Impact of accurate diagnosis of interstitial lung diseases on postoperative outcomes in lung cancer.

OBJECTIVE: The prognostic impact of interstitial lung disease (ILD) subclassification based on both high-resolution computed tomography (HRCT) scan findings and histopathological findings is unknown. METHODS: We retrospectively analyzed 104 patients who were diagnosed with clinical ILD according to HRCT scan findings and who underwent lung cancer surgery. Via an expert multidisciplinary discussion, we re-classified HRCT scan findings and validated the histopathological patterns of ILDs in lung specimens. RESULTS: There were several mismatches between HRCT scan findings and histological patterns. Moreover, 87 (83.7%) and 6 (5.8%) patients were diagnosed with definitive ILD and pathological non-ILD, respectively. Finally, 82 patients with idiopathic interstitial pneumonias (IIPs) were divided into the idiopathic pulmonary fibrosis (IPF) (n = 61) group and the other group (n = 21). The 5-year overall survival rate of the IPF group was significantly lower than that of the other group (22.8% vs 67.9%; p = 0.011). Sub-classification of IIPs was found to be an independent prognostic factor for overall survival in patients with lung cancer. CONCLUSION: An accurate diagnosis of IIPs/IPF according to both HRCT scan findings and histological patterns is important for providing an appropriate treatment among patients with lung cancer who presented with clinical ILD.

Necessity of Multi-Step Surgical Treatment for Patients with Interstitial Lung Disease and a Pneumothorax.

PURPOSE: A pneumothorax occurs in 3%-8% of patients with idiopathic pulmonary fibrosis. A pneumothorax may predict a poor outcome in patients with interstitial lung disease (ILD), and it is difficult to treat patients with ILD and a pneumothorax. PATIENTS AND METHODS: We retrospectively studied data from all 12 patients with ILD and a pneumothorax who underwent surgical treatment at Toho University Omori Medical Center Hospital between 2009 and 2021. RESULTS: Of the 12 patients, 2 had home oxygen therapy preoperatively and were classified with grade IV interstitial pneumonia (IP). Six patients had preoperative pleurodesis and two had postoperative one using auto-blood. Three patients (25%) had multi-step surgery ≥2, and 5 patients had surgical resection of bullae. No patients had postoperative acute exacerbations and all were discharged from the hospital in a stable condition. The 5-year overall survival rate for all patients was 70.0%. The median survival time was not reached. One patient with unclassified IP was doing well 116 months after surgery. CONCLUSION: Patients with ILD and a pneumothorax were shown to require multi-step surgical treatment and can anticipate long-term survival.

Surgical lung biopsy for interstitial lung diseases-a single center study of 129 patients.

Background: According to guidelines for the diagnosis and treatment of interstitial lung diseases (ILDs), a diagnostic surgical lung biopsy should be used to obtain the differential diagnosis of an ILD in patients with ILDs, which are difficult to distinguish clinically. However, the risk of developing postoperative complications such as postoperative pulmonary fistula or acute exacerbation is a concern. The purpose of this study was to evaluate the safety of surgical lung biopsy for the differential diagnosis of ILDs. Methods: From October 2007 to July 2019, 129 patients thought to have ILD underwent a surgical lung biopsy at Toho University Omori Medical Center. We conducted a retrospective study on the diagnosis and safety of surgical lung biopsy for patients with ILD. Results: The 30- and 60-day mortality was 0%. Postoperative complications occurred in 13 of 129 (10.1%) patients. The complications included pneumothorax in 8 (6.2%) patients after removal of the chest tube, postoperative pneumonia in 2 (1.0%), and acute exacerbation in 1 (0.8%). Postoperative pneumothorax was observed in 4 of 13 patients (30.7%) who underwent a biopsy of the apex of the lung (right S1, left S1+2), which was a significantly higher rate of postoperative pneumothorax than seen for patients undergoing biopsy at other sites (P=0.0086). Conclusions: Surgical lung biopsy for the differential diagnosis of an ILD was performed safely. However, biopsy sites for ILDs need to be carefully selected to avoid postoperative complications.

