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BACKGROUND: Spontaneous regression of malignant tumors is a rare phenomenon, especially in primary lung cancer. The underlying mechanisms remain unclear, but they may often involve immunological mechanisms. CASE PRESENTATION: In January 2020, a 78-year-old female underwent examination during follow-up of interstitial pneumonia. Chest X-ray and computed tomography (CT) scan revealed a 1.2 × 1.2 cm nodule in the left lower lobe. Based on CT-guided percutaneous transthoracic needle biopsy (PTNB), it was diagnosed as small cell lung cancer (SCLC). Immunohistochemical staining showed that tumor cells were positive for CD56, synaptophysin, and chromogranin A. Twenty-three days after the CT-guided PTNB, repeat CT scan showed that the tumor size regressed to 0.6 × 0.6 cm. The tumor showed positive uptake in fluorodeoxyglucose (FDG) positron emission tomography (PET)-CT. The maximum standardized uptake value of the nodule was 2.24. PET-CT and enhanced magnetic resonance imaging of the brain showed no distant or lymph node metastasis. The patient's preoperative disease was diagnosed as cT1aN0M0, stageIA1, SCLC. In March 2020, she underwent left lower lobectomy and mediastinal lymph node dissection. Pathological examination of the resected specimen showed that the small tumor cells were dense with a high nucleus to cytoplasm ratio, and the morphological diagnosis was small cell carcinoma. The resected tumor size regressed to 0.05 × 0.02 cm, and no lymph node metastasis was observed. Because it was extremely small, immunohistochemical staining could not be conducted. Active fibrosis and inflammation were present around the tumor. Finally, the patient was pathologically diagnosed as SCLC pT1miN0M0, stage IA1. The patient is alive without recurrence 23 months after surgery with no adjuvant therapy. CONCLUSIONS: We present a rare surgical case of pathologically confirmed spontaneous regression of SCLC after CT-guided PTNB. Although spontaneous regression is extremely rare, we should recognize this phenomenon.
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The coverage technique using absorbable mesh was first described in a European guideline published in 2015 as a preventive method for the recurrence of spontaneous pneumothorax. We performed a meta-analysis based on a literature search of primary studies that compared the postoperative recurrence rate of primary spontaneous pneumothorax between the use and nonuse of polyglycolic acid sheet coverage. Two reviewers independently selected and evaluated the quality of the relevant studies. The risk ratio in each study was calculated in a random-effect meta-analysis. Statistical heterogeneity among the included studies was quantitatively evaluated using the I2 index, and publication bias was assessed using a funnel plot. A total of 19 retrospective cohort studies were analyzed: 1524 patients who underwent wedge resection alone (the control group) and 1579 who received additional sheet coverage. Polyglycolic acid sheet coverage was associated with a lower recurrence rate than that in the control group (risk ratio: 0.27, 95% confidence interval 0.20-0.37, P < 0.001; I2 0%). The funnel plot suggested possible publication bias. The covering technique reduced the recurrence rate of pneumothorax after thoracoscopic surgery to one-fourth.
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Neumotórax , Complicaciones Posoperatorias , Toracoscopía/efectos adversos , Humanos , Masculino , Neumotórax/epidemiología , Neumotórax/etiología , Neumotórax/terapia , Complicaciones Posoperatorias/epidemiología , Complicaciones Posoperatorias/etiología , RecurrenciaRESUMEN
BACKGROUND: There have been few reports on surgically treated primary lung cancer accompanied by contralateral partial anomalous pulmonary venous connection (PAPVC). In such cases, repair of the PAPVC might be necessary to avoid postoperative right-heart failure due to the increased flow of the left-to-right shunt. CASE PRESENTATION: We herein report a case of lung adenocarcinoma treated by left-upper lobectomy with bronchoplasty and pulmonary arterial angioplasty after induction chemoradiation therapy followed by surgical correction of the PAPVC in the right-upper lobe. The patient is alive without recurrence of lung cancer or any symptoms of heart failure 17 months after pulmonary resection. CONCLUSION: When considering performing major pulmonary resection for lung tumor, thoracic surgeons should pay close attention to the presence of a PAPVC not only on the ipsilateral side of the lung tumor, but also the contralateral side, although it is a rare phenomenon.
