後より呼吸困難が出現し、胸部X線で大量の右胸水貯留を認め、横隔膜交通症が疑われた。聴診で収縮期雑音、右側呼吸音の減弱を認めた。胸部X線で右胸水貯留を、胸部CTで右側の大量胸水を認めたが横隔膜面に異常所見は認めなかった。胸水穿刺により胸水中のグルコース濃度は154mg/dlと血糖測定値118mg/dlと比べ高値でなかったが胸水ドレナージ後にCAPDをいったん中止したところ胸水貯留を認め、横隔膜交通症と診断し、交通部の閉鎖のため胸腔鏡下手術を行った。術後第3病日にドレーンを抜去し、CAPDを再開した。術後1年3ヵ月経過したが再発を認めていない。

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その他リンク： https://search-tp.jamas.or.jp/index.php?module=Default&action=Link&pub_year=2014&ichushi_jid=J00349&link_issn=&doc_id=20140926040004&doc_link_id=1390282763058449408&url=https%3A%2F%2Fcir.nii.ac.jp%2Fcrid%2F1390282763058449408&type=CiNii&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00003_2.gif

記述言語：日本語   出版者・発行元：新潟県医師会  

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：MOSBY-ELSEVIER  

OBJECTIVE: Although lobectomy is the standard surgical procedure for operable non-small cell lung cancer (NSCLC), sublobar resection also has been undertaken for various reasons. The aim of this study was to identify risk factors of locoregional recurrence and poor disease-specific survival in patients with clinical stage IA NSCLC undergoing sublobar resection. METHODS: We retrospectively reviewed 328 patients with clinical stage IA NSCLC who underwent segmentectomy or wedge resection. Demographic, clinical, and pathologic factors were analyzed using the log-rank test as univariate analyses, and all factors were entered into a Cox proportional hazards regression model for multivariate analyses to identify independent predictors of locoregional recurrence and poor disease-specific survival. RESULTS: The 5- and 10-year locoregional recurrence-free probabilities were 84.8% and 83.6%, respectively, and the 5- and 10-year disease-specific survivals were 83.6% and 73.6%, respectively. Four independent predictors of locoregional recurrence were identified: wedge resection (hazard ratio [HR], 5.787), microscopic positive surgical margin (HR, 3.888), visceral pleural invasion (HR, 2.272), and lymphatic permeation (HR, 3.824). Independent predictors of poor disease-specific survival were identified as follows: smoking status (Brinkman Index; HR, 1.001), wedge resection (HR, 3.183), microscopic positive surgical margin (HR, 3.211), visceral pleural invasion (HR, 2.553), and lymphatic permeation (HR, 3.223). All 4 predictors of locoregional recurrence also were identified as independent predictors of poor disease-specific survival. CONCLUSIONS: Segmentectomy should be the surgical procedure of first choice in patients with clinical stage IA NSCLC who are being considered for sublobar resection. Patients having tumors presenting with no suspicious of pleural involvement would be suitable candidates for sublobar resection.

DOI： 10.1016/j.jtcvs.2013.02.057

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記述言語：日本語  

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記述言語：日本語   出版者・発行元：(NPO)日本呼吸器外科学会  

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：LIPPINCOTT WILLIAMS & WILKINS  

INTRODUCTION: We attempted to assess the correlation between the Doppler mode image patterns during endobronchial ultrasound-guided (EBUS) transbronchial needle aspiration and the expression of angiogenesis-related molecules within lymph nodes in patients with non-small-cell lung cancer. METHODS: Thirty-eight archived EBUS- transbronchial needle aspiration samples of lymph nodes (27 metastatic and 11 nonmetastatic) in patients with non-small-cell lung cancer with Doppler mode ultrasound image were analyzed. The Doppler mode image of the vasculature of the targeted lymph node was categorized into the following groups: normal blood flow, low blood flow (LBF), and high blood flow (HBF). Vascular index ratio (vascular area/lymph node area) of each metastatic lymph node was calculated. Total RNA and protein was extracted and analyzed for expression of HIF-1α, VEGF-A, and VEGF-C by quantitative RT-PCR and enzyme-linked immunosorbent assay. RESULTS: Within the 27 metastatic lymph nodes, eight were categorized into the LBF group and 19 into the HBF group. Vascular index ratio was significantly higher in HBF than LBF (p = 0.0003). mRNA expression of HIF-1α and VEGF-A was significantly higher in metastatic lymph nodes than in benign lymph nodes (p < 0.0001). Compared with LBF and HBF, HIF-1α mRNA expression was significantly higher in LBF (p = 0.01) and VEGF-C mRNA expression was significantly higher in HBF (p = 0.0315). There was no significant difference in protein expression by enzyme-linked immunosorbent assay analysis. CONCLUSIONS: The vascularity of metastatic lymph nodes observed by EBUS correlates with the mRNA expression of HIF-1α and VEGF-C (not VEGF-A). This correlation is a clinical utility that needs to be evaluated further.

DOI： 10.1097/JTO.0b013e318265b4df

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：ELSEVIER SCIENCE INC  

BACKGROUND: The evaluation of donor lungs by normothermic ex vivo acellular perfusion has improved the safety of organ utilization. However, this strategy requires a critical re-evaluation of the parameters used to assess lungs during ex vivo perfusion compared with those traditionally used to evaluate the donor lung in vivo. Using a porcine model, we studied the physiology of acellular lung perfusion with the aim of improving the accuracy of clinical ex vivo evaluation. METHODS: Porcine lungs after 10 hours of brain death and 24 hours of cold ischemia and uninjured control lungs were perfused for 12 hours and then transplanted. PaO2, compliance, airway pressure and pulmonary vascular resistance were measured. Ventilation with 100% nitrogen and addition of red blood cells to the perfusate were used to clarify the physiologic disparities between in vivo blood perfusion and ex vivo acellular perfusion. RESULTS: During 12 hours of ex vivo perfusion, injured lungs developed edema with decreased compliance and increased airway pressure, but ex vivo PO2 remained stable. After transplantation, injured lungs demonstrated high vascular resistance and poor PaO2. A reduced effect of shunt on ex vivo lung perfusion PO2 was found to be attributable to the linearization of the relationship between oxygen content and PO2, which occurs with acellular perfusate. CONCLUSIONS: Ex vivo PO2 may not be the first indication of lung injury and, taken alone, may be misleading in assessing the ex vivo lung. Thus, evaluation of other physiologic parameters takes on greater importance.

