記述言語：英語   掲載種別：研究論文（学術雑誌）  

BACKGROUND: Patients with non-small cell lung cancer (NSCLC) carrying SMARCA4 mutations (SMARCA4-Mut) tend to have more advanced disease and a poor prognosis. However, due to the rarity of this mutation and the lack of related studies, the characteristics of SMARCA4-Mut NSCLC patients remains poorly determined. To clarify the clinical characteristics and prognostic factors of SMARCA4-Mut NSCLC, we initiated the present study to provide a clinical reference. METHODS: We used data from two cohorts of NSCLC-SMARCA4-mutated samples: The Cancer Genome Atlas (TCGA) database and our center's clinical data. The TCGA database was used to obtain 481 NSCLC-SMARCA4-Mut samples for clinical characterization. The center collected data on 224 consecutive NSCLC patients treated between December 2020 to July 2022. Among them, 26 harbored SMARCA4 mutations, and 20 were eligible for inclusion in the study. Clinical, pathological, and molecular features, as well as prognostic role of SMARCA4 mutations were analyzed. Additionally, we analyzed the prognostic impact of Napsin A expression in SMARCA4-Mut patients. RESULTS: The TCGA database included 480 patients with SMARCA4-Mut NSCLC, 311 males (64.8%) and 169 females (35.2%), with a median age of 67 years. Among the 20 SMARCA4-Mut patients in our center series, 12 (60%) were males and 8 (40%) females, with a median age of 63. The intergroup prognostic correlation analysis showed that SMARCA4-Mut patients had significantly worse prognosis than those the wild-type SMARCA4 (SMARCA4-WT) (P=0.04). Within the SMARCA4-Mut group, patients with Napsin A expression had longer overall survival (OS) (P=0.03) than those without expression. Median survival in the Napsin A-positive and negative groups was 32 and 15 months, respectively. According to time-dependent receiver operating curve analysis, patients with Napsin A expression had significantly longer first-line treatment progression-free survival (PFS1) [area under the curve (AUC) =0.748] and OS (AUC =0.586). No prognostic value of Napsin A was found in patients SMARCA4-WT patients. CONCLUSIONS: SMARCA4-Mut is an adverse prognostic feature in NSCLC patients. Napsin A expression in SMARCA4-Mut patients is associated with prolonged OS.

DOI： 10.21037/tlcr-24-381

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

BACKGROUND: Chordoma, a rare malignant tumor arising from notochordal tissue, usually occurs along the spinal axis. Only a few published reports of primary lung chordomas exist. Herein, we present a case of primary lung chordoma and discuss important considerations for diagnosing rare chordomas. CASE PRESENTATION: We report a case of primary lung chordoma in a 39-year-old male with a history of testicular mixed germ-cell tumor of yolk sac and teratoma. Computed tomography revealed slow-growing solid lesions in the left lower lobe. We performed wedge resection for suspected germ-cell tumor lung metastasis. Histologically, large round or oval cells with eosinophilic cytoplasm were surrounded by large cells with granular, lightly eosinophilic cytoplasm. Tumor cells were physaliphorous. Immunohistochemistry was positive for brachyury, S-100 protein, epithelial membrane antigen, vimentin, and cytokeratin AE1/AE3, suggesting pulmonary chordoma. Re-examination of the testicular mixed germ-cell tumor revealed no notochordal elements. Although some areas were positive for brachyury staining, hematoxylin and eosin (HE) staining did not show morphological features typical of chordoma. Complementary fluorescence in situ hybridization (FISH) of the lung tumor confirmed the absence of isochromosome 12p and 12p amplification. Thus, a final diagnosis of primary lung chordoma was established. CONCLUSIONS: In patients with a history of testicular mixed germ cell tumors, comparison of histomorphology using HE and Brachyury staining of lung and testicular tumors, and analyzing isochromosome 12p and 12p amplification in lung tumors using FISH is pivotal for the diagnosis of rare lung chordomas.

DOI： 10.1186/s13000-024-01522-0

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

BACKGROUND: Atezolizumab, one of the immune checkpoint inhibitors, has been approved as an adjuvant treatment following resection and platinum-based chemotherapy in patients with stage II-IIIA non-small cell lung cancer with 1% or more programmed death ligand-1 (PD-L1) expression. The Food and Drug Administration (FDA) has approved SP263 as a companion diagnostic assay for adjuvant treatment with atezolizumab; however, in clinical practice, the 22C3 assay is most commonly used for advanced non-small cell lung cancer. Therefore, our study aimed to compare two PD-L1 assays, SP263 and 22C3, to evaluate whether 22C3 could replace SP263 when deciding whether to administer adjuvant atezolizumab. METHODS: We retrospectively and prospectively analyzed 98 patients who underwent surgical resection at Kanagawa Cancer Center (Japan). An immunohistochemistry assay was performed for all the cases with both SP263 and 22C3. We statistically analyzed the concordance of PD-L1 expression between SP263 and 22C3 assays. RESULTS: The concordance between the two assays using Cohen's kappa was κ = 0.670 (95% CI: 0.522-0.818) at the 1% cutoff and κ = 0.796 (95% CI: 0.639-0.954) at the 50% cutoff. The Spearman correlation coefficient of 0.874 (p < 0.01) indicated high concordance. PD-L1 expression with 22C3 resulted slightly higher than that with SP263. CONCLUSIONS: This study showed a high concordance of PD-L1 expression with the SP263 and 22C3 assays. Further studies examining the therapeutic effects of adjuvant atezolizumab are required.

DOI： 10.1111/1759-7714.15319

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記述言語：英語  

DOI： 10.21037/tlcr-23-738

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

OBJECTIVES: The choice of therapeutic intervention for postoperative air leak varies between institutions. We aimed to identify the optimal timing and patient criteria for therapeutic intervention in cases of postoperative air leaks after lung resection. METHODS: This study utilized data from a prospective multicenter observational study conducted in 2019. Among the 2187 cases in the database, 420 cases with air leaks on postoperative day 1 were identified. The intervention group underwent therapeutic interventions, such as pleurodesis or surgery, while the observation group was monitored without intervention. A comparison between the intervention group and the observation group were analyzed using the cumulative distribution and hazard functions. RESULTS: Forty-six patients (11.0%) were included in the intervention group. The multivariate analysis revealed that low body mass index (p = 0.019), partial resection (p = 0.010), intraoperative use of fibrin glue (p = 0.008), severe air leak on postoperative day 1 (p < 0.001), and high forced expiratory volume in 1 s (p = 0.021) were significant predictors of the requirement for intervention. The proportion of patients with persistent air leak in the observation group was 20% on postoperative day 5 and 94% on postoperative day 7. The hazard of air leak cessation peaked from postoperative day 3 to postoperative day 7. CONCLUSIONS: This research contributes valuable insights into predicting therapeutic interventions for postoperative air leaks and identifies scenarios where spontaneous cessation is probable. A validation through prospective studies is warranted to affirm these findings.