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OBJECTIVES: The aim of this study was to evaluate the impact of the preoperative body mass index (BMI) on the postoperative outcomes in patients with completely resected non-small cell lung cancer (NSCLC). MATERIALS AND METHODS: The data of patients with NSCLC in whom R0 resection was achieved were extracted from the database of NSCLC samples accumulated by the Japanese Joint Committee of Lung Cancer Registry in the year 2010, and the surgical outcomes including postoperative morbidity, mortality and the prognosis, were evaluated. RESULTS: Among 18,978 registered lung cancer cases, 16,509 patients (9996 men and 6513 women) were extracted. The median of age was 69 years old, and the histologic types included adenocarcinoma (n = 12,029), squamous cell carcinoma (n = 3286), large-cell carcinoma (n = 488) and others. The patients were divided into three groups according to their BMI: normal (BMI 18.5 to <25), underweight (BMI < 18.5) and overweight (BMI ≥ 25). Multivariate logistic regression analyses of factors associated with postoperative morbidity and mortality showed no significant differences among the three groups. In comparison to the normal group, the overall survival (OS) of the underweight group was significantly worse (p < 0.001) while that of the overweight group was marginally better (p = 0.075). A multivariate analysis of factors associated with OS showed that in addition to the age, sex and clinical stage, the preoperative BMI (underweight group vs. normal group: hazard ratio [HR] 1.417 [95% confidence interval {CI}: 1.278-1.572, p < 0.001], overweight group vs. normal group: HR 0.883 [95% CI: 0.806-0.967, p = 0.007]) was an independent prognostic factor. A multivariate analysis for the disease-free survival (DFS) also showed the preoperative BMI to be an independent significant prognostic factor. CONCLUSIONS: The preoperative BMI is an independent prognostic factor in patients with completely resected NSCLC. A low preoperative BMI was associated with significantly poor survival in Japan.
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Carcinoma de Pulmón de Células no Pequeñas , Neoplasias Pulmonares , Anciano , Índice de Masa Corporal , Carcinoma de Pulmón de Células no Pequeñas/complicaciones , Carcinoma de Pulmón de Células no Pequeñas/epidemiología , Carcinoma de Pulmón de Células no Pequeñas/cirugía , Femenino , Humanos , Japón/epidemiología , Neoplasias Pulmonares/complicaciones , Neoplasias Pulmonares/epidemiología , Neoplasias Pulmonares/cirugía , Masculino , Pronóstico , Sistema de Registros , Estudios RetrospectivosRESUMEN
OBJECTIVE: Clinical evidence comparing paravertebral (PVB) and continuous intercostal nerve (ICB) blocks for pain management post video-assisted thoracic surgery (VATS) is limited. This study confirms the analgesic effect of ICB using two catheters is not inferior to that of PVB under direct vision. METHODS: Fifty patients who underwent VATS lobectomy from July 2015 to March 2016 were prospectively recruited and randomly assigned to PVB and ICB groups. Postoperative pain was assessed using the visual analog scale (VAS). VAS score at rest at 24 h was the primary endpoint. Data on time required for catheter insertion, adverse effects, and frequency of additional analgesics as secondary endpoints were also collected. Noninferiority was assessed by adding a VAS margin of 15 mm to the PVB group. RESULTS: No significant differences were observed between the VAS scores of the two groups except at 48 h after surgery, with a margin noted for the PVB group. No significant differences were detected in the frequency of additional analgesics and occurrence of adverse effects. CONCLUSIONS: Our results could not clearly establish noninferiority of ICB to PVB. Improvements in ICB may be necessary for it to be used as an alternative method to PVB.
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Analgésicos Opioides/uso terapéutico , Bloqueo Nervioso/métodos , Dolor Postoperatorio/prevención & control , Cirugía Torácica Asistida por Video , Anciano , Antiinflamatorios no Esteroideos/uso terapéutico , Cateterismo Periférico , Quimioterapia Combinada , Femenino , Flurbiprofeno/análogos & derivados , Flurbiprofeno/uso terapéutico , Humanos , Nervios Intercostales , Enfermedades Pulmonares/cirugía , Masculino , Persona de Mediana Edad , Dimensión del Dolor , Pentazocina/uso terapéutico , Estudios Prospectivos , Encuestas y CuestionariosRESUMEN
Psychrophilic algae blooms can be observed coloring the snow during the melt season in alpine snowfields. These algae are important primary producers on the snow surface environment, supporting the microbial community that coexists with algae, which includes heterotrophic bacteria and fungi. In this study, we analyzed the microbial community of green and red-colored snow containing algae from Mount Asahi, Japan. We found that Chloromonas spp. are the dominant algae in all samples analyzed, and Chlamydomonas is the second-most abundant genus in the red snow. For the bacterial community profile, species belonging to the subphylum Betaproteobacteria were frequently detected in both green and red snow, while members of the phylum Bacteroidetes were also prominent in red snow. Furthermore, multiple independently obtained strains of Chloromonas sp. from inoculates of red snow resulted in the growth of Betaproteobacteria with the alga and the presence of bacteria appears to support growth of the xenic algal cultures under laboratory conditions. The dominance of Betaproteobacteria in algae-containing snow in combination with the detection of Chloromonas sp. with Betaproteobacteria strains suggest that these bacteria can utilize the available carbon source in algae-rich environments and may in turn promote algal growth.