DOI： 10.1016/j.healun.2012.08.016

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：LIPPINCOTT WILLIAMS & WILKINS  

INTRODUCTION: Even for patients with clinical N0 non-small-cell lung cancer (NSCLC), several invasive tests are available to pathologically confirm the presumptive mediastinal stage by radiologic modalities. The aim of this study was to determine a high-risk population for mediastinal nodal metastasis in patients with clinical stage IA NSCLC, which would be suitable for mediastinal staging by invasive modalities, such as mediastinoscopy or endobronchial ultrasound-guided transbronchial needle aspiration. METHODS: We retrospectively reviewed peripheral clinical stage IA NSCLC patients who had undergone surgical resection with systematic mediastinal lymphadenectomy from 1998 to 2011. To identify predictors for mediastinal nodal metastasis, univariate and multivariate logistic regression analyses were performed. For the significant factors, optimal cutoff points were determined with a receiver operating characteristic analysis. RESULTS: Among the 894 patients eligible for this study, the overall prevalence of mediastinal nodal metastasis was 7.5%. The following four predictors for mediastinal nodal metastasis were identified: age, preoperative serum carcinoembryonic antigen level, tumor size on preoperative radiologic findings, and consolidation/tumor ratio on high-resolution computed tomography. Of the patients with all four predictors identified by the multivariate analyses and receiver operating characteristic analyses (age ≤ 67 years, carcinoembryonic antigen ≥ 3.5 ng/ml, tumor size ≥ 2.0 cm, and consolidation/tumor ratio ≥ 89%), the prevalence of mediastinal nodal metastasis was 33.8%. CONCLUSIONS: Among the clinical stage IA NSCLC patients in whom all four predictors were identified, one third of the patients showed mediastinal nodal metastasis, and thus, those patients should be a target for mediastinal node assessment by invasive modalities, such as mediastinoscopy or endobronchial ultrasound-guided transbronchial needle aspiration.

DOI： 10.1097/JTO.0b013e31825871de

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：NATURE PUBLISHING GROUP  

Acellular normothermic ex vivo lung perfusion (EVLP) is a novel method of donor lung preservation for transplantation. As cellular metabolism is preserved during perfusion, it represents a potential platform for effective gene transduction in donor lungs. We hypothesized that vector-associated inflammation would be reduced during ex vivo delivery due to isolation from the host immune system response. We compared ex vivo with in vivo intratracheal delivery of an E1-, E3-deleted adenoviral vector encoding either green fluorescent protein (GFP) or interleukin-10 (IL-10) to porcine lungs. Twelve hours after delivery, the lung was transplanted and the post-transplant function assessed. We identified significant transgene expression by 12 hours in both in vivo and ex vivo delivered groups. Lung function remained excellent in all ex vivo groups after viral vector delivery; however, as expected, lung function decreased in the in vivo delivered adenovirus vector encoding GFP (AdGFP) group with corresponding increases in IL-1β levels. Transplanted lung function was excellent in the ex vivo transduced lungs and inferior lung function was seen in the in vivo group after transplantation. In summary, ex vivo delivery of adenoviral gene therapy to the donor lung is superior to in vivo delivery in that it leads to less vector-associated inflammation and provides superior post-transplant lung function.

DOI： 10.1038/mt.2012.57

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：ELSEVIER SCIENCE INC  

BACKGROUND: Despite recent studies reporting on the results of prospective intentional sublobar resection for patients with small non-small cell lung cancer (NSCLC), few studies have investigated predictors for prognosis or recurrence exclusively in patients undergoing intentional sublobar resection. METHODS: We retrospectively reviewed 223 patients with small (2 cm or less) peripheral NSCLC who underwent intentional segmentectomy at the Niigata Cancer Center Hospital between 1992 and 2009. The significant demographic, clinical, and pathologic factors identified with the log rank test in univariate analyses were analyzed with the Cox proportional hazards regression model to examine independent predictors for prognosis and recurrence in multivariate analysis. RESULTS: The 5-year and 10-year overall survival rates were 89.6% and 81.0%, respectively, and the 5-year and 10-year recurrence-free probabilities were 91.1% and 91.1%, respectively. Eight patients had locoregional recurrence, and 12 had distant recurrence. Multivariate analyses revealed that age more than 70 years (hazard ratio [HR] 2.389), male (HR 2.750), more than 75% consolidation/tumor ratio on high-resolution computed tomography (HR 2.750), and lymphatic permeation (HR 5.618) were independent poor prognostic factors, and lymphatic permeation (HR 16.257) was an independent predictor for recurrence. CONCLUSIONS: The factors related to upstaging on pathologic diagnosis were not identified as independent predictors; therefore, the current patient selection criterion seems reasonable. If lymphatic permeation is present on pathologic findings, careful follow-up is recommended. The predictors identified in this study will support assessment and interpretation of the results of ongoing prospective randomized trials of lobar versus sublobar resection in patients with small peripheral NSCLC.

DOI： 10.1016/j.athoracsur.2012.02.093

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：ELSEVIER SCIENCE INC  

BACKGROUND: Plasma lactate has been used as a marker of poor prognosis in clinical conditions. However, the relationship between lactate production and lung function during acellular normothermic ex vivo lung perfusion (EVLP) is unclear. We investigated the kinetics of lactate metabolism during EVLP and the correlation of this marker with outcomes after transplant. METHODS: Human donor lungs in our clinical EVLP trial (CLs; n = 28) and rejected donor lungs for experimental use (Els; n = 8) were perfused ex vivo using the Toronto technique. Lactate level, lactate/pyruvate (L/P) ratio, and glucose level in the perfusate were measured. In CLs, we examined the relationship between lactate metabolism during EVLP and early post-transplant outcomes. The hypoxia-inducible factor 1 sub-unit 1α (HIF-1α) level in lung tissue was examined in ELs. RESULTS: We performed double-lung EVLP in CLs and single-lung EVLP in ELs. In CLs, the lactate and L/P ratios at the end of EVLP had no correlation with early post-transplant outcomes despite lactate elevation during EVLP. Although lactate elevation was also present in all ELs, we were able to identify 2 groups based on L/P ratio at the end of EVLP. The group with the high L/P ratio had higher airway pressure during EVLP and higher HIF-1α in lung tissue at the end of EVLP. CONCLUSIONS: Lactate increases seen in the EVLP perfusate most often represent physiologic lactate production by the lung in a setting with reduced lactate clearance. Thus, patients who underwent transplantation after EVLP had good outcomes despite lactate elevation during EVLP.

DOI： 10.1016/j.healun.2011.07.014

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：LIPPINCOTT WILLIAMS & WILKINS  

BACKGROUND: : Samples obtained by endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) have been shown to be useful for molecular analysis. METHODS: : The purpose of this study was to evaluate the feasibility of simultaneous isolation of DNA, RNA, and protein using EBUS-TBNA samples. We extracted DNA, RNA, and protein from 59 archived samples obtained by EBUS-TBNA. All samples were mixed with DNA, RNA, and protein-protective solution immediately after taking the biopsy and stored in -80°C for at least 1 year (range, 12 to 30 mo). We used QIAzol Lysis Reagent for the sequential isolation of total RNA, DNA, and protein. The concentration of RNA and DNA was measured and the quality of RNA was evaluated. The concentration of protein was measured using the Bradford protein assay. RESULTS: : Total RNA was successfully isolated in all 59 samples. DNA was isolated in 58 of 59 (98.3%) samples and protein was isolated in 57 of 59 (96.6%) samples. On average, 7.18 μg of total RNA, 7.79 μg of DNA, and 3.96 mg of protein were isolated. RNA integrity number (RIN) was measured in 32 samples and the average RIN number was 6.2 (range, 2.7 to 7.3). Twenty of 32 total RNA samples (62.5%) showed a RIN of >6. CONCLUSIONS: : DNA, RNA, and protein can simultaneously be isolated from archived samples obtained by EBUS-TBNA. This method facilitates direct comparisons of alterations in the genome, transcriptome, and proteome within metastatic lymph nodes through a minimally invasive approach.

