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乳癌は発見時の腫瘍の大きさ,所属リンパ節転移数などにより,外科治療後の予後が大きく左右されるため,早期発見,早期治療が重要である.今回われわれは1997年4月から2003年9月までの6.5年間の当院人間ドックでの視触診による乳癌検診の成績および外科治療を含めた臨床的検討を行った.総受診者数は15,683人で,平均年齢は51.4歳であった.要精検者数は543人(3.46%),乳癌発見数は15人(0.10%),陽性反応的中率は2.76%であった.最大腫瘍径が2 cm以下の乳癌は13例(87%)であった. 15例の組織型は硬癌が7例(46%),乳頭腺管癌が3例(20%),充実腺管癌が2例(13%),粘液癌,髄様癌,小葉癌がそれぞれ1例(7%)と,低分化の硬癌が最も多かったが,リンパ節転移では12例(80%)が陰性であり,早期の乳癌が多かったことを裏づける結果であった.予後はn1βの1例が再発死亡した以外,現在無再発生存中である.発見乳癌に占める最大腫瘍径2 cm以下の乳癌の割合が87%と高率であったことは乳癌からの救命という乳癌検診の目的と合致しており,当院の乳癌検診の状況は妥当なものであると考えられた.

甲状腺乳頭癌初回手術後35年目に上腹部皮下に単発の転移性腫瘍をきたした1例を経験したので報告する.症例は73歳の女性.甲状腺乳頭癌で35年前に甲状腺全摘術および頸部リンパ節郭清術が行われた.上腹部皮下の腫瘍は15×15mm大で,比較的軟らかく,可動性良好であった.穿刺吸引細胞診ではclass V,甲状腺乳頭癌からの転移が疑われた.頸部リンパ節,骨,肺転移を認めなかったため,腫瘍が摘出された.低分化の甲状腺乳頭癌であり,サイログロブリンの免疫染色にて陽性所見であった.甲状腺乳頭癌の血行性遠隔転移は舌,皮膚,脳などの報告が散見されるが,稀であり,本症例も血行性転移が推測された.

乳腺原発内分泌細胞癌は稀な腫瘍であるが,われわれはその1例を経験したので報告する.症例は66歳女性で主訴は右乳腺腫瘤であった.超音波検査所見,マンモグラフィ検査所見では境界明瞭で良性腫瘍が考えられた.穿刺吸引細胞診検査では血性内容液が見られ, class IIあるいはIIIであったため,確定診断の目的で腫瘍摘出術が施行された. HE染色による病理組織学的所見およびクロモグラニンA染色の陽性所見に加えて,戻し電顕検査にてdense core-granuleが確認されたため乳腺原発内分泌細胞癌と診断された.

症例は60歳,男性. 2001年9月,発熱,腹痛を主訴に当院入院.精査にて下部胆管癌と診断され2001年11月膵頭十二指腸切除術が施行された.切除標本にて胆管癌と別に胆嚢底部に25×20mm大の平坦浸潤型腫瘍を認めた.病理組織検査にて胆管癌は結節浸潤型腺癌,胆嚢病変は小細胞癌で,免疫染色ではグレメリウス,クロモグラニン, NSEが陽性であった.術後にCPT-11+CDDPの補助化学療法を施行し,無再発生存中である.胆嚢原発小細胞癌は稀な疾患であるが,切除後早期に再発をきたすため化学療法の併用を必要とする意見が多いが一定の見解は得られていない.また胆嚢小細胞癌報告例のなかでも胆管腺癌との同時性重複癌症例はなく,極めて稀な症例と考えられ報告する.