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OBJECTIVES: The standard therapy for patients with T3N0-1M0 non-small cell lung cancer (NSCLC) involving the chest wall is considered surgical resection and adjuvant therapy. However, the compliance of adjuvant therapy is relatively low, and the prognosis for those patients has been unsatisfactory. Therefore, we conducted a phase II study of induction chemoradiotherapy followed by surgery with the aim of improving the survival. PATIENTS AND METHODS: This treatment strategy consisted of induction chemotherapy (two cycles of cisplatin at 80mg/m2 on Day 1 and vinorelbine at 20mg/m2 on Days 1 and 8) concurrent with radiotherapy (40Gy in 20 fractions) followed by surgery. The inclusion criteria were patients with resectable T3N0-1M0 NSCLC involving the chest wall who were 20-70 years of age. The primary end point was the 3-year survival, assuming an expected rate of 67%. RESULTS: From January 2009 to November 2012, 51 eligible patients were enrolled. Induction therapy was completed as planned in 49 (96%) patients without treatment-related death, and 25 (51%) had a partial response. Complete resection combined with the involved chest wall was achieved in 46 (92%) patients, and a pathologic complete response was seen in 13 (26%) patients. Five patients experienced major postoperative complications, and 1 patient died of acute exacerbation of interstitial pneumonia. With a median follow-up period of 42 months, the 3- and 5-year overall survivals of all registered patients were 77% and 63%, respectively. There was a significant difference in the survival rate between patients with a pathologic complete response and those with a residual tumor (p=0.039). CONCLUSION: The mature results of this study in a multi-institutional setting showed the treatment strategy to be safe and effective with a high rate of pathologic response for patients with NSCLC involving the chest wall.
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Carcinoma de Pulmón de Células no Pequeñas/terapia , Quimioradioterapia , Quimioterapia de Inducción/métodos , Neoplasias Pulmonares/terapia , Pared Torácica/patología , Adulto , Anciano , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapéutico , Carcinoma de Pulmón de Células no Pequeñas/mortalidad , Carcinoma de Pulmón de Células no Pequeñas/patología , Cisplatino/administración & dosificación , Cisplatino/uso terapéutico , Terapia Combinada , Femenino , Humanos , Neoplasias Pulmonares/mortalidad , Neoplasias Pulmonares/patología , Masculino , Persona de Mediana Edad , Terapia Neoadyuvante , Estadificación de Neoplasias , Estudios Prospectivos , Tasa de Supervivencia , Resultado del Tratamiento , Vinblastina/administración & dosificación , Vinblastina/análogos & derivados , Vinblastina/uso terapéutico , VinorelbinaRESUMEN
PURPOSE: We conducted a comparative study to evaluate analgesic efficacy between paravertebral block via the surgical field (PVB-sf), in which the catheter was inserted into the ventral side of the sympathetic trunk in the paravertebral space by a thoracic surgeon under thoracoscopic visualization, and epidural block (Epi) using ropivacaine for post-thoracotomy pain relief. METHODS: Lung cancer patients scheduled for lobectomy via thoracotomy were randomly allocated to receive either PVB-sf or Epi (n = 36 per group). Before thoracotomy closure, 0.375% ropivacaine was administered as a bolus (PVB-sf, 20 mL; Epi, 5 mL), followed by a 300-mL continuous infusion of 0.2% ropivacaine at 5 mL/h. Postoperative pain was assessed using a visual analog scale (VAS) score at various time points, including the primary endpoint of 2 h after ropivacaine bolus injection. Sensory block area, vital signs, serum ropivacaine concentrations, and side effects were also evaluated. RESULTS: The Epi group showed significantly lower VAS scores and blood pressure and a wider sensory block area than the PVB-sf group at all evaluation time points. While the mean serum ropivacaine concentration in the PVB-sf group was significantly higher than that in the Epi group until 1 h after injection of the ropivacaine bolus, there was no significant difference at any subsequent assessment point. The incidence of side effects was similar between the groups. CONCLUSION: The Epi was superior to PVB-sf for the management of post-thoracotomy pain in this patient cohort. The number of dermatomes anaesthetized by Epi was greater than that anaesthetized by PVB-sf. No difference in complication rates was observed between the two groups.