DOI： 10.1097/LBR.0b013e31823302b7

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記述言語：日本語   出版者・発行元：特定非営利活動法人 日本呼吸器内視鏡学会  

DOI： 10.18907/jjsre.33.4_297_4

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記述言語：英語   出版者・発行元：JOHN WILEY & SONS INC  

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掲載種別：研究論文（学術雑誌）   出版者・発行元：Elsevier BV  

DOI： 10.1016/j.transproceed.2009.04.010

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：ELSEVIER SCIENCE INC  

BACKGROUND: The establishment of limited resection procedures for non-small cell lung cancer is expected. Many groups have suggested noninvasive bronchioloalveolar carcinoma (BAC) to be a potential indication for limited resection. METHODS: We designed a prospective phase II study evaluating limited resection for noninvasive BAC diagnosed by intraoperative pathologic examination. From 1999 to 2007, limited resection was the procedure in 46 patients (16 men and 30 women; median age, 69 years; range, 49 to 83) who were diagnosed intraoperatively as having noninvasive BAC. The first end point was the predictive value of the intraoperative pathologic examination for noninvasive BAC diagnosis. The second end point was overall survival, disease-free survival, and cancer-specific survival, calculated using the Kaplan-Meier method. RESULTS: We performed wedge resections for 44 patients and segmentectomy for 2 patients. Permanent pathologic examination revealed 3 patients had primary lung adenocarcinomas other than noninvasive BAC. The predictive value of intraoperative pathologic examination for noninvasive BAC diagnosis was 94%. During a median 51-month follow-up, there were only 2 cancer unrelated deaths. The 5-year overall survival rate and the disease-free survival rate were 93%, and the 5-year cancer-specific survival rate was 100%. CONCLUSIONS: The results of our prospective phase II study indicate that limited resection, mainly by wedge resection, is a potentially curative surgical procedure and may be an acceptable alternative to lobectomy for patients with noninvasive BAC. Furthermore, an intraoperative pathologic diagnosis of noninvasive BAC is strongly predictive and allows for an intraoperative decision to perform a limited resection in these patients.

DOI： 10.1016/j.athoracsur.2009.06.051

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記述言語：日本語   出版者・発行元：(NPO)日本呼吸器外科学会  

以前よりmicropapillary patternは乳癌、卵巣癌、膀胱癌などで予後不良因子として認識され、近年、肺癌でも報告が相次いでいる。今回我々は、リンパ節転移をきたした末梢小型肺腺癌の1例を経験した。症例は52歳男性。胸部CT上、左S3領域に約15mmの辺縁不整な胸膜陥入、spiculaを伴った結節を認めた。術前診断で左肺腺癌、cT1N0M0:stage IAであり、左上葉切除ND2aを施行した。組織学的所見では、線維血管間質を欠くmicropapillary patternを示していた。免疫組織学的所見では、TTF-1(+)、CK7(+)、SP-A(+)、CK20(-)であり原発性肺癌と診断した。肺内・縦隔リンパ節に転移を認め、病理診断はpT1N2M0:stage IIIAであった。小型の肺結節でも、本疾患のような組織型の存在も念頭におき、迅速な診断が望まれる。(著者抄録)

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その他リンク： https://search-tp.jamas.or.jp/index.php?module=Default&action=Link&pub_year=2009&ichushi_jid=J02256&link_issn=&doc_id=20090731210005&doc_link_id=10.2995%2Fjacsurg.23.703&url=https%3A%2F%2Fdoi.org%2F10.2995%2Fjacsurg.23.703&type=J-STAGE&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00007_3.gif

記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：ELSEVIER IRELAND LTD  

BACKGROUND: Overexpression of KIT, a tyrosine kinase receptor protein encoded by the proto-oncogene c-kit, is observed in human neoplasms such as gastrointestinal stromal tumors (GISTs), myeloproliferative disorders, melanoma and seminoma. In patients with GIST, overexpression of mutated KIT within the tumor is predictive of response to molecular targeted therapy using imatinib. However, the role of KIT expression in thymic carcinoma is not fully understood. METHODS: Thymic epithelial tumors from 37 patients (17 thymic carcinomas and 20 thymomas) were examined. Immunohistochemical staining with anti-KIT polyclonal antibody and anti-CD5 was performed. Mutation analyses in the juxtamembrane domains, exons 9 and 11, and in the tyrosine kinase domains, exons 13 and 17, were undertaken using polymerase chain reaction (PCR) and direct DNA sequencing in KIT-positive samples. RESULTS: KIT- and CD5-positive staining was observed only in thymic carcinoma. Percentage of positive staining was 100% in squamous cell carcinoma, with no positive staining in other histologies, including atypical carcinoid. Mutation analysis of the KIT gene was performed in 11 squamous cell carcinomas, 1 adenocarcinoma and 1 adenosquamous cell carcinoma. None of the tested samples showed mutations in any of the four exons. CONCLUSIONS: Squamous cell carcinoma of the thymus frequently expressed KIT and CD5 proteins, whereas other tumors did not. Unlike GIST, overexpression of KIT does not necessarily indicate gene mutation in thymic carcinoma. KIT and CD5 appear useful for evaluating and subtyping thymic epithelial tumors.

DOI： 10.1016/j.lungcan.2008.03.035

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記述言語：日本語   出版者・発行元：(株)南江堂  

著者らが経験した気管狭窄に対する気管切除・再建手術5例について報告した。年齢は1〜73歳で、性別は男性1例、女性4例であった。原疾患は先天性気管狭窄兼軟化症1例、気管挿管後の気管狭窄1例、甲状腺癌気管浸潤による気管狭窄3例であった。アプローチ方法は頸部襟状切開+胸骨正中切開が1例、頸部襟状切開4例で、切除範囲は4軟骨輪が2例、4軟骨輪が1例、5軟骨輪が1例、6軟骨輪+食道が1例であった。再建には5-0マクソン糸を1例、4-0バイクリル糸を4例に用いた。5例とも吻合部合併症はみられず、小児例は術後20日間の人工呼吸管理を要したが、他の4例は手術終了後または翌日に気管チューブを抜去できた。その後の経過は5例とも良好であった。

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その他リンク： https://search-tp.jamas.or.jp/index.php?module=Default&action=Link&pub_year=2008&ichushi_jid=J00349&link_issn=&doc_id=20080924140001&doc_link_id=1390282763056443520&url=https%3A%2F%2Fcir.nii.ac.jp%2Fcrid%2F1390282763056443520&type=CiNii&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00003_2.gif

記述言語：日本語   出版者・発行元：長岡赤十字病院  

画像上原発性肺癌が疑われる未確診症例と、術前確診があるも細気管支肺胞上皮癌(BAC)の可能性がある症例に対し、腫瘍を含む部分切除後に術中迅速組織診を行い、BACの場合には手術終了とした。腫瘍が肺門に近い場合、同一区域内に複数の腫瘍を認める場合には区域切除を施行した。適応症例は56症例(男性20例、女性36例、平均66歳、平均術後経過観察期間43ヵ月)であった。画像上腫瘍径は平均17mmで、53例に部分切除、3例に区域切除を施行した。3例は部分切除を2ヶ所施行し、1例は切除区域内に2ヶの腫瘍を認めた。9例では術前肺切除を施行していた。3例に一部浸潤傾向を認め、再手術による標準手術の適応としたが、本人の希望で経過観察とした。原発死症例はなく、全症例で再発所見は認めなかった。本術式は非侵襲的かつ根治性が得られる術式と考えられた。