膵solid cystic tumorは若年女性に好発する比較的稀な疾患である.今回われわれはTurner症候群に併存した膵solid cystic tumorの1例を経験したので報告する.症例は35歳の女性で, 1999年8月健診での腹部超音波にて膵腫瘍を指摘され,当院受診.腹部CT, MRIから膵尾部solid cystic tumorと診断された.また低身長,原発性無月経があり染色体分析が行われたが46, X, i(q10)/45Xの性染色体異常を示し, Turner症候群と診断された. 2000年7月膵尾部切除が行われた.腫瘍は病理組織学的に膵solid cystic tumorであった.組織エストロゲンレセプター,プロゲステロンレセプターは陰性であり,本症例では膵solid cystic tumorの発現あるいは発育における女性ホルモンの関与は否定的であった. Turner症候群に合併する膵腫瘍は極めて稀とされるが文献的考察を加えて報告する.

甲状腺癌のほとんどを占める乳頭癌は分化度の高いものが多く,早期発見および適切な外科治療により治癒が期待できる.今回われわれは, 1997年4月から2002年3月までの5年間の当院人間ドックにおける触診での甲状腺癌検診の成績および外科治療を含めた臨床的検討を行った.発見率は総受診者25,139人中58人(0.23%)で,男性は17,443人中11人(0.06%),女性は7,696人中47人(0.61%)であった.最大腫瘍径が1cm以下のいわゆる微小癌は25例(43%)であった.組織型は乳頭癌は56例(96%)で,濾胞癌,髄様癌はそれぞれ1例(2%)であった.リンパ節転移陽性は27例(47%)に認められた.いずれも手術時合併症はなく現在再発を認めていない.人間ドックでの早期発見により侵襲,合併症が少ない治療が可能で患者のQOLは向上することが期待され,検診の意義は十分にあると考えられる.

症例は88歳,女性. 2001年6月腹痛を主訴に来院.右側腹部から右下腹部に圧痛,筋性防御を認めた.胸部・腹部単純X線写真ではfree airを認めなかったが,腹部造影CT検査にて右側後腹膜に広範な低吸収域を認めた.汎発性腹膜炎として開腹手術が行われた.十二指腸下行部外側に径3cm大の憩室とその穿孔を認め,憩室切除,縫合閉鎖およびドレナージが行われた.病理組織学的には切除された憩室は層構造が破壊され好中球浸潤とフィブリンの析出が著明であった.術後経過は良好であった. 十二指腸憩室は日常臨床上よく見られる疾患であるが外科的治療の対象となるものは稀である.興味深いCT所見を呈した十二指腸憩室穿孔の1例を経験したので若干の文献的考察を加えて報告する.

症例は75歳,男性. 1999年3月横行結腸癌に対して横行結腸切除(D2郭清)が施行された.病理組織学的に中分化腺癌, se, ly1, v0, n (-)であった. 2000年11月腹部CTで脾上極に径10mm大の低吸収域を認めた. 2001年4月脾腫瘍の増大と血清中CEA値の上昇を認めたため大腸癌孤立性脾転移と診断され, 2001年5月脾摘出術が行われた.病理組織学的に高分化腺癌で大腸癌の脾転移と診断された.術後CEA値は正常化したが,再手術3ヵ月後に肝両葉に多発転移を, 10ヵ月後に胸腔内転移を認めた.化学療法を施行しているが脾摘手術後14ヵ月経過した現在,坦癌生存中である.稀な大腸癌の孤立性脾転移の1例を経験したので文献的考察を加えて報告する.

A kindred with five members with papillary thyroid carcinoma is reported. The patients were three females and two males. The index patient was a 21-year-old man, whose mother had undergone a surgical therapy for papillary thyroid carcinoma in other hospital 8 years before his admission. In addition his elder brother with papillary thyroid carcinoma visited the hospital. Because of the family history, a screening study for thyroid disease was performed on other six members of the family and revealed that there were two patients with papillary thyroid carcinoma. One was a 49-year-old aunt of index patient and the other was a 79-year-old grand mother. The surgical treatments were performed for four out of these five patients in the hospital. It is believed that total thyroidectomy seems to be the choice of operation for papillary thyroid carcinoma with a familial occurrence. In these cases, however, we employed near total thyroidectomy to prevent from postoperative complications. A family screening study which may permit early detection of the disease should be continued strictly.