Adenocarcinoma in situ detected on a thin-walled lung cavity: a case report.

BACKGROUND: Cavitary lesions pathologically diagnosed as adenocarcinoma in situ (AIS) have been rarely reported. The examination of these type of lesions is necessary for a better understanding of the mechanisms underlying their formation and development of more efficient diagnostic and treatment strategies. Here, we present the case of a patient with cavitary lung carcinoma, diagnosed as AIS, who underwent partial resection. CASE PRESENTATION: A 72-year-old man presented with an abnormal shadow on chest radiography. Computed tomography findings showed a nodule in the right upper lobe, which was later diagnosed as an adenocarcinoma via transbronchial biopsy. A thin-walled cavity with partial thickening in the right lower lobe was also noted. We suspected that the thin-walled cavitary lesion was malignant, and performed wedge resection during a right upper lobectomy. AIS was diagnosed based on the histopathological findings of the thickened part of the thin-walled cavity. CONCLUSIONS: This study highlights that, although rare, AIS may be observed in cavitary lung carcinoma cases, particularly in thin-walled lesions.

Intraoperative argon-plasma coagulation treatment for patients with malignant pleural mesothelioma.

Malignant pleural mesothelioma (MPM) is often associated with asbestos exposure and carries an extremely poor prognosis. The present study assessed the effectiveness of argon plasma coagulation (APC) treatment in patients with MPM who underwent radical pleural decortication (PD). The clinical data from 11 patients who underwent radical PD treated with APC at Toho University Omori Medical Center from July 2015 to March 2020 were retrospectively analyzed. Clinical features, local recurrence, and clinical prognoses were evaluated. The median overall survival was 18.5 months, and the 1- and 2-year overall survival rates were 71.6 and 43.0%, respectively. One patient survived 5 years but had recurrent tumors. The median disease-free survival was 11.1 months. The 1- and 2-year disease-free survival rates were 49.9 and 12.5%, respectively. Three patients had no recurrences, two of whom were followed continuously (39.6 and 10.2 months). The present study revealed that APC treatment for MPM might be associated with good survival and prognosis. APC as an additional intraoperative treatment for patients with MPM may be further investigated with larger multi-center clinical trials to support its efficacy.

Spigot in pneumothorax cavity: A rare complication of endobronchial Watanabe spigot.

Spigot dropping is a rare but an intractable complication, because it is difficult to salvage a dropped spigot from the thoracic cavity. If the pneumothorax with a large fistula is recurrent, replacement with a larger size spigot may be recommended.

Necessity of Thin Section CT in the Detection of Pulmonary Metastases: Comparison between 5 mm and 1 mm Sections of CT.

BACKGROUND: The aim of this study was to evaluate the difference in the ability of 1-mm and 5-mm section Computed Tomography(CT) to detect pulmonary metastases in patients with pulmonary metastases. METHODS: We retrospectively analyzed the CT findings of 106 patients with pulmonary metastases due to malignancies treated at Toho University Omori Medical Center between 2013 and 2020. RESULTS: Cases with only one nodule evaluated by 5-mm section CT had significantly lower discordance with 1-mm section CT than cases with two or more nodules detected by a 5 mm section (p = 0.0161). After reference to a 1 mm section, cases with only one nodule reevaluated by 5-mm section CT had significantly lower discordance than cases with two or more nodules reevaluated using 5-mm section CT. In cases with only one nodule, reevaluation using a 5 mm section was consistent with evaluation using a 1 mm section. However, this was not observed in cases with two or more nodules, with a significant difference between one nodule and two or more nodules. CONCLUSIONS: If there are two or more nodules observed in 5-mm section CT it may be necessary to reevaluate using 1-mm section CT to determine the exact number of pulmonary metastases.

