Risks of segmentectomy for interstitial pneumonia with diffuse pulmonary ossification.

An 84-year-old man with a history of progressive interstitial pneumonia presented to our department with lung cancer (cT2aN0M0-IB) in right S6. Moreover, computed tomography revealed progressive diffuse pulmonary ossification in the bilateral lower pulmonary lobes. S6 segmentectomy was performed via video-assisted thoracoscopic surgery. It was difficult to divide the intersegmental plane using a stapler because of severe fibrosis and pulmonary ossification with bone marrow formation. Pulmonary ossification may be an important finding for surgical planning because of severe fibrosis or inflammation associated with severe lung condition. We suggest that the surgical indications and approaches for such cases should be reconsidered because pulmonary ossification can be associated with severe lung conditions.

Efficacy of robot-assisted thoracoscopic surgery for managing thymoma recurrence following sternotomy: a case report.

This report addresses the management strategy and effectiveness of robot-assisted thoracoscopic surgery (RATS) for treating local recurrence of thymoma, a condition often complicated by severe adhesions and limited data on re-operation following median sternotomy. We report about a 43-year-old man with thymoma recurrence 4 years after thymothymectomy via a median sternotomy. Follow-up computed tomography revealed a nodule adjacent to the left brachiocephalic vein, indicating possible thymoma recurrence. Thus, re-operation was performed using a left-sided approach via RATS with an artificial pneumothorax. The manipulation space was secured with an artificial pneumothorax, and multidirectional manipulation using RATS demonstrated good efficacy. Collectively, this case highlights the efficacy of RATS as a viable approach for managing thymoma recurrence in mediastinal locations, particularly when sternotomy is complicated by severe adhesions.

[Educational Impact of Using Three-dimentional Models for Preoperative Simulation of Segmentectomy for Medical Students].

BACKGROUND: Lung segment anatomy is complex and difficult for medical students to comprehend, so education is a challenging issue. Three-dimensional (3D) models may be a more effective teaching tool for medical students. We evaluated the usefulness of 3D models in education for segmentectomy. METHODS: Sixty-six students who participated in clinical training for thoracic surgery from November 2020 to March 2022 were included in the study. Computed tomography (CT) images, 3D-CT images, and 3D models were used to investigate students' level of understanding for each lung segment. Levels of understanding were assessed using a questionnaire administered using the interview method. The results of the questionnaire were tabulated and analyzed using the Kruskal-Wallis test. RESULTS: The response rate was 100%. Comprehension scores for all questions were highest for 3D models, followed by 3D-CT and CT. These results suggest that use of a 3D entity model may have a high educational effect. CONCLUSION: Although it is unclear whether students' comprehension was directly related to their understanding of correct anatomy, our results suggest that 3D models may be an effective way for medical students to understand lung segmentectomy.

Tumor volume doubling time as a potential predictor of prognosis in clinical stage I lung squamous cell carcinoma.

Background: Tumor volume doubling time (VDT) has been shown to predict prognosis in various non-small cell lung carcinoma with scant evidence for lung squamous cell carcinoma (SCC). The purpose of this study was to investigate the prognostic value of tumor VDT in resected lung SCCs. Methods: In this study, subjects were 51 patients who underwent lobectomy for clinical stage I SCC of the peripheral lung at our institution between January 2006 and April 2020. Univariable and multivariable analyses of overall survival (OS) and recurrence-free survival (RFS) were performed using the Cox proportional hazards model. The Kaplan-Meier method was used to create OS and RFS curves and to determine statistical significance. The cut-off value of VDT was defined by receiver operating characteristic (ROC) curve analysis on survival. Results: Multivariable analysis found only VDT (HR, 0.990; 95% CI: 0.979-0.997) to be an independent predictor of OS. Also, only VDT (HR, 0.989; 95% CI: 0.978-0.995) was an independent predictor of RFS. The 5-year OS rates were 88.4% and 30.4% in the long (≥150 days) and short (<150 days) VDT groups, respectively (P=0.002). The 5-year RFS rates were 88.8% and 26.5% in the long (≥150 days) and short (<150 days) VDT groups, respectively (P<0.001). Conclusions: Tumor VDT was found to be a useful prognostic predictor in clinical stage I lung SCC in this study.

Prognostic impact of the tumor volume doubling time in clinical T1 non-small cell lung cancer with solid radiological findings.