症例は75歳, 女性.1992年3月21日, 左下葉の肺硬化性血管腫に対して核出術を施行した.術後, 外来で経過観察されていたが, 手術より約4年後の1996年5月, 胸部X線写真上, 左上下肺野に腫瘤陰影が多数認められ, 擦過細胞診で肺硬化性血管腫と診断された.本症例はその臨床経過より再発と考えられた.従来より肺硬化性血管腫の手術術式は核出術が一般的であったが, 核出術施行後の局所再発症例の報告や本症例を考えると, 可能であれば部分切除術以上の術式の選択が必要と思われた.また, まれではあるが再発を念頭においた術後の経過観察が必要と思われた.

鈍的胸部外傷による気管・気管支損傷は比較的まれであるが, 多くの症例は受傷直後より, 皮下気腫および高度の呼吸困難等の臨床症状を呈し, 救命には迅速な処置が要求される.今回我々は受傷後気管支損傷を疑う症状がなく経過し, 受傷8日後に発症した左完全無気肺にてはじめて診断し得た外傷性左主気管支損傷の1手術例を経験した。症例は26歳の男性.二輪車を運転中に転倒, 受傷した.初診時の胸部X線および胸部CTで同側の気胸や縦隔気腫を認めなかった.受傷8日後に左無気肺が出現し, 気管支鏡検査にて左主気管支損傷および閉塞と診断, 狭窄部の気管支を切除し, 気管支形成術を施行した。受傷直後, 臨床的に気管・気管支損傷を積極的に疑わない多発外傷についても, 気管・気管支損傷の可能性を常に念頭におく必要があると思われた.

BACKGROUND Aromatic hydrocarbons, including benzol[a]pyrene, in tobacco smoke first require metabolic activation by phase I enzymes, cytochrome P450s (CYP450s), and then are subjected to detoxification by phase II enzymes, the glutathione-S-transferases. A high risk lung carcinoma group has been reported to have specific polymorphisms of the cytochrome P450 (CYP1A1) gene and the glutathione-S-transferase (GSTM1) gene. In this study, the authors investigated whether such genotypes were also risk factors for esophageal carcinoma. METHODS Subjects were comprised of 89 esophageal carcinoma patients and 137 noncancer controls. Forty-nine of the patients and 60 of the control subjects were smokers. Genotypic studies of both CYP1A1 and GSTM1 were performed in the cancer tissues of all 89 patients. Genotypes of peripheral blood leukocytes taken from the control subjects were also determined. Genotypes of the CYP1A1 and GSTM1 genes were determined by the polymerase chain reaction. RESULTS Patients who were heavy smokers with the genotypes Val/Val (V/V) for CYPIAI and the combined genotype of V/V for CYP1A1 and GSTM1- were a statistically high risk group compared with control subjects (P < 0.01, chi-square = 10.6 vs. P < 0.01, chi-square = 11.0). The association of V/V for CYPIAI with a smoking index ≥ 600 in esophageal carcinoma patients was estimated at 6.63 (95% confidence interval [CI], 1.86-23.7). The association of combined genotypes of V/V of CYP1A1 and GSTM1 with a smoking index ≥ 600 in esophageal carcinoma patients was estimated at 12.7 (95% CI, 1.97-81.8) CONCLUSIONS Specific genotypes of the CYP1A1 and GSTM1- genes are related to the incidence of esophageal carcinoma, especially in heavy smokers. Cancer 1997; 80:852-7. © 1997 American Cancer Society.

右鎖骨上窩に発生したデスモイド腫瘍再発に対する再手術例を経験したので報告する.症例は, 51歳, 女性で, 1992年10月, 他院にて右鎖骨上窩腫瘍に対する手術が施行された.1995年5月同部の再腫脹及び右上肢の熱感と疼痛を主訴に当科に入院した。精査の結果, 右鎖骨上窩腫瘍再発の診断で1995年6月14日再手術を施行した.78gの腫瘤を初回手術時の人工血管とともに摘出し, 右鎖骨下動脈人工血管再置換術を施行した.病理組織学的検索の結果, 腫瘍は, 右鎖骨上窩の胸壁デスモイド腫瘍再発と診断された.本腫瘍の治療原則は, 可及的広範囲切除と思われるが, 本症例のごとく再発例に対しても積極的な外科治療が必要と思われる.