Prognostic and functional impact of perioperative LAMA/LABA inhaled therapy in patients with lung cancer and chronic obstructive pulmonary disease.

BACKGROUND: Chronic obstructive pulmonary disease (COPD) is an important risk factor for postoperative complications and mortality. To determine the effects of perioperative combination therapy, using a long-acting muscarinic antagonist (LAMA) and a long-acting ß2 agonist (LABA), on preoperative lung function, postoperative morbidity and mortality, and long-term outcome in COPD patients. METHODS: Between January 2005 and October 2019, 130 consecutive patients with newly diagnosed COPD underwent surgery for lung cancer. We conducted a retrospective review of their medical record to evaluate that LAMA/LABA might be an optimal regimen for patients with COPD undergoing surgery for lung cancer. All patients were received perioperative rehabilitation and divided into 3 groups according to the type of perioperative inhaled therapy and management: LAMA/LABA (n = 64), LAMA (n = 23) and rehabilitation only (no bronchodilator) (n = 43). We conducted a retrospective review of their medical records. RESULTS: Patients who received preoperative LAMA/LABA therapy showed significant improvement in lung function before surgery (p < 0.001 for both forced expiratory volume in 1 s (FEV1) and percentage of predicted forced expiratory volume in 1 s (FEV1%pred). Compared with patients who received preoperative LAMA therapy, patients with LAMA/LABA therapy had significantly improved lung function (ΔFEV1, LAMA/LABA 223.1 mL vs. LAMA 130.0 mL, ΔFEV1%pred, LAMA/LABA 10.8% vs. LAMA 6.8%; both p < 0.05). Postoperative complications were lower frequent in the LAMA/LABA group than in the LAMA group (p = 0.007). In patients with moderate to severe air flow limitation (n = 61), those who received LAMA/LABA therapy had significantly longer overall survival and disease-free survival compared with the LAMA (p = 0.049, p = 0.026) and rehabilitation-only groups (p = 0.001, p < 0.001). Perioperative LAMA/LABA therapy was also associated with lower recurrence rates (vs. LAMA p = 0.006, vs. rehabilitation-only p = 0.008). CONCLUSIONS: We believe this treatment combination is optimal for patients with lung cancer and COPD.

Persistence of the Postoperative Change in the Six-minute Walking Distance of Lung Cancer Patients with Chronic Obstructive Pulmonary Disease.

OBJECTIVES: The aim of this prospective follow-up study was to investigate the difference before and after surgery in the six-minute walking distance (6MD) of lung cancer patients with chronic obstructive pulmonary disease (COPD) and to examine the long-term effect of the change in 6MD in the early postoperative period. METHODS: This was a retrospective analysis of 25 COPD patients who underwent lung cancer surgery and perioperative rehabilitation in our department. Assessments of 6WD were carried out preoperatively and at 1, 3, and 6 months postoperatively. The changes in 6MD at 1, 3, and 6 months postoperatively compared with the preoperative value were designated the 1-month Δ6MD, the 3-month Δ6MD, and the 6-month Δ6MD, and the associations between them were investigated. RESULTS: The mean 6MD distance was 412.0±27.3 m (95% confidence interval) preoperatively, 369.0±33.8 m at 1 month, 395.6±32.2 m at 3 months, and 400.0±38.2 m at 6 months, with a significant difference between the preoperative and 1-month values (P<0.01). There were strong correlations between 1-month and 3-month Δ6MDs (r =0.74, P<0.0001) and between 1-month and 6-month Δ6MDs (r =0.88, P<0.0001). CONCLUSIONS: In lung cancer patients with COPD, the 1-month Δ6MD was strongly associated with both the 3-month Δ6MD and the 6-month Δ6MD. These findings suggest that the decrease in exercise tolerance of patients whose 6MD is low at 1 month postoperatively may be prolonged, and such patients may therefore be in greater need of postoperative outpatient rehabilitation.