BACKGROUND: The purpose of this study was to investigate better radiological prognostic factors in clinical T1 pure-solid non-small cell lung cancer (NSCLC). METHODS: This study enrolled 284 patients with clinical T1 solid NSCLC who underwent anatomical lung resection. The Cox proportional hazard model was used to evaluate the prognostic impact of tumor volume doubling time (VDT) at disease-free survival (DFS) and cancer-specific survival (CSS). RESULTS: The median VDT was 347 days. Age (hazard ratio (HR) = 1.04; 95% confidence interval (CI), 1.01-1.07) and standardized uptake value max (SUVmax) (>6.0) (HR = 2.61; 95% CI, 1.52-4.66) were identified as significantly independent worse prognostic factors for DFS in a multivariable analysis without VDT. Furthermore, a multivariable analysis without SUVmax identified age (HR = 1.06; 95% CI, 1.03-1.09), CEA (>5.0 ng/ml) (HR = 2.34; 95% CI, 1.30-4.02), tumor diameter on CT (>2.0 cm) (HR = 1.91; 95% CI, 1.18-3.13), and VDT (HR = 4.03; 95% CI, 2.41-6.93) as significantly independent worse prognostic factors for DFS. CONCLUSIONS: The VDT value could be a useful prognostic factor in clinical T1 solid NSCLC.

Preoperative Master's double two-step test may predict survival after lobectomy in patients with lung cancer.

BACKGROUND: The Master's double two-step test (MDT), which is used to screen for coronary heart disease, is difficult for physically impaired patients to complete. The purpose of this study was to clarify the relationship between the results of the MDT and prognosis after lung cancer surgery. METHODS: Between May 2004 and September 2019, 1,434 patients underwent complete resection for lung cancer at our hospital. Among them, 418 with pathological stage I disease who underwent lobectomy were evaluated. We defined patients who could accomplish the MDT as the complete MDT group and those who could not as the incomplete MDT group. Patients who could not perform the MDT due to physical problems were included in the incomplete MDT group. We explored the prognostic impact of the MDT results in these patients. RESULTS: Fifty-three patients (12.7%) were in the incomplete MDT group; compared with the complete MDT group, they were older and had poorer performance status and respiratory function. However, the incidence of postoperative complications and 90-day mortality did not differ significantly between groups. Multivariate analyses revealed that age (p < 0.001), Charlson comorbidity index (p = 0.013), incomplete MDT (p = 0.049) and carcinoembryonic antigen (CEA) level (p = 0.003) were prognostic factors for worse overall survival; age (p < 0.001) and incomplete MDT (p = 0.022) were prognostic factors for worse non-cancer-specific survival. CONCLUSIONS: Although incomplete MDT was not associated with postoperative complications, 90-day mortality or cancer-specific survival, MDT results may be significantly associated with non-cancer-specific survival.

[Carinal Resection and Reconstruction for Second Primary Lung Cancer Five Years After the Left Upper Lobectomy].

A tumor was detected at the tracheal carina to the orifice of the left main bronchus in a 66-year-old man who had undergone a left upper lobectomy for lung cancer five years before and was diagnosed as a squamous cell carcinoma. Carinal resection and reconstruction was performed because of the tumor relapse after the treatment by argon plasma coagulator. Carinal resection was performed under the median sternotomy with reconstruction by the montage method. The patient was discharged on the 8th postoperative day without any postoperative complications.

Prediction of lymph node metastasis of clinical stage IA non-small cell lung cancer based on the tumor volume doubling time.

PURPOSE: To investigate whether the volume doubling time is a preoperative predictor of lymph node metastasis of clinical stage IA non-small cell lung cancer (NSCLC). METHODS: The subjects of this retrospective study were 204 patients who underwent lobectomy and mediastinal lymph node dissection for clinical stage IA NSCLC. We analyzed the relationship between lymph node metastasis and clinicopathological factors, including the volume doubling time. RESULTS: Lymph node metastasis developed in 24 (11.8%) patients. Multivariable analysis identified consolidation diameter (Odds ratio = 1.407; 95% confidence interval, 1.007-1.966, p = 0.046) and the solid-part tumor volume doubling time (Odds ratio = 0.982; 95% confidence interval, 0.973-0.991, p < 0.001) as independent predictors of lymph node metastasis. The combination of a larger consolidation diameter (> 1.9 cm) and a shorter solid-part tumor volume doubling time (< 132 days) had sensitivity, specificity, and accuracy of 79.2%, 94.4%, and 92.6%, respectively. CONCLUSIONS: The consolidation diameter and solid-part tumor volume doubling time can be useful preoperative predictors of lymph node metastasis of clinical stage IA NSCLC.