A 49-year-old female was admitted to the hospital because of an abnormal shadow on a chest X-ray film. Chest X-ray examination revealed an about 3×2 cm an sharply circumscrived tumor overlapping cardiac shadow and chest CT showed a tumor in the left lower posterior mediastinum. Neurogenic tumor or congenital cyst was suspected. We performed thoracoscopic surgery when the polypiform tumor wlas found arising from the parietal pleura of the discending aorta near the diaphragm. This tumor was diagnosed as extralobar pulmonary sequestration because of abnormal artery fed from the aorta and postoperative microscopic findings. The postoperative course was uneventful, and she was discharged 5 days after the operation without wound pain. Thoracoscopic surgery is very useful for diagnosis and treatment of intrathoracic tumors, because it provides minimal surgical intervention and pain.

術前, 経過中に急速な増大を認めた肺原発悪性線維性組織球腫 (以下MFH) の1例を経験したので報告する.症例は40歳女性.左背部痛, 血性胸水を主訴に来院した.術前の画像診断では胸部CTおよびMRIにて左肺門から左下葉にかけて腫瘤が認められた.気管支鏡検査では内腔に異常所見は認められず, 組織学的確定診断は得られなかった.また, 全身検索でその他の異常所見は認められなかった.このため肺原発の間葉系悪性腫瘍を疑い手術を施行したところ, 病理組織学的にはHE染色にてstoriform patternを呈し, 免疫組織化学検査にて組織球マーカーによる染色が陽性でありMFHと診断された.術後化学療法を施行, 現在10ヵ月経過しているが無再発生存中である.

真性赤血球増加症 (polycythemia vera 以下PV) を合併した肺癌の1手術例を経験した.症例は65歳男性.精査の結果, 右上葉原発の肺癌 (腺癌, T1N2M0, stage IIIA) と診断された.血液検査にて全血球成分の増加を認め, 特に赤血球系は著しく増加していた.諸検査の結果, PVの確定診断を得た.術前に瀉血を9回 (計36000nl) 行い, ヘマトクリットを70%から55%まで低下させたうえで手術を施行したところ, 合併症はみられず順調に経過した.PVは DICの前段階とされ, 術後, 出血, 血栓症などの合併症がおきやすく死亡率も高いとされているが, 適切な術前管理により, 術後合併症を防止することが可能であると考えられた.

症例は34歳, 男性.検診の胸部X線写真上右上縦隔の異常陰影を指摘され, 縦隔腫瘍の疑いで当院に紹介された.胸部X線では右上肺野縦隔側に境界鮮明な腫瘤影を認め, 胸部CT, MRI検査にて, 上方は甲状腺右側から, 右腕頭静脈と鎖骨下動脈の間より下方は上大静脈の裏側の上縦隔に達する嚢胞性腫瘤と診断された.頸部からの穿刺による内容液検査ではアミラーゼは221U/lと軽度の上昇を示したのに対し, サイログロブリンは120.4mg/mlと著明に高値であった.本症例は右悪性甲状腺腫を合併していたため, 一期的に手術を施行した.胸骨縦切開および頸部襟状切開にてアブローチし, 嚢腫摘出, 甲状腺右葉切除および頸部郭清を施行した.組織学的に嚢腫は鯉嚢胞と診断された.また嚢胞壁内に異所性甲状腺組織が存在した.これらの所見より本症例は頸部より上縦隔に進展増大した鰐嚢胞と診断された.また組織学的所見より, 本嚢胞の成因および増大に甲状腺上皮が関与していることが推測された.