DOI： 10.3390/jcm13041166

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

BACKGROUND: In the phase 3 FLAURA trial, osimertinib was compared with first-generation epidermal growth factor receptor tyrosine kinase inhibitors (EGFR-TKIs) as a first-line treatment for EGFR-mutant non-small cell lung cancer (NSCLC). Osimertinib showed longer progression-free survival (PFS), overall survival (OS), and a similar safety profile. However, more studies demonstrating the effectiveness and safety of osimertinib as a first-line strategy are needed in real-world populations. METHODS: We enrolled 1,556 patients with EGFR-mutated stage IIIc-IV NSCLC from the CAPTRA-Lung database. All patients received either osimertinib (n=202) or a first-generation EGFR-TKI (n=1,354) as their initial treatment. To adjust for differences in baseline characteristics between two groups, 1:2 propensity score matching (PSM) was performed. Propensity scores included gender, age, Eastern Cooperative Oncology Group performance status score, smoking history, family history of tumor, pathology, EGFR mutations, and central nervous system (CNS) metastases. The standardized mean differences (SMD) before and after PSM were calculated to examine the balance of covariate distributions between two groups. RESULTS: After PSM, 202 patients receiving osimertinib and 404 patients receiving first-generation EGFR-TKIs were finally identified. SMD of each matched variable is less than 0.10. The median PFS was 19.4 months [95% confidence interval (CI): 14.3-24.4] in the osimertinib arm and 10.9 months (95% CI: 9.3-12.5) in the comparator arm [hazard ratio (HR) for progression, 0.47; 95% CI: 0.38-0.59; P<0.001). The median OS was 40.5 months (95% CI: 27.1-54.0) vs. 34.3 months (95% CI: 30.6-38.0) in two groups, respectively (HR for death, 0.76; 95% CI: 0.58-1.00; P=0.045). The incidence of grade 3 adverse events (AEs) between the two groups was 1% and 4.2%, respectively. No grade 4 AEs and treatment-related deaths were reported in both groups. CONCLUSIONS: In real-world settings, osimertinib demonstrates longer PFS and OS, with a similar safety profile to that of comparator EGFR-TKIs when used as a first-line strategy in NSCLC patients.

DOI： 10.21037/tlcr-23-577

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

BACKGROUND: The recurrence site that influences post-recurrence survival (PRS) in patients with non-small cell lung cancer (NSCLC) undergoing surgery and the preoperative predictors of recurrence remain unclear. METHODS: Cohorts 1 and 2 had 4520 (who underwent complete resection for p-stage 0-IIIA NSCLC) and 727 (who experienced recurrence after surgery) patients, respectively. The initial sites of recurrence were the lungs (309 cases), thoracic lymph nodes (225 cases), pleura (112 cases), bone (110 cases), central nervous system (86 cases), adrenal gland (25 cases), abdomen (60 cases), cervical and axillary lymph nodes (38 cases), chest wall (13 cases), skin (5 cases), and eye and tongue (3 cases). For cohort 2 analysis, the initial recurrence site that resulted in poor PRS was analyzed by multivariable analysis using a Cox proportional hazard model. For cohort 1 analysis, the preoperative predictors of recurrence patterns with poor PRS were analyzed by multivariable analysis using a logistic regression model. RESULTS: In cohort 2 analysis, recurrence in the central nervous system (hazard ratio [HR], 1.70; p < 0.001), bone (HR, 1.75; p < 0.001), abdomen (HR, 2.39; p < 0.001), and pleura (HR, 1.69; p < 0.001) were independent poor prognostic recurrent sites for PRS and they were high-risk sites (HRS). Intrathoracic lymph nodes, cervical and axillary lymph nodes, lungs, chest wall, adrenal gland, eye and tongue, and skin were low-risk sites (LRS) that did not affect PRS. Patients with multiple LRS without HRS recurrence had a worse prognosis than those with a single LRS without HRS recurrence (5-year PRS 20.2% vs. 37.7%, p < 0.001) and were comparable to those with HRS recurrence (p = 1.000). In cohort 1 analysis, preoperative predictors for HRS and multiple LRS recurrences were positron emission tomography (PET) maximum standardized uptake value (maxSUV) ≥ 3.2 (HR, 5.09; p < 0.001), clinical nodal metastasis (HR, 2.00; p < 0.001), tumor size ≥ 2.4 cm (HR, 1.96; p < 0.001) and carcinoembryonic antigen (CEA) ≥ 5 ng/ml (HR, 1.41; p = 0.004). The cumulative incidence rates of HRS and multiple LRS recurrences within 5 years were 55.9%, 40.9%, 26.3%, 11.1%, and 3.5% (p < 0.001) in patients with 4, 3, 2, 1 and 0 of the above risks, respectively. CONCLUSIONS: HRS and multiple LRS were vital recurrences associated with poor PRS. Preoperative PET maxSUV, clinical nodal metastasis, tumor size, and CEA level predicted the incidence of vital recurrence.

DOI： 10.1186/s12885-023-11582-y

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記述言語：英語  

DOI： 10.1016/j.cllc.2023.11.001

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

BACKGROUND: Impact of RNA-binding motif protein 10 (RBM10) and programmed death-ligand 1 (PD-L1) on the postoperative prognosis of patients with epidermal growth factor receptor gene mutation (EGFR-Mt) lung adenocarcinoma with pathological lymph node metastasis is still unclear. METHODS: Patients who underwent curative surgery for pN1-N2 EGFR-Mt lung adenocarcinoma (n=129) harboring the EGFR exon 19 deletion mutation (Ex19) (n=66) or EGFR exon 21 L858R mutation (Ex21) (n=63) between January 2010 and December 2020 were included in this retrospective study. The prognoses of patients with low/high cytoplasmic RBM10 expression and PD-L1 negativity/positivity based on immunohistochemistry (IHC) of resected specimens were compared using the log-rank test. The effects of RBM10 and PD-L1 expression on overall survival (OS) were examined via multivariable analysis using the Cox proportional hazards regression model. The effects of RBM10 and PD-L1 expression on progression-free survival (PFS) of EGFR-tyrosine kinase inhibitors (TKIs) therapy among patients with recurrent pN1-N2 EGFR-Mt lung adenocarcinoma (n=67) were examined using log-rank tests. RESULTS: The RBM10 low expression group showed significantly better 5-year OS than the RBM10 high expression group (89.4% vs. 71.5%, P=0.020), and the PD-L1 negative group tended to have longer 5-year OS than the PD-L1 positive group (86.4% vs. 68.4%, P=0.050). Multivariable analysis showed that high RBM10 expression [hazard ratio (HR), 3.12; 95% confidence interval (CI): 1.19-8.17; P=0.021] and PD-L1 positivity (HR, 3.80; 95% CI: 1.64-8.84; P=0.002) were independent poor prognostic factors for OS. PFS of patients with relapse and first-line EGFR-TKI treatment was significantly better in the PD-L1-negative group than in the PD-L1-positive group (34.5 vs. 12.1 months, P=0.045). PFS of patients with Ex21 relapse and first-line EGFR-TKI treatment was significantly better in the RBM10 low expression group than in the RBM10 high expression group (25.5 vs. 13.0 months, P=0.025). CONCLUSIONS: High RBM10 expression and PD-L1 positivity are poor prognostic factors for OS in patients with pN1-N2 EGFR-Mt lung adenocarcinoma after curative surgery. In patients with recurrent pN1-N2 EGFR-Mt lung adenocarcinoma, PD-L1 and RBM10 expression may influence response to EGFR-TKIs.

