Composite resection of the left upper lobe and superior segment (S6) of the lower lobe for lung cancer with a mediastinal lingular and basal pulmonary artery.

Background: Preoperative evaluation and awareness of anatomical variations in the pulmonary vessel is essential for a secure pulmonary resection. We herein present a patient who underwent complex pulmonary resection for lung cancer with a mediastinal lingular and basal pulmonary artery that had been detected by preoperative three-dimensional computed tomography.

Case Presentation: The patient was an asymptomatic 66-year-old woman who had a 39-pack-year smoking habit.

Lung Adenocarcinoma in Never Smokers: Problems of Primary Prevention from Aspects of Susceptible Genes and Carcinogens.

Global statistics estimate that approximately 25% of patients with lung cancer are never smokers. We suggest that genes related to susceptibility to metabolic syndrome were present among those related to susceptibility to lung adenocarcinoma (AC) in never smokers. There are many questions concerning lung AC in never smokers, which is increasing in incidence, with female predominance, good prognosis, unique genes related to susceptibility and good response to treatment with specific agents.

Genes associated with succeptibility to lung adenocarcinoma among never smokers suggest the mechanism of disease.

Global statistics estimate that 15% of all cases of lung cancer in men and 53% in women are not attributable to smoking, and these data indicate that worldwide, approximately 25% of patients with lung cancer are never smokers. The etiology of lung cancer is disputed. The present study reviews the genes associated with susceptibility to lung cancer among never smokers and suggests possibilities for the involvement of metabolic syndrome.

Improvements in surgical results for lung cancer from 1989 to 1999 in Japan.

Background: In 1986, Japanese Association for Thoracic Surgery started a nationwide survey of the number of primary lung cancer undergoing resection and this survey was continued annually. Thereafter, investigations of lung cancer surgical results have been conducted three times. The postoperative overall 5-year survival rate was 47.

Risk of Acute Exacerbation After Video-assisted Thoracoscopic Lung Biopsy for Interstitial Lung Disease.

Biopsy by video-assisted thoracoscopic surgery (VATS) for interstitial pneumonia allows collection of samples sufficient for accurate histologic diagnosis. Although VATS is relatively safe, several reports have suggested that surgical lung biopsy may be a risk factor for acute exacerbation of idiopathic pulmonary fibrosis (IPF). We retrospectively reviewed data on the 113 cases that underwent biopsy by VATS to diagnose diffuse parenchymal lung disease in our department between 1994 and 2006, and analyzed its complications, in particular, risk of acute exacerbation of IPF.

Pulmonary resection in patients aged 80 years or over with clinical stage I non-small cell lung cancer: prognostic factors for overall survival and risk factors for postoperative complications.

Introduction: This retrospective study was designed to identify the predictors of long-term survival and the risk factors for complications after surgery in patients aged 80 years or older with clinical (c)-stage I non-small cell lung cancer.

Methods: The Japanese Joint Committee of Lung Cancer Registry collated the clinicopathological profiles and outcomes of 13,344 patients who underwent pulmonary resection for primary lung cancer in 1999. The data of 367 patients aged 80 years or older with c-stage I non-small cell lung cancer were analyzed for prognostic factors and risk factors for postoperative complications.

[Mucinous bronchiolo-alveolar cell carcinoma with marked serum elevation of CA19-9: report of a case].

An 83-year-old woman was referred to our hospital to examine for an infiltration shadow in the right lower lobe with progressive bronchorea Computed tomography showed an infiltration lesion with the longest diameter of 10 cm in the right lower lobe and a tumor with the longest diameter of 3 cm in the middle lobe. Serum level of carbohydrate antigen (CA) 19-9 markedly increased to 37,670 U/ml over a period of 3 months. The pathologic study obtained by a transbronchial tumor biopsy revealed a mucinous adenocarcinoma The patient underwent video-assisted thoracoscopic right middle and lower bi-lobectomies with nodal sampling.

Visceral pleura invasion impact on non-small cell lung cancer patient survival: its implications for the forthcoming TNM staging based on a large-scale nation-wide database.

