Changes in pedicle pericardial fat tissue around the anastomotic site after tracheobronchoplasty.

PURPOSE: Pericardial fat is appropriate tissue to cover the bronchial anastomotic site because its harvesting is minimally invasive. We investigated the changes in pericardial fat tissue around the anastomotic site after pulmonary resection with tracheobronchoplasty. METHODS: The subjects of this study were 43 lung cancer patients who underwent pulmonary resection with tracheobronchoplasty. We measured the maximum cross-sectional area and average computed tomography (CT) values of the pedicle pericardial fat pad around the anastomotic site 1 week and then 6 months after the operation. RESULTS: The average volume of the residual pedicle pericardial fat pad 6 months postoperatively was 61%. A body mass index (BMI) < 21.2 kg/m2 (P = 0.031) and a blood albumin level < 3.4 g/dl (P = 0.005) were significant predictors of pedicle flap shrinkage. Patients with fat tissue shrinkage had significantly elevated CT values 6 months postoperatively (P = 0.029), whereas those without shrinkage maintained low CT values. CONCLUSIONS: Preoperative nutritional conditions, reflected in high BMI and blood albumin levels, correlated with a high residual pedicle pericardial fat pad. Conversely, patients with pedicle flap shrinkage had significantly increased CT values, suggesting that the fat might have taken on another form such as scar tissue.

Surgical outcomes of primary lung cancers following esophagectomy for primary esophageal carcinoma.

BACKGROUND: The aim of this retrospective study is to evaluate the perioperative complications and prognosis of patients with a history of resected esophageal carcinoma who subsequently underwent pulmonary resection of a primary lung cancer. METHODS: The study cohort comprised 23 patients who had undergone curative resection of a primary lung cancer following esophagectomy for a primary esophageal carcinoma. Clinical characteristics and surgical outcomes were analyzed. RESULTS: The initial treatment for esophageal carcinoma was esophagectomy by thoracotomy in 10 patients and video assisted thoracoscopic surgery in 13. The treatments for lung cancer comprised wedge resection in three patients, segmentectomy in seven and lobectomy in 13. The pulmonary resections were performed by thoracotomy in six and video assisted thoracoscopic surgery in 17. The average operating time for the lung cancer surgeries was 202 min and average blood loss 122 ml. There were no perioperative deaths or severe complications. Three- and Five-year overall survival rates were 78.0% and 68.2%. According to univariate survival analysis, age, restrictive ventilatory impairment and histology of lung cancer were significant predictors of poor prognosis (all P < 0.05). Significantly more of the patients with than without restrictive ventilatory impairment died of other diseases (P = 0.0036). CONCLUSIONS: Pulmonary resection for primary lung cancers following esophagectomy for esophageal carcinoma is acceptable in selected patients. Such surgery requires caution concerning intrathoracic adhesions and postoperative prolonged air leakage. Patients with restrictive ventilatory impairment had a poorer prognosis, and the indication for surgery in these patients should be carefully considered.

[Sleeve Lobectomy for Right Middle Lobe and S6 Segment Lung Cancer:Report of a Case].

A 76-year-old man showed an abnormal chest shadow at the follow-up of treated gastric cancer. Chest computed tomography revealed mass lesions in the right middle and left upper lobes, and bronchoscopy revealed a nodular lesion at the entrance of the right B6. The right middle lobe and B6 lesions were diagnosed as lung cancer, and sleeve resection for the right middle lobe and S6 segment was performed. On postoperative day 98, partial resection of the left lung lesion was performed, and the pathological diagnosis was also lung cancer.

Combined sleeve lobectomy for centrally located primary lung cancer and lung cancer with hilar lymph node metastasis.