Diaphragm reconstruction by GORE DUALMESH in patients undergoing resection for thoracic malignancies.

BACKGROUND: We used GORE DUALMESH for the reconstruction of diaphragms in patients with thoracic malignancies. Here, we report the results. METHODS: Between July 2015 and August 2017, diaphragm reconstruction using 2-mm GORE DUALMESH was performed in 7 patients undergoing surgical resection for thoracic malignancies. After resection of the diaphragm, the mesh was trimmed to the size of defect and placed with the smooth surface facing the chest cavity and the rough surface facing the abdomen. It was fixed with interrupted sutures consisting of synthetic monofilament nonabsorbable 1-0 to 2 threads. RESULTS: Indications for resection were malignant pleural mesothelioma and primary lung cancer in 5 and 2 patients, respectively. Patients with malignant pleural mesothelioma underwent pleurectomy with decortication; patients with primary lung cancer underwent lung lobectomy. Right and left diaphragm reconstruction was performed for 4 and 3 patients, respectively. Neither complications related to diaphragm reconstruction nor displacement of mesh occurred during a follow-up period ranging from 11 days to 37 months. CONCLUSIONS: GORE DUALMESH is a good synthetic material for diaphragm reconstruction, because its smooth surface prevents adhesions to the lung and its rough surface allows adherence to abdominal tissue.

Long-term survival of airway silicone stents in patients with central airway stenosis or obstruction due to thoracic malignancy.

OBJECTIVES: Silicone airway stents are used to manage central airway stenosis or obstruction, although their impact on long-term survival remains unknown in patients with central airway stenosis or obstruction due to thoracic malignancy. In this study, we retrospectively analyzed the impact of silicone stents on survival. METHODS: We retrospectively analyzed clinical data of 106 patients with central airway stenosis or obstruction due to thoracic malignancy treated by stenting at Toho University Omori Medical Center between 1998 and 2018. RESULTS: Patients treated with silicone stents had significantly higher survival rates than patients treated with metallic stents (p = 0.0173). Silicone stents patients also had significantly more additional treatments for thoracic malignancy after stenting than metallic stents patients (p = 0.0007). Notably, significantly more silicone stents patients underwent chemoradiotherapy or radiotherapy (p = 0.0268, p = 0.0300). During multivariate analyses, the additional treatment, including chemoradiotherapy or radiotherapy, was an independent optimal prognostic factor. CONCLUSIONS: Silicone stents patients had significantly higher survival rates than metallic stents patients. Although stenting for airway stenosis or obstruction due to thoracic malignancy may be mainly palliative, additional treatments after stenting should be considered to improve the prognoses of patients with airway stenosis or obstruction due to thoracic malignancy.

Streptococcus anginosus group infection as a predictor for the progression of descending necrotizing mediastinitis.

BACKGROUND: The prognosis of descending necrotizing mediastinitis (DNM), especially that extending inferiorly to the carina, remains poor. The identification of additional prognostic factors may improve the prognosis. METHODS: We retrospectively analyzed six patients who underwent thoracic surgery for DNM extending to the anterior and posterior mediastinum inferior to the carina (Endo classification type IIB) from 2014 to 2020. We reviewed their characteristics, clinical course, causative bacteria, and treatment to investigate their prognostic factors. RESULTS: The median patient age was 62 years. Five patients were men and one patient was a woman. The causative disease in three of the patients was pharyngolaryngeal, and for the others, it was an odontogenic infection. Five patients had sepsis and four had disseminated intravascular coagulation (DIC) at surgery. Four patients had polymicrobial infections of aerobic and anaerobic bacteria, all of whom showed gas bubbles on a chest computed tomography scan and detection of Streptococcus anginosus group (SAG). All patients underwent cervicotomy, tracheostomy, and mediastinal drainage and debridement via a transthoracic approach. Three patients underwent additional surgery or drainage because an additional abscess appeared postoperatively. The median duration of hospitalization was 58 days and the mixed infections, including SAG, were all detected in the three cases of long-term hospitalization. No disease-associated death was observed during the follow-up period of 18 months. CONCLUSIONS: Mixed infection, including SAG, may be a predictor for DNM aggravation and spread. Gas bubbles on a chest computed tomography scan suggest polymicrobial aerobic and anaerobic infections including SAG, which require broad-spectrum antibiotic therapy and aggressive drainage and surgery.

