[Management of patients with ischemic heart disease in lung cancer resection].

We reviewed the medical records of 1,047 consecutive patients with lung cancer who underwent surgery between April 2005 and March 2014. Among them 49 patients(4.7%)had concomitant ischemic heart disease. Coronary angiography showed coronary artery stenosis in 41 patients, of whom 14 patients received bare metal stents and 9 patients received drug-eluting stents. Three patients underwent plain old balloon angioplasty. Coronary artery bypass graft were performed in 5 patients. Eight patients with coronary spastic angina were also included in the present study. Aspirin administration was continued in 9 patients and heparinization was performed in 14 patients during the perioperative period. Postoperative major adverse cardiac events within 30-days occurred in 3 patients(6.1%)resulting in a single fatality(2.0%). No major cardiac events, including stent thrombosis, developed in patient who received coronary stent. Perioperative aspirin administration and heparinization were not significantly associated with intraoperative bleeding during the operation.

[Diaphragmatic hernia complicated with diaphragmatic resection by automatic stapling device].

Nowadays, a diaphragmatic lesion is sometimes resected with use of an automatic stapling device, especially through video-assisted thoracoscopic procedure. We herein report 2 patients with a diaphragmatic hernia after diaphragmatic resection by automatic stapling devices. Etiology and cause of postoperative diaphragmatic hernia are discussed. Diaphragmatic resection by mechanical stapler was performed for thymic epithelial tumor recurring at the diaphragmatic pleura in both patients: 48-year-old man and 72-year-old woman. The former patient underwent a right diaphragmatic resection (3×4 cm in size) with a cartridge of mechanical stapler. Computed tomography (CT) and magnetic resonance imaging showed asymptomatic right diaphragmatic hernia 2 months after surgery. No symptom and progression occurred 8 years later. The latter patient underwent a right diaphragmatic resection (6×7 cm in size) with 2 cartridges of mechanical stapler. Diaphragmatic hernia advanced 7 months after surgery and required surgical intervention. Diaphragmatic repair was successful with the use of 8×6 cm expanded polytetrafluoroethylene patch. Surgical stump after diaphragmatic resection with automatic stapling device is easy to rupture during diaphragmatic movement synchronized with respiratory movement. Diaphragmatic resection with use of stapling device, which is a simple procedure, should be contraindicated.

Successful surgical treatment of epithelioid hemangioendothelioma involving multiple liver lesions and bilateral lung nodules.

Epithelioid hemangioendothelioma (EHE) affects many organs, particularly lung and liver, and typically presents as multiple lesions. Treatment for EHE is not yet standardized, but surgery is appropriate when lesions are resectable. In our patient, radiography revealed multiple bilateral pulmonary nodules, and CT showed several liver tumors. The liver masses and those in the right lung were removed during the initial surgery; pathology of hepatic specimens confirmed the diagnosis of EHE. During the second operation, the left lung nodules were excised, and all were EHEs. Surgical removal of multiorgan multinodular EHE is a viable treatment option, especially for young patients.

Can the Japanese National Clinical Database risk calculator predict long-term survival of patients who undergo palliative segmentectomy for primary lung cancer?

OBJECTIVES: Selection criteria for palliative limited surgery in patients with non-small cell lung cancer (NSCLC) can vary by institution or surgeon. We retrospectively reviewed outcomes of poor-risk patients who underwent palliative segmentectomy (PS), using the National Clinical Database Risk Calculator (RC). METHODS: We retrospectively analyzed medical records of patients with NSCLC tumors ≥ 20 mm and consolidation/tumor ratios ≥ 0.5 on computed tomography, who underwent PS from January 2009 to March 2016. Median follow-up time was 47 months (range 2-102 months). RESULTS: We enrolled 67 patients (median age: 73.0 years), of whom 54 received thoracoscopic surgery and 28 received medial lymph-node dissection. The RC's mean predictive probability rate for perioperative mortality or severe complications was 7.1%. Of the 67 patients, 24 patients (43.0%) suffered post-surgical complications, including 2 (3%) who died in hospital; 17 eventually suffered NSCLC recurrences and/or metastases, 11 eventually died from NSCLC, and 17 died from other diseases. Five-year overall survival (OS) was 59.4%. When the patients were divided into high-risk (HR) and low-risk (LR) groups based on the RC, 5-year OS was significantly less in the HR group (43.9%) than in the LR group (82.2%; P < 0.05). CONCLUSION: The RC, which was developed primarily to determine perioperative risk, can predict long-term prognosis for compromised patients who undergo PS.

The length of the left superior pulmonary vein stump after left upper lobectomy depends on its position to the left atrial appendage.

BACKGROUND: A longer left superior pulmonary vein (LSPV) stump may increase the risk for postoperative cerebral infarction. Although the residual stump is generally longer after left upper lobectomy (LUL) than for other lobectomies, the length of the LSPV stump after LUL may be influenced by the anatomical relationship between the left atrial appendage (LAA) and the LSPV. Our aim in this study was to investigate the influence of this anatomical relationship on the residual length of the LSPV stump after LUL. METHODS: This was a retrospective analysis of 85 patients who underwent LUL at our institution, between January 2014 and March 2018. Based on pre-operative computed tomography (CT) images, the anatomical relationship between the LSPV and the LAA was classified into two patterns, namely an antero-superior and a postero-inferior pattern. The length of the LSPV stump for these two patterns was evaluated on postoperative CT images and compared between the two groups. RESULTS: Of the 85 patients, 49 were classified in the antero-superior pattern and 36 in the postero-inferior pattern. The mean length of the LSPV stump after LUL, overall, was 21.9 (range, 15-38) mm, with the stump being significantly longer for the antero-posterior (24.2 mm) than postero-inferior (18.9 mm) pattern. CONCLUSIONS: The anatomical relationship between the LSPV and LAA, identified on pre-operative CT images, was associated with the length of the LSPV stump after LUL.

Incidental haemothorax after sublobar resection: did staple line scratch chest wall?

We herein report a case of life-threatening haemothorax that occurred 40 days after pulmonary segmentectomy in a 60-year-old man. The patient uneventfully underwent resection of the apical and posterior segments of the right upper lobe by video-assisted thoracic surgery for early-stage lung cancer. An emergency operation of haemostat for active bleeding from the intercostal artery was successful via a right thoracotomy. The bleeding point was in the vicinity of the staple line dividing the intersegmental plane. This case reveals that scratch by staples can cause haemothorax through incidental injury of the intercostal artery.

Revival of impaired lung perfusion after sleeve lobectomy.

Sleeve resection, a mainstay for centrally-located lung cancer, is a challenging procedure when the preserved lung is impaired. We herein reported a 61-year-old male who underwent right upper sleeve lobectomy for squamous cell carcinoma located at the orifice of the upper bronchus. The tumor invaded the main bronchus. A lung perfusion scan showed severe impairment, while the right middle and lower lobes were well expanded. Not only the spirogram, but also the lung perfusion in the residual lung, had markedly recovered at 2 months after the right upper extended sleeve lobectomy. The patient is currently living his normal daily life. Residual lung perfusion can be revived, even if it is impaired preoperatively.