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Amidas/administración & dosificación , Bloqueo Nervioso/métodos , Dolor Postoperatorio/tratamiento farmacológico , Toracotomía/métodos , Anciano , Analgésicos/uso terapéutico , Anestesia Epidural/efectos adversos , Anestesia Epidural/métodos , Anestesia Local/efectos adversos , Anestesia Local/métodos , Anestésicos Locales/administración & dosificación , Presión Sanguínea , Femenino , Humanos , Masculino , Persona de Mediana Edad , Bloqueo Nervioso/efectos adversos , Dimensión del Dolor , Estudios Prospectivos , RopivacaínaRESUMEN
BACKGROUND: The chest wall is the most common neighboring structure involved by locally advanced lung cancers. However, the optimal treatment strategy for such tumors has not been established. This phase II trial was therefore conducted with the aim of evaluating whether induction chemoradiotherapy followed by surgery improves the survival of patients with T3N0 or T3N1 lung cancer involving the chest wall. METHODS: Patients with resectable T3N0 or T3N1 non-small cell lung cancer involving the chest wall were candidates for this study. Induction therapy consisted of two cycles of cisplatin and vinorelbine chemotherapy concurrent with 40 Gy of radiation. Surgical resection was performed 3 to 6 weeks after the last day of chemotherapy. RESULTS: From January 2009 to November 2012, 51 eligible patients (40 stage IIB and 11 stage IIIA tumors) were entered in this study. Induction therapy was completed as planned in 49 (96%) patients, and 25 (51%) had a partial response revealed on computed tomography. Forty-eight patients underwent pulmonary resection combined with chest wall resection, and 44 (92%) underwent a complete resection. Pathologic examinations of the resected specimens revealed no viable tumor cells in 12 (25%) cases and minimal residual disease in 31 (65%) cases. Five patients experienced major postoperative complications, and 1 patient died of postoperative exacerbation of interstitial pneumonia. CONCLUSIONS: The initial results of this study showed the treatment regimen to be safe and feasible with a high rate of a pathologic response for patients with lung cancer involving the chest wall in a multiinstitutional setting.
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Carcinoma de Pulmón de Células no Pequeñas/terapia , Quimioradioterapia , Neoplasias Pulmonares/terapia , Neumonectomía , Pared Torácica/patología , Adulto , Anciano , Carcinoma de Pulmón de Células no Pequeñas/mortalidad , Carcinoma de Pulmón de Células no Pequeñas/patología , Terapia Combinada , Femenino , Humanos , Quimioterapia de Inducción , Neoplasias Pulmonares/mortalidad , Neoplasias Pulmonares/patología , Masculino , Persona de Mediana Edad , Invasividad Neoplásica , Estadificación de NeoplasiasRESUMEN
Inflammatory myofibroblastic tumor is a rare tumor deriving from mesenchymal tissue. Approximately 50% of inflammatory myofibroblastic tumors harbor an anaplastic lymphoma kinase fusion gene. Pulmonary inflammatory myofibroblastic tumors harboring tropomyosin3-anaplastic lymphoma kinase or protein tyrosine phosphatase receptor-type F polypeptide-interacting protein-binding protein 1-anaplastic lymphoma kinase have been reported previously. However, it has not been reported that inflammatory myofibroblastic tumors harbor echinoderm microtubule-associated protein-like 4-anaplastic lymphoma kinase fusion gene which is considered to be very specific to lung cancers. A few tumors harboring echinoderm microtubule-associated protein-like 4-anaplastic lymphoma kinase fusion gene other than lung cancers have been reported and the tumors were all carcinomas. A 67-year-old man had been followed up for a benign tumor for approximately 3 years before the tumor demonstrated malignant transformation. Lobectomy and autopsy revealed that an inflammatory myofibroblastic tumor harboring echinoderm microtubule-associated protein-like 4-anaplastic lymphoma kinase fusion gene had transformed into an undifferentiated sarcoma. This case suggests that echinoderm microtubule-associated protein-like 4-anaplastic lymphoma kinase fusion is an oncogenic event in not only carcinomas but also sarcomas originating from stromal cells.
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Neoplasias Pulmonares/genética , Neoplasias Pulmonares/patología , Neoplasias de Tejido Muscular/genética , Neoplasias de Tejido Muscular/patología , Proteínas de Fusión Oncogénica/genética , Anciano , Autopsia , Resultado Fatal , Humanos , Inflamación , Neoplasias Pulmonares/metabolismo , Masculino , Neoplasias de Tejido Muscular/metabolismoRESUMEN
PURPOSE: A paravertebral block (PVB) given via the surgical field can be safer and technically simpler than an epidural block (EP) for postoperative pain control. We conducted this clinical trial to confirm the effectiveness of PVB after thoracotomy. METHODS: In this non-inferiority trial, patients were randomly assigned to receive PVB (n = 35) or EP (n = 35). The primary endpoint was the pain assessed using the visual analog scale (VAS) at rest, 2, 24, and 48 h after thoracotomy, with the non-inferiority margin set at 15 mm. The secondary end points were the pain assessed using the VAS on exercising and on coughing, 2, 24, and 48 h after surgery, respectively, and the complications and need for additional analgesic agents. RESULTS: This trial revealed that PVB was not inferior to EP with respect to the primary end point: The mean VAS scores at rest, 2, 24, and 48 h after thoracotomy were 26.3, 10.8, and 8.3 mm in the PVB group and 23.6, 12.4, and 12.6 mm in the EP group, respectively (P < 0.01 for non-inferiority at all points). There were no significant differences between the groups in the incidence of complications or the need for additional analgesic agents. CONCLUSION: PVB may replace EP for postoperative pain control because of its technical simplicity and safety.
