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The surgical approach for anatomical lung resection includes open thoracotomy, video-assisted thoracoscopic surgery, and robot-assisted thoracoscopic surgery. We evaluated the short-term outcomes and the learning curve wherein a thoracic resident doctor consecutively performed video-assisted thoracoscopic anatomical lung resection for lung cancer.We retrospectively reviewed 91 cases of consecutive video-assisted thoracoscopic anatomical lung resections for lung cancer performed by a thoracic resident doctor between November 2017 and March 2020. The thoracic resident doctor had no previous experience performing video-assisted thoracoscopic or open anatomical lung resection.Lobectomy was performed in 80 cases. Simple segmentectomy was performed in 11 cases. No cases required intraoperative conversion to open thoracotomy. The median operative time and blood loss were 148 min and 10 ml, respectively. There were no serious postoperative complications or deaths 30 days after surgery. The learning curve was examined using the cumulative sum method with operative time as a factor, and it took 21 cases to attain experience.Our resident doctor safely performed video-assisted thoracoscopic anatomical lung resections and it took 21 cases to stabilize the surgical technique. The surgical technique was possibly stabilized earlier than previously reported, although this was a study of a single resident doctor.

Background/aim Perforation and postoperative complications have a negative effect on long-term outcomes in patients with colorectal cancer (CRC). The aim of this study was to evaluate the clinical factors with special reference to postoperative complications predicting the long-term outcome in those for whom curative resection for perforated CRC was performed. Patients and methods Patients who underwent curative resection for perforated CRC at stage II or III from April 2003 to March 2020 were included. Clinical factors were retrospectively analyzed. Results Forty-four patients met the selection criteria. The 30-day mortality rate was 4.5% and the complication rate was 47.7%. Excluding 30-day mortality, five-year recurrence-free survival (RFS) and overall survival (OS) were 62.3% and 73.6%, respectively. Multivariate analysis showed that postoperative complications (p=0.005) and pT4 pathological factor (p=0.009) were independent prognostic factors for RFS. Only postoperative complications (p=0.023) were an independent prognostic factor for OS. Conclusion Postoperative complications were significantly associated with RFS and OS, and pT4 was associated with RFS. The prevention and management of postoperative adverse events may be important for perforated CRC.

Objective Resection is usually recommended for locally recurrent rectal cancer (LRRC) for which R0 resection is possible, but its suitability varies by individual patient risk. Here, we report outcomes of resected LRRC in our hospital. Methods We retrospectively evaluated short- and long-term results of 33 patients who underwent resections for LRRC from January 2003 to December 2019. Results At the initial surgeries for these 33 patients, their disease stages at that time were Stage I: n=2, Stage II: n=12, Stage III: n=11, Stage IV: n=6, and unknown: n=2. Patients with Stage IV disease at their initial surgeries underwent radical one-step or two-step procedures. Metastasis to other organs was observed in 5 patients at the their initial LRRC diagnoses. At the LRRC surgeries, 7 patients received palliative surgeries; 26 received intent-to-treat resections, of which 17 were R0 resections. All-grade postoperative complications were observed in 11 patients, including 1 surgery-related death. Five-year overall survival rates were all cases: 38.4%; R0 group: 52.3%, R1 or R2 group: 19.4%, and palliative surgery group: 0%. The R0 group thus had significantly better prognosis than other patients (P = 0.0012). Eleven patients in the R0 group (64.7%) suffered re-recurrences but some patients achieved long-term survival through chemotherapy, radiation therapy, and surgery for metastasis to other organs, even after re-recurrence. Conclusion Long-term prognosis after surgery for LRRC was significantly better for patients with R0 margins. Multimodal treatments may greatly improve survival for patients who suffer re-recurrences after local recurrence resections.

