[A Case of Advanced Gastric Cancer with Para-Aortic Lymph Node Metastasis with Long-Term Survival by Chemotherapy and Surgery].

Chemotherapy is the standard treatment for unresectable gastric cancer, but there is no clear evidence of therapeutic lymphadenectomy in conversion surgery after the tumor shrinks or the combined effect of perioperative chemotherapy. A 63-year-old man was diagnosed with advanced gastric cancer by upper gastrointestinal endoscopy; computed tomography (CT)showed swelling of the gastric regional lymph nodes, abdominal para-aortic lymph nodes, and left supraclavicular lymph node. After 4 courses of combination therapy with S-1 and cisplatin(SP therapy), CT showed that the left supraclavicular lymph node disappeared and the para-aortic lymph node was reduced. Distal gastrectomy and D2 plus para-aortic lymph node dissection were performed as conversion surgery. Two courses of postoperative SP therapy were administered, and S-1 monotherapy was continued for 2 years and 6 months. After 5 years and 1 month since the operation, the patient is alive without recurrence. This case shows that SP therapy can be effective as chemotherapy for unresectable gastric cancer. In addition, that conversion surgery after chemotherapy may contribute to recurrence-free survival.

Left upper lobectomy for cancer of the left lung with a rare mediastinal left basal pulmonary artery.

We report a rare case wherein a mediastinal left basal pulmonary artery was detected during surgery. Intraoperative findings revealed mediastinal left lingular and basal segments of the pulmonary artery (A4+5 + A8-10) just dorsal to the superior pulmonary vein. The mediastinal left basal pulmonary artery is classified by its branching type, (1) complete type-wherein the entire that all basal pulmonary artery flow lies between the superior pulmonary vein and the left upper bronchus, as in like this case, (2) incomplete type-wherein that a part of the left basal pulmonary artery segment is on the flow mediastinal side. It is important to understand this rare aberration for undergoing safe surgery.

[Present Status and Future Issues of Multidisciplinary Treatment of Lung Cancer from the Viewpoint of a Respiratory Surgeon].

With the advent of molecular targeted therapeutic agents and immunity checkpoint inhibitors, lung cancer drug therapy has advanced. We cannot expect to improve the performance of surgical treatment without drug therapy. The problem of improving the performance of surgical treatment for lung cancer is:① the role of surgery in multidisciplinary treatment for c-stageⅢ N2 lung cancer, ② post-operative adjuvant therapy, ③ multidisciplinary treatment of post-operative recurrence, ④ salvage surgery, and ⑤ sublobar resection in high risk cases. We will describe each of these with reference to our own experiences and literature considerations.

[A case of pulmonary dirofilariasis with a single nodule on an apical lesion of the right upper lobe].

A 75-year-old man with chronic gastritis and gastro-esophageal regurgitation syndrome was admitted to our hospital complaining of continuous productive cough, and an abnormal shadow was noted on a chest X-ray film. Chest computed tomography revealed a nodule 2.8 cm in diameter with a regular margin on the right apex. Fiberoptic bronchoscopy was performed, but did not yield a definitive diagnosis. We suspected primary lung cancer, and therefore, lung partial resection was performed under thoracoscopic surgery. The intraoperative pathological findings revealed inflammatory granuloma with necrosis, and pulmonary dirofilariasis was finally diagnosed. Pulmonary dirofilariasis is an important differential diagnosis in elderly patients with a chest abnormal nodular shadow. Lesions have been reportedly observed in the peripheral portion of the right lower lobe in many previous reports. However, in this case, a nodular lesion was noted in the right apex.