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In patients with lung cancer invading the left atrium, performing complete resection is difficult. In many cases of complete resection, pneumonectomy is performed. We herein report two techniques in which complete resection with negative margins at the intrapericardial pulmonary vein and left atrium was achieved without pneumonectomy. In the first technique, the groove of the pericardium between the right and left atrium was dissected and an atrial cuff was made in a manner that elongated the intrapericardial pulmonary vein. In the second technique, traction was applied to the atrial cuff, and only the middle lobe vein of the elongated pulmonary vein was resected, to perform atrial cuff plasty. The upper lobe vein and inferior pulmonary vein could be preserved. These techniques of PV elongation and atrial cuff plasty are suitable for both achieving complete resection and lung preservation for lung cancer patients with invasion of the left atrium.

Highlights • The treatment of patients for lung cancer with vertebral body invasion remains challenging. • We reported a case that total vertebrectomy (Th2) and dissection subclavian artery for lung cancer invading spine and subclavian artery. • We experienced complete resected one case that tumor location and invading was very complicated., Introduction Surgery for primary lung cancer invading the spine remains challenging. Here, we present a case of superior sulcus tumor (SST) with vertebral invasion, successfully resected with total vertebrectomy (Th2) and dissection of involved apical chest wall and the subclavian artery (SCA). Presentation of case A 62-year-old man was referred with the diagnosis of lung squamous cell carcinoma originating from left upper lobe (clinical stage IIIA/T4N0M0) involving the thoracic vertebrae (Th2) as well as the apical chest wall including three ribs (1st, 2nd and 3rd) and SCA. After induction concurrent chemo-radiotherapy, we achieved complete resection by three-step surgical procedures as follows: first, the anterior portion of involved chest wall including SCA was dissected through the trans-manubrial approach (TMA); next, the posterior portion of involved chest wall including ribs was dissected and left upper lobectomy with nodal dissection was performed through posterolateral thoracotomy; finally, total vertebrectomy (Th2) was performed through posterior mid-line approach. Discussion This tumor was existence of anterior and posterior position in pulmonary apex region. So that, it is very important for complete resecting this complicated tumor to work out operation’s strategy. Conclusion Surgery may be indicated for SST invading the spine, when complete resection is expected.

Follow-up by chest CT is often performed routinely after stereotactic body radiotherapy (SBRT) for primary lung cancer. We investigated how often periodical chest CT detected lung-cancer related chest events (failure in the chest, new primary lung cancer), and how often chest CT follow-ups led to curative intent salvage treatment. Between 2006 and 2009, 90 stage I primary lung cancers in 86 patients received SBRT. In principle, chest CT was scheduled every 2–3 months in the first two years, and every 3–4 months thereafter. Median time to follow-up by chest CT was 26 months (1–61 months). Twenty-seven lung-cancer related chest events were detected by periodical chest CT after SBRT. The three-year lung-cancer related chest event free rate was 62 %. It was possible to apply curative-intent salvage treatment to 56 % of the lung-cancer related chest events. The two-year overall survival rate was 66 % among the 13 patients who received curative-intent salvage treatment (radiotherapy, 11; surgery, 2). Post-SBRT lung-cancer related chest events (as detected by periodical chest CT) were not uncommon (approximately 40 % at 3 years from SBRT), and it was possible to treat more than half of these lesions with curative-intent salvage treatment.

To define the factors associated with increased risk of isolated locoregional failure that may justify postmastectomy radiotherapy in patients with T1/2 breast cancer and 1–3 positive lymph nodes. Between 1990 and 2002, 248 patients who had pT1–2 breast cancer and 1–3 positive lymph nodes were treated with mastectomy without radiotherapy (age 32–84, median 54). Median follow-up time was 82 months (range 2–189 months). For all patients, the 8-year isolated locoregional failure-free rate was 95 %. In univariate analysis, hormone receptor status and administration of hormone therapy were statistically significant factors, and vascular invasion was the borderline significant factor for isolated locoregional failure-free rates (P = 0.0377, 0.0181, and 0.0555, respectively). The 8-year isolated locoregional failure-free rates were 98 % for patients with positive hormone receptor status and 90 % for patients with negative hormone receptor status, 97 % for patients who received hormone therapy and 89 % for patients who did not receive hormone therapy, 92 % for patients with vascular invasion and 97 % for patients without vascular invasion. In multivariate analysis for hormone receptor status and vascular invasion, the former was statistically significant (P = 0.0491) and the latter was borderline significant (P = 0.0664). When patients had both negative hormone receptor and positive vascular invasion status, the 8-year isolated locoregional failure-free rates decreased to 83 %. With regard to patients who had pT1/2 breast cancer and 1–3 positive lymph nodes, isolated locoregional failure was not common in general; however, patients who had both negative hormone receptor status and vascular invasion were comparatively high-risk patients for isolated locoregional failure.