Highlights • Extremely rare case of appendiceal metastasis of squamous cell carcinoma of the lung. • Metastatic appendiceal tumor tend to perforate. • Surgery is recommended. • CT and PET-CT are useful for diagnosis., Introduction Lung cancer is one of the most common cancers. On the other hand, lung cancer metastasis to the appendix is extremely rare, and in many cases it has been diagnosed with the onset of acute perforating appendicitis. Presentation of case An 85-year-old man with fever and abdominal pain visited our hospital. He had a history of squamous cell carcinoma of the left upper and lower lobes, metastasis to the ipsilateral lung and femur. CT showed that a finding of acute perforating appendicitis, emergency cecal resection was performed. Examination of the resected specimen showed that the appendix was thickened overall, with a white nodular structure at the root and a perforation in the middle. The final diagnosis was acute perforating appendicitis caused by metastatic squamous cell carcinoma from the lung. The patient had no particular problems during the postoperative course. Discussion A PubMed search was performed, this appears to be the first reported case of appendiceal metastasis of squamous cell carcinoma of the lung. Since squamous cell carcinoma of the lung has a stronger tendency for local extension than other histological types, perforating appendicitis due to distant metastasis to the abdominal organs and metastasis to the appendix was reported as a very valuable case. Conclusion Because the progression of concomitant or secondary appendicitis is rapid, we recommend frequent imaging modalities, prophylactic appendectomy be considered for patients who also have lung cancer and imaging findings show suspected metastasis to the appendix.

Schwannomas that occur in the retroperitoneal cavity are rare. We herein report a patient who underwent safe laparoscopic resection by using a preoperative 3D computed tomography (CT) image and a fluorescent ureteral stent during the surgery. A 47-year-old man presented with left lower abdominal pain. CT showed a 10-cm continuous retroperitoneal tumor originating at the third lumbar nerve in the lower left abdomen. Schwannoma was suspected. We underwent laparoscopic resection of the tumor guided by 3D images obtained preoperatively. A fluorescent ureteral stent was implanted during the surgery to improve visibility and protect the left ureter. The resection was completed without injury of other organs and vessels. The patient was discharged on postoperative Day 5. By performing a preoperative simulation using 3D CT images, we could anticipate the anatomical findings and easily identify them intraoperatively. In addition, the fluorescent ureteral stent provided visual support, thereby contributing to safe surgery.

Introduction and importance Crystal-storing histiocytosis (CSH) is a rare clinical entity characterized by an abnormal increase in the number of histiocytes with massive accumulation of crystallized immunoglobulins. Yano et al. reported only one case of gastric CSH associated with Sjögren's syndrome. In this report, we present a case of pulmonary CSH with Sjögren's syndrome, and discuss the relevant literature. Case presentation A 64-year-old woman who had never smoked presented with cough 2 years earlier. Chest CT showed that the nodule in the right lower lobe had slowly enlarged to 12 × 10 mm. We suspected primary lung cancer and performed video-assisted thoracoscopic right S6 segmentectomy. Histopathological evaluation of the resected specimen revealed crystal-storing histiocytosis. As of 6 months postoperatively, no recurrence has been identified. Clinical discussion Eighteen cases of pulmonary CSH have been described in the English language peer-reviewed literature, including our case. In this case, the patient had a history of Sjögren's syndrome, but no lymphoproliferative or plasma cell disorder (LP-PCD). Therapy for all patients without LP-PCD was excisional resection of the lung. Treatment and prognosis of patients with CSH varied according to the defined pathology. Jones et al. reported the case of 54-year-old woman without LP-PCD who presented with a solitary asymptomatic focus of CSH in the lung and initially underwent lesion resection, but showed recurrence 10 years later. Conclusion Pulmonary CSH is one differential diagnosis for pulmonary nodule enlargement in patients with autoimmune disease. Surgical resection appears to represent an effective therapeutic option for localized CSH, but long-term follow-up remains necessary., Highlights • Pulmonary crystal-storing histiocytosis (CSH) with Sjögren's syndrome is extremely rare. • Pulmonary CSH is one differential diagnosis for pulmonary nodule enlargement in patients with autoimmune disease. • Surgical resection appears to represent an effective therapeutic option for localized CSH. • Although pulmonary CSH is a benign tumor, long-term follow-up is warranted.