Preoperative undernutrition predicts postoperative complications of acute empyema.

INTRODUCTION: Surgery for acute empyema is associated with postoperative complications and relapse. Establishing a predictor for postoperative complications may improve prognosis. OBJECTIVES: To demonstrate undernutrition as a predictor of complications after surgery for acute empyema. METHODS: We retrospectively analyzed 52 consecutive patients who underwent surgery for acute empyema from 2004 to 2019 and validated the correlation of undernutrition with serum albumin level, patient characteristics, hospital stay, and postoperative complications. RESULTS: The median preoperative serum albumin level was 2.4 g/dL (range: 1.1-3.4). The levels in all patients were lower than the standard value (3.5 g/dL). Patients were divided into two groups based on the median serum albumin levels: the low serum albumin level group (group L, n = 28) and the high serum albumin level group (group H, n = 24). Group L patients were significantly older (64.5 vs 52.9 years, P = .002), had lower median body mass index (21.0 vs 24.2, P = .008), and significantly had Streptococcus anginosus group as the causative bacteria (50% vs 21%, P = .044). Their hospitalization duration was significantly longer (28.1 vs 14.8 days, P < .001), and postoperative complications were significant or tended to be more frequent (all incidence; 11 (39%) vs 2 (8%), P = .012, respiratory-related; 7 (25%) vs 1 (4%), P = .056) in group L. Further analyses revealed that other undernutrition indicators also correlated with postoperative complications. CONCLUSIONS: Preoperative serum albumin level is a valid predictor of complications after surgery for acute empyema. Preoperative nutrition management for empyema patients may reduce the occurrence of postoperative complications.

A novel finding related to bulla and bleb formation in patients with primary spontaneous pneumothorax.

BACKGROUND: Spontaneous pneumothorax is a common problem globally. Bullas and blebs have been implicated in this problem, but the etiology of their formation is unknown. We aim to show the relation between a novel clinical finding, the pulmonary delayed inflation (PDI) sign, and the etiology of bulla and bleb formation in young patients. METHODS: We retrospectively analyzed data from 111 patients with pneumothorax and a control group of 27 patients. We evaluated the relation between the PDI sign and other clinical factors. RESULTS: The PDI sign was observed in 78 patients. Of these, 75 exhibited the PDI sign in only the upper lobe. Regardless of smoking status, patients 34 years of age or younger had a significantly higher incidence of the PDI sign than, patients 55 years of age or older and control patients. The inflation time in patients 34 years of age or younger, regardless of smoking status, was significantly longer than in patients 55 years of age or older and patients in the control group. There was no significant association between inflation time and the presence of asthma. CONCLUSIONS: The novel PDI sign is seen in patients 34 years of age or younger. Because this sign may indicate a peripheral bronchial abnormality and may be related to the formation of blebs and bullae in young patients with spontaneous pneumothorax, it is possible that it can be used to develop effective treatments for pneumothorax in young patients.

Contributions of Airway Stent for Long-term Outcome in Patients With Malignant Central Airway Stenosis or Obstruction.