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Anestesia Epidural , Bloqueo Nervioso/métodos , Dolor Postoperatorio/prevención & control , Toracotomía , Adulto , Anciano , Femenino , Humanos , Masculino , Persona de Mediana Edad , Dolor Postoperatorio/diagnóstico , Factores de Tiempo , Adulto JovenRESUMEN
PURPOSE: Carcinoembryonic antigen (CEA) is a tumor marker widely used for nonsmall cell lung cancer (NSCLC). The aim of this study was to evaluate changes in serum CEA levels as a surrogate marker for tumor response to chemotherapy in NSCLC. METHODS: From 1995 through 2005, we retrospectively analyzed 24 NSCLC patients who had high serum CEA levels (>5 ng/ml) and who received chemotherapy followed by surgery. We compared serum CEA levels with tumor response, as defined by Response Evaluation Criteria in Solid Tumors (RECIST) or World Health Organization (WHO) criteria, as well as with histological response. RESULTS: Serum CEA levels after chemotherapy significantly decreased in patients who achieved partial response, defined by RECIST or WHO criteria (p = 0.004 and p = 0.008, respectively), when compared with the CEA levels before chemotherapy. In contrast, there was no significant difference in CEA levels in patients with either stable disease or no response to chemotherapy. They decreased significantly, however, in patients in whom less than one-third of tumor cells was viable by pathological examination, but not in patients in whom more than a third was viable (p = 0.008). Using the receiver-operating characteristic (ROC) curve analysis, we found that a 60% reduction of CEA levels was an appropriate cutoff value in predicting a good response to chemotherapy. When the value was set at that level, the sensitivity of CEA for RECIST was 82%, and the specificity was 69%. CONCLUSION: Serum CEA concentration was a useful surrogate marker for the evaluation of tumor response to chemotherapy and seemed to be comparable with RECIST in NSCLC patients who had elevated CEA levels prior to treatment.
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Antineoplásicos/administración & dosificación , Antígeno Carcinoembrionario/sangre , Carcinoma de Pulmón de Células no Pequeñas/tratamiento farmacológico , Neoplasias Pulmonares/tratamiento farmacológico , Adulto , Anciano , Biomarcadores/sangre , Carcinoma de Pulmón de Células no Pequeñas/sangre , Carcinoma de Pulmón de Células no Pequeñas/cirugía , Femenino , Humanos , Neoplasias Pulmonares/sangre , Neoplasias Pulmonares/cirugía , Masculino , Persona de Mediana Edad , Terapia Neoadyuvante , Inducción de Remisión , Estudios RetrospectivosRESUMEN
OBJECTIVE: Lobectomy with systematic complete mediastinal lymph node dissection is standard surgical treatment for localized non-small cell lung cancer. However, selective mediastinal lymph node dissection based on lobe-specific metastases (selective dissection) has often been performed. This study was designed to evaluate the validity of the selective lymph node dissection. METHODS: From 1995 through 2003, 625 patients in our hospital had surgery for complete mediastinal lymph node dissection and 147 for selective dissection. We evaluated whether selective dissection adversely affected overall survival. To minimize possible biases due to confounding by treatment indication, we performed a retrospective cohort analysis by applying a propensity score. The propensity score was calculated by logistic regression based on 15 factors available that were potentially associated with treatment indication. Patients were divided into 4 groups according to quartile, and comparison between selective dissection and complete mediastinal lymph node dissection was made using propensity score quartile-stratified Cox proportional hazard models. RESULTS: Comparison of baseline characteristics between patients having selective dissection and patients having complete mediastinal lymph node dissection according to propensity score quartile supported comparability of the 2 groups. The 5-year overall survival rates were 76.0% for selective dissection versus 71.9% for complete mediastinal lymph node dissection. The 5-year survival probabilities stratified by propensity score quartile consistently showed no marked difference. In multivariate models, there was no significant difference between the 2 groups (hazard ratio = 1.17, P = .500) as also seen in the analysis without propensity score (hazard ratio = 1.06; 95% confidence interval, 0.68-1.64; P = .810). Therefore, selective dissection showed no significant impact on poor survival compared with complete mediastinal lymph node dissection. CONCLUSIONS: Selective lymph node dissection did not worsen the survival of patients with non-small cell lung cancer.