Background/objective With increased life expectancy, the incidence of colorectal cancer in oldest-old patients has been rising. Advanced age is a risk factor for adverse outcomes after surgery. This study aimed to evaluate the short- and long-term outcomes of curative resection for colorectal cancer in nonagenarians. Methods Patients who had undergone curative resection for colorectal cancer (CRC) at Stage I to III from January 2010 to December 2019 were included. Cases of emergent surgery were excluded. The clinical characteristics were documented retrospectively, and factors affecting the long-term outcome were analyzed using multivariate analysis. Results Fifty patients met the selection criteria. Most of them were women (58.0%), and the median age was 92 years. Among these patients, 29 (58.0%) had a poor performance status (ASA-PS≥3). Laparoscopic surgery was performed in 42.0% of the patients, and 50% of the patients had postoperative complications classified as Clavien–Dindo grade 2 or severer, including 3 patients (6.0%) with grade 3 disease. No postoperative mortality occurred. The 30-day, 180-day, 1-year, 3-year and 5-year survival rates were 100%, 80.4%, 71.0%, 46.3%, and 33.8%, respectively. Multivariate analysis showed that a preoperative poor performance status (ASA-PS≥3) (HR: 3.067; 95% CI: 1.220–7.709; p = 0.017) was an independent prognostic factor for OS. Conclusion Curative elective resections for CRC in nonagenarians were performed safely without postoperative mortality. The preoperative performance status was significantly associated with OS after curative elective resection of colorectal cancer in nonagenarians. Our results suggest that excellent long-term outcomes can be achieved in a selected group with a good performance status.

Solitary diaphragmatic metastasis from early endometrial cancer is quite rare. We present a case of a 58-year-old woman who had been performed radical surgery for stageⅠA, G1 endometrial cancer 3 years before. The patient was referred to our hospital for chest abnormal shadow. Computed tomography (CT) and Magnetic resonance imaging (MRI) showed a mass in the right diaphragm, without the finding of liver invasion. We performed partial resection of diaphragm through video-assisted thoracoscopic surgery (VATS). After surgery, there were no serious complications and was discharged from the hospital on day 6 from surgery. Nine months later, the patient is alive without recurrence.

Extrapleural hematoma caused by thoracic vertebral burst fracture is very rare. We present the case of a 70-year-old man who was treated with a combination of video-assisted thoracic surgery (VATS) and extrathoracic operation. The patient was admitted to our hospital with complaints of dyspnea and pain in both legs. Computed tomography (CT) demonstrated a massive extrapleural hematoma in the right thoracic cavity, and 12th thoracic vertebral burst fracture. We treated the patient with pharmacotherapy because CT showed no active bleeding and the circulation and respiratory dynamics were stable. One week later, the hematoma was not reduced by pharmacotherapy, so we performed combination surgery of VATS. After surgery, there were no serious complications and the patient was discharged from the hospital on day 11 from surgery. In the following 2 months, there was no evidence of recurrence. The combination of VATS and extrathoracic operation was safe, and good result was obtained.

Scedosporium apiospermum is an opportunistic fungus that can cause various types of infections, including localized infections and life-threatening disseminated infections, particularly in immunocompromised patients. Treatment is especially challenging due to its multidrug resistance. We herein report the case of a 73-year-old woman who was non-immunocompromised but developed S. apiospermum lung infection and a pulmonary tumorlet. To our knowledge, this is the first report of the coexistence of pulmonary S. apiospermum infection and tumorlet. The lung lesion was successfully treated by surgical excision without any antifungal agents, and no recurrence of the tumorlet or S. apiospermum infection has occurred.

Scedosporium apiospermum is an opportunistic fungus that can cause various types of infections, including localized infections and life-threatening disseminated infections, particularly in immunocompromised patients. Treatment is especially challenging due to its multidrug resistance. We herein report the case of a 73-year-old woman who was non-immunocompromised but developed S. apiospermum lung infection and a pulmonary tumorlet. To our knowledge, this is the first report of the coexistence of pulmonary S. apiospermum infection and tumorlet. The lung lesion was successfully treated by surgical excision without any antifungal agents, and no recurrence of the tumorlet or S. apiospermum infection has occurred.

Bronchoscopic lung volume reduction (BLVR) for severe emphysema is less invasive than lung volume reduction surgery. Fibroblast growth factor-2 (FGF-2) has been reported to enhance fibrogenesis and angiogenesis. The aim of this study was to investigate the feasibility of BLVR with the FGF-2, and ability to reduce lung volume and promote recovery of lung function. The BLVR based on FGF-2 is less invasive than surgical procedures, and can be performed repeatedly if the effectiveness of volume reduction is inadequate. This simple bronchoscopic approach allows selective reduction in the volume of the emphysematous parenchyma, and intratracheal administration of FGF-2 induces an increase in pulmonary blood flow, thus allowing recovery of pulmonary function.

