Sublobar resection for metachronous stage I second primary non-small cell lung cancer: A single-centre experience.

INTRODUCTION: More patients are developing second primary lung cancer (SPLC). This study aimed to evaluate the impact of the extent of SPLC resection on outcomes. MATERIAL AND METHODS: We retrospectively investigated 1,895 patients with lung cancer who underwent pulmonary resection from 2011 to 2018. SPLC was diagnosed using the criteria of Martini and Melamed. Patients with pathological stage I SPLC who underwent lobectomy for first primary lung cancer (FPLC) were included in the study. Outcomes and clinical factors that could affect survival were evaluated. RESULTS: Fifty-four patients were eligible for the study. Lobectomy, segmentectomy, or wedge resection was performed for 10, 32, and 12 patients, respectively. Neither overall nor relapse-free survival was significantly different based on the extent of resection for stage I SPLC. Multivariate analysis revealed that interval between FPLC and SPLC of less than 5 years was an independent risk factors for worse relapse-free survival after SPLC resection (interval: hazard ratio, 0.28; P = 0.048). The median interval from prior resection to secondary resection was 68 months. CONCLUSIONS: Sublobar resection might be a realistic option for stage I SPLC. To realize early detection of SPLC that can undergo radical sublobar resection, the surveillance period after prior resection of FPLC is worth reconsidering.

[Surgical Procedure and Perioperative Outcomes of Three-port Video-assisted Thoracoscopic Surgery Thymectomy for Thymoma, Including en-bloc Resection of Adjacent Organs].

This report discusses the treatment and outcomes of three-port video-assisted thoracoscopic surgery (VATS) thymectomy for thymoma. We reviewed perioperative results of 159 thymoma cases( excluding thymic carcinoma) over 16 years. Thoracoscopic surgery was indicated for Masaoka stagesⅠ to Ⅲ, tumor diameter up to 12 cm, and resection of surrounding organs up to the lung, pericardium+reconstruction, internal thoracic artery and vein, left brachiocephalic vein, and phrenic nerve+reconstruction. The mean age of patients was 56.9±12.7, with 71 males and 88 females. The surgical approach was right-sided in 110 cases, left-sided in 47 cases, and bilateral in 2 cases. Total thymectomy was performed in 141 cases, with total thymectomy plus combined resection of other organs (lungs, pericardium, and phrenic nerve) ±reconstruction in 18 cases. The World Health Organization( WHO) classification( 5th edition) was type A/AB/B1/B2/B3/micronodular thymoma with lymphoid stroma (MNTLS) = 20/49/32/45/11/2, and Masaoka classification was stageⅠ/Ⅱ/Ⅲ=69/86/4. The three-port VATS technique offers several advantages, including its applicability to other surgeries, avoidance of contralateral thoracic cavity opening, safety in thymectomy without open conversion, and a mean postoperative hospital stay of 3 days.

Impact of postoperative remote infection on length of stay and medical costs in hospitals in Japan.

PURPOSE: To analyze the impact of postoperative remote infections (PRIs) on medical expenditure. METHODS: The subjects of this retrospective study were 338 patients who had undergone gastroenterological surgery at one of the 20 Japanese institutions within the Japan Society for Surgical Infection (JSSI) and mainly authorized as educational institutions. The patients were allocated to 169 pairs of those with a PRI (PRI (+) group) matched with those without a PRI (PRI (-) group). PRIs included pneumonia, urinary tract infection (UTI), catheter-associated blood stream infection (CA-BSI), and antibiotic-associated enteritis. RESULTS: SSI developed in 74 of the 338 patients (22 without PRI and 52 with PRI). The SSI incidence was significantly higher in the PRI (+) group (p < 0.001). The difference in the median postoperative length of hospital stay was 15 days, indicating a significant prolongation in the PRI (+) group (p < 0.001). The PRI (+) group also had a higher rate of inter-hospital transfer (p < 0.01) and mortality (p < 0.001). Similarly, the difference in median postoperative medical fees was $6832.3, representing a significant increase in the PRI (+) group (p < 0.001). CONCLUSIONS: The postoperative length of hospital stay is longer and the postoperative medical expenditure is higher for patients with a PRI than for those without a PRI.