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Carcinoma de Pulmón de Células no Pequeñas/patología , Neoplasias Pulmonares/patología , Pulmón/patología , Escisión del Ganglio Linfático , Ganglios Linfáticos/patología , Adulto , Anciano , Anciano de 80 o más Años , Carcinoma de Pulmón de Células no Pequeñas/cirugía , Estudios de Cohortes , Femenino , Humanos , Neoplasias Pulmonares/cirugía , Metástasis Linfática , Masculino , Mediastino , Persona de Mediana Edad , Neumonectomía , Puntaje de Propensión , Estudios Retrospectivos , Análisis de Supervivencia , Resultado del Tratamiento , Adulto JovenRESUMEN
BACKGROUND: The Blake drain (BD) has recently begun to be used as a chest tube after pulmonary resection; however, its fluid drainage and air evacuation characteristics remain unclear. We compared the performance of the 19F BD with that of the 32F conventional drain (CD). METHODS: We studied 148 consecutive patients (74 with BD; 74 with CD) who underwent pulmonary resection. Postoperative drainage rates (daily drainage and total drainage) were analyzed to assess fluid drainage. Air evacuation was evaluated to determine whether subcutaneous emphysema or insufficient residual lung expansion developed when air leakage occurred. The BD group was initially managed with water seal or suction, whereas the CD group was managed with water seal. Furthermore, we experimentally measured the evacuation pressure required to expel a constant volume of air through various chest tubes to determine basic air evaluation performance of the tubes. RESULTS: Drainage rates on the operative day were significantly lower in the BD group than in the CD group, but were similar in both groups on the following day with greater variation in the water-sealed BD group. Among cases with air leakage, air evacuation insufficiency was more frequent in the BD group (16 of 22, 73%) than in the CD group (4 of 17, 24%; p = 0.004). The experiment revealed that air evacuation performance of the 19F BD was equivalent to that of the 12F CD, indicating that the BD requires higher intrathoracic pressure for air evacuation. CONCLUSIONS: Suction is required for the BD to obtain fluid drainage performance comparable to that of the water-sealed CD. When air leakage occurs, air evacuation by the BD tends to be insufficient, irrespective of suction conditions.
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Drenaje/métodos , Neumonectomía/métodos , Tubos Torácicos , Drenaje/efectos adversos , Drenaje/instrumentación , Diseño de Equipo , Humanos , Periodo Posoperatorio , Estudios Retrospectivos , Succión/métodosRESUMEN
The optimal extent of a combined resection in patients with lung cancer invading the chest wall remains controversial. To assess whether specific preoperative findings could lead to the precise evaluation of the depth of chest wall invasion and evade en-bloc resection of the chest wall in cases of tumor invasion limited to the parietal pleura, 132 patients with resected lung cancer involving the chest wall were retrospectively surveyed for the preoperative findings, surgical procedures, pathological results, and survival. A pathological examination of the resected specimens showed that 58 tumors had invaded only to the parietal pleura (shallow invasion) and 74 had involved the soft tissue or ribs (deep invasion). A multivariate analysis showed that preoperative CT findings of obvious tumor invasion beyond the parietal pleura (p = 0.005) and complaints of chest pain (p = 0.015) were independent indicators of deep invasion. In patients with lung cancer involving the chest wall, chest pain and/or invading on chest CT suggested that an en-bloc resection was a suitable surgical procedure, because 79% of those patients had deep invasion. On the other hand, in patients without chest pain and invasion on chest CT, an extrapleural approach was recommended at first based on the fact that 63% of them had shallow invasion. In practice, an extrapleural resection was performed in 40 cases and an en-bloc resection in 10 patients with shallow invasion. There was no significant difference in the survival between the two surgical procedures. Therefore, the CT findings of obvious tumor invasion beyond the parietal pleura and/or the presence of chest pain indicate the need to perform an en-bloc resection in patients with lung cancer involving the chest wall. However, in patients without these findings, an extrapleural approach could be initially attempted for chest wall resection, because an en-bloc resection had no survival benefit for patients with shallow invasion.