DOI： 10.21037/tlcr-23-355

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

BACKGROUND: The efficacy of adjuvant chemotherapy (ACT) in elderly patients with completely resected p-stage II-IIIA non-small-cell lung cancer (NSCLC) remains unclear because all previous randomized controlled trials on ACT have been conducted among patients aged <75 years. Thus, this study aimed to evaluate the effectiveness of ACT in elderly patients with completely resected NSCLC. PATIENTS: We extracted the nationwide data of 812 patients aged ≥75 years who underwent lobectomy with mediastinal nodal dissection in 2010 and were diagnosed with p-stage II-IIIA NSCLC, from nationwide registry data accumulated in 2016. METHODS: We classified the 812 patients into 2 groups based on the ACT administration status and analyzed the differences in their postoperative overall survival (OS). RESULTS: Overall, 295 patients received ACT (36.3%; group A), whereas 517 patients did not (63.70%; group N). Group A showed significantly better OS as a whole (hazard ratio [HR]: 0.650 [95% confidence interval {CI}: 0.526-0.804]), in the p-stage II subset (HR: 0.688 [95% CI: 0.513-0.925]), and p-stage IIIA subset (HR: 0.547 [95% CI: 0.402-0.743]) than group N. Even after propensity score matching, group A showed significantly better OS as a whole (HR: 0.626 [95% CI: 0.495-0.792]), in the p-stage II subset (HR: 0.690 [95% CI: 0.493-0.964]), and p-stage IIIA subset (HR: 0.554 [95% CI: 0.398-0.772]) than group N. CONCLUSION: ACT is recommended even in elderly patients with completely resected p-stage II-IIIA NSCLC. Hence, physicians should not avoid ACT in patients with completely resected NSCLC based solely on age.

DOI： 10.1016/j.cllc.2023.10.001

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

BACKGROUND: Segmentectomy is considered a less invasive procedure than lobectomy for patients with non-small cell lung cancer (NSCLC); however, little is known about the physiological mechanism underlying the lower invasiveness of segmentectomy. This study is aimed to compare the differences in the long-term changes in the psoas muscle mass after segmentectomy and lobectomy in patients with NSCLC. METHODS: Overall 315 recurrence-free patients who underwent segmentectomy (n = 93) or lobectomy (n = 222) for clinical stage 0-I NSCLC between January 2016 and December 2018 and underwent computed tomography during the entire period of 6 months ≤ postoperative year (POY) 0.5 < 12 months, 12 months ≤ POY 1 < 24 months, 24 months ≤ POY 2 < 36 months, and 36 months ≤ POY 3 < 48 months were included. Bilateral psoas muscle area (PMA) at the L3 level was measured using each cross-sectional computed tomography scan. Differences between the segmentectomy and lobectomy groups in the mean change of postoperative PMA from the preoperative period were analysed using Student's t-test and mixed analysis of variance. Multivariable analysis was performed to identify the risk factors for PMA loss on POY 3 using logistic regression analysis. RESULTS: The lobectomy group had a significantly larger PMA change than the segmentectomy group during each postoperative period (P < 0.001). Mixed analysis of variance revealed that the mean PMA change was significantly smaller in the segmentectomy group than in the lobectomy group during the observation period (P < 0.001). The mean change in the PMA was significantly larger from POY1 (-2.5%) to POY2 (-3.9%) and POY3 (-4.7%) in the lobectomy group (P = 0.003 and P < 0.001). However, PMA remained unchanged during the postoperative observation period in the segmentectomy group. In the multivariable analysis, the risk factors for PMA change ≤-3.3% (cut-off: mean change of PMA) at POY3 included lobectomy [odds ratio (OR), 3.32; 95% confidence interval (CI), 1.90-5.82; P < 0.001], male sex (OR, 1.92; 95% CI, 1.02-3.62; P = 0.044) and open thoracotomy (OR, 1.84; 95% CI, 1.11-3.05; P = 0.017). After propensity score matching, the mean change in PMA was smaller in the segmentectomy group (n = 75) than in the lobectomy group (n = 75) during the postoperative observation period (P < 0.001). CONCLUSIONS: Psoas muscle mass was better maintained during the postoperative period by segmentectomy than by lobectomy. Psoas muscle mass reduction progressed over a long postoperative period after lobectomy. Segmentectomy via complete video-assisted thoracic surgery is associated with a lower likelihood of sarcopenia progression.

DOI： 10.1002/jcsm.13328

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

OBJECTIVES: This study aimed to compare cancer control after segmentectomy and lobectomy in patients with radiologically pure-solid clinical stage IA3 non-small-cell lung cancer (NSCLC). METHODS: Patients with radiologically pure-solid clinical stage IA3 NSCLC who underwent lobectomy or segmentectomy at 3 institutions between 2010 and 2019 were identified. We estimated propensity scores to adjust for confounding variables regarding tumour malignancy, including age, sex, smoking history, tumour size, maximum standardized uptake value on 18F-fluorodeoxyglucose positron emission tomography, lymph node dissection, histological type and lymphatic, vascular and pleural invasion. Cumulative incidence of recurrence (CIR) was evaluated as a primary end point. RESULTS: Among 412 patients, postoperative recurrence occurred in 7 of 44 patients (15.9%) undergoing segmentectomy, and 71 of 368 patients (19.3%) undergoing lobectomy. CIR was comparable between patients undergoing segmentectomy (5-year rate, 21.9%) and those undergoing lobectomy (5-year rate, 20.8%; P = 0.88). Locoregional recurrence did not differ between patients undergoing segmentectomy (6.8%) and those undergoing lobectomy (9.0%). In multivariable analysis, segmentectomy (versus lobectomy) was not identified as an independent prognostic factor for CIR (hazard ratio, 1.045; 95% confidence interval, 0.475-2.298; P = 0.91). In propensity score matching of 40 pairs, CIR was not significantly different between patients undergoing segmentectomy (5-year rate, 20.7%) and those undergoing lobectomy (5-year rate, 18.4%; P = 0.81). CONCLUSIONS: Cancer control may be comparable between segmentectomy and lobectomy in patients with radiologically pure-solid clinical stage IA3 NSCLC. Further studies are warranted to clarify the survival benefits of segmentectomy in these patients.