Postoperative Infection after Colorectal Surgery: Subanalysis of Data from the 2015 Japan Postoperative Infectious Complications Survey.

BACKGROUND: Most surveillance programs for postoperative infection focus on surgical site infections (SSI). However, postoperative remote infections are of emerging clinical importance. Using data from a multicenter survey administered to patients who underwent gastrointestinal surgery, we investigated the incidence of SSI and remote infection after colorectal surgery. METHODS: From September 2015 through March 2016, 1,724 patients underwent colorectal surgery in 28 affiliated centers in Japan. We retrospectively recorded patient age, sex, surgical site, surgical approach, wound classification, performance status at discharge, and postoperative infection status. RESULTS: Postoperative infection was noted in 236 (13.7%) patients; 150 and 86 patients underwent colon and rectal surgeries, respectively (incidence of postoperative infection: 13.7% and 14.8%). The incidence of postoperative infection was significantly lower after laparoscopic surgery than after open surgery, in colon and rectal surgery (p < 0.001). Among patients with postoperative infections, 211 (89.4%) had a single infection and 25 (10.6%) had multiple infections. Among patients with a single postoperative infection, SSI and remote infection occurred in 143 (60.6%) and 68 (28.8%) patients, respectively. The most common multiple postoperative infections were "incisional and organ/space SSIs" and "organ/space SSI and bacteremia of unknown origin" (n = 3 each). CONCLUSIONS: This study revealed the prevalence distributions for postoperative SSI and remote infections. Because of the substantial effect of remote infections on patient quality of life and the associated social burden, prospective periodic surveillance for SSI and remote infection is necessary for careful evaluation and prevention.

Association of Respiratory Tract Infection after Gastroenterological Surgery with Postoperative Duration of Hospitalization and Medical Expenses: Subanalysis of Data from a Multicenter Study.

BACKGROUND: Postoperative infections can be classified as surgical site infections and remote infections. Postoperative respiratory tract infections (PRTI) are a type of remote infection and may be associated with prolonged hospitalization and increased medical expenses. This study compared postoperative duration of hospitalization and medical expenses between patients with and without PRTI after gastrointestinal surgery. METHODS: We retrospectively analyzed data from a multicenter study of centers affiliated with the Japan Society for Surgical Infection and used 1-to-1 matching analysis to evaluate 86 patients who underwent gastrointestinal surgery during the period from March 1, 2014 through February 29, 2016. RESULTS: Duration of postoperative hospitalization was significantly longer for patients with PRTI (38.6 days) than for those without PRTI (16.1 days), and postoperative medical expenses were significantly higher for patients with PRTI (1388.2 USD) than for those without PRTI (629.4 USD). CONCLUSIONS: Duration of hospitalization is longer and medical expenses are higher for patients that develop surgical site infections. This study found that this was also the case for patients with PRTI after gastrointestinal surgery. However, further studies are needed in order to confirm these results.

Current status of post-operative infections due to antimicrobial-resistant bacteria after digestive tract surgery in Japan: Japan Postoperative Infectious Complications Survey in 2015 (JPICS'15).