To investigate genetic features of esophageal cancer, we have examined 93 squamous cell carcinomas of the esophagus for loss of heterozygosity (LOH), using 41 restriction fragment length polymorphism (RFLP) markers representing all autosomal chromosomes. Allelic losses at frequencies of at least 30% were observed at loci on chromosomal arms 3p (35%), 3q (30%), 5q (36%), 9p (57%), 9q (60%), 10p (33%), 13q (43%), 17p (62%), 17q (46%), 18q (38%), 19q (32%), and 21q (37%). These results suggest that several putative tumor suppressor genes, in addition to the cyclin D and TP53 genes that are sometimes mutated in esophageal carcinomas, may be associated with development and/or progression of esophageal cancer. By a comparison of LOH on each chromosomal arm with clinicopathological parameters, we have found a significant correlation between LOH on 19q and regional lymph node metastases. Interestingly, the frequency of LOH on 17q was significantly higher in tumors in female patients (12 of 14 cases) than in those in male patients (20 of 56 cases) (P = 0.0009 by Fisher's exact test). Furthermore, we examined for mutations of the APC gene on chromosome arm 5q. Screening of nearly one third of the APC coding region, including the MCR (mutation cluster region), revealed no alterations. Therefore, although allelic loss at the APC locus is frequent in squamous cell carcinomas of the esophagus, it is likely that a gene on 5q other than APC is involved in esophageal tumorigenesis. Genes Chromosom Cancer 10:177–182 (1994). © 1994 Wiley-Liss, Inc.

The Turcot syndrome (TS) is a rare, probably autosomal recessive, disorder characterized by development of primary neuroepithelial tumors of the central nervous system (CNS) and numerous adenomatous colorectal polyps. To examine the possible involvement of mutations of the APC gene, which is responsible for familial adenomatous polyposis (FAP), in Turcot syndrome, we examined DNAs from TS patients for alterations in this gene by means of ribonuclease protection analysis. Germ-line APC mutations were detected in each of three unrelated cases of TS, and additional (somatic) mutations were observed in colonic adenomas that had developed in one of these patients. However, no somatic mutations in APC were found among 91 neuroepithelial tumors (medulloblastoma, glioblastoma, astrocytoma, and oligodendroglioma), whether sporadic or associated with TS. These results suggest that the APC gene is associated with pathogenesis of one feature of TS, but that at least one other gene is responsible for the genesis of neuroepithelial tumors in the CNS.

To investigate genetic features in small and flat colorectal carcinomas that arise de novo, we searched for genetic alterations in six sporadic tumors by examining their APC, K-ras, and p53 genes. Two of the six tumors carried detectable mutations within the mutation cluster region (MCR) of the APC gene; both mutations were predicted to cause truncation of the gene product. Four tumors carried mutations of the p53 gene; three were missense mutations in exon 5, and the other was a 3-bp deletion in exon 6. However, neither codon 12 nor codon 13 of K-ras contained detectable mutation in any tumors. Hence, as “adenoma-carcinoma sequence” model of development of colorectal carcinoma, inactivation of the APC and p53 genes appear to be Involved in development of the de novo type of colorectal carcinoma even though the adenoma stage is not observed. © 1994 Wiley-Liss, Inc.

Neurilemoma, like other non-epithelial tumors, seldom occurs in the thyroid gland. A 57-year-old man was first referred to our hospital with an asymptomatic anterior neck tumor. A solid tumor was detected in the right lobe of the thyroid and an enucleation of the thyroid tumor was performed. The tumor was 35 x 33 x 33 mm in size, and diagnosed as Antoni A type neurilemoma. We were only able to find seven previously reported detailed cases of primary neurilemoma of the thyroid gland. A review of these cases, however, revealed that neurilemoma tends to develop in the right lobe of the thyroid gland. An operation is thus considered necessary and an enucleation of the tumor is appropriate.