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記述言語：日本語   出版者・発行元：(NPO)日本呼吸器外科学会  

症例は65歳、男性。2002年4月、検診の胸部X線で左下葉の嚢胞状病変と結節影を指摘された。当院内科で気管支拡張症に伴う炎症を疑い、経過観察していた。2003年7月の胸部CTで結節影の増大を認め、肺癌の可能性を否定し得ず8月6日手術を施行した。術中迅速病理診断では過誤腫と診断されたが、嚢胞がほぼ下葉全体を占めていたため左下葉切除術を施行した。術後病理結果はほぼ下葉全体に広がる多発性の嚢胞病変(multicystic lesion)と辺縁不規則な、異型のない成熟した平滑筋の増生巣を認め、fibroleiomyomatous hamartomaと診断した、本疾患は非常に稀であり、長期的予後について検討された報告はなく、今後も注意深い経過観察が必要と思われる。(著者抄録)

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その他リンク： https://search-tp.jamas.or.jp/index.php?module=Default&action=Link&pub_year=2008&ichushi_jid=J02256&link_issn=&doc_id=20081014200013&doc_link_id=10.2995%2Fjacsurg.22.920&url=https%3A%2F%2Fdoi.org%2F10.2995%2Fjacsurg.22.920&type=J-STAGE&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00007_3.gif

記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：ELSEVIER SCIENCE BV  

BACKGROUND: Electroporation has been shown to increase the efficacy of intramuscular injection of plasmid DNA, resulting in a higher level of foreign gene expression. Using this technique, we examined the effect of viral IL-10 gene transfer on the prevention of tracheal allograft stenosis in an animal model. METHODS: On the day of tracheal transplantation, recipient Lewis rats were intramuscularly injected with either plasmid pCAGGS-LacZ or plasmid pCAGGS-viral IL-10, followed immediately by electroporation. Tracheas from Brown Norway donors were transplanted into the backs of Lewis recipients, and the histology of the grafts were assessed 2 and 4 weeks after transplantation. RESULTS: The serum level of IL-10 peaked at 2000 pg/ml one day after injection; the level then slowly decreased, but was maintained above 1000 pg/ml until 8 days after injection. At Day 28, the airway lumina of the tracheal allografts were almost completely obliterated by fibroproliferative tissue in the control pCAGGS-LacZ-treated rats. In rats injected once with pCAGGS-viral IL-10, luminal obliteration was significantly decreased compared with the control pCAGGS-LacZ-treated rats (mean luminal opening 46.8% vs 0% p<0.05). The loss of epithelial cells lining the airway was also decreased in the IL-10-treated group (mean epithelial coverage 42% vs 5% p<0.05). Multiple injections with pCAGGS-viral IL-10 did not further improve the histological changes. CONCLUSION: IL-10 gene transfer by intramuscular injection using electroporation attenuated tracheal allograft stenosis associated with mild epithelial injury.

DOI： 10.1016/j.trim.2008.05.001

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記述言語：日本語   出版者・発行元：(株)南江堂  

術前画像検索で遠隔転移やリンパ節を認めず、腫瘍最大径1cm以下の原発性肺癌62例(男34例・女28例・平均64歳)に対する手術成績を報告した。術式は肺葉切除・リンパ節郭清の標準術式が37例(A群)、部分・区域切除の縮小手術が25例(B群)であった。術中迅速病理診断で細気管支肺葉上皮癌(BAC)の場合はすべて積極的縮小手術とし、それ以外を原則的に標準術式とした。病理組織型は腺癌49例、扁平上皮癌8例、カルチノイド2例、大細胞癌、小細胞癌、腺扁平癌各1例で、迅速病理診断BACの14例は永久標本でもBACであった。術後病理病期はStage IAが57例、IBが2例、IIAが1例、IIIBが2例であった。累積生存曲線における5年生存率は90%、10年は84%で、A群はそれぞれ91%、84%、B群は90%、90%と有意差はなかった。なお非浸潤癌(BAC)の5年生存率は100%、浸潤癌は88%と有意差を認めた。在院死は1例、再発死亡3例、術後5年以内死亡2例であった。

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記述言語：日本語   掲載種別：研究論文（学術雑誌）  

This study investigated the characteristics and long-term results of surgical treatment for primary lung cancer in patients aged 80 years or older, mainly based on difference between the sexes. Seventy-four patients aged 80 years or older who underwent surgical resection for primary lung cancer in our institute between 1986 and 2005 were retrospectively reviewed. Fifty-six patients were male and 18 were female. The median age of all patients was 81 years. Twenty-two males (39%) and 5 females (28%) had co-existing diseases preoperatively. Twenty-nine males (52%) and 17 females (94%) had adenocarcinoma. Forty-four males (79%) and 16 females (89%) had pathological stage I disease. Eleven males (20%) and 1 female (6%) developed postoperative complications that adversely affected the patient's morbidity and mortality. There was 1 surgical mortality (1.4%) and 1 hospital mortality (1.4%). The postoperative 5-year survival rate was 23% in 56 males and 58% in 18 females. The 5-year survival rate was 10% in 35 males underwent lobectomy, 58% in 20 males underwent wedge resection, and 70% in 15 females underwent lobectomy. These findings seems to indicate that long-term outcomes for males were worse than those for females. The data suggest that the indication of lobectomy should be more strictly limited in male patients than in female patients aged 80 years or older.

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記述言語：日本語   出版者・発行元：(株)南江堂  

1986〜2005年の20年間に当院で手術を施行した手術時年齢80歳以上の原発性肺癌患者74例を対象に、性差による予後について検討した。対象の内訳は、男56例(80〜85歳)、女18例(80〜84歳)であった。1996年を境に前後10年間をそれぞれ前期、後期と分けると、前期19例(男14例、女5例)、後期は55例(男42例、女13例)であった。術後予後に影響を及ぼす術前併存疾患は男22例、女5例にみられた。術式では片肺全摘例はなく、肺葉切除は男35例、女15例で、肺部分切除は男20例、女3例に施行した。術後病理組織型では、腺癌は男29例、女17例で扁平上皮癌は男23例、女1例で、小細胞癌+扁平上皮癌3例と大細胞癌1例が男にみられた。術後病理分類では、StageIAは男35例、女9例とStageIBは男9例、女7例で、両方で男79%、女89%を占めた。術後合併症は男11例、女1例に認め、術後早期死亡における手術関連死亡は男2例、他病死は男3例、女1例あり、肺癌再発死亡は男1例であった。術後長期予後と累積生存率で比較すると3年生存率は男52%、女70%、5年生存率は男23%、女58%、10年生存率は男0%、女58%であった。5年生存率を性別、術式別に比較すると女・肺葉切除後が70%と最も良く、次いで男・部分切除後が58%であった。最も悪かったのは男・肺葉切除後で10%であった。以上より超高齢者の男性に対する肺葉切除の適応は厳格にすべきと考えられた。

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その他リンク： https://search-tp.jamas.or.jp/index.php?module=Default&action=Link&pub_year=2008&ichushi_jid=J00349&link_issn=&doc_id=20080424060001&doc_link_id=1390001288079740672&url=https%3A%2F%2Fcir.nii.ac.jp%2Fcrid%2F1390001288079740672&type=CiNii&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00003_2.gif

記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：LIPPINCOTT WILLIAMS & WILKINS  