BACKGROUND: Centrally located lung cancer or metastatic hilar lymph nodes can invade the airway and other hilar structures, and they must be removed to achieve complete resection. METHODS: We retrospectively assessed the clinical course of 47 patients with centrally located lung cancer or metastatic hilar lymph nodes who underwent sleeve lobectomy from January 2010 to December 2017. RESULTS: The invaded structure other than the airway was the pulmonary artery in 21 patients, chest wall in 3, esophageal muscular wall in 2, vagus nerve in 2, pericardium in 2, left atrium in 1, phrenic nerve in 1 and superior vena cava in 1. Twenty-four patients were treated with sleeve lobectomy alone (simple sleeve lobectomy), and 23 patients were treated with sleeve lobectomy with additional methods (combined sleeve lobectomy). Adverse events occurred in 10 patients (48%) in the simple sleeve lobectomy group and 7 patients (30%) in the combined sleeve lobectomy group. During the follow-up period, 15 patients developed recurrent disease and 12 patients died. Patients in the combined sleeve lobectomy group had significantly shorter overall survival (P = 0.004) and disease-free survival periods (P = 0.013). Combined sleeve lobectomy was a significantly poor prognostic factor in the univariate and multivariate analyses. Patients who underwent sleeve lobectomy with an additional method other than angioplasty had a significantly poorer prognosis. However, no patient developed recurrent disease in the hilar area. CONCLUSIONS: Combined sleeve lobectomy has acceptable adverse events and good local controllability. However, combined sleeve lobectomy is associated with a significantly poorer prognosis than simple sleeve lobectomy in terms of overall survival and disease-free survival.

Sarcopenia is a novel poor prognostic factor in male patients with pathological Stage I non-small cell lung cancer.

OBJECTIVES: Sarcopenia is the progressive loss of muscle mass and strength, and has a risk of adverse outcomes such as disability, poor quality of life and death. As prognosis depends not only on disease aggressiveness, but also on a patient's physical condition, sarcopenia can predict survival in patients with various cancer types. However, its effects on postoperative prognosis in patients with localized non-small cell lung cancers (NSCLC) have never been reported. METHODS: We retrospectively investigated 215 male patients with pathological Stage I NSCLC. L3 muscle index is defined as the cross-section area of muscle at the third lumbar vertebra level, normalized for height, and is a clinical measurement of sarcopenia. We then investigated the effect of preoperative sarcopenia on their postoperative prognosis. RESULTS: Our 215 subjects included 30 patients with sarcopenia. Sarcopenia was significantly associated with body mass index, nutritional condition, serum CYFRA 21-1 level and pathological stage, but not with preoperative respiratory function or performance status. Frequency of postoperative complications, length of postoperative hospital stay, thoracic drainage period or causes of death were not correlated with the presence of sarcopenia. The sarcopenia group had a significantly shorter median overall survival (32 months) than the no-sarcopenia group. CONCLUSION: Sarcopenia might not affect short-term outcomes in patients with early-stage lung cancer. Sarcopenia was a predictor of poor prognosis in male patients with Stage I NSCLC. As sarcopenic patients with NSCLC patients are at risk for significantly worse outcomes, their treatments require careful planning, even for those with Stage I disease.

Stark Spectroscopy of Rubrene. II. Stark Fluorescence Spectroscopy and Fluorescence Quenching Induced by an External Electric Field.

We report Stark fluorescence spectroscopy investigation of rubrene dispersed in a poly(methyl methacrylate) film. The features of the fluorescence spectrum are analogous to those in solutions. In the Stark fluorescence spectrum, the decrease of the fluorescence quantum yield in the presence of an external electric field is observed. This result shows that the yield of nonradiative decay processes is increased by the application of an external electric field. It is known that the fluorescence quantum yield for rubrene, which is nearly unity at room temperature, depends on temperature, and a major nonradiative decay process in photoexcited rubrene is ascribed to a thermally activated intersystem crossing (ISC). Equations that express the field-induced fluorescence quenching in terms of the molecular parameters are derived from the ensemble average of electric field effects on the activation energy of the reaction rate constant in random orientation systems. The molecular parameters are then extracted from the observed data. It is inferred that the field-induced increase in the yield of other intramolecular and intermolecular photophysical processes in addition to the ISC should be taken into account.

