Proximal ligation technique prevents thrombus formation in the pulmonary vein stump after lobectomy.

PURPOSE: To assess the risk factors for thrombosis in the pulmonary vein stump (PVT) and the efficacy of proximal ligation in preventing PVT after lobectomy. METHODS: In total, 649 surgical patients with lung cancer were retrospectively reviewed. To compare the clinical effectiveness of PV proximal ligation, the simple stapler group (290 patients) and the proximal ligation group (359 patients who underwent thread ligation at the pericardial reflection with/without a stapler) were analyzed. RESULTS: In the simple stapler group, 12 of 290 patients (4.1%) developed PVT. Among these, 9 of 58 underwent left upper lobectomy (LUL). In contrast, 5 of the 359 patients (1.4%) in the proximal ligation group developed PVT. All five patients received LUL. The incidence of PVT in the proximal ligation group was significantly lower than that in the simple stapler group (p = 0.0295) as well as in the analysis by LUL alone (p = 0.0263). A logistic regression analysis indicated that higher BMI and LUL were associated with the development of PVT (p = 0.0031, p < 0.0001), and PV proximal ligation reduced PVT (p = 0.0055). CONCLUSION: Proximal ligation of the PV has the potential to prevent PVT, especially after LUL.

Expression of the transient receptor potential channel c3 correlates with a favorable prognosis in patients with adenocarcinoma of the lung.

BACKGROUND: The cation channels of the transient receptor potential (TRP) superfamily are implicated in cancer formation; in particular, TRPC3 has been shown to contribute to the progression of human ovarian cancer. However, the relationship between TRP expression and the clinicopathological characteristics of lung cancer and patient prognosis is not well understood. Therefore, we investigated the relationship between TRP expression and the prognosis of patients with adenocarcinoma of the lung. METHODS: We used semiquantitative real-time reverse transcription polymerase chain reaction to assess the expression of TRP mRNA in tumor samples from 95 patients with adenocarcinoma of the lung. We then correlated the TRP mRNA levels with clinicopathological factors. We also used immunohistochemical staining to determine the localization of expressed TRP. RESULTS: The 5-year overall and disease-free survival rates among patients expressing higher levels of TRPC3 mRNA were significantly better than the corresponding rates among patients expressing lower levels (P=0.004, P=0.002, respectively, by log-rank test). Multivariate Cox proportional hazard analyses revealed that tumor size (hazard ratio, 2.46; 95% confidence interval [CI], 1.06 to 5.79; P=0.036), n2 (hazard ratio, 3.81; 95% CI, 1.29 to 11.77; P=0.015) and TRPC3 (hazard ratio, 2.71; 95% CI, 1.33 to 5.59; P=0.006) were independent factors affecting the 5-year overall survival rate. Immunohistochemistry showed that the cytoplasm of tumor cells were stained positively for TRPC3. CONCLUSIONS: Higher levels of TRPC3 expression in tumor cells are an independent predictor of a better prognosis in patients with adenocarcinoma of the lung.

[Reconstruction of the superior vena cava by artificial graft bypass between right brachiocephalic vein and right atrial appendage preserving azygos vein circulation for mediastinal non-seminomatous germ cell tumor].

A 24-year-old man was admitted to our hospital for surgical resection of mediastinal non-seminomatous germ cell tumor after 4 courses of BEP therapy (cisplatin, bleomycin, etoposide). Although it became markedly smaller after chemotherapy, the tumor invaded the superior vena cava (SVC) and the left brachiocephalic vein (LBCV). Venogram demonstrated SVC obstruction above the azygos vein and missing LBCV. A blood return from the left upper limb was shown through thoracodorsal vein, intercostal vein, and accessory hemi-azygos continuation. Excision of residual tumor with SVC and LBCV was done through a median sternotomy. Vascular reconstruction was performed between the right brachiocephalic vein and the right atrial appendage with ringed polytetrafluoroethylene graft. SVC was sutured just above the azygos vein to preserve collateral circulation. LBCV reconstruction was abandoned because distal end of LBCV was entirely surrounded by postchemotherapy scar tissue. Venous occlusive symptoms were not seen in both intraoperative and postoperative period.

Expression of histone deacetylase 1 correlates with a poor prognosis in patients with adenocarcinoma of the lung.

UNLABELLED: Histone deacetylase (HDAC) inhibitors (HDACis) are now attracting attention as promising therapeutic agents for the treatment of cancer. However, the relation between HDAC1 expression and the clinicopathological characteristics of non-small cell lung cancer (NSCLC) is not well understood. We therefore investigated the relationship between HDAC1 expression by tumors and the clinicopathological characteristics of patients with adenocarcinoma of the lung. METHODS: We used semi-quantitative real time reverse transcription polymerase chain reaction to assess expression of HDAC1 mRNA in tumor samples from 93 patients with adenocarcinoma of the lung. We then correlated HDAC1 mRNA levels with known clinicopathological factors. RESULTS: We found that the 5-year disease-free survival rate among patients strongly expressing HDAC1 was significantly poorer than among those expressing lower levels (P=0.005 by log-rank test). Multivariate Cox proportional hazard analyses revealed that being male (hazard ratio, 3.56; 95% CI, 1.58-8.42; P=0.002), nodal metastasis (hazard ratio, 7.98; 95% CI, 2.99-22.1; P<.001) and HDAC1 (hazard ratio, 2.17; 95% CI, 1.04-4.84; P=0.039) were all independent factors affecting 5-year disease-free survival. CONCLUSION: Stronger HDAC1 expression by tumor cells is an independent predictor of a poor prognosis in patients with adenocarcinoma of the lung.