Studies have demonstrated that cardiopulmonary bypass (CPB) adversely affects pulmonary circulation, which is involved in metabolism in the lung, and that pulmonary circulation after CPB can restore the prostaglandin E2 (PGE2) level mainly standing for levels of key vasostimulators augmented during CPB, which may influence systemic tissue perfusion and body oxygen metabolism. However, in lung transplantation (Lx), pulmonary circulation is restored to the graft, which might induce another CPB reaction. We prospectively examined the influence of CPB on body oxygen metabolism in Lx. Left Lx was successfully performed on 10 dogs (group-on: with normothermic CPB without cardiac arrest, group-off. without CPB; n = 5 vs. 5). At 30 minutes after graft perfusion, the right pulmonary artery and bronchus were clamped. Body weight, donor-to-recipient body weight ratio, and clinical parameters were comparable between the two groups, except for the hematocrit level during CPB. At 90 minutes after graft perfusion, mixed venous oxygen saturation (SVO2) was lower (p < 0.01) and 02 extraction rate (p < 0.01), PGE2 (p = 0.025), and arterial blood ketone body ratio (KBR) (p < 0.01) were higher in group-on than in group-off, whereas these parameters were comparable before graft perfusion between the two groups. 02 consumption and acetic acid were higher in group-on than in group-off, whereas 0, delivery and 3-hydroxy propioic acid were comparable between the groups. In conclusion, Lx during CPB may induce a new inflammatory reaction and influence body oxygen metabolism, contrary to the restoration of pulmonary circulation after CPB.

DOI： 10.1097/MAT.0b013e31815b2d36

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：ACADEMIC PRESS LTD- ELSEVIER SCIENCE LTD  

PURPOSE: Acute respiratory distress syndrome is characterized by neutrophil accumulation in the lungs and the activation of several cytokines produced by macrophages. Olprinone hydrochloride, a specific phosphodiesterase III inhibitor, has anti-inflammatory effects and inhibits the activation of macrophages, in addition to its inotropic and vasodilatory effects. The purpose of this study was to examine the beneficial effects of olprinone on lipopolysaccharide (LPS)-induced pulmonary inflammation. MATERIALS AND METHODS: Lung inflammation was produced by intravenous LPS injection into rats. The rats were divided into four groups: a vehicle group in which normal saline was injected, an olprinone group in which olprinone was injected at a dose of 0.2mg/kg, a dexamethasone group in which dexamethasone was injected at a dose of 5mg/kg, and a control group. In each group, drug was injected intraperitoneally 30 min before the intravenous administration of LPS. The blood was obtained at 1h and then animals were sacrificed at 6h and blood and lung specimen were obtained for cytokine analysis and pathological examination. On another set of experiment, bronchioloalveolar lavage (BAL) was performed for cytokine analysis of BAL fluid. The macrophages isolated from normal rat by BAL were cultured in vitro with the presence of LPS and olprinone or dexamethasone, and supernatant was collected. The levels of several cytokines in the serum, in the BAL fluid, and in the culture supernatant were determined. RESULTS: The animals injected with LPS were found to have an influx of neutrophils in the lungs, and inflammatory cytokines, such as TNF-alpha and IL-6, and anti-inflammatory cytokine IL-10 were produced. Pretreatment with olprinone or dexamethasone significantly inhibited the LPS-induced neutrophil influx into the lungs, suppressed inflammatory cytokines TNF-alpha and IL-6. The level of anti-inflammatory cytokine IL-10 increased in an olprinone group. The inhibition of TNF-alpha and IL-6, and the augmentation of IL-10 release were also observed in in vitro culture of isolated rat alveolar macrophages when olprinone (10(-5)mol/ml) and LPS (10 microg/ml) were cultured together. However, the level of IL-10 in serum and culture supernatant was suppressed in a dexamesathone group. CONCLUSION: LPS-induced lung inflammation is strongly inhibited by olprinone accompanying the enhancement of IL-10 and the inhibition of inflammatory cytokines. Results of the in vitro experiment suggest that alveolar macrophages may play an important role in ameliorating LPS-induced lung inflammation and the mechanism of its effect is different from that of steroid.

DOI： 10.1016/j.pupt.2007.01.007

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記述言語：日本語   出版者・発行元：特定非営利活動法人 日本呼吸器外科学会  

DOI： 10.2995/jacsurg.22.458_1

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記述言語：日本語   出版者・発行元：(株)南江堂  

18歳男性。通常型間質性肺炎に対し米国で脳死肺移植を受け、3ヵ月経過後も呼吸機能改善が停滞した。胃膨満感や胸やけがあり、呼吸機能検査でFVC 1.11l、FEV1.0 0.81lであった。開胸肺生検を施行したが、組織学的に感染や拒絶反応はなかった。胸部CTで肺野末梢に小粒状影とスリガラス陰影が散在し、末梢気管支壁の肥厚を認め、また呼気相ではモザイク状の含気部分を認めた。肺換気・血流シンチグラムでは微小誤嚥による慢性炎症の可能性が示唆された。腹部単純X線では胃内食物残渣の貯留所見を、造影後には造影剤の排泄遅延を認めた。24時間胃・食道pHモニターでは、胃内容物の影響で正確な評価は困難であった。胃食道逆流、胃機能低下に伴う微小誤嚥が呼吸機能低下の原因と診断し、まず幽門形成術を施行し、術後24時間胃・食道pHモニターで食道内pH4以下の時間率が13.6と逆流を認めた。それから約3ヵ月後(肺移植から約9ヵ月後)に噴門形成術を施行し、逆流改善とともに呼吸機能の改善傾向がみられた。胃・食道pHモニターは逆流状態の程度、術後の改善判定に有用であった。

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記述言語：日本語   出版者・発行元：長岡赤十字病院  

病院移転後の著者らの施設における胸部外傷治療の現状と問題点について検討した。対象は新病院開院の1997年9月〜2006年12月までに入院治療した胸部外傷患者157例(男性126例、女性31例・平均年齢60歳)であった。1)受傷原因は交通事故84例(53.5%)、転落36例(22.9%)、転倒14例(8.9%)、自殺未遂5例(3.2%)、喧嘩4例(2.5%)、スキー事故3例(1.9%)、その他44例であった。2)損傷形態は肺挫傷157例(100%)、血気胸144例(91.7%)、肋骨骨折109例(69.4%)、胸骨骨折6例、気管・主気管支損傷3例であった。3)入院期間は平均9日で、胸腔ドレナージ施行は109例(69.4%)、呼吸器管理は10例(6.4%)であった。4)手術は5例に行なわれ、手術死亡や在院死亡はなかった。以上、これらのことからも、重症胸部外傷患者は搬送途中で必ず状態が悪化するため、気管内吸引と再挿管ができる設備と体勢の整備が必要と考えられた。

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

OBJECTIVE: To assess the benefit of video-assisted thoracic surgery (VATS), we compared time-related quality of life (QOL) after lobectomy performed by VATS to that performed by thoracotomy. METHODS: Thirty-three patients underwent surgery for lung cancer during the period April 2001 through November 2002 completed a mailed questionnaire after surgery. RESULTS: Over time, improved QOL was reported in six dimensions by VATS patients but in only two dimensions by thoracotomy patients. There was significant improvement in bodily pain subscores in both groups during the 36 months after surgery. At 3 months after surgery, QOL scores for all eight dimensions were lower in the VATS group, but QOL scores for all eight dimensions did not differ significant between groups at 3 or 12 months after surgery. At 36 months after surgery, QOL scores for six dimensions were higher in the VATS group, and the difference was significant in scores for two dimensions. CONCLUSION: We found recovery was quicker in patients who underwent VATS than in those who underwent thoracotomy.