胸腺腫の血行性あるいはリンパ行性転移は比較的稀れとされている.最近われわれは胸腺腫にて胸腺腫および胸腺全摘出術を施行後, 5年2ヵ月, 13年10ヵ月後にそれぞれ肺転移が発見され, 再手術にて転移巣を切除し得た2症例を経験した。初回手術時の病期はそれぞれ正岡分類の病期III期, IVa期と明かな被膜浸潤を呈していたが, 組織学的に上皮細胞の異型性あるいは血管侵襲像は明かでなく, 初回手術時に転移の危険性を予測するのは困難と思われた.胸腺腫の他臓器転移例で外科治療の適応になる症例は稀れであるが, 呈示した2症例のように転移巣が肺に限局し, かつ転移巣出現までに長期間を要した症例に対しては積極的な手術も必要であろう.

症例は78歳,男性.食欲不振を主訴に当院入院となった.入院2週間後から腹痛,嘔吐が出現し腹部CTで内ヘルニアによるイレウスが疑われ開腹手術が行われた.開腹するとTreitz靱帯から130cmの位置で空腸が約30cmにわたり,横行結腸間膜に生じた径3cmの異常裂孔から網嚢内に嵌入していた.用手整復後,横行結腸間膜異常裂孔の縫合閉鎖が行われた.術後経過は良好であった.

We examined somatic mutations of the adenomatous polyposis coli (APC) gene in 63 colorectal tumors (16 adenomas and 47 carcinomas) developed in familial adenomatous polyposis (FAP) and non-FAP patients. In addition to loss of heterozygosity (LOH) at the APC locus in 30 tumors, 43 other somatic mutations were detected. Twenty-one of them were point mutations; 16 nonsense and two missense mutations, and three occurred in introns at the splicing site. Twenty-two tumors had frameshift mutations due to deletion or insertion; nineteen of them were deletions of one to 31 bp and three were a 1-bp insertion. One tumor had a 1-bp deletion in an intron near the splicing site. Hence, 41 (95%) of 43 mutations resulted in truncation of the APC protein. Over 60% of the somatic mutations in the APC gene were clustered within a small region of exon 15, designated as MCR (mutation cluster region), which accounted for less than 10% of the coding region. Combining these data and the results of LOH, more than 80% of tumors (14 adenomas and 39 carcinomas) had at least one mutation in the APC gene, of which more than 60% (9 adenomas and 23 carcinomas) had two mutations. These results strongly suggest that somatic mutations of the APC gene are associated with development of a great majority of colorectal tumors.

肺癌の治療成績は不良であるが, そのなかで比較的予後良好なTIN0M0肺癌の手術成績について検討した。当教室で切除されたT1N0M0肺癌73例の5年生存率は80.8%であった.組織型別では扁平上皮癌の方が腺癌より若干予後良好であり, 特に肺野型扁平上皮癌では癌死はなかった.手術根治度では絶対的治癒切除の方が相対的非治癒切除より若干予後良好であり, 扁平上皮癌の絶対的治癒切除では癌死はなかった.腺癌で絶対的治癒切除を行った29例中7例 (24%) に再発・転移を認めた.そのなかで腫瘍経が20mm以下の肺野型早期腺癌では, 絶対的治癒切除をなし得た12例中2例に癌死が認められた。T1N0M0扁平上皮癌では絶対的治癒切除により治癒が期待できるが, T1N0M0腺癌では絶対的治癒切除を行っても再発・転移を20～30%に認めるため, より有効な補助療法の確立が必要と考えられた.

We report a rare case of neurilemoma originating from the left recurrent nerve in the superior mediastinum.

To investigate genetic features of esophageal cancer, we have examined a large number of squamous cell carcinomas of the esophagus (ESCs) for loss of heterozygosity (LOH) using polymorphic DNA markers representing all autosomal chromosomes. Allelic losses at frequencies of at least 30% were observed at loci on chromosomal arms on 3p (33%), 3q (30%), 5q (36%), 9p (57%), 9q (60%), 10p (33%), 13q (43%), 17p (62%), 17q (46%), 18q (38%), 19q (32%), and 21q (37%). By comparing the LOH on each chromosomal arm with the clinicopathologic parameters of patients, we found a significant correlation between LOH on 19q and regional lymph node metastasis. Interestingly, the frequency of LOH on 17q was significantly higher in tumors from female patients (12 of 14 cases) than in those from male patients (20 of 56 cases) P =0.0009 by Fisher’s exact test). Subsequent analysis of allelic losses in DNA extracts isolated from 106 lesions among 32 patients with ESCs revealed that allelic losses on 3p or 17p occurred frequently even in dysplastic lesions, and that allelic losses on these chromosomal arms were observed in cancerous tissues as well. We detected allelic losses of the short and long arms of chromosome 9 at low frequency in lesions with mild dysplasia but often in lesions with severe dysplasia and in intraepithelial cancers. Our results suggested that inactivation of tumor suppressor genes on 3p and 17p occurs at an early stage of esophageal carcinogenesis, and that genes on 9p and 9q are likely to play important roles in malignant changes.