Stark Spectroscopy of Rubrene. I. Electroabsorption Spectroscopy and Molecular Parameters.

Electroabsorption spectroscopy investigation and the determination of molecular parameters for rubrene dispersed in a poly(methyl methacrylate) (PMMA) matrix are reported. The features of the band system in the absorption spectrum in PMMA are analogous to those in solutions. The changes in the electric dipole moment and the polarizability between the excited and ground states are determined from analysis of the Stark effect in the absorption band. The change in the transition dipole moment in the presence of an external electric field is also observed. Although rubrene is predicted to be classified as a nonpolar molecule, there is a contribution of the difference in the electric dipole moment between the excited and ground states to the electroabsorption spectrum. The origin of the nonzero difference in the electric dipole moment is argued. Stark fluorescence spectroscopy investigation is reported in Part II of this series.

[Multiple Pulmonary Sclerosing Pneumocytoma with Abnormal Accumulation of Fluorodeoxyglucose-positron Emission Tomography Diagnosed by Surgical Treatment;Report of a Case].

A 36-year-old Chinese woman was referred to our hospital for further examination of an abnormal shadow on chest X-ray. Chest computed tomography(CT) revealed a 5 mm circular nodule in diameter in right lung S3 and a 32 mm mass in diameter in right lung S7. The S7 mass showed an abnormal accumulation of SUVmax=4.0 on positron emission tomography( PET)-CT. Transbronchial biopsy was performed, but failed to rule out possible malignancy. Differential diagnoses were multiple lung benign tumor, multiple lung metastases from unknown primary cancer, malignant lymphoma or primary lung cancer, and so on. We performed surgical resection for diagnosis. She underwent lung partial resection of S3 at 1st, and the intraoperative diagnosis of carcinosarcoma was made. Therefore, we performed additional lobectomy of the right lower lobe and mediastinum lymph node dissection. The postoperative course was uneventful. Pathological diagnosis was both pulmonary sclerosing pneumocytoma. No findings of recurrence have been detected at 1-year postoperatively.

GLUT1 and PKM2 may be useful prognostic predictors in patients with non­small cell lung cancer following curative R0 resection.

Lung cancer has a poor prognosis despite recent progresses being made regarding its treatment. In addition, there is a paucity of reliable and independent prognostic predictors for non-small cell lung cancer (NSCLC) following curative resection. Glycolysis is associated with the malignancy and proliferation of cancer cells. Glucose transporter 1 (GLUT1) promotes glucose uptake, whereas pyruvate kinase M2 (PKM2) promotes anaerobic glycolysis. The present study aimed to evaluate the relationship between the expression of GLUT1 and PKM2 and the clinicopathological features of patients with NSCLC, and to identify a reliable prognostic factor for NSCLC following curative resection. Patients with NSCLC who underwent curative surgery were retrospectively enrolled to the present study. GLUT1 and PKM2 expression was assessed using immunohistochemistry. Subsequently, the association between the clinicopathological features of patients with NSCLC and the expression of GLUT1 and PKM2 was assessed. Of the 445 patients with NSCLC included in the present study, 65 (15%) were positive for both GLUT1 and PKM2 expression (G+/P+ group). GLUT1 and PKM2 positivity was significantly associated with sex, absence of adenocarcinoma, lymphatic invasion and pleural invasion. Furthermore, patients with NSCLC in the G+/P+ group presented significantly poorer survival rates than those expressing other markers. G+/P+ expression was significantly associated with poor disease-free survival. In conclusion, the findings of the present study indicated that the combination of GLUT1 and PKM2 may be considered a reliable prognostic factor for patients with NSCLC following curative resection, especially in patients with stage I NSCLC.

Restrictive Ventilatory Impairment as a Poor Prognostic Factor in Patients Who Undergo Surgical Resection for Metachronous Second Primary Lung Cancer.