肺に穿破した縦隔成熟型奇形腫の2症例を経験し，その病因，臨床像について文献的考察を加え報告する．症例1は19歳女性．前胸部痛で来院，胸部CTで径3cmの前縦隔腫瘍を指摘され成熟型奇形腫の診断で手術を行った．手術所見では腫瘍は右肺上葉と強固に癒着しており，上葉部分切除および心膜合併切除を伴う腫瘍切除術を行った．組織学的には腫瘍は豊富な膵組織を有する成熟型奇形腫で，肺実質内に穿破していた．症例2は35歳女性．右胸部痛と血痰で来院，胸部X線で右中肺野に腫瘤影を指摘され，胸部CT，MRIで前縦隔奇形腫が疑われた．術中所見では腫瘍は右肺に穿破しており中葉切除を伴う腫瘍切除術を施行した．組織学的診断で成熟型奇形腫の肺内穿破と診断した．本疾患は多彩な臨床症状を呈し，確定診断に苦慮することも多いが今回MRIが有用であった．

症例は31歳，男性．生来健康であった．嚥下時の違和感が出現し持続するため近医受診した．胸部単純写真にて気管の右方偏位，CTにて上縦隔腫瘍を指摘され，精査加療目的に当科紹介となった．術前に確定診断を得ることができず，手術を施行したところ微小甲状腺癌の縦隔リンパ節転移であり，甲状腺左葉切除，左頚部郭清，縦隔腫瘍切除，左反回神経切除と再建，気管8リング合併切除再建を行った．術後経過は良好で，気管縫合不全や狭窄などの合併症はなく軽快退院した．現在術後12ヵ月経過したが，明らかな再発を認めず外来にて経過観察中である．縦隔腫瘍の鑑別疾患として，甲状腺癌の縦隔リンパ節転移も念頭においた精査が必要であると思われた．

To clarify the relationship between morphological measurements of hepatic volume by computed tomography (CT-vol) and functional volume (RI-vol) by technetium-99m galactosyl human serum albumin (99mTc-GSA) scintigraphy, and its clinical significance, we examined 16 patients with a background liver status of either normal liver function (n = 4), chronic hepatitis or cirrhosis (n = 7), or obstructive jaundice (n = 5). In five patients who underwent preoperative portal vein embolization (PVE), volumetric measurement was performed 2 weeks after PVE. The mean values of CT-vol and RI-vol of the right lobe were 692± 147 cm3 (66.1 ± 10.7%) and 668 ± 159 cm3 (67.8 ± 13.2%), respectively, and those of the left lobe were 329 ± 138 cm3 (33.9 ± 10.6%) and 328± 170 cm3 (32.2 ± 13.2%), respectively. There were no significant differences in the volume measurements between the two volumetric techniques. Correlations between CT-vol and RI-vol in the right and left lobes were positive and significant (r = 0.912 and 0.903, respectively; both P′s < 0.001). The mean values of post-PVE CT-vol and RI-vol of the right lobe in five patients were significantly different (628 ± 149 and 456± 211 cm3, respectively; P = 0.033). However, the mean values of post-PVE CT-vol and RI-vol of the left lobe were not different (496 ± 124 and 483± 129 cm3, respectively). We propose that volumetric measurement by 99mTc-GSA scintigraphy is useful for detecting changes in functional volume of individual lobes of the liver and is a more dynamic method compared with detection of morphological changes by CT scan.