Introduction: No analyses have been reported on the impact of visceral pleura invasion (VPI) on staging, in relation with the International Association for the Study of Lung Cancer proposals for the 7th edition of the tumor, node, metastasis (TNM) classification of the International Union Against Cancer staging system. The purpose of this study was to evaluate the impact of VPI on survival and propose a method of incorporating VPI status into the TNM classification.

Methods: We reviewed the data on 9758 non-small cell lung cancer patients, who underwent anatomic surgical resection in 1999, accumulated by the Japanese Joint Committee for Lung Cancer Registration, to gain insight into their clinicopathologic characteristics and outcomes.

[Video-assisted thoracoscopic removal for mediastinal mature teratoma following extraction of cystic components].

Video-assisted thoracoscopic resection for mediastinal mature teratoma is sometimes converted to open thoracotomy. Because it has rich components including pancreatic tissue and dense adhesion, even when it is asymptomatic. Prior to thoracoscopic resection, extraction of the cystic components with the aid of a 20 Fr tube can provide a wide thoracoscopic view leading to easier complete removal.

[Port-access lobectomy for lung cancer: experience in the single institute].

We reviewed the data on 171 patients who underwent thoracoscopic lobectomy for lung cancer via 5 access ports at our institution between April 2005 and May 2008. Port-access lobectomy was completed in 153 patients and conversions to open thoracotomy were required in 18 patients. Among the above 153 patients, mean operative time was 145 minutes and the mean blood loss was 159 ml.

A dangerous venous variation in thoracoscopic right lower lobectomy.

Anatomical variations of the pulmonary vessels present a potential risk of intraoperative bleeding and damage to pulmonary circulation during pulmonary resection. We present details of a dangerous variation of the superior pulmonary vein associated with thoracoscopic right lower lobectomy that could potentially be divided if there was no preoperative foreknowledge of individual vessel configurations.

Large-cell neuroendocrine carcinoma without immunohistological positivity or serum elevation of CEA until relapse.

We herein report a case of large cell neuroendocrine carcinoma (LCNEC) originating in the right lung upper lobe and showing unique features at relapse in the right middle lobe. The relapsed tumor pathology included a carcinoembryonic antigen (CEA)-positive mantle component and a CEA-negative core area. The latter showed the same pathological picture as the original tumor, both histologically and immunohistochemically.

[Atypical pulmonary carcinoid tumor with abnormal elevation of serum gastrin-releasing peptide precursor: report of a case].

We report a rare case of atypical pulmonary carcinoid tumor accompanied by elevation of serum gastrin-releasing peptide precursor (ProGRP). A 55-year-old male presented to our hospital with a history of bloody sputum. The level of serum ProGRP was elevated to 781 pg/ml (normal < 46 pg/ml).

[Surgical outcome of tracheobronchial reconstruction for lung cancer].

We retrospectively evaluated the surgical outcome after sleeve lobectomy and pneumonectomy with tracheobronchial reconstruction for lung cancer. From 1993 to 2008, 46 patients with primary lung cancer underwent these surgical procedures. Seventeen patients (37%) received induction therapy, 15 received chemotherapy, while chemoradiotherapy or radiotherapy alone were received by one patient each.

Reexpansion pulmonary edema.

When a rapidly reexpanding lung has been in a state of collapse for more than several days, pulmonary edema sometimes occurs in it. This is called reexpansion pulmonary edema (RPE). In this article, I present my views on the history, clinical features, morphophysiological features, pathogenesis, and treatment of RPE.

Spontaneous regression of symptomatic thymoma caused by infarction.

We herein report a 38-year-old man who had spontaneous regression of a thymoma with repeating episodes of chest pain that initially occurred 2 years earlier when the tumor was 35 mm in the long axis. Left video-assisted thoracoscopic thymothymectomy was performed. Pathology examination showed a thymoma 15 mm in the long axis, classified B2 in the World Health Organization classification and stage II by Masaoka staging.

Novel retractor for lymph node dissection by video-assisted thoracic surgery.