PURPOSE: To evaluate the prognostic impact of restrictive ventilatory impairment in patients who undergo pulmonary resection of metachronous second primary lung cancer. METHODS: The clinical characteristics and surgical outcomes of 70 patients with metachronous second primary lung cancer were analyzed. RESULTS: The surgical procedures consisted of wedge resection in 40 patients, segmentectomy in 17, lobectomy in 12, and completion pneumonectomy in one. Patients who underwent ipsilateral pulmonary resection developed more perioperative complications (p = 0.0339). Three-year and 5-year overall survival rates were 78.2% and 69.2%, respectively. In univariate analysis, sex, restrictive ventilatory impairment, and histology of second primary lung cancer were significantly poor prognostic factors (all p <0.05). Multivariate analysis identified restrictive ventilatory impairment to be an independent predictor of a poor prognosis (p = 0.0193). In the 22 patients who died, the cause of death was lung cancer in 11 and other diseases, including pneumonia and respiratory failure, in 11. Death from another disease was significantly more common in patients with restrictive ventilatory impairment (p = 0.0216). CONCLUSION: Restrictive ventilatory impairment was an independent predictor of a poor prognosis in patients with a second primary lung cancer. Restrictive ventilatory impairment as a result of repeated thoracic surgery may increase the likelihood of death from another disease.

Usefulness of pyruvate dehydrogenase-E1α expression to determine SUVmax cut-off value of [18F]FDG-PET for predicting lymph node metastasis in lung cancer.

A more accurate cut-off value of maximum standardized uptake value (SUVmax) in [18F]fluorodeoxyglucose positron emission tomography/computed tomography ([18F]FDG-PET/CT) is necessary to improve preoperative nodal staging in patients with lung cancer. Overall, 223 patients with lung cancer who had undergone [18F]FDG-PET/CT within 2 months before surgery were enrolled. The expression of glucose transporter-1, pyruvate kinase-M2, pyruvate dehydrogenase-E1α (PDH-E1α), and carbonic anhydrase-9 was evaluated by immunohistochemistry. Clinicopathological background was retrospectively investigated. According to PDH-E1α expression in primary lesion, a significant difference (p = 0.021) in SUVmax of metastatic lymph nodes (3.0 with PDH-positive vs 4.5 with PDH-negative) was found, but not of other enzymes. When the cut-off value of SUVmax was set to 2.5, the sensitivity and specificity were 0.529 and 0.562, respectively, and the positive and negative predictive values were 0.505 and 0.586, respectively. However, when the cut-off value of SUVmax was set according to PDH-E1α expression (2.7 with PDH-positive and 3.2 with PDH-negative), the sensitivity and specificity were 0.441 and 0.868, respectively, and the positive and negative predictive values were 0.738 and 0.648, respectively. The SUVmax cut-off value for metastatic lymph nodes depends on PDH-E1α expression in primary lung cancer. The new SUVmax cut-off value according to PDH-E1α expression showed higher specificity for [18F]FDG-PET in the diagnosis of lymph node metastasis.

Elevation of the Neutrophil-to-Lymphocyte Ratio Is a Significant Postoperative Poor Prognostic Factor in Patients With Clinical T3-4 Centrally Located Primary Lung Cancer.

BACKGROUND/AIM: In centrally located non-small cell lung cancer (CLNSCLC) surgery, large tumors and extension to neighboring structures prevent the attainment of adequate surgical fields and make operations more difficult, and some patients have extremely poor outcomes. This study aimed to identify novel postoperative prognostic factors in patients with advanced CLNSCLC. PATIENTS AND METHODS: CLNSCLC was defined as a tumor requiring pneumonectomy or sleeve lobectomy for complete removal. We retrospectively investigated the clinical courses of 35 patients with cT3-4 CLNSCLC. RESULTS: This study included 21 patients with cT3 and 14 with cT4 lung cancer. Nine patients underwent pneumonectomy and 26 underwent sleeve lobectomy. Univariate analysis revealed that a high neutrophil-to-lymphocyte ratio (NLR, p=0.005) and carcinoembryonic antigen (CEA) positivity (p=0.028) were significant poor prognostic factors. Only high NLR (p=0.020) was a significant independent predictor in multivariate analysis. Nine of 16 patients with high NLR (56%) experienced disease recurrence, whereas 6 of 19 patients without high NLR (32%) had recurrent disease. CONCLUSION: High NLR and CEA positivity were significant poor prognostic factors in patients with cT3-4 CLNSCLC, and only high NLR was an independent predictor. Our findings may be helpful in selecting optimal treatments for advanced CLNSCLC.