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Adenocarcinoma/patología , Carcinoma de Células Escamosas/patología , Neoplasias Pulmonares/patología , Neumonectomía/métodos , Procedimientos Quirúrgicos Torácicos/métodos , Pared Torácica/patología , Adenocarcinoma/mortalidad , Adenocarcinoma/cirugía , Adulto , Anciano , Anciano de 80 o más Años , Carcinoma de Células Escamosas/mortalidad , Carcinoma de Células Escamosas/cirugía , Femenino , Humanos , Neoplasias Pulmonares/mortalidad , Neoplasias Pulmonares/cirugía , Masculino , Persona de Mediana Edad , Invasividad Neoplásica , Cuidados Preoperatorios , Pronóstico , Estudios Retrospectivos , Tasa de Supervivencia , Pared Torácica/cirugía , Tomografía Computarizada por Rayos XRESUMEN
OBJECTIVE: The TNM classification has been widely used as a guide for estimating prognosis and is the basis for treatment decisions on various solid tumors. The International Association for the Study of Lung Cancer Staging Committee has proposed a new staging system for the next revision scheduled in 2009. However, its validity has not been established fully. Here we assessed its utilities and drawbacks. METHODS: We reviewed 1556 consecutive patients with non-small cell lung cancers who underwent pulmonary resection in our institution and reviewed their survival characteristics based on the 2009 system compared with the current (1997) system. RESULTS: The numbers of patients with stage IIA disease increased remarkably when using the 2009 system because of the reclassification of stages IB and IIB. Although the 5-year survival rates of the patients with stage IB and IIA disease in the 1997 system showed no difference with the 2009 system, the survival rates of patients with stage IB disease was 68.0%, which is better than that of patients with stage IIA disease (57.6%). The patient survival curves showed stepwise deterioration as the numbers increased, except for patient with stage IV disease. CONCLUSIONS: Our study supported the proposal for this new staging system. Compared with the 1997 system, the 2009 system appears to be superior in separating stage IB and IIA disease and provides an even distribution among the stage groupings, although it is slightly complicated. The survival characteristics of 1556 resected cases in this single Japanese institution validated the proposed 2009 system.
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Carcinoma de Pulmón de Células no Pequeñas/mortalidad , Neoplasias Pulmonares/mortalidad , Estadificación de Neoplasias/normas , Carcinoma de Pulmón de Células no Pequeñas/cirugía , Humanos , Neoplasias Pulmonares/cirugía , Neumonectomía , Pronóstico , Estudios Retrospectivos , Tasa de SupervivenciaRESUMEN
BACKGROUND: Although the prognoses of patients with resectable lung cancer involving neighboring structures vary, the current tumor-nodes-metastasis (TNM) classification system does not elucidate criteria for tumor subcategorization. METHODS: We studied 196 consecutive patients who underwent resection of non-small cell lung cancer involving neighboring structures at the Aichi Cancer Center Hospital and were diagnosed as pathologic T3 diseases using the current staging system. Tumors were divided into six groups based on the involved neighboring structures: parietal or mediastinal pleura, subpleural soft tissue, ribs, main bronchus, pericardium, and diaphragm. RESULTS: The overall 5-year survival rate was 39.8%. The survival rates for the six groups were: pleura (n = 62), 54.8%; subpleural soft tissue (n = 50), 30.0%; rib (n = 25), 24.0%; main bronchus (n = 33), 48.5%; pericardium (n = 14), 21.4%; and diaphragm (n = 12), 33.3%. The combined pleura and bronchus groups (n = 95) demonstrated significantly better survival outcome than the other groups (n = 101): 52.6% and 27.7%, respectively (p = 0.0002). Furthermore, among 108 patients with pT3N0 (stage IIB) disease, the prognostic difference between the pleura and bronchus groups (n = 50) and the other groups (n = 58) was significant: 64.0% and 25.9%, respectively (p < 0.0001). Similar results were confirmed in patients with complete resection (n = 159). CONCLUSIONS: Subcategorization of resectable lung cancer involving neighboring structures resulted in tumor groups infiltrating pleura or main bronchus, and those involving subpleural structures, pericardium, or diaphragm.