Objective Bronchopleural fistula is a critical complication that may occur after pulmonary resection. Early closure of the fistula is required to prevent thoracic empyema or aspiration pneumonia. We have designed a novel procedure for bronchoscopic occlusion of the fistula with a collagen screw plug and assessed its feasibility in an experimental animal model. Methods Adult beagle dogs underwent right or left pneumonectomy, and the bronchial stump was closed with the Sweet method. A silicone bar (2 mm in diameter) was then placed in the middle of the bronchial stump. Seven days after the operation, the silicone bar was removed bronchoscopically, and fistula formation was confirmed. A screw-shaped 2% collagen screw plug (20 mm long and 3 mm in diameter) was mounted at the end of a modified endoscopic cannula and then inserted into the fistula. Autologous platelet-rich plasma was then soaked onto the inserted plug. Results Nine of 10 beagle dogs with bronchopleural fistula were treated successfully by plug occlusion. One dog died of pneumothorax caused by dislocation of the plug. Pathologic examination revealed that the collagen sponge had been replaced by fibrous tissue and that the fistula was covered with normal epithelium. Although soaking with platelet-rich plasma made the plug airtight immediately, the use of platelet-rich plasma seemed to make no distinct difference with respect to the treatment result or pathologic findings. Conclusion Bronchoscopic occlusion with a collagen screw plug is a promising option for treatment of small bronchopleural fistulas after pulmonary surgery.

Background and Objectives Recently, the use of the potassium-titanyl-phosphate (KTP) laser with a wavelength of 532 nm, which is half the wavelength of the neodymium:yttrium-aluminum-garnet (Nd:YAG) laser, has been expanding in many fields, since this laser offers hemostasis and vaporization with minimal coagulation of the underlying structures. The purpose of this study was to determine the usefulness of the KTP laser in limited lung resection done for pulmonary nodular lesions. Study Design/Patients and Methods We used the KTP laser to manage 10 partial resections (Group 1) and 16 segmentectomies (Group 2). The variables that were used to compare the two methods of resection included intra-operative blood loss, mean drainage time, and post-operative morbidity. Results The mean intra-operative blood loss was smaller in Group 1 (152.8 ± 65.0 cc, P = 0.002) than in Group 2 (341.9 ± 178.6 cc). Mean drainage time was shorter in Group 1 (1.8 ± 1.0 days, P = 0.0141) than in Group 2 (3.6 ± 2.9 days). The results of both groups with respect to hemostatic and healing effects were satisfactory. On histopathologic evaluation, the KTP laser-irradiated field tissue alteration consisted of two layers with a depth up to 2 mm. Conclusions The results of this study suggest that the KTP laser has the potential to become a useful and reliable tool for limited lung resection. Lasers Surg. Med. 38:290–295, 2006. © 2006 Wiley-Liss, Inc.

術前未確定診断の肺腫瘤性病変に対するに対する術中針生検（NAB）の有用性と安全性を検討した．術中NABを行った197例を対象とし合併症・正診率を評価した．また肺癌であった182例（NAB群）の再発と予後を確定診断後に手術した肺癌症例469例（POD群）と比較した．NABの悪性診断の感度は94％，正診率93.9％であった．NAB偽陰性の11例中9例は腺癌でうち6例は細気管支肺胞上皮癌であった．11例の平均腫瘍径は21mm，1例を除きIA期であった．NABによる重篤な合併症は認めなかった．NAB群で癌性胸膜炎による再発は5例（2.7％）でPOD群（10例，2.3％）と有意差はなく，早期の播種症例はなかった．IA期の5年生存率は91.2％でPOD群（81.5％）と差はなかった．肺癌確定診断のためのNABは合併症も少なく安全で，播種や予後増悪の可能性は極めて低い．

Study objectives Fibroblast growth factor (FGF)-2 is one of the most powerful angiogenic growth factors to be evaluated as an agent for the promotion of angiogenesis. The aim of this study is to investigate whether intratracheal administration of controlled-release FGF-2 microspheres restores pulmonary function in beagle dogs with emphysema Design Randomized, controlled, experimental animal study Subjects Eighteen Wister rats and 15 adult beagle dogs Methods In the rat study, we compared the time profiles of the radioactivity remaining after intratracheal injection of 125 I-labeled FGF-2, either incorporated with the controlled-release microspheres or as an aqueous solution. In the dog study, elastase-induced emphysema models were developed in 10 animals, classified into the following three groups: control group (n = 5), emphysema model with empty microspheres-treated group (FGF − group, n = 5), and emphysema model with FGF-2 containing microspheres-treated group (FGF + group, n = 5) Results In the rat study, controlled-release microspheres maintained higher whole-lung FGF-2 concentrations after intratracheal administration. In the dog study, Pao 2 in the FGF + group was significantly higher than in the FGF − group after treatment. Pulmonary perfusion dynamic MRI revealed significant improvement in the signal intensity of damaged lung with the FGF + group. Linear intercept of the FGF + group was significantly reduced than the FGF − group Conclusion Results indicate that intratracheal administration of FGF-2 induced an increase in pulmonary blood flow in the damaged lung and led to recovery of pulmonary function. The controlled-release microsphere system increased the effectiveness of FGF-2