Surgical Outcomes After Pulmonary Resection With Typical or Atypical Bronchoplasty in Patients With Primary Lung Cancer.

BACKGROUND/AIM: Atypical bronchoplasty is essential for complete tumor removal and preservation of peripheral lung tissue. This study compared surgical outcomes after atypical or typical bronchoplasty in patients who underwent pulmonary sleeve resection with bronchoplasty. PATIENTS AND METHODS: Typical bronchoplasty was defined as that after one-lobe sleeve resection; atypical bronchoplasty was defined as that after sleeve bilobectomy or sleeve removal of one lobe plus segments. Double-barreled bronchoplasty was also included in the atypical group. Surgical outcomes were retrospectively investigated according to type of bronchoplasty. RESULTS: Fifty-one patients underwent typical bronchoplasty and 20 atypical bronchoplasty. Recurrence was seen in 17 out of 51 (33%) patients after typical bronchoplasty and 10 out of 20 patients (50%) after atypical bronchoplasty. The recurrence-free survival rate was significantly poorer in the atypical bronchoplasty group (p=0.038). However, patients in the atypical bronchoplasty group were able to receive anticancer treatment for tumor recurrence, and there was no significant difference in overall survival rates between the groups. CONCLUSION: Preservation of pulmonary function by atypical bronchoplasty might contribute to tolerability of anticancer treatment for tumor recurrence. Pulmonary resection with atypical bronchoplasty is reliably beneficial for overall survival.

Peripheral pulmonary mucous gland adenoma with a cavity mimicking lung cancer.

A 71-year-old woman presented to our hospital because of a 10 mm nodule with a cavity in right lower lobe on chest computed tomography. Fluorodeoxyglucose-positron emission tomography showed slight accumulation in the nodule (maximum standard uptake value 2.08). Her serum carcinoembryonic antigen concentration was 5.4 ng/mL. Wedge resection of the tumor was performed for diagnostic and treatment purposes. Findings on intraoperative pathological examination of a frozen section were suspicious for adenocarcinoma. We, therefore, performed a right lower lobectomy and mediastinal lymph node dissection. Postoperative histological examination revealed a mucous gland adenoma. The patient's postoperative course was favorable and she was discharged 7 days after surgery. Four months later, the serum carcinoembryonic antigen concentration had decreased to 3.1 ng/mL. Pulmonary mucous gland adenomas are rarely located peripherally. These benign tumors should be considered, even in the presence of high serum carcinoembryonic antigen concentrations or increased fluorodeoxyglucose uptake on fluorodeoxyglucose-positron emission tomography.

Large Tumor Size and High Neutrophil-to-lymphocyte Ratio Predicts Poor Prognosis After Pneumonectomy or Sleeve Lobectomy in Patients With Non-small-cell Lung Cancer.

BACKGROUND/AIM: The neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR) are useful biomarkers in non-small cell lung cancer (NSCLC). The aim of this study was to identify novel prognostic factors after pneumonectomy or sleeve lobectomy. PATIENTS AND METHODS: The clinical courses of 68 patients with NSCLC who underwent pneumonectomy or sleeve lobectomy were retrospectively investigated. RESULTS: High NLR (p=0.002) and PLR (p=0.006), and large tumor (>40 mm) (p=0.024) were indicative of poor prognosis in univariate analysis. High NLR (p=0.021) and large tumor (>40 mm) (p=0.017) remained independent factors indicating poor prognosis in multivariate analysis. Eighteen patients with both high NLR and large tumor (>40 mm) had significantly poorer prognoses than the remaining patients, 10 of them having recurrences within a short time after surgery. CONCLUSION: A high NLR and large tumor size indicate a poor prognosis after pneumonectomy or sleeve lobectomy. Our findings may be helpful in selecting optimal treatments for this subgroup of patients.