DOI： 10.1093/icvts/ivad138

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

OBJECTIVE: The efficacy of tegafur-uracil as adjuvant chemotherapy for patients with completely resected stage I non-small-cell lung cancer is proven; however, its efficacy for elderly patients remains unclear. Herein, we evaluated the effectiveness of adjuvant chemotherapy for elderly patients with completely resected stage I non-small-cell lung cancer based on real-world Japanese data using propensity score matching. METHODS: This retrospective study extracted data from a nationwide registry study, performed in 2016, on patients ≥75 years who underwent lobectomy with mediastinal nodal dissection for non-small-cell lung cancer in 2010 and were diagnosed with p-stage IA (>2 cm) or stage IB non-small-cell lung cancer. We classified the 1294 patients into two groups-Group A, postoperative adjuvant chemotherapy (n = 295, 22.8%) and Group N, no adjuvant chemotherapy (n = 999, 77.2%)-and analyzed differences in postoperative overall survival between groups. RESULTS: Group A showed no advantage in overall survival over Group N as a whole (hazard ratio: 0.824 [95% confidence interval: 0.631-1.076]), in p-stage IA (hazard ratio: 0.617 [95% confidence interval: 0.330-1.156]) and in p-stage IB (hazard ratio: 0.806 [95% confidence interval: 0.597-1.088]) subsets. Even after propensity score matching, Group A showed no significant advantage in overall survival over Group N as a whole (hazard ratio: 0.975 [95% confidence interval: 0.688-1.381]), in p-stage IA (hazard ratio: 1.390 [95% confidence interval: 0.539-3.586]) and in p-stage IB (hazard ratio: 0.922 [95% confidence interval: 0.633-1.343]). CONCLUSIONS: adjuvant chemotherapy for completely resected p-stage IA (>2 cm) and stage IB non-small-cell lung cancer showed no benefit for recommendation for elderly patients; considering the risk of adverse events, we do not recommend adjuvant chemotherapy for elderly patients.

DOI： 10.1093/jjco/hyad116

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

BACKGROUND: The PACIFIC trial findings drastically changed the c-stage III non-small cell lung cancer (NSCLC) treatment strategy. However, it remains uncertain whether surgery is no longer needed for treatment. We aimed to evaluate the efficacy of surgery and explore the prognostic factors of better outcomes in surgery-treated patients than in PACIFIC regimen-treated patients. PATIENTS AND METHODS: From 2010 to 2020, 107 patients with clinical N2-stage III NSCLC underwent lung resection in our institute. We analyzed and compared the yearly postoperative overall survival (OS) benchmarks of these patients to those of patients treated in the PACIFIC trial. RESULTS: The 1-, 2-, 3-, 4-, and 5-year OS rates of patients were 87.7%, 73.9%, 64.9%, 58.2%, and 55.4%, respectively, all of which were superior to those of PACIFIC regimen-treated patients. However, patients with cT3/T4 tumors and skip, multistation, distant, and bulky N2 metastases, as well as those who underwent bronchoplasty, showed inferior results in several yearly benchmarks than in PACIFIC regimen-treated patients. Multivariate analyses conducted among factors mentioned above showed that cT3/T4 tumor was a worse prognostic factor for surgery-treated patients than for PACIFIC regimen-treated patients (hazard ratio [HR] 1.89, P = .036). Distant N2 metastasis was also a worse prognostic factor, although its effect was not statistically significant (HR 1.81, P = .082). CONCLUSION: Surgery remains the mainstay of N2-positive c-stage III NSCLC treatment, and the PACIFIC regimen may be suitable only for patients with unresectable disease. However, surgery should be cautiously considered for patients with cT3/4 disease.

DOI： 10.1016/j.cllc.2023.07.004

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

Pericardial defects are rare congenital disorders. We report a case of a left lower lobectomy in a patient with lung cancer, a congenital complete left-sided pericardial defect and severe pleural adhesions. The pleural adhesions between the epicardium and lungs were carefully dissected. A left lower lobectomy with mediastinal nodal dissection was performed under complete video-assisted thoracoscopic surgery without pericardial reconstruction. The patient remained asymptomatic for 20 months postoperatively. Careful dissection of severe adhesions is necessary in patients with severe cardiac pulsations.

DOI： 10.1093/icvts/ivad113

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記述言語：日本語   掲載種別：研究論文（学術雑誌）  

There are various approaches to surgery for anterior mediastinal tumors, including median sternotomy, multi-port and single-port video-assisted thoracic surgery, and robot-assisted thoracic surgery. According to the 2017 Annual Report of The Japanese Association for Thoracic Surgery, mediastinal tumor resection is about one-tenth of lung resection. Therefore, we consider that it is necessary to standardize the technique at each institution to acquire stable minimally invasive surgical techniques. We reported on our center's techniques and innovations in minimally invasive surgery for anterior mediastinal tumors, and used a learning curve to reveal that sharing knowledge within the team can reduce operative time.

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：Elsevier BV  

BACKGROUND: Several methods for chest drainage after pulmonary resection of malignant lung tumors exist, but consensus on the ideal method has not been reached. METHODS: We conducted a multicenter prospective observational study. We enrolled 2200 patients who underwent lung resection for lung tumors. Of the 1470 patients who underwent anatomic resection, 347 showed air leak on the morning of postoperative day 1. They were assigned to 3 groups according to the chest drainage method on postoperative day 1. RESULTS: Of 347 patients with postoperative air leaks, 107 (30.8%), 179 (51.6%), and 61 (17.6%) were assigned to water seal, continuous suction, and digital drainage, respectively. The median postoperative air leak duration was significantly longer with digital drainage (4.0 days) than with either water seal (2.5 days) or continuous suction (3.0 days; P = .009). Chest tubes were required for significantly more days on average with digital drainage (6.0 days) than with water seal (4.0 days) or continuous suction (4.0 days; P = .003). Prolongation of air leak duration was significantly more likely to occur in patients with body mass index <18.5 kg/m2 (hazard ratio [HR], 1.6; 95% CI, 1.1-2.3), moderate or severe air leak on postoperative day 1 (HR, 2.0; 95% CI, 1.5-2.6), or digital drainage (HR, 1.4; 95% CI, 1.01-1.9). CONCLUSIONS: Water seal was associated with significantly shorter duration of postoperative air leak and chest drainage compared with continuous suction and digital drainage.