The clinical significance of and discrepancy between the indocyanine green retention rate at 15min (ICGR15) and liver activity at 15min (LHL15) by technetium-99m galactosyl human serum albumin ( [Formula: see text] -GSA) scintigraphy and clinical outcome were examined in 140 patients who underwent hepatectomy. Both ICGR15 and LHL15 were significantly associated with portal pressure and liver function tests, fibrotic degree and regeneration of the remnant liver ( [Formula: see text] ). The significance of the correlation between LHL15 and liver functions and HAI score appeared to be better than that with ICGR15. A significant correlation was observed between ICGR15 and LHL15 ( [Formula: see text] 0.591, [Formula: see text] ) for all but 12 patients (8.6%). Of three patients with LHL15 better than ICGR15, two had obstructive jaundice and one had an intrahepatic shunt. Patient outcome was relatively good. In nine patients with LHL15 worse than ICGR15, the HAI score was higher (=7) and six of the nine had hepatic failure or uncontrolled ascites. Complications were frequently observed in patients with LHL15 below 0.875 (80% versus 30%, [Formula: see text] ). Our results indicate that [Formula: see text] -GSA scintigraphy is a reliable auxiliary test of hepatic functional reserve combined with ICGR15 for selecting the extent of hepatectomy and predicting patient outcome.

This study was designed to provide a histopathological analysis focusing on fibrosis (staging) and necroinflammatory reaction (grading, hepatitis activity index: HAI) in noncancerous liver tissue, and mitotic index (MI) in cancerous liver tissue to predict prognosis in 81 patients with chronic hepatitis or cirrhosis who underwent hepatectomy for hepatocellular carcinoma (HCC). The incidence of grade 2/3 and higher HAI was higher in patients with viral hepatitis C. The incidence of grade 2/3 was associated with vascular invasion of HCC, postoperative liver dysfunction, and cancer recurrence. Higher MI (≥5) was significantly associated with vascular invasion, poor histological differentiation, and recurrence rate (P < 0.05). Multivariate analysis showed that higher grade was the factor strongly associated with cancer recurrence (odds ratio: 10.621, P = 0.006). Higher MI correlated with overall patient survival (P < 0.05) by univariate analysis. Grading and MI are the useful prognostic markers for predicting tumor recurrence and patient survival.

Extensive sternal resection carries the risk of difficult reconstruction and surgical complications. A 79-year-old woman underwent sternal resection and reconstruction for sternal chondrosarcoma. However, 18 months after the first operation, she developed six metastatic tumors on the anterior chest wall. She underwent subtotal sternectomy and rib resection, leaving a defect measuring 17 × 14 cm. Reconstruction of the anterior chest wall using a titanium plate sandwiched between two polypropylene mesh sheets is described. This method is potentially applicable to extensive anterior chest resection, and its advantages compared with conventional prostheses are rigidity, flexibility, and usability., General Thoracic and Cardiovascular Surgery, 60(9), pp.590-592; 2012

症例は23歳の女性. 平成13年7月4日より腹痛嘔吐が出現し7月7日当院を受診した. 触診上, 左下腹部に圧痛を伴った鶏卵大腫瘤を触知した. 腹部エコー, CT検査において左下腹部にターゲットサインを認め, また上部小腸の拡張を認めた. 小腸重積症の診断で高圧注腸を試みたが, 整復が困難であったため緊急手術を行った. 回腸末端部より90cm口側の回腸が約15cmにわたって重積を起こしており, 約40cmの回腸を切除した. 重積回腸先進部の粘膜面に径約3cmの腫瘍を認めた. 病理組織学的には, 粘膜下組織と筋層内に平滑筋組織と混在する導管構造を認め, 迷入膵Heinrich分類III型と診断した. 迷入膵は胃, 十二指腸, 空腸などの膵の近傍に好発する疾患で, 回腸に発生することは比較的まれである. 回腸迷入膵は腸重積を引き起こし発症することが多く, 高圧注腸による整復が困難で腸切除を余儀なくされることが多い. 発生部位は回腸末端部より100cmまでの下部回腸に好発する.