BACKGROUND: Although an airway stent is used for malignant central airway stenosis or obstruction, long-term outcomes are unknown. In this study, we retrospectively analyzed the clinical features of patients who required stenting for malignant central airway stenosis or obstruction. PATIENTS AND METHODS: We retrospectively analyzed clinical data from 116 patients with stenting for central airway stenosis or obstruction who underwent treatment at Toho University Hospital from 1998 to 2018. We evaluated the clinical features, prognoses, and complications for stenting in these patients. RESULTS: The distribution of the 116 patients was as follows: lung cancer, 53; esophageal cancer, 40; thyroid cancer, 8; and others, 15. Patients with thyroid cancer had a significantly higher rate of complications after stenting than patients with lung cancer (P=0.0062), esophageal cancer (P=0.0029), and others (P=0.0062). Patients with esophageal cancer had a significantly worse prognosis than patients with lung and thyroid cancer. In patients with lung cancer the prognosis was significantly different between patients who underwent additional treatment for lung cancer after stenting and patients with no treatment (P=0.0398), and patients who received chemoradiotherapy for lung cancer after stenting had a significantly better prognosis than patients with no treatment (P=0.0306). CONCLUSION: Stenting for airway stenosis/obstruction may improve prognosis in patients with lung or thyroid cancer, especially if patients with lung cancer undergo additional treatments after stenting, although airway stenting for patients with esophageal cancer was palliative. New treatment strategies may be necessary for patients with esophageal cancer after stenting to improve prognosis.

Mediastinal tumor resection in a patient with spinocerebellar degeneration.

BACKGROUND: In spinocerebellar degeneration (SCD) patients, general and regional anesthesia may cause postoperative dysfunction of respiratory, nerve and muscle systems. We present the surgical case of thymoma developed in patient with SCD. CASE PRESENTATION: A 47-year-old woman with spinocerebellar degeneration was admitted because of a well-defined mass measuring 48 × 31 mm in anterior mediastinum. She showed limb, truncal, ocular, and speech ataxia; hypotonia; areflexia; sensory disturbances; and muscle weakness. Her eastern cooperative oncology group performance status was 4. Surgical resection was performed via video-assisted thoracic surgery and under general anesthesia only without epidural analgesia. The mass was diagnosed as type B1 thymoma without capsular invasion (Masaoka stage I). The patients got a good postoperative course by cooperation with anesthesiologists and neurologists in perioperative managements. She has been well over 3 years of follow-up. CONCLUSIONS: In conclusion, careful surgical and anesthesia management is essential for providing an uneventful postoperative course in patients with SCD. Especially, selection of minimal invasive approach and avoid diaphragmatic nerve damage are the most important points in surgical procedures.

Good syndrome with cytomegalovirus hepatitis: successful resection of Thymoma: a case report.

BACKGROUND: Good syndrome is a rare condition, manifesting as immunodeficiency due to hypogammaglobulinemia associated with thymoma. Herein, we present a patient with Good syndrome whose thymoma was resected after treatment of cytomegalovirus hepatitis. CASE PRESENTATION: The patient was a 45-year-old woman presenting with fever, cough, and nasal discharge, and was diagnosed with thymoma and hypogammaglobulinemia. She subsequently developed cytomegalovirus hepatitis that was treated by immunoglobulin. After resolution of the hepatitis, she underwent thymectomy through a left anterior thoracotomy. Her postoperative course was uneventful, and while receiving ongoing immunoglobulin therapy, she has been doing well without signs of infection. CONCLUSIONS: Management of infections is important for patients with Good syndrome. To minimize the risk of perioperative infection, we should take care while planning the surgical approach and procedure.

Toward improving prognosis prediction in patients undergoing small lung adenocarcinoma resection: Radiological and pathological assessment of diversity and intratumor heterogeneity.