In nonrandomized studies, the video-assisted thoracic surgical (VATS) lobectomy seems to be a safe and effective procedure for treatment of lung cancer. However, there are some difficulties in VATS complete mediastinal lymph node dissection. The presence of the lymph node deep in the mediastinal space necessitates retraction of the surrounding organs.

[Complete thoracoscopic lobectomy with systematic nodal dissection via 5 ports for lung cancer].

We herein report a procedure for thoracoscopic lobectomy with mediastinal dissection for primary lung cancer using 5 access ports. A thoracoscope is inserted through an access port on the mid-axillary line in the 6th intercostal space. The availability of 4 instruments through 4 ports makes it easy to divide bronchus and pulmonary vessels and to dissect mediastinal lymph nodes.

[Case of pneumothorax due to pulmonary metastases from uterine leiomyosarcoma].

A 44-year-old woman who had undergone hystero-oophorectomy for uterine sarcoma presented to our hospital with palindromic pneumothorax and her chest CT revealed multiple cystic lesions. After admission video-assisted thoracoscopic surgery (VATS) showed the pulmonary lesions to be primarily leiomyoma, however, further examination revealed that her uterine sarcoma resected in 2000 exhibited not only mitosis but also venous invasion. We therefore considered her lung tumors as metastases from uterine leiomyosarcoma.

[Combined thoracoscopic and open chest approach of lobectomy with inferior chest wall resection for advanced lung cancer].

Patients with advanced non-small cell lung cancer invading a chest wall are surgical candidates if complete resection is possible. When a primary tumor locating the lower lobe invades an inferior chest wall, either a wide skin incision or double skin incisions to secure surgical views both for dissection of hilum and mediastinum and for inferior chest wall resection is necessary. Wider incision causes higher rate of wound necrosis and infection.

[Hemoptysis one year after video-assisted thoracoscopic bullectomy for spontaneous pneumothorax: report of a case].

A 63-year-old man who had underwent video-assisted thoracoscopic bullectomy for left spontaneous pneumothorax 1 year before developed recurrent hemoptysis. Chest computed tomography showed previous stapling of the subsegmental bronchus in the left apico-posterior segment Bronchial arteriography showed hypervascularization of bronchial artery in the left upper segment and pooling of contrast medium along the staple-suture line. Video-assisted thoracoscopic apico-posterior segmentectomy was performed successfully.

[Massive hemoptysis due to traction bronchiectasis caused by thoracic radiotherapy 23 years earlier].

We reported a 72-year-old woman who had a massive hemoptysis due to traction bronchiectasis in the left upper lobe. The patient underwent left radical mastectomy followed by thoracic radiotherapy for left breast cancer. The chest computed tomography showed traction bronchiectasis in the atrophic left upper lobe and the bronchial angiography showed hypervascularization of bronchial and internal thoracic arteries to the left upper lobe.

[Surgical treatment of an endobronchial inflammatory pseudotumor].

A 62-year old man with an abnormal chest radiograph was referred to our hospital for further evaluation. Chest computed tomography (CT) revealed a 3.0 cm tumor on the hilum of the right S3 segment.

[Video-assisted thoracoscopic left upper lobectomy for lung cancer patients: bronchial dissection technique prior to pulmonary artery dissection].

Background: Dissection of anterior segmental artery anatomically crossing over apico-posterior segmental bronchus during left upper lobectomy may sometime cause life-threatening vascular injury.

Patients And Technique: Between August 2006 and July 2007, 12 patients with clinical stage IA-lung cancer underwent the video-assisted thoracoscopic left upper lobectomy with bronchial dissection prior to anterior and apico-posterior pulmonary artery dissections following dissection of lingular segmental artery.

Results: Operation time ranged from 75 minutes to 190 minutes (average 132 +/- 39 minutes).

Descending necrotizing mediastinitis secondary to retropharyngeal abscess without cervical spread.

Cervical infections can cause neck phlegmonosa and occasionally develop lethal mediastinitis. We report a 52-year-old man with a retropharyngeal abscess causing descending mediastinis without cervical spread. Thoracoscopic drainage without cervicotomy was successful.