Impact of Central Airway Infiltration Type in Primary Lung Cancer Patients Treated With Sleeve Lobectomy.

BACKGROUND/AIM: There are two types of lung cancer cell infiltration into the central airway. One is when a centrally located lung cancer directly infiltrates the central airway and the other is when cancer cells in the metastatic hilar lymph node infiltrate the central airway. We aimed to identify the impact of central airway infiltration type on the clinical features of patients undergoing sleeve lobectomy. PATIENTS AND METHODS: The clinical courses of 58 primary lung cancer patients who underwent sleeve lobectomy between January 2010 and December 2020 were investigated. RESULTS: Primary tumors directly infiltrated into the central airway in 42 patients, whereas 16 patients had infiltration of cancer cells from the metastatic hilar lymph node. Primary tumor infiltration was a poor prognostic factor according to both univariate (p=0.016) and multivariate analyses (p=0.042). Operation times (p=0.240) and incidences of adverse events (p=0.926) were not associated with the type of central airway infiltration. CONCLUSION: The type of airway infiltration was an independent poor prognostic factor after sleeve lobectomy in primary lung cancer patients. Our findings may guide the selection of optimal treatments for this patient population.

Lung cancer surgery after COVID-19 infection in a patient with severe interstitial pneumonia and restrictive ventilatory impairment.

BACKGROUND: The spread of COVID-19 infection increased the number of patients who underwent pulmonary resection for lung cancer after COVID-19 infection. It is unclear how previous infection with COVID-19 affects perioperative complications and acute exacerbation of interstitial pneumonia after surgery in patients with interstitial pneumonia. CASE PRESENTATION: An 80-year-old man was referred to our hospital because of a tumor in his left lung. Chest computed tomography showed a 28-mm nodule in the lower lobe of the left lung and usual interstitial pneumonia in bilateral lungs. Bronchoscopic examination was performed, which diagnosed squamous cell carcinoma. Pulmonary function testing revealed restrictive ventilatory impairment, and we planned to perform basal segmentectomy of the left lung. However, before the planned surgery, the patient contracted symptomatic COVID-19. Chest computed tomography revealed ground-glass opacities owing to COVID-19. The patient was admitted for surgery 7 weeks after COVID-19 infection. Preoperatively, pulmonary function testing was repeated, which revealed decreased % vital capacity (%VC) and % diffusing capacity for carbon monoxide (%DLco). The 6-min walk test indicated a distance of 500 m, and the percutaneous oxygen saturation at the end of the test was 94%. Basal segmentectomy of the left lung was performed by video-assisted thoracoscopic surgery. The patient's postoperative course was favorable, and he was discharged without the need for oxygen inhalational therapy 12 days after the surgery. Pathological examination of the resected specimen revealed usual interstitial pneumonia in the non-cancerous areas of the lung. Additionally, the infiltration of immature fibroblasts in the alveoli and perivascular infiltration of inflammatory cells were observed, which were consistent with fibrotic change after inflammation owing to COVID-19. Three months after the surgery, the patient was alive without recurrence or acute exacerbation of the interstitial pneumonia. Pulmonary function testing 6 weeks after surgery revealed decreased %VC and %DLco. Testing 12 weeks after surgery revealed persistently decreased %VC and improved %DLco (Table 1). Table 1 Pulmonary function test results before and after COVID-19 infection and 6 and 12 weeks after surgery VC (ml) %VC (%) %DLco (%) Before COVID-19 infection 2070 71.9 74.9 7 weeks after COVID-19 infection 1700 59.6 51.9 6 weeks after surgery 1500 52.6 53.1 12 weeks after surgery 1510 53.0 61.7 %VC % vital capacity, %DLco % diffusing capacity for carbon monoxide CONCLUSION: We successfully performed basal segmentectomy of the left lung for lung cancer 7 weeks after COVID-19 infection in a patient with severe interstitial pneumonia and restrictive ventilatory impairment.