This study was undertaken to investigate the efficacy of a video-assisted thoracoscopic (VATS) approach for stage I and II thymoma through comparisons with the transsternal approach. The indications for VATS resection were clinical stage I or II thymoma, a tumor less than 50 mm, located within the thymic lobes and separated from the brachiocephalic vein. Data were collected between 1995 and 2007. Twenty-seven patients underwent total thymectomy (15 by VATS and 12 by the transsternal approach). The mean tumor size was 36.3 (22–50) mm for VATS and 37.6 (15–55) mm for the transsternal group (p = 0.7862). The mean lengths of the operation were 249.8 min and 227.9 min (p = 0.2728), respectively. The mean intraoperative blood loss was significantly lower in VATS, at 92.3 ml, than the 225.1 ml lost in the transsternal group (p = 0.0020). The morbidity rates were 13.3 and 8.3 % (p = 0.6812), respectively. There was no mortality in either group. The mean follow-up periods were 109.0 (37–145) months following VATS and 102.0 (44–175) months following the transsternal approach. One stage II patient developed pleural dissemination three years after VATS resection. Other patients survived with no recurrence. VATS resection of early stage thymoma can be performed with less bleeding and with a comparable prognosis to the transsternal approach. VATS resection should thus be considered as a viable option for treatment.

The aim of our retrospective study was to compare the factors contributing to postoperative complications according to the extent of hepatectomy.We examined 166 patients with hepatobiliary carcinoma who underwent hepatectomy. Patients were divided into three groups according to the type and extent of hepatectomy: 1) left lobectomy (n=27), 2) right lobectomy or posterior segmentectomy (n=55) and 3) other hepatectomies (n=84). Patient demographics, major complications (infection, ascites, pleural effusion, atelectasis, static symptoms of the stomach, biliary leakage and hepatic failure) after hepatectomy were analyzed.In patients with obstructive jaundice, lobectomy was the most commonly performed operation due to the extent of tumor along the main hepatic duct. Prolonged ascites or massive pleural effusion was frequently observed after right lobectomy (p=0.001) and posterior segmentectomy (p=0.002). However, the incidences of these complications were similar in patients with chronic viral hepatitis. Symptoms related to gastric stasis and biliary leakage were significantly more common after left lobectomy than other surgeries. The incidence of hepatic failure was higher (p0.05) after major hepatectomy, particularly right lobectomy, than other surgeries.Our results emphasize the need to understand characteristics of specific complications occurring after different types of hepatic resection surgery to prevent post-hepatectomy complications.

Aims In a previous pilot study, we reported the usefulness of the modified the Cancer of the Liver Italian Program (CLIP) score for patients with hepatocellular carcinoma (HCC). To determine the best staging system for predicting the survival of HCC patients, we conducted a comparative analysis of prognosis using multivariate analysis in 210 Japanese HCC patients who underwent hepatic resection. Methods We compared the survival as predicted by various staging systems, including tumour node metastasis (TNM) stage of the American Joint Commission on Cancer (AJCC) and the Liver Cancer Study Group of Japan, the Japan Integrated Staging (JIS) score (Japanese TNM and Child-Pugh classification), CLIP score and our modified CLIP score using protein induced by vitamin K absence or antagonist II (PIVKA-II). Results Univariate analysis showed that discrimination of disease-free survival in the early and advanced stages by the JIS score and modified CLIP score was clearer than by the Japanese or AJCC TNM or the original CLIP score. Discrimination between stages of overall survival by all staging systems was significant. Multivariate analysis showed that the JIS, CLIP and modified CLIP scores were better staging systems for predicting survival than the Japanese and AJCC TNM. The modified CLIP score showed the lowest Akaike information criteria statistical value for disease-free and overall survival, which means the best discrimination ability for patient survival compared with the JIS score and CLIP score. Conclusions A staging system that combines tumour factors, sensitive tumour marker(s) and hepatic function is the best predictor of prognosis of HCC patients.