DOI： 10.1016/j.athoracsur.2022.06.042

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

Lymphovascular invasion (LVI) is a fundamental step toward the spread of cancer. Extracellular vesicles (EVs) promote cellular communication by shuttling cargo, such as microRNAs (miRNAs). However, whether EV-associated miRNAs serve as biomarkers for LVI remains unclear. This study aimed to identify EV-associated miRNAs related to LVI and validate the miRNA levels from patients with early-stage lung adenocarcinoma (LADC). Blood samples were collected from patients undergoing pulmonary resection for stage I LADC before surgery. The patients were classified into three groups according to the presence of LVI and postoperative recurrence. Serum-derived EVs in the derivation cohort were used for small RNA sequencing, while the selected LVI miRNA candidates were validated via real-time quantitative polymerase chain reaction using 44 patient and 16 healthy donor samples as the validation cohorts. Five miRNAs (miR-99b-3p, miR-26a-5p, miR-93-5p, miR-30d-5p, and miR-365b-3p) were assessed, and miR-30d-5p (p = 0.036) levels were significantly downregulated in the LVI-positive group. miR-30d-5p levels in healthy donors were lower than those in LADC patients. Patients with high miR-30d-5p levels had favorable survival compared to those with low miR-30d-5p levels. miR-30d-5p level in EVs may serve as a promising biomarker for detecting LVI in patients with early-stage LADC.

DOI： 10.1038/s41598-023-32041-5

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

BACKGROUND: We aimed to clarify the risk factors for postoperative recurrence in patients with epidermal growth factor receptor (EGFR)-mutated stage I lung adenocarcinoma, using EGFR wild-type adenocarcinoma as a comparator, to select optimal candidates for adjuvant therapy with EGFR tyrosine kinase inhibitor (TKI). METHODS: Data of patients with pathologic stage I EGFR-mutated (n = 713) and wild-type (n = 673) adenocarcinoma who did not receive adjuvant therapy were retrospectively analyzed. The cumulative incidence of recurrence (CIR) was estimated using Gray's method, and multivariable Fine-Gray competing risk models identified independent risk factors associated with recurrence. RESULTS: The CIR did not differ significantly between patients with EGFR-mutated and wild-type adenocarcinoma (P = .32). Multivariable analysis revealed that greater size (cm) of invasive tumor (hazard ratio 1.539; 95% CI, 1.077-2.201), lymphovascular invasion (hazard ratio 5.180; 95% CI, 2.208-12.15), pleural invasion (hazard ratio 3.388; 95% CI, 1.524-7.533), and high-grade histologic subtype (hazard ratio 4.295; 95% CI, 1.539-11.99) were independent risk factors for recurrence in patients with EGFR-mutated adenocarcinoma. The 5-year CIR was significantly higher among patients with these factors (tumor size greater than 2 cm, 15.9%; lymphovascular invasion, 26.9%; pleural invasion, 39.3%; and high-grade subtype, 44.4%) than among patients without them (4.4%, 2.2%, 3.9%, and 5%, respectively; P < .001). For patients with EGFR wild-type adenocarcinoma, independent risk factors for recurrence were invasive tumor size, lymphovascular invasion, and pleural invasion, but not histologic subtypes. CONCLUSIONS: Even for patients with EGFR-mutated stage I lung adenocarcinoma, recurrence risk is stratified. Adjuvant therapy may be considered if they have high-risk factors for recurrence.

DOI： 10.1016/j.athoracsur.2023.01.024

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

OBJECTIVES: This study aimed to determine the clinical characteristics for predicting low-grade cancer in radiologically solid predominant non-small-cell lung cancer (NSCLC) and compare the survival outcomes of wedge resection with those of anatomical resection for patients with and without these characteristics. METHODS: Consecutive patients with clinical stages IA1-IA2 NSCLC showing radiologically solid predominance ≤2 cm at 3 institutions were retrospectively evaluated. Low-grade cancer was defined as the absence of nodal involvement and blood vessel, lymphatic and pleural invasion. The predictive criteria for low-grade cancer were established by multivariable analysis. The prognosis of wedge resection was compared with that of anatomical resection for patients who met the criteria, using the propensity score-matched analysis. RESULTS: Among 669 patients, multivariable analysis showed that ground-glass opacity (GGO) (P < 0.001) on thin-section computed tomography and an increased maximum standardized uptake value on 18-fluoro-2-deoxyglucose positron emission tomography/computed tomography (P < 0.001) were independent predictors of low-grade cancer. The predictive criteria were defined as GGO presence and maximum standardized uptake value ≤1.1 (specificity: 97.8%, sensitivity: 21.4%). In the propensity score-matched pairs (n = 189), overall survival (P = 0.41) and relapse-free survival (P = 0.18) were not significantly different between patients who underwent wedge resection and anatomical resection among those who fulfilled the criteria. CONCLUSIONS: The radiologic criteria for GGO and a low maximum standardized uptake value could predict low-grade cancer, even in solid-dominant NSCLC sized ≤2 cm. Wedge resection could be an acceptable surgical option for patients with radiologically predicted indolent NSCLC showing a solid-dominant appearance.

DOI： 10.1093/icvts/ivac285

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記述言語：日本語   掲載種別：研究論文（学術雑誌）  

PURPOSE: When performing segmentectomy, we aim to keep adequate distance from the tumor using three-dimensional( 3D) images of the pulmonary artery perfusion area and the indocyanine green( ICG) injection method. The effectiveness and improvement of this method were examined. PATIENTS AND METHOD: We retrospectively investigated 50 consecutive patients who underwent segmentectomy with this method. In simulation, we measured the predicted margin distance( PMD) on a 3D image. Then, we measured the actual margin distance (AMD) on resected specimens fixed in formalin. We compared these two distances and evaluated factors influencing shorter AMD. RESULTS: The median AMD was 1.7 cm, and there was no positive margin case. The median ratio of AMD/PMD was 0.73. In multivariate analysis, shorter PMD and no resection of subsegment bronchi next to the tumor were significant factors associated with shorter AMD( p<0.001, p=0.014). CONCLUSIONS: Our method was effective for segmentectomy. For adequate AMD, a longer PMD in simulation and subsegmental bronchi resection next to the tumor should be considered.