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記述言語：日本語   出版者・発行元：(株)永井書店  

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記述言語：日本語   出版者・発行元：(NPO)日本呼吸器外科学会  

一般に気胸に対する手術は全身麻酔下に行われる。しかし、臨床の場では全身麻酔のリスクが高い症例にしばしば遭遇する。当科ではそのような症例に局所麻酔下に胸腔鏡手術を行ってきたので報告する。対象は1996年4月から2005年3月までに局所麻酔下に胸腔鏡手術を行った難治性気胸12例。男性11例、女性1例、平均年齢71歳であった。術前評価で全身麻酔のリスクが高いと考えられた症例は11例で、1例は全身麻酔拒否の症例であった。手術時間は平均50分。術中合併症は無かったが、術後合併症として肺炎と膿胸を併発した1例を失った。手術目的を達成した症例は9例で、いずれも術中にブラを確認できた症例であった。手術適応を十分に検討し、術前評価を十分に行えば、全身麻酔のリスクが高い難治性気胸症例に対する局所麻酔下胸腔鏡手術は有用であり、検討に値する手技と考えられた。(著者抄録)

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その他リンク： https://search-tp.jamas.or.jp/index.php?module=Default&action=Link&pub_year=2007&ichushi_jid=J02256&link_issn=&doc_id=20070329270004&doc_link_id=10.2995%2Fjacsurg.21.118&url=https%3A%2F%2Fdoi.org%2F10.2995%2Fjacsurg.21.118&type=J-STAGE&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00007_3.gif

記述言語：日本語   出版者・発行元：特定非営利活動法人 日本呼吸器外科学会  

DOI： 10.2995/jacsurg.21.426_1

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記述言語：日本語   出版者・発行元：特定非営利活動法人 日本呼吸器外科学会  

DOI： 10.2995/jacsurg.21.353_4

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記述言語：日本語   出版者・発行元：特定非営利活動法人 日本呼吸器外科学会  

DOI： 10.2995/jacsurg.21.430_1

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記述言語：日本語   出版者・発行元：特定非営利活動法人 日本呼吸器外科学会  

DOI： 10.2995/jacsurg.21.334_3

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：MOSBY-ELSEVIER  

OBJECTIVE: The purpose of this study was to investigate the effects of cardiopulmonary bypass and ultrafiltration on graft function in a canine single-lung transplantation model. METHODS: Fifteen left single-lung transplantations were done in weight-mismatched canine pairs. The animals were divided into 3 groups: group 1, in which transplantation was done without cardiopulmonary bypass; group 2, in which transplantation was done with cardiopulmonary bypass and in which the cardiopulmonary bypass flow was decreased slowly with controlled pulmonary artery pressure; and group 3, in which transplantation was done with cardiopulmonary bypass and ultrafiltration. Hemodynamic parameters and lung function were monitored for 6 hours after reperfusion. The grafts were harvested for histologic studies, myeloperoxidase assay, and real-time quantitative reverse transcription-polymerase chain reaction of mRNA encoding interleukin 6. RESULTS: The hemodynamic parameters were similar among the 3 groups. In group 1 PaO2 and alveolar to arterial gradient for O2 levels were excellent throughout the 6-hour observation period, but in group 2 they progressively deteriorated. However, ultrafiltration significantly (P = .02) improved the PaO2 level in group 3. On histology, interstitial edema and polynuclear cell infiltration were most marked in group 2 and significantly worse than in groups 1 and 3. Myeloperoxidase assay and real-time quantitative reverse transcription-polymerase chain reaction showed increased myeloperoxidase activity and interleukin 6 gene expression in group 2 grafts compared with group 1 grafts. Myeloperoxidase activity and interleukin 6 gene expression were suppressed with ultrafiltration. CONCLUSIONS: Cardiopulmonary bypass had negative effects on the graft, but ultrafiltration attenuated acute lung dysfunction by reducing the inflammatory response.

DOI： 10.1016/j.jtcvs.2006.08.020

Web of Science

PubMed

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記述言語：日本語   出版者・発行元：(NPO)日本呼吸器外科学会  

稀な真菌感染症であるScedosporium apiospermumによる肺感染症に対して肺切除を施行した2症例を経験したので報告する.症例1は66歳女性.34歳時に気管支拡張症と診断されたが,無症状で経過していた.1989年より喀血が出現し,近医で加療を受けていた.1996年9月2日多量の喀血が出現し,手術目的に当院へ紹介,入院した.右上葉の病変が喀血の原因と診断し,右上葉切除を施行した.採取した切除標本の組織培養でScedosporium apiospermumが検出された.症例2は27歳女性,中国からの帰国子女.1997年3月喀血で発症.1998年2月胸部異常影を指摘され,結核の疑いで当院へ入院.抗結核薬の投与にかかわらず病変の増大を認めたため,右上葉切除を施行した.採取した切除標本の組織培養でScedosporium apiospermumが検出された.2症例とも術後の経過は良好であった(著者抄録)

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記述言語：日本語   出版者・発行元：(株)医学書院  

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記述言語：日本語   出版者・発行元：(NPO)日本呼吸器外科学会  

4年間に開窓術後の慢性膿胸に対する単純創閉鎖術を施行した7例の手術成績を,従来の術式である腔縮小術と比較検討した.6例は腔縮小術の手術侵襲が過大と判断し,単純創閉鎖術を施行した.本術式は手術時間が短く,術中出血量が少なく,術後入院期間も短い傾向にあった.全身状態不良の1例では,硬膜外麻酔+局所麻酔下に手術を施行したが,術中の苦痛もなく,十分安全に行えた.再発を1例に認めたが,腔縮小術を行って治癒した.細菌培養陰性で,気管支肺胞瘻がないか,あるいは少数存在しても術中に肋間筋弁等の被覆によって容易にコントロール可能な症例であれば,本術式は全身状態不良の症例に対してよい適応と考えられた.また,低侵襲性,安全性,美容的観点等の利点を考慮すると,腔縮小術に耐えられる全身状態良好な症例にも適応があると考えられた

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記述言語：日本語   出版者・発行元：特定非営利活動法人 日本呼吸器外科学会  

DOI： 10.2995/jacsurg.20.851_4

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記述言語：日本語   出版者・発行元：特定非営利活動法人 日本呼吸器外科学会  

DOI： 10.2995/jacsurg.20.904_2

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記述言語：日本語   出版者・発行元：(NPO)日本呼吸器外科学会  

47歳男性.患者は30歳時に筋強直性ジストロフィーと診断され他院で経過観察中であったが,胸部X線で縦隔異常影を認め,精査で縦隔嚢胞と診断され紹介入院となった.所見では,顔面浮腫,心電図で左室肥大,呼吸機能検査で拘束性換気障害を認めた.更にX線では右上縦隔に肺を圧迫する腫瘤を認め,CT・MRIでは上縦隔右側に嚢胞状腫瘤を認めた.CTガイド下腫瘤を穿刺し,嚢胞内容物の採取とドレナージを行ったところ,内容物は漿液性で,腫瘍マーカーはCEA,SCCともに軽度上昇,細胞診で悪性所見はなかった.ドレナージ後,症状・所見とも改善し退院したが,2週間後に再度の顔面浮腫と呼吸困難の出現で再入院となった.腫瘍はドレナージ前の大きさに戻っていた.患者希望で摘出手術を行わず,CTガイド下に嚢胞内エタノール注入療法を行った結果,治療4週後に腫瘤は消失し,以後再発は認められていない