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Neoplasias de los Bronquios/secundario , Carcinoma de Pulmón de Células no Pequeñas/mortalidad , Carcinoma de Pulmón de Células no Pequeñas/secundario , Causas de Muerte , Neoplasias Pulmonares/mortalidad , Invasividad Neoplásica/patología , Neoplasias Pleurales/secundario , Adulto , Anciano , Anciano de 80 o más Años , Análisis de Varianza , Carcinoma de Pulmón de Células no Pequeñas/patología , Carcinoma de Pulmón de Células no Pequeñas/terapia , Quimioterapia Adyuvante , Estudios de Cohortes , Terapia Combinada , Intervalos de Confianza , Femenino , Humanos , Neoplasias Pulmonares/patología , Neoplasias Pulmonares/terapia , Metástasis Linfática , Masculino , Persona de Mediana Edad , Análisis Multivariante , Estadificación de Neoplasias , Neumonectomía/métodos , Probabilidad , Pronóstico , Radioterapia Adyuvante , Medición de Riesgo , Análisis de Supervivencia , Resultado del TratamientoRESUMEN
BACKGROUND: Lung cancer staging system proposed in 2007 adopts detailed tumor size cut-off values. Alternatively, visceral pleural invasion is deemed an important prognosticator, but has not been easily incorporated into the staging system. METHODS: We studied 1,245 patients with resected nonsmall-cell lung cancer. Among patients with current pathologic stage IB (pT2N0M0) disease, those with worse prognosis were reclassified as stage IIA based on tumor size and degree of visceral pleural invasion defined by the Japan Lung Cancer Society: P0 = no pleural involvement beyond elastic layer; P1 = infiltration beyond elastic layer without exposure to pleural surface; and P2 = exposure to pleural surface. RESULTS: The current pT2 category was divided into five groups based on size (
Asunto(s)
Carcinoma de Pulmón de Células no Pequeñas/secundario , Neoplasias Pulmonares/patología , Invasividad Neoplásica/patología , Neoplasias Pleurales/secundario , Carga Tumoral , Adulto , Anciano , Anciano de 80 o más Años , Biopsia con Aguja , Carcinoma de Pulmón de Células no Pequeñas/clasificación , Carcinoma de Pulmón de Células no Pequeñas/mortalidad , Carcinoma de Pulmón de Células no Pequeñas/cirugía , Estudios de Cohortes , Femenino , Humanos , Inmunohistoquímica , Japón , Neoplasias Pulmonares/clasificación , Neoplasias Pulmonares/mortalidad , Neoplasias Pulmonares/cirugía , Masculino , Persona de Mediana Edad , Análisis Multivariante , Estadificación de Neoplasias , Neoplasias Pleurales/mortalidad , Neoplasias Pleurales/patología , Neoplasias Pleurales/cirugía , Neumonectomía/métodos , Probabilidad , Pronóstico , Sistema de Registros , Estudios Retrospectivos , Medición de Riesgo , Análisis de SupervivenciaRESUMEN
In recent years, the clinical use of high-resolution computed tomography has greatly advanced the diagnosis of small lesions of the peripheral lung. Such small lesions are often associated with ground-glass opacity in computed tomography findings. The noninvasive bronchioloalveolar carcinoma component with a replacement growth pattern of alveolar lining cells manifests as ground-glass opacity. Bronchioloalveolar carcinoma is classified as a subset of lung adenocarcinoma, but has a distinct clinical presentation, tumor biology, and favorable prognosis. Most small peripheral lung lesions including bronchioloalveolar carcinoma putatively originate from the peripheral airway epithelium, in which the epidermal growth factor receptor gene is frequently mutated. As with other subsets of non-small cell lung cancer, surgical resection is a potentially curative treatment. For the ground-glass opacity type of tiny lesions, particularly those less than 1 cm in their greatest dimension, the question has been raised whether lobectomy is really needed. Although several authors in Japan suggest the suitability of limited resection including segmentectomy and wedge resection without any nodal dissections for these small lung adenocarcinomas, this procedure should be validated in future clinical trials.
Asunto(s)
Adenocarcinoma/terapia , Neoplasias Pulmonares/terapia , Adenocarcinoma/diagnóstico por imagen , Adenocarcinoma/patología , Humanos , Neoplasias Pulmonares/diagnóstico por imagen , Neoplasias Pulmonares/patología , Tomografía Computarizada por Rayos XRESUMEN
Radical resection has been considered the only possible way to save the lives of patients with esophageal cancer. Therefore, tremendous efforts have been made in order to improve the surgical results for resectable locoregional esophageal cancer. Various surgical approaches have been developed. Combination therapies such as neoadjuvant, adjuvant chemotherapy, and neoadjuvant chemoradiation have been extensively investigated in numerous randomized clinical trials. Due to insufficient surgical results and high postoperative mortality rates, definitive chemoradiation has been studied as alternative treatment in selected patients, based on the concept that combined-modality therapy allows simultaneous treatment of locoregional disease and systemic micrometastases. Chemoradiation has shown survival rates equivalent to surgery in some non-randomized comparative studies. Presently, concerns appear to be shifting to the question of whether definitive chemoradiation could be an alternative to surgery in the primary treatment of resectable locoregional esophageal cancer. Recently, 2 randomized trials, comparing definitive chemoradiation with chemoradiation and surgery were published. These trials seem to show at first glance that definitive chemoradiation can achieve results comparable to surgery with neoadjuvant chemoradiation. More sophisticated trials should be conducted as treatment modalities used in these trials are far from routine.