Elevation of Neutrophil-to-Lymphocyte Ratio Is a Significant Poor Prognostic Factor in Completely Resected Centrally Located Lung Squamous Cell Carcinoma.

BACKGROUND/AIM: The neutrophil-to-lymphocyte ratio (NLR) plays key roles in cancer growth. This study aimed to identify novel prognostic factors in patients who underwent complete resection of centrally located lung squamous cell carcinoma. PATIENTS AND METHODS: We retrospectively investigated the clinical courses of 45 patients who underwent sleeve lobectomy or pneumonectomy for centrally located squamous cell carcinoma. RESULTS: High NLR (p<0.001) and pathological T3/4 (p=0.008) were significant poor prognostic factors according to univariate analysis. Patients with pathological N2 had poor prognosis; however, there was no significant difference (p=0.095). Among these factors, only high NLR (p=0.003) was an independent poor prognostic factor according to multivariate analysis. Of the 23 patients with high NLR, 11 (49%) had recurrence, whereas in the 22 patients without high NLR, only two (9%) had recurrence. CONCLUSION: High NLR is an independent poor prognostic factor in centrally located lung squamous cell carcinoma. Our findings may guide the selection of optimal treatments for this subgroup of patients.

Detailed Surgical Techniques and Short-term Clinical Outcomes of Sleeve Lobectomy for Locally Advanced Right Lower Lobe Lung Cancer.

BACKGROUND/AIM: The surgical techniques of pulmonary resection with bronchoplasty for right lower lobe lung cancer are not well investigated. This study aimed to provide a detailed description of the pulmonary resection with bronchoplasty technique, including the appropriate patient selection process, in right lower lobe lung cancer patients. PATIENTS AND METHODS: The clinical courses of 17 right lower lobe lung cancer patients who had undergone pulmonary resection with bronchoplasty were retrospectively investigated. RESULTS: Of the 17 patients, 9 had right lower sleeve lobectomy, 5 had right middle and lower sleeve lobectomy, and 3 had right lower sleeve lobectomy with double-barreled bronchoplasty. The median follow-up period was 26 months. There were no treatment-related deaths. Distant organ recurrence was observed in 5 patients and local recurrence was identified in 3. One patient had pneumonia and another had prolonged air leak. Two patients, each of whom had either lower sleeve lobectomy or lower sleeve lobectomy with double-barreled bronchoplasty, developed bronchopleural fistula, and both patients were treated with additional surgery. CONCLUSION: Pulmonary resection with bronchoplasty should be performed only in oncologically and anatomically select patients. Our findings can be used as a guide to select the optimal treatments for this subgroup of patients.

Lymph Node Metastasis Location and Postoperative Adjuvant Chemotherapy in Patients With pN1 Stage IIB Non-small Cell Lung Cancer.

BACKGROUND/AIM: The benefit of adjuvant chemotherapy for patients with pN1 non-small cell lung cancer (NSCLC) according to the location of lymph node (LN) metastases remains unclear. In this study, we examined the location of LN metastasis and prognosis to identify the significance of adjuvant chemotherapy. PATIENTS AND METHODS: Thirty-five patients with pathological T1a-2bN1M0 NSCLC who underwent curative resection between 2010 and 2016 were enrolled in the study. We defined patients with LN metastasis extending in stations 10-12 as the hilar group (n=22), and only in stations 13-14 as the intralobar group (n=13). RESULTS: There was a significant difference in the overall survival (OS) (p=0.042) and disease-free survival (DFS) rates (p=0.021) between the intralobar and hilar groups. In the intralobar group, there were no significant differences in the OS and DFS rates according to adjuvant chemotherapy. However, patients without adjuvant chemotherapy had a poorer OS (p<0.001) and DFS rates (p<0.001) in the hilar group. CONCLUSION: Prognosis significantly differed according to adjuvant chemotherapy in the hilar group.