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

OBJECTIVES: We aimed to clarify the differences in prognosis between wedge resection and segmentectomy performed for cN0 non-small cell lung cancer (NSCLC) measuring ≤ 2 cm, with consolidation tumor ratio (CTR) > 0.25. METHODS: This multicenter study included 570 patients with cN0 NSCLC (tumor size ≤ 2 cm, CTR > 0.25) who underwent wedge resection (n = 244) and segmentectomy (n = 326) between January 2010 and December 2018. After propensity score matching (PSM, 1:1 method), 182 patients were matched for clinical characteristics (age, sex, laterality, smoking index, tumor size, CTR, carcinoembryonic antigen value, positron-emission tomography-documented maximum standardized uptake value, clinical stage, and tumor disappearance rate) and intergroup comparison of disease-free survival (DFS) and overall survival (OS). Using Gray's test, an intergroup comparison of the cumulative incidence of lung cancer-specific mortality was performed. RESULTS: After PSM, similar DFS (5-year DFS, 79.9% vs. 87.1%, p = 0.103) and OS (5-year OS, 88.7% vs. 88.9%, p = 0.719) rates were observed in the wedge resection and segmentectomy groups. We observed no significant intergroup differences in lung cancer-specific mortality (5-year cumulative incidence: 4.6% vs. 3.5%; p = 0.235). Subgroup analysis revealed no specific subgroup demonstrating improved DFS or OS after undergoing wedge resection or segmentectomy. CONCLUSION: DFS, OS, and lung cancer-specific mortality were comparable between wedge resection and segmentectomy of cN0 NSCLC-tumor size ≤ 2 cm and CTR > 0.25. Large-scale prospective clinical trials are warranted to compare the prognoses of wedge resection and segmentectomy for these tumors.

DOI： 10.3389/fonc.2023.1253414

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

Discrepancies between radiological whole tumor size (RTS) and pathological whole tumor size (PTS) are sometimes observed. Unexpected pathological upsize may lead to insufficient margins during procedures like sublobar resections. Therefore, this study aimed to investigate the current status of these discrepancies and identify factors resulting in pathological upsize in patients with early-stage non-small cell lung cancer (NSCLC). Data from a multicenter database of 3,092 patients with clinical stage 0-IA NSCLC who underwent pulmonary resection were retrospectively analyzed. Differences between the RTS and PTS were evaluated using Pearson's correlation analysis and Bland-Altman plots. Unexpected pathological upsize was defined as an upsize of ≥ 1 cm when compared to the RTS, and the predictive factors of this upsize were identified based on multivariable analyses. The RTS and PTS showed a positive linear relationship (r = 0.659), and the RTS slightly overestimated the PTS. The Bland-Altman plot showed 131 of 3092 (5.2%) cases were over the upper 95% limits of agreement. In multivariable analyses, a maximum standardized uptake value (SUVmax) of the primary tumor on 18-fluoro-2-deoxyglucose positron emission tomography/computed tomography (odds ratio [OR], 1.070; 95% confidence interval [CI], 1.035-1.107; P <0.001) and the adenocarcinoma histology (OR, 1.899; 95% CI, 1.071-3.369; P =0.049) were independent predictors of unexpected pathological upsize. More of the adenocarcinomas with pathological upsize were moderately or poorly differentiated, when compared to those without. The RTS tends to overestimate the PTS; however, care needs to be taken regarding unexpected pathological upsize, especially in adenocarcinomas with a high SUVmax.

DOI： 10.1053/j.semtcvs.2022.12.001

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

OBJECTIVES: This study aimed to analyze the risk of death from non-lung cancer after segmentectomy or lobectomy for early-stage lung cancer. METHODS: A total of 1,385 patients underwent lobectomy or segmentectomy for clinical stage 0-I primary lung cancer, with no evidence of recurrence after surgery, between January 2008 and December 2018. Risk factors for non-lung cancer deaths were analyzed using multivariable logistic regression analysis. The overall survival (OS) of patients with low and high comorbidities who underwent lobectomy and segmentectomy was compared using a log-rank test. RESULTS: Patients with non-lung cancer deaths (n = 126) were more likely to have undergone lobectomy than patients with non-recurrence survival (n = 1,259). Multivariable analysis revealed that age (≥ 65 years), smoking index (≥ 600), BMI (≤ 18.5 kg/m2), interstitial pneumonia, %VC (≤ 96.4%), and lobectomy were risk factors for non-lung cancer death. Patients who underwent segmentectomy had significantly better 5-year OS than those who underwent lobectomy, after propensity score matching (94.6% vs 90.4%, p = 0.027). Patients with high comorbidities (patients with more than two of the following risks: age ≥ 65 years, smoking index ≥ 600, BMI ≤ 18.5 kg/m2, Charlson Comorbidity Index ≥ 1, %VC ≤ 96.4%) who underwent segmentectomy had a better 5-year OS than those who underwent lobectomy (92.8% vs 87.8%, p = 0.016). However, there was no difference in 5-year OS between segmentectomy and lobectomy in patients with low comorbidities (98.5% vs 97.4%, p = 0.867). CONCLUSIONS: The impact of lobectomy and segmentectomy on non-lung cancer deaths depends on the extent of the patients' comorbidities.

DOI： 10.1093/ejcts/ezac458

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

DOI： 10.1245/s10434-022-12808-2

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

BACKGROUND: There are few reports on the utility of the maximum standardized uptake value (SUVmax) for predicting the prognosis of early-stage lung adenocarcinoma based on the latest tumor-node-metastasis (TNM) classification. This study aimed to determine whether clinicopathologic factors, including the SUVmax, affect prognosis in these patients. PATIENTS AND METHODS: We enrolled 527 patients with c-stage IA lung adenocarcinoma who underwent lobectomy or greater resection between 2011 and 2017. Recurrence-free survival (RFS) and overall survival (OS) were analyzed using Kaplan-Meier curves and compared using the log-rank test. Factors associated with RFS and OS were determined using the Cox proportional hazards model. RESULTS: RFS was significantly different based on tumor stage. In contrast, there was no significant difference in OS between patients with stage IA2 and IA3 disease (p = 0.794), although there were significant differences in OS between patients with stage IA1 and IA2 disease (p = 0.024) and between patients with stage IA1 and IA3 disease (p = 0.012). Multivariate analysis demonstrated that SUVmax was independently associated with both RFS and OS among patients with c-stage IA lung adenocarcinoma (RFS, p = 0.017; OS, p = 0.047). Further, even though there was no significant difference in OS between patients with stage IA2 and IA3 disease (n = 410), SUVmax was able to stratify patients with high and low RFS and OS among these patients (RFS, p < 0.001; OS, p < 0.001). CONCLUSION: SUVmax was an important preoperative factor to evaluate prognosis among patients with c-stage IA lung adenocarcinoma as well as the current TNM classification.

