Right Lower Sleeve Lobectomy: Detailed Technique and Perioperative Patient Management.

PURPOSE: This report reviews our experience with right lower sleeve lobectomy and describes our technique and approach to perioperative patient management. METHODS: We retrospectively reviewed 11 patients who underwent right lower sleeve lobectomy for lung cancer. Surgical techniques and perioperative management were also investigated. RESULTS: Bronchoplasty was performed using 4-0 absorbable monofilament sutures. The deepest portion was anastomosed using continuous sutures; interrupted sutures were used for the more superficial portions. The truncus intermedius and right middle lobe bronchus should be anastomosed in a natural position. Anastomosis patency was confirmed using intraoperative bronchoscopy. Separation of the right upper and middle lobes and pericardiotomy at the inferior edge of the superior pulmonary vein are useful for mobilizing the right middle lobe. Death during hospitalization and treatment-related death did not occur. One patient developed pneumonia, and another developed a bronchopleural fistula. CONCLUSION: We reported our technique of right lower sleeve lobectomy and our approach to perioperative patient management. Sharing knowledge is essential to completing this rare surgery.

[Factors and Mechanisms of Pleural Dissemination in Surgically Treated Cases of Lung Metastasis Originated from Pancreatic Cancer].

Pancreatic cancer with distant metastasis typically results in a poor prognosis, but patients with only pulmonary metastasis are reported to have a relatively good prognosis. In this study, we investigated the clinicopathological data and prognosis of 15 patients who underwent surgery for lung metastasis of pancreatic cancer at our hospital between April 2010 and December 2021. The median disease-free interval after pancreatic cancer treatment was 24.5 (9.6-71.8) months. Ten of the 15 patients underwent successful radical resection, while the remaining 5 had pleural dissemination and underwent non-radical resection. The median follow-up duration was 13.5 months, with the median survival time for radical resection and non-radical resection cases being 49.5 months and 31.2 months, respectively. This indicates significantly worse prognosis for non-radical resection cases( p=0.010). Furthermore, the median CA19-9 levels before lung resection were 22 U/ml for radical resection and 2,181 U/ml for non-radical resection cases, significantly higher in the latter (p=0.049). Immunostaining of resected specimens revealed that MMP-2 was positive in 11 of 15 cases, particularly in 4 of 5 cases with pleural dissemination. CA19-9 levels before lung resection may be a predictive factor for pleural dissemination, and MMP-2 may play a role in the mechanism of pleural dissemination.

[Long-Term Survival Following Multidisciplinary Therapy for Pancreatic Head Cancer with Liver Metastasis].

A 71-year-old female was referred to our hospital for liver dysfunction. After careful examination, she was diagnosed with resectable pancreatic head cancer. Pancreatoduodenectomy was scheduled. In the laparotomy, 2 nodules on the liver were found. A frozen section examination of the liver nodule revealed adenocarcinoma. S-1 chemotherapy was administered for about 17 months to treat the unresectable pancreatic cancer. After chemotherapy, computed tomography(CT) revealed that the pancreatic tumor remained unchanged, and there was no distant metastasis. Positron emission tomography( PET)-CT revealed no significant uptake in the pancreatic tumor and no distant metastasis. The patient was then observed for about 10 months without chemotherapy. After that, CT showed that the size of the pancreatic tumor had increased, but there were no signs of distant metastases. Therefore, pancreatoduodenectomy was performed. Histopathological examination revealed invasive ductal adenocarcinoma in the pancreas head. The patient underwent adjuvant chemotherapy with S-1 for 5 months. So far, she has survived without any recurrence for 57 months after the initial surgery.