To identify factors affecting local control of stereotactic body radiotherapy (SBRT) for lung tumors including primary lung cancer and metastatic lung tumors.Between June 2006 and June 2009, 159 lung tumors in 144 patients (primary lung cancer, 128; metastatic lung tumor, 31) were treated with SBRT with 48-60 Gy (mean 50.1 Gy) in 4-5 fractions. Higher doses were given to larger tumors and metastatic tumors in principle. Assessed factors were age, gender, tumor origin (primary vs. metastatic), histological subtype, tumor size, tumor appearance (solid vs. ground glass opacity), maximum standardized uptake value of positron emission tomography using (18)F-fluoro-2-deoxy-D: -glucose, and SBRT doses.Follow-up time was 1-60 months (median 18 months). The 1-, 2-, and 3-year local failure-free rates of all lesions were 90, 80, and 77 %, respectively. On univariate analysis, metastatic tumors (p0.0001), solid tumors (p = 0.0246), and higher SBRT doses (p = 0.0334) were the statistically significant unfavorable factors for local control. On multivariate analysis, only tumor origin was statistically significant (p = 0.0027). The 2-year local failure-free rates of primary lung cancer and metastatic lung tumors were 87 and 50 %, respectively.A metastatic tumor was the only independently significant unfavorable factor for local control after SBRT.

Intrapericardial vessel management is one of the necessary techniques for respiratory surgeons. We collected cases that had undergone intrapericardial vessel management for lung cancer, and herein discuss the practical performance and safety of this treatment method. We identified 23 (5.6%) of 413 patients who had undergone lung cancer surgery during the 30-month period from January 2011 to June 2013 at our institution. Twenty cases had large sized tumors near the hilum. Three cases demonstrated severe adhesion in the intrathoracic region due to a previous operation. The lung cancer staging was stage ⅠA in 1 case, stage ⅠB in 4 cases, stage ⅡB in 5 cases, stage ⅢA in 11 cases, stage ⅢB in 1 case, and stage Ⅳ in 1 case. We performed lobectomy in 11 cases, bilobectomy in 6 cases, and pneumonectomy in 6 cases. The average operation time was 366 minutes (137-965). Post operative complications were observed in five cases, including two cases of air-leakage and three cases of arrhythmia. All cases were able to walk on foot at discharge. It is important to clearly understand intrapericardial anatomy in order to carry out successful intrapericadial vessel management.

Many studies have been performed, on the clinical outcome and prognostic factors in patients with cervical cancer treated with radical hysterectomy and postoperative radiotherapy, but no useful method for predicting the risk of recurrence has been established. The purpose of this study was to analyze histopathological prognostic factors. In addition, we proposed a new risk classification and evaluated its usefulness. One hundred and thirty patients with stage I-II uterine cervical cancer were treated with radical hysterectomy and postoperative radiotherapy at Ehime University Hospital between 1978 and 1997. All surgical specimens were reviewed, and the relationship between histopathological factors and the clinical outcome was analyzed. Of the histopathological prognostic factors of the surgical specimens analyzed, six factors (parametrial invasion, venous infiltration, pelvic lymph node metastases, thickness of the residual muscular layer, tumor depth, and tumor growth pattern) were significant prognostic factors. In particular, venous infiltration and pelvic lymph node metastases were strongly correlated with recurrence. Using the above five factors (excluding the thickness of the residual muscle layer), all patients were scored based on the total number of poor prognostic factors, and were classified into three groups. Patients with a score of 0–1 were classified as the low-risk group, those with a score of 2 as the intermediate group, and those with a score of 3–5 as the high-risk group. The 5-year disease-free survival rates were 93% in the low-risk group, 82% in the intermediate group, and 56% in the high-risk group (P < 0.05). Six prognostic factors were found. Our risk classification seems to be clinically useful to predict which patients are at risk of recurrence.