DOI： 10.1245/s10434-022-12684-w

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

BACKGROUND: Pathological stage IB-IIIA lung adenocarcinoma with an epidermal growth factor receptor (EGFR) mutation (Mt) has a high recurrence rate even after complete resection. However, there have been few reports on the risk factors for Mt recurrence. This study aimed to analyze the clinicopathological factors related to the relapse-free survival (RFS) of patients with pathological stage IB-IIIA primary lung adenocarcinoma with and without an EGFR mutation. METHODS: Patients who underwent curative surgery for Mt (n = 208) harboring the EGFR exon 21 L858R point mutation or EGFR exon 19 deletion mutation and EGFR mutation wild-type lung adenocarcinoma (Wt, n = 358) between January 2010 and December 2020 were included. Patients who received adjuvant EGFR-tyrosine kinase inhibitors were excluded. The prognostic factors for RFS were analyzed using a multivariable Cox regression analysis. RESULTS: The 5-year RFS rates in the Mt and Wt groups were 43.5 and 52.3%, respectively (p = 0.907). Prognostic factors for RFS in the Mt group included smoking history (hazard ratio [HR], 1.49; p = 0.049), blood vessel invasion (HR, 1.84; p = 0.023), and lymph node metastasis (HR, 1.96; p = 0.005). However, adjuvant chemotherapy was not a prognostic factor (HR, 1.02; p = 0.906). In contrast, positron emission tomography (PET) max standardized uptake value (SUV) ≥ 6.0 (HR, 1.53; p = 0.042), lymphatic vessel invasion (HR, 1.54; p = 0.036), lymph node metastasis (HR, 1.79; p = 0.002), and adjuvant chemotherapy (HR, 0.60; p = 0.008) were prognostic factors for RFS in the Wt group. CONCLUSIONS: Prognostic factors for RFS in stage IB-IIIA primary lung adenocarcinoma differ by epidermal growth factor receptor mutation status. The impact of adjuvant chemotherapy on RFS also differed by EGFR mutation status.

DOI： 10.1186/s12885-022-10057-w

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

BACKGROUND: Epidermal growth factor receptor-tyrosine kinase inhibitor (EGFR-TKI) is an important treatment for lung adenocarcinoma patients with EGFR gene mutations. The purpose of this study was to review the efficacy of first-generation EGFR-TKIs and the incidence of T790M after first-generation TKI resistance in stage IV lung adenocarcinoma patients with positive EGFR gene mutation expression associated with EGFR mutant protein. METHODS: Tumor tissues were collected from stage IV lung adenocarcinoma patients with EGFR gene mutation who received first-generation EGFR-TKI targeted therapy. Patients were followed up through outpatient and inpatient systems. Immunohistochemistry was used to detect the expression of corresponding EGFR mutant protein in tumor tissues. The incidence of T790M mutation after first-generation TKI resistance and the correlation between the mutant protein and progression-free survival (PFS) after first-generation TKI treatment were investigated. RESULTS: T790M mutation rates were 37.93% (11/29) and 42.50% (17/40) in the EGFR mutation groups, respectively, after first-generation TKI treatment for drug resistance. In patients with exon 19 deletion, T790M mutations were found in 63.64% (7/11) of patients with positive protein expression and 22.22% (4/18) of patients with negative protein expression (P=0.026; χ2=4.974). The mutation rate of T790M after drug resistance in patients with L858R mutation was 53.57% (15/28) and 16.67% (2/12) in the protein expression-positive and negative groups, respectively (χ2=4.682, P=0.030). The variations were statistically significant. CONCLUSIONS: After resistance to the first-generation EGFR-TKI treatment, the occurrence of T790M mutation may be related to the expression of EGFR mutant protein in patients with EGFR gene mutation.

DOI： 10.21037/atm-22-3850

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

BACKGROUND: Although a well-acknowledged component of curative surgery for lung cancer, investigators have recently questioned the need for mediastinal lymph node dissection (MLND) in early-stage lung cancer cases. As such, the accurate prediction of N2 stage prior to surgery has become increasingly critical. But diagnostic biomarkers predicting N2 metastases are deficient, which are urgently needed. METHODS: We extracted the data of non-small cell lung cancer (NSCLC) patients whose clinical information and follow-up data are complete and without preoperative induction therapy from the Surveillance, Epidemiology, and End Results (SEER) database. The SEER program registries routinely collect demographic and clinic data on patients. And the prognostic differences were analyzed according to the presence or absence of MLND in their lung resection using the R package. Subsequently, the correlations between pN2 metastasis and clinical characteristics were analyzed. In parallel, the long non-coding RNAs (lncRNAs) associated with pN2 status were screened in The Cancer Genome Atlas (TCGA) database by expression difference analysis between pN0-N1 and pN2 patients using limma. Their diagnostic efficiency for detecting N2 metastases was evaluated using receiver operating characteristic (ROC) curves, and a combined diagnostic model was constructed using logistic regression and ROC curve analyses in lung adenocarcinoma (LUAD). RESULTS: There were 16,772 patients in MLND group, and 2,699 cases in no-MLND group. The clinical data from SEER showed that the incidence of N2 metastasis was low in pT1 NSCLC (1,023/16,772, 6.10%), but the prognosis of no-MLND patients was poorer than those who underwent MLND (P<0.001, HR =1.605). Pathological N2 metastasis was correlated with age, histologic type, and tumor size. On the other hand, five lncRNAs (LINC00892, AC099522.2, LINC01481, SCAMP1-AS1, and AC004812.2) were screened and confirmed as potential diagnostic biomarkers for detecting N2 metastasis in pT1 LUAD. The AUC of the combined indicators was 0.857. CONCLUSIONS: MLND may be oncologically necessary for selected T1 NSCLC patients based on the metastasis incidence and prognosis. A diagnostic model combining LINC00892, AC099522.2, LINC01481, SCAMP1-AS1, and AC004812.2 expression levels may have the potential to be a diagnostic biomarker for detecting N2 metastasis in pT1 LUAD. This study suggests that MLND might be omitted in patients with lower expression level of this diagnostic model.

DOI： 10.21037/tlcr-22-207

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記述言語：英語  

DOI： 10.21037/jtd-22-97

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

Circulating tumor cells (CTCs) are dislodged from the primary tumor into the bloodstream, travel within the bloodstream to distant organs, and finally extravasate and proliferate as epithelial metastatic deposits. The relationship between the existence of CTCs and tumor prognosis has been demonstrated by many researchers. In surgery for malignancies, the surgical manipulation of tumors and tissues around the tumor may lead to the release of CTCs into the bloodstream. The non-touch isolation technique (NTIT) has been advocated to prevent the release of CTCs during surgery. The concept of NTIT is the prevention of intraoperative increment of CTCs from the primary tumor by the early blockade of outflow vessels, and 'pulmonary vein (PV)-first lobectomy' during surgery for non-small-cell lung cancer (NSCLC) corresponds to this technique. The concept of PV-first lobectomy is well known among thoracic surgeons, but evidence of its efficacy for preventing the increase of intra- and postoperative CTCs and for improving postoperative prognosis is still uncertain. Our study summarizes evidence regarding the relationship between NTIT and CTCs in NSCLC and suggests the need for further research on CTCs and CTC-detecting modalities.