PURPOSE: We herein report the findings of the Japan Postoperative Infectious Complication Survey in 2015 (JPICS'15), which evaluated the rate of post-operative infections and colonization due to antimicrobial-resistant (AMR) bacteria after digestive tract surgery. METHODS: This survey by the Japan Society of Surgical Infection included patients undergoing digestive tract surgery at 28 centers between September 2015 and March 2016. Data included patient background characteristics, type of surgery, contamination status, and type of post-operative infections, including surgical site infections (SSIs), remote infections (RIs), and colonization. RESULTS: During the study period, 7,565 surgeries (of 896 types) were performed; among them, 905 cases demonstrated bacteria after digestive tract surgery. The survey revealed that post-operative infections or colonization by AMR bacteria occurred in 0.9% of the patient cohort, constituting 7.5% of post-operative infections, including 5.6% of SSIs and 1.8% of RIs. Extended-spectrum ß-lactamase-producing Enterobacteriaceae and methicillin-resistant Staphylococcus aureus were the predominant AMR bacteria isolated from patients after digestive tract surgery. Patients infected with AMR bacteria had a poor prognosis. CONCLUSION: Our results reveal that 7.5% of the post-operative infections were due to AMR bacteria, indicating the need for antibacterial coverage against AMR bacteria in patients with critical post-operative infections.

Successful perioperative infection control measures after gastroenterological surgery reduced the number of cases of methicillin-resistant Staphylococcus aureus or Clostridioides (Clostridium) difficile infection to almost zero over a 30-year period: a single-department experience.

PURPOSE: To investigate changes in the incidence of postoperative infections in the surgical department of a teaching hospital. METHODS: During the 30-year period from September 1987 to August 2017, 11,568 gastroenterological surgical procedures were performed in our surgical department. This 30-year period was divided into seven periods (A-G), ranging from 2 to 7 years each and based on the infection control methods used in each period. We then compared the rates of incisional surgical site infection (SSI) and organ/space SSI; remote infection (RI) including respiratory tract infection (RTI), intravascular catheter-related infection, and urinary tract infection (UTI); and antibiotic-associated colitis caused by methicillin-resistant Staphylococcus aureus (MRSA) enteritis or Clostridioides (Clostridium) difficile-associated disease (CDAD) among the seven periods. RESULTS: In periods B (September 1990-August 1997) and E (November 2004-July 2007), when a unique antibiotic therapy devised in our department was in use, MRSA was isolated from only 0.3% and 0.4% of surgical patients, respectively, and these rates were significantly lower than those in the other periods (p < 0.05). The rate of CDAD increased during period F (August 2007-July 2014), but in period G (August 2014-August 2017), restrictions were placed on the use of antibiotics with a strong anti-anaerobic action and, in this period, the rate of CDAD was only 0.04%, which was significantly lower than that in period F (p < 0.05). CONCLUSIONS: Limiting the use of antibiotics that tend to disrupt the intestinal flora may reduce the rates of MRSA infection and CDAD after gastroenterological surgery.

Current status of postoperative infections after digestive surgery in Japan: The Japan Postoperative Infectious Complications Survey in 2015.

AIM: To survey postoperative infections (PI) after digestive surgery. METHODS: This survey, conducted by the Japan Society of Surgical Infection, included patients undergoing digestive surgery at 28 centers between September 2015 and March 2016. Data collected included patient background characteristics, type of surgery, contamination status, and type of PI, including surgical site infection (SSI), remote infection (RI), and antimicrobial-resistant (AMR) bacterial infections and colonization. RESULTS: Postoperative infections occurred in 10.7% of 6582 patients who underwent digestive surgery (6.8% for endoscopic surgery and 18.7% for open surgery). SSI and RI, including respiratory tract infection, urinary tract infection, antibiotic-associated diarrhea, drain infection, and catheter-related bloodstream infection, occurred in 8.9% and 3.7% of patients, respectively. Among all PI, 13.2% were overlapping infections. The most common overlapping infections were incisional and organ/space SSI, which occurred in 4.2% of patients. AMR bacterial infections occurred in 1.2% of patients after digestive surgery and comprised 11.5% of all PI. Rate of AMR bacterial colonization after digestive surgery was only 0.3%. CONCLUSION: Periodic surveillance of PI, including AMR bacteria, is necessary for a detailed evaluation of nosocomial infections.