OBJECTIVES: Prediction of prognosis based on the ground-glass opacity (GGO) ratio for small (≤2 cm) lung adenocarcinomas is not completely accurate. The aim of this study was to clarify the diversity of small adenocarcinomas and to identify ways to more accurately predict prognosis. MATERIALS AND METHODS: We retrospectively reviewed 62 patients (64 lesions) that underwent lobectomy for small (≤2 cm) lung adenocarcinoma. Proportions of histological components were measured and the presence of tumor spread through air spaces (STAS) was assessed. The correlations between GGO and histological components were examined. Furthermore, histological components of pure GGO lesions were analyzed using CT values. The intratumor heterogeneity of programmed death ligand 1 (PD-L1) expression was analyzed in 40 lesions. Furthermore, the relationship between CT/histological findings and prognoses was analyzed. RESULTS: In 13 pure GGO lesions, 7 (53.8%) lesions contained invasive components such as papillary, acinar, solid, and colloid. Tumor spread through air spaces (STAS) was also found in pure GGO lesions. Pure GGO lesions containing invasive components (p =  0.002) and STAS-positive lesions (p =  0.011) demonstrated strongly higher CT value. Differences in expression of PD-L1 among histological subtypes were observed in four of six (66.7%) PD-L1 positive lesions. Patients with papillary component, positivity for STAS, or CT value ≥ -140.6 Hounsfield units (HU) had significant poorer prognoses than patients without those in disease-free survival analyses (p =  0.007, p =  0.048, p = 0.012). Patients with the CT value < -383.4 HU and GGO ≥ 50% did not have recurrence. CONCLUSIONS: Invasive component and STAS can be present even in small GGO lesions, and patients with papillary components or STAS showed significantly poorer prognoses. STAS-positive lesions were strongly associated with a high CT value, and combined use of GGO ratio and CT value may be able to predict recurrences of lung cancer more accurately.

Resection of a Superior Mediastinal Mature Teratoma Using Intraoperative Neural Monitoring.

A 33-year-old woman presented with a right cervical mass. Contrast computed tomography showed a multilocular tumor with a clear border and heterogeneous contents including fat and calcification. The tumor was located adjacent to the vagus and recurrent nerves. To avoid injury of these nerves, we resected the tumor through a median sternotomy and right cervical lateral incision. Intraoperative neural monitoring was performed using an NIM TriVantage EMG tube (Medtronic, Minneapolis, MN). After the surgery, no neuropathy such as hoarseness was recognized. Pathological diagnosis showed a benign mature teratoma. Intraoperative neural monitoring is useful for superior mediastinal surgery around the vagus and recurrent nerves.

The role of video-assisted thoracoscopic surgery in the diagnosis of interstitial lung disease.

BACKGROUND: When a clinical context is indeterminate for idiopathic pulmonary fibrosis (IPF), or a chest high-resolution computed tomography (HRCT) pattern is not indicative of typical or probable usual interstitial pneumonia (UIP) in patients with interstitial lung disease (ILD), surgical lung biopsy should be considered to make a confident diagnosis on the basis of multidisciplinary diagnosis (MDD). AIM: The aim of this study was to evaluate the role and safety of video-assisted thoracoscopic surgery (VATS) in patients with ILD. METHODS: A total of 143 patients with ILD underwent VATS at Toho University Medical Center Omori Hospital between March 2004 and April 2017. We conducted a retrospective study on the usefulness and safety of VATS in the diagnosis of ILD under MDD. RESULTS: The 30-day mortality was 0%. The postoperative complication rate was 12.6%, which included 5 cases of pneumothorax after discharge (3.5%), 4 cases of prolonged air leakage (2.8%), and 2 cases of acute exacerbation (1.4%). Three of 9 cases (33.3%) complicated by pneumothorax after discharge or prolonged air leakage were resected specimens of pleuroparenchymal fibroelastosis (PPFE). Two patients had acute exacerbation, who were ultimately diagnosed as having idiopathic unclassifiable IP and had histologically significant irregular dense fibrosis and numerous fibroblastic foci. The comparison between chest HRCT and histopathological findings revealed 55 cases of possible UIP [UIP (45%), NSIP (25%), and unclassifiable IP (29%)] and 21 cases of inconsistent with UIP [UIP (10%), NSIP (33%), organizing pneumonia (10%), unclassifiable IP (24%), and PPFE (24%)]. CONCLUSION: VATS can be safely performed to obtain a confident diagnosis for appropriate treatment strategies in patients with ILD.