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記述言語：日本語   出版者・発行元：(NPO)日本肺癌学会  

根治可能な早期肺癌症例の増加と手術成績の向上に伴って,術後経過観察中に異時性の肺多発癌(第2癌)を経験する機会が多くなった.1)1996〜2003年の間に原発性肺癌手術症例は523例で,19例に第2癌を確認し,16例に手術を施行した.第2癌の手術時年齢は平均75歳で,第2癌の手術までの感覚は8〜86ヵ月であった.2)第1癌に対する術式は肺葉切除14例,区域切除2例で,第2癌の術式は肺葉切除4例,区域切除4例,部分切除8例であった.3)第2癌の臨床病期は全てI期で,IA期11例,IB期5例で,病理病期はIA期13例,IB期1例,IIB期2例であった.4)手術死亡および在院死亡はなく,術後合併症もなかった.5)第2癌手術後の5年生存率は56.8%で,区域切除以下の縮小手術を行った12例の5年生存率は71.1%であった.肺葉切除4例に5年生存症例はなかった.以上,第2癌の発生を念頭においた経過観察で,縮小手術で根治可能な段階で第2癌を発見することが重要だと考えられた

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その他リンク： https://search-tp.jamas.or.jp/index.php?module=Default&action=Link&pub_year=2005&ichushi_jid=J01244&link_issn=&doc_id=20050803350004&doc_link_id=%2Fec7jaluc%2F2005%2F004503%2F004%2F0235-0239%26dl%3D0&url=https%3A%2F%2Fwww.medicalonline.jp%2Fjamas.php%3FGoodsID%3D%2Fec7jaluc%2F2005%2F004503%2F004%2F0235-0239%26dl%3D0&type=MedicalOnline&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00004_2.gif

記述言語：英語   掲載種別：研究論文（学術雑誌）  

OBJECTIVE: The aim of this study was to assess the adequacy of our intentional limited resection for small peripheral lung cancer based on intraoperative pathologic exploration. METHODS: Patients who had stage IA non-small cell lung cancer (NSCLC) with a maximum tumor diameter of 2 cm or less were candidates for limited resection. If bronchioloalveolar carcinoma (BAC) was suspected on computed tomography and intraoperative pathologic exploration revealed the lesion as BAC without foci of active fibroblastic proliferation (Noguchi type A and B), wedge resection was performed. If the tumor was not suspected of being Noguchi type A or B, extended segmentectomy with intraoperative lymph node exploration was performed. RESULTS: Limited resection was performed in 34 patients, wedge resection in 14, and extended segmentectomy in 20. The median follow-up period after wedge resection was 36 months, and all patients are alive with no signs of recurrence. The median follow-up period after extended segmentectomy was 54 months. No local recurrences were found, but distant metastasis was diagnosed in one patient. The 5-year survival rate after extended segmentectomy was 93%. In the same period, lobectomy was performed in 57 patients with stage IA NSCLC with a maximum tumor diameter of 2 cm or less, and the 5-year survival rate was 84%. There were no significant differences in 5-year survival between extended segmentectomy and lobectomy. CONCLUSIONS: Careful selection of patients based on high-resolution computed tomography findings and intraoperative pathologic exploration makes intentional limited resection an acceptable option for the treatment of small peripheral NSCLC.

PubMed

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記述言語：日本語   出版者・発行元：(株)南江堂  

特発性間質性肺炎(IIPs)を合併した肺癌手術症例25例の治療成績を検討した.8例には肺葉切除+ND2a郭清の標準手術を行い(標準治療群),17例には部分切除などの縮小手術(縮小治療群)を行った.局所再発は標準治療群で2例(25.0%)に,縮小治療群で5例(29.4%)に認めた.全例の3年生存率は43%であり,臨床病期,術式による有意差はみられなかった.術後のIIPs急性増悪はなかった.IIPs合併肺癌の手術に際しては,急性増悪を常に念頭に置き,根治性を保った術式の選択が必要と考えられた

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その他リンク： https://search-tp.jamas.or.jp/index.php?module=Default&action=Link&pub_year=2005&ichushi_jid=J00349&link_issn=&doc_id=20050208470001&doc_link_id=1390564238031235840&url=https%3A%2F%2Fcir.nii.ac.jp%2Fcrid%2F1390564238031235840&type=CiNii&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00003_2.gif

記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：SPRINGER JAPAN KK  

Objective: The aim of this study was to assess the adequacy of our intentional limited resection for small peripheral lung cancer based on intraoperative pathologic exploration. Methods: Patients who had stage IA non-small cell lung cancer (NSCLC) with a maximum tumor diameter of 2 cm or less were candidates for limited resection. If bronchioloalveolar carcinoma (BAC) was suspected on computed tomography and intraoperative pathologic exploration revealed the lesion as BAC without foci of active fibroblastic proliferation (Noguchi type A and B), wedge resection was performed. If the tumor was not suspected of being Noguchi type A or B, extended segmentectomy with intraoperative lymph node exploration was performed. Results: Limited resection was performed in 34 patients, wedge resection in 14, and extended segmentectomy in 20. The median follow-up period after wedge resection was 36 months, and all patients are alive with no signs of recurrence. The median follow-up period after extended segmentectomy was 54 months. No local recurrences were found, but distant metastasis was diagnosed in one patient. The 5-year survival rate after extended segmentectomy was 93%. In the same period, lobectomy was performed in 57 patients with stage IA NSCLC with a maximum tumor diameter of 2 cm or less, and the 5-year survival rate was 84%. There were no significant differences in 5-year survival between extended segmentectomy and iobectomy. Conclusions: Careful selection of patients based on high-resolution computed tomography findings and intraoperative pathologic exploration makes intentional limited resection an acceptable option for the treatment of small peripheral NSCLC.

DOI： 10.1007/s11748-005-1005-7

Web of Science

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記述言語：日本語   出版者・発行元：特定非営利活動法人 日本呼吸器外科学会  

DOI： 10.2995/jacsurg.19.473_4

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記述言語：日本語   出版者・発行元：(NPO)日本呼吸器外科学会  

症例1:57歳女.左背部痛と発熱を主訴とした.約37年前に絨毛癌に対して至急卵巣全摘術を施行され,その後,左肺転移疑いで左上肺野に放射線治療を受けた既往があった.諸検査の結果,約37年前の放射線治療の晩期合併症として骨壊死を伴う放射線潰瘍が形成されたと診断し,再建術を施行した.病理診断はchronic radiation dermatitisであった.外来にて経過観察していたところ,術後3年頃より左前胸部腫瘤が出現し,左前胸部放射線潰瘍の診断で胸壁切除,大胸筋弁による再建術を施行した.症例2:68歳女.34年前に右乳癌に対し胸筋合併乳房切除術と放射線治療を施行され,約9年前に右前胸部手術創の潰瘍を認め,デブリードマンおよび再建術を施行された.今回,再び潰瘍が出現し,諸検査の結果,34年前の放射線治療による放射線潰瘍に対して行われた再建術後の再発と診断し,デブリードマンと広背筋皮弁を用いた再建術を施行した.両症例共に術後経過は良好で再燃は認めない