We report here the result of a screening for germ-line mutations in the adenomatous polyposis coli (APC) gene in 61 new familial adenomatous polyposis (FAP) patients as well as a summary of the results of 150 patients. Examination of the entire coding region of the APC gene, based on a ribonuclease protection assay coupled with the polymerase chain reaction (PCR), disclosed mutations that were considered to cause significant defects in the APC product in 97 of 150 unrelated FAP patients. Our findings revealed the following characteristics of the germ-line mutations of APC: 1) the great majority of the mutations were found to truncate the APC product; 2) almost all of the mutations were located within the first half of the coding region; 3) no correlation was observed between the locations of germ-line mutations and extracolonic manifestations in FAP patients; 4) more than 80% of base substitutions in the APC gene were from cytosine to other nucleotides, nearly one-third of which occurred at the GpG site. Our results provide information helpful to an understanding of the APC gene and will also contribute to presymptomatic diagnosis of members in FAP families.

Objective To clarify the effects of lung volume reduction surgery (LVRS) on cardiopulmonary circulation during exercise in comparison with pulmonary lobectomy for lung cancer. Summary background data LVRS improves pulmonary function and dyspnea symptoms acutely in selected patients with heterogeneous emphysema. However, there are few data concerning the effects of LVRS on the cardiopulmonary circulation, especially during exercise. Methods Pulmonary function tests and pulmonary hemodynamic study at rest and during exercise were performed before and 6 months after LVRS (seven patients) or pulmonary lobectomy (eight patients). In the workload test, an electrically braked bicycle ergometer (25 w) was used in the supine position for at least 2 minutes or until exhaustion or breathlessness developed. Results After lung lobectomy, the values of vital capacity, percentage of predicted vital capacity, forced expiratory volume in 1 second, percentage of predicted forced expiratory volume in 1 second, residual volume/total lung capacity, and maximal voluntary ventilation deteriorated significantly. Six months after LVRS, however, vital capacity, percentage vital capacity showed no significant change, and forced expiratory volume in 1 second, percentage of forced expiratory volume in 1 second, diffusing capacity for carbon monoxide, and maximal voluntary ventilation showed marked improvement. Cardiac index was changed neither at rest nor during exercise in either group by the operation. Although postoperative pulmonary arterial pressure in the lobectomy group was significantly increased by the exercise, LVRS did not affect postoperative pulmonary arterial pressure at rest or during exercise. Pulmonary capillary wedge pressure in the lobectomy group showed no significant change after the operation, whereas LVRS ameliorated the marked elevation of pulmonary capillary wedge pressure observed during exercise. After lobectomy, significant increases in the pulmonary vascular resistance index were observed at rest and during exercise. LVRS markedly increased the pulmonary vascular resistance index at rest but not during exercise. In the lobectomy group, the postoperative flow-pressure curve moved upward, and its gradient became steeper than the preoperative one. In the LVRS group, the curve moved upward in a parallel fashion. These results show that much more right-sided heart work is needed to achieve the same cardiac output against higher pulmonary arterial pressure, not only after lobectomy but also LVRS. Conclusion The current study demonstrated that the effects of LVRS on the cardiopulmonary circulation were not negligible, especially during exercise, and successful LVRS may depend on improved respiratory function and also preserved cardiac function that can tolerate the damage to the pulmonary vascular bed induced by this operation.