Aims. The new Japanese staging system for hepatocellular carcinoma (HCC), the Japan integrated staging (JIS) score, accounts for both Child–Pugh classification and Japan tumour node metastasis (TNM) staging. However, in HCC patients who undergo hepatectomy, liver function is relatively good and a better prognostic classification of hepatic function is necessary. Methods. The present study was designed to analyse the modified JIS score using liver damage grade by the Liver Cancer Study Group of Japan instead of the Child–Pugh classification (using the category indocyanine green retention rate at 15 min [ICG R15 ] instead of encephalopathy), and to compare the Japan TNM stage in 101 patients who underwent resection of HCC. Results. The liver damage grade showed significantly better discrimination of disease-free and overall survival than did the Child–Pugh classification. The modified JIS score system showed significant differences of disease-free and overall survivals in each score and this system was superior for discriminating survivals compared with the TNM staging. Conclusions. The combined staging system of hepatic function, particularly ICG R15 , and tumour stage provides a better prediction of prognosis. The JIS score using the liver damage grade was a useful predictor of prognosis of HCC patients who underwent hepatic resection.

Aims: The new staging system proposed by the Cancer of the Liver Italian Program (CLIP) for hepatocellular carcinoma (HCC) accounts for both liver dysfunction and tumour characteristics. The present study was designed to analyze UICC TNM stage, CLIP and modified CLIP in 91 patients who underwent hepatic resection for HCC. Methods: In the modified CLIP, scoring of AFP was replaced by that of protein induced by vitamin K absence or antagonist II (PIVKA-II; predictive value, ≥400 mAU/ml). Results: After hepatic resection, 54 patients developed recurrent tumours. High PIVKA-II was a significant determinant of recurrence (p

This study was designed to provide a histopathological analysis focusing on fibrosis (staging) and necroinflammatory reaction (grading, hepatitis activity index: HAI) in noncancerous liver tissue, and mitotic index (MI) in cancerous liver tissue to predict prognosis in 81 patients with chronic hepatitis or cirrhosis who underwent hepatectomy for hepatocellular carcinoma (HCC). The incidence of grade 2/3 and higher HAI was higher in patients with viral hepatitis C. The incidence of grade 2/3 was associated with vascular invasion of HCC, postoperative liver dysfunction, and cancer recurrence. Higher MI (or = 5) was significantly associated with vascular invasion, poor histological differentiation, and recurrence rate (P0.05). Multivariate analysis showed that higher grade was the factor strongly associated with cancer recurrence (odds ratio: 10.621, P = 0.006). Higher MI correlated with overall patient survival (P0.05) by univariate analysis. Grading and MI are the useful prognostic markers for predicting tumor recurrence and patient survival.

Objective The feasibility of a nerve guide tube for regeneration of the phrenic nerve with the aim of restoring diaphragmatic function was evaluated in a canine model. Methods The nerve tube, made of woven polyglycolic acid mesh, had a diameter of 3 mm and was filled with collagen sponge. This polyglycolic acid–collagen tube was implanted into a 10-mm gap created by transection of the right phrenic nerve in 9 beagle dogs. The tubes were implanted without a tissue covering in 5 of the 9 dogs (group I), and the tubes were covered with a pedicled pericardial fat pad in 4 dogs (group II). Chest x-ray films, muscle action potentials, and histologic samples were examined 4 to 12 months after implantation. Results All of the dogs survived without any complications. X-ray film examination showed that the right diaphragm was paralyzed and elevated in all dogs until 3 months after implantation. At 4 months, movement of the diaphragm in the implanted side was observed during spontaneous breathing in 1 dog of group I and in 3 dogs of group II. In the dogs showing diaphragm movement, muscle action potentials were evoked in the diaphragm muscle, indicating restoration of nerve function. Regeneration of the phrenic nerve structure was also examined on the reconstructed site using electron microscopy. Conclusion The polyglycolic acid–collagen tube induced functional recovery of the injured phrenic nerve and was aided by coverage with a pedicled pericardial fat pad.