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記述言語：日本語   出版者・発行元：新潟医学会  

44歳男.声のかすれが出現し,前胸部の腫瘤を自覚した.胸部CTで上縦隔に腫瘍を指摘された.前胸部腫瘍の生検を施行し,胸腺癌(扁平上皮癌)と診断した.画像上,腕頭動脈への腫瘍の直接浸潤が疑われ,正岡分類III期と診断した.PACE療法を施行した.副作用としては,grade 4の好中球減少,grade 2の便秘が出現したが,補助療法にていずれも短期間で改善した.PRと判定した.腫瘍摘出術,胸腺摘出術を施行した.術後は合併症なく順調に経過し退院した.術後放射線療法を外来にて施行した.外来で経過観察中であり,これまでのところ再発を認めていない

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記述言語：日本語   出版者・発行元：(株)南江堂  

すりガラス状陰影(GGO)を主体とする細気管支肺胞型腺癌に対する縮小手術の成績とその妥当性を検討した.1996年10月から2003年4月までに細気管支肺胞型腺癌の疑いにて縮小手術を施行した症例のうち,CT上腫瘍径20mm以下かつ腫瘍全体に対するGGO領域の比率が50%以上の58例を対象とした.58例中48例に部分切除,2例に区域切除が行われ,8例は浸潤性増殖や高度線維化などにより肺葉切除へ移行した.術中迅速病理診断と術後病理標本の対比では56例の結果は一致したが2例は過小評価であった.また,術後合併症は肺胞瘻1例を認めたのみであり,術後2〜80ヵ月間の観察では肺葉切除に移行した症例を含め57例が無再発生存中である.HRCTと病理所見を野口分類で対比するとtypeA+Bでは腫瘍最大径が有意に小さく,高濃度部分や線状陰影の有無についても有意に少なかった.線状陰影のない10mm以下の病変では縮小手術の対象と考えられた

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記述言語：日本語   出版者・発行元：特定非営利活動法人 日本呼吸器外科学会  

DOI： 10.2995/jacsurg.18.428_1

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記述言語：日本語   出版者・発行元：特定非営利活動法人 日本呼吸器外科学会  

DOI： 10.2995/jacsurg.18.399_3

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記述言語：日本語   出版者・発行元：特定非営利活動法人 日本呼吸器外科学会  

DOI： 10.2995/jacsurg.18.442_1

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記述言語：日本語   出版者・発行元：特定非営利活動法人 日本呼吸器外科学会  

DOI： 10.2995/jacsurg.18.340_2

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記述言語：日本語   掲載種別：研究論文（学術雑誌）  

Fifty-eight patients who had small lung tumors 2 cm or less with ground-glass opacity (GGO) component more than 50% on high resolution computed tomography (HRCT) underwent intentional limited resection. After bronchioloalveolar carcinoma without both active fibroblastic proliferation and invasive sign to the stroma was confirmed, limited resection was completed in 50 patients. In 8 patients, procedure was converted lobectomy because of microscopic invasive sign in 4, active fibroblastic proliferation in 2, and other reasons in 2. Unexpected invasive sign was found by detailed post-operative examination in 2 cases. Five-year survival rate was 98% with a mean follow-up period of 48.8 months. A limitation of intra-operative diagnosis was revealed and the accuracy of diagnosis should be improved by not only intra-operative pathological diagnosis but also HRCT images.

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：ELSEVIER SCIENCE BV  

Objective: The purpose of this study was to determine whether lobectomy without radical systematic mediastinal lymphadenectomy (LA) is a satisfactory alternative surgical treatment for octogenarians with clinical stage I non-small cell lung cancer (NSCLC). Methods: From April 1985 through December 2001, 49 patients aged 80 years and older who underwent surgical treatment for clinical stage I NSCLC were reviewed. Lobectomy without radical systematic mediastinal LA was performed for 27 patients (LA0 group) and lobectomy with radical systematic mediastinal LA was performed for 22 patients (LA group). Results: The mortality rate was 0% in the LA0 group and 4.5% in the LA group. Five-year survival rate according to the type of surgery was 44.8% in the LA0 group and 55.5% in the LA group, a difference that was not significant (P = 0.88). Although there was no significant statistical difference, postoperative pulmonary complication was more frequent in the LA group than in the LA0 group (32% in the LA group versus 11% in the LA0 group P = 0.07). Five-year survival rates according to serum carcinoembryonic antigen (CEA) levels were 0% for patients with elevated CEA levels (n = 9) and 56.5% for patients with normal CEA levels (n = 40) (P &lt; 0.01). Conclusion: Lobectomy without radical systematic mediastinal LA appears to be a satisfactory surgical procedure for octogenarians with clinical stage I NSCLC. However, mediastinoscopy is necessary in such octogenarians if their serum CEA level is elevated so that the precise clinical stage can be determined and an accurate prognosis can be given. (C) 2003 Elsevier Science B.V. All rights reserved.

DOI： 10.1016/S1010-7940(03)00014-9

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記述言語：日本語   出版者・発行元：日本肺癌学会  

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記述言語：日本語   出版者・発行元：日本肺癌学会  

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記述言語：日本語   出版者・発行元：日本肺癌学会  

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記述言語：日本語   出版者・発行元：日本肺癌学会  

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記述言語：日本語   出版者・発行元：日本肺癌学会  

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記述言語：日本語   出版者・発行元：日本肺癌学会  

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記述言語：日本語   出版者・発行元：(一社)日本移植学会  

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記述言語：日本語   出版者・発行元：新潟大学  

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その他リンク： http://search.jamas.or.jp/link/ui/2008208851

記述言語：日本語   出版者・発行元：日本肺癌学会  

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記述言語：日本語   出版者・発行元：日本肺癌学会  

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記述言語：日本語   出版者・発行元：日本肺癌学会  

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記述言語：日本語   出版者・発行元：一般社団法人日本外科学会  

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記述言語：日本語   出版者・発行元：日本肺癌学会  

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記述言語：日本語   出版者・発行元：日本肺癌学会  

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記述言語：日本語   出版者・発行元：日本肺癌学会  

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記述言語：日本語   出版者・発行元：日本肺癌学会  

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記述言語：日本語   出版者・発行元：新潟大学  

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その他リンク： http://search.jamas.or.jp/link/ui/2006320757

記述言語：日本語   出版者・発行元：一般社団法人日本外科学会  

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記述言語：日本語   出版者・発行元：日本肺癌学会  

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記述言語：日本語   出版者・発行元：新潟大学  

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その他リンク： http://search.jamas.or.jp/link/ui/2005200833

記述言語：日本語   出版者・発行元：日本肺癌学会  

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記述言語：日本語   出版者・発行元：日本肺癌学会  

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記述言語：日本語   出版者・発行元：日本肺癌学会  

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記述言語：日本語   出版者・発行元：日本肺癌学会  

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記述言語：日本語   出版者・発行元：日本肺癌学会  

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記述言語：日本語   出版者・発行元：一般社団法人日本外科学会  

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記述言語：日本語   出版者・発行元：日本肺癌学会  

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記述言語：日本語   出版者・発行元：日本肺癌学会  

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