DOI： 10.3390/cancers14061448

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

OBJECTIVES: This retrospective study aimed to elucidate the effect of epidermal growth factor receptor (EGFR) gene mutations on the prognosis of patients with pathological stage II-IIIA primary lung cancer after curative surgery. MATERIALS AND METHODS: We enrolled 539 patients with p-stage II-IIIA (8th edition tumor-node-metastasis [TNM] classification) lung cancer who underwent curative resection at Kanagawa Cancer Center between January 2010 and December 2020 and whose tumors were tested for EGFR mutations. Relapse-free survival (RFS) and overall survival (OS) of patients with EGFR-mutant lung cancer (Mt, n = 126) including EGFR exon 21 L858R point mutation and EGFR exon 19 deletion mutation and EGFR mutation-wild lung cancer (Wt, n = 413) were analyzed using Kaplan-Meier curves and compared using a log-rank test. Cox regression analysis was performed to evaluate the effects of EGFR gene mutations on RFS and OS at each stage. RESULTS: There were 56/256 patients with p-stage II EGFR-Mt/Wt and 70/157 patients with p-stage IIIA EGFR-Mt/Wt. The 5-year RFS rate of patients with EGFR-Mt/Wt was 46.6%/52.0% (p = 0.787) for p-stage II and 17.4%/29.7% (p = 0.929) for p-stage IIIA. The 5-year OS rate was 92.0%/65.7% (p = 0.001) for p-stage II and 56.0%/39.3% (p = 0.016) for p-stage IIIA. EGFR-Mt was not an independent prognostic factor for OS of patients with p-stage IIIA lung cancer (hazard ratio [HR], 0.95; 95% confidence interval [CI], 0.51-1.76; p = 0.872); however, EGFR-Mt was an independent favorable prognostic factor for OS of patients with p-stage II lung cancer (HR, 0.59; 95% CI, 0.36-0.96; p = 0.034). CONCLUSION: The OS of lung cancer patients with p-stage II or IIIA, classified according to the 8th edition TNM classification, was remarkably favorable. Incorporating EGFR mutations to the anatomical TNM classification may lead to a more accurate prognosis prediction.

DOI： 10.1016/j.lungcan.2021.11.002

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

OBJECTIVES: The objective of this study was to determine the variation in intrapleural pressure (IPP) with and without air leakage using a digital chest drainage system (DCS) for each pressure setting. METHODS: In this retrospective single-centre study, we analysed 49,553 h of air leakage after anatomical lung resection in 714 patients between 2018 and 2020. The transition of mean IPP and mean air leak flow was monitored using DCS, and the association between mean IPP and mean air leak flow was examined. The relationship between the transition of mean IPP and air leakage according to the varying suction pressures on DCS was also investigated. RESULTS: Overall, 272 patients (38.1%) showed air leakage after surgery. The mean IPP in patients without air leakage was -12.0 ± 2.9 cmH2O and maintained at about -12 cmH2O constantly, while the mean IPP in patients with air leakage was -8.3 ± 1.9 cmH2O, which changed to -12 cmH2O instantly if air leakage disappeared (P < 0.001). Among patients with air leakage, the mean IPP changed more distinctly in patients with mild suction management than in those with conventional suction management (-5.0 ± 2.6 to -11.5 ± 4.2 and -8.8 ± 1.3 to -12.1 ± 2.5 cmH2O, respectively; P < 0.001). CONCLUSIONS: The change in IPP on a DCS is useful for detecting air leakage. Furthermore, management with a mild suction setting on DCS makes it easy to recognize the disappearance of postoperative air leakage.

DOI： 10.1093/icvts/ivab122

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

Background: Staple-line coverage is an effective method for prevention of postoperative recurrence of pneumothorax. However, the recurrence rate in young patients is still unsatisfactory using this method. Moreover, there is no consensus about the optimal material for use in this technique. To explore new material for this technique, we conducted this study to evaluate the safety of an absorbable topical collagen hemostat (INTEGRAN®) for staple-line coverage in pneumothorax surgery in young patients. Methods: A single-arm prospective interventional study was performed in 25 patients (age <25 years old) with primary spontaneous pneumothorax (PSP) who underwent wedge resection with staple-line coverage with INTEGRAN® between 2017 and 2020. The rate of material-related adverse events (defined as a body temperature ≥38 ℃ continuing for ≥2 days, postoperative WBC >18,000/mm3 and/or CRP >15 mg/dL, or acute empyema within 30 postoperative days) was defined as the primary endpoint. The 1-year postoperative rates of recurrence and of new bullae around the staple-line were also measured. Results: The median age was 19 years old. None of the patients had a body temperature ≥38 ℃ continuing for ≥2 days, extra-abnormal examination data, and acute empyema findings. At 1-year postoperatively, the recurrence rate was 12.0%, and the rate of new bullae around the staple-line was 16.7%. Conclusions: This study showed the safety of use of INTEGRAN® for staple-line coverage in pneumothorax surgery in young adults. The short-term recurrence rate was acceptable given the high-risk cohort examined in the study. A prospective randomized controlled study is needed for evaluation of the efficacy of INTEGRAN® for prevention of recurrence of PSP. Trial Registration: UMIN000026530 at UMIN Clinical Trials Registry.

DOI： 10.21037/jtd-21-274

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

Background: The staging of patients with a tumor of diameter 4.1-5.0 cm and no lymphatic/distant metastases have been up-graded to stage IIA in the latest 8th edition of the TNM staging system. However, the efficacy of adjuvant tegafur-uracil (UFT) therapy in these patients, which has been recommended in the guideline issued by The Japan Lung Cancer Society, remains unclear. We evaluated the efficacy of adjuvant UFT therapy among a cohort by retrospective analyses of multicentric database. Methods: In 2005-2007, 130 patients with p-stage IB non-small cell lung cancer (NSCLC) (diagnosed according to the 7th edition of the TNM staging system) and tumor size of ≥3.1 cm underwent anatomic complete resection at nine of our affiliated hospitals. We retrospectively reviewed the clinicopathological characteristics and the outcomes among these patients. Results: Ninety-eight patients had tumor size of 3.1-4.0 cm (T2a group), whereas 32 patients had tumor size >4.0 cm (T2b group). Overall, patients who received adjuvant UFT showed a tendency of better outcomes than patients who did not [hazard ratio (HR) 0.564; 95% confidence interval (CI), 0.257-1.238, P=0.147]. In subgroup analyses, patients who received adjuvant UFT also tended to show better outcomes than those who did not in both T2a group and T2b group (HR 0.504; 95% CI, 0.202-1.255, P=0.132 in T2a group and HR 0.855; 95% CI, 0.181-4.033, P=0.843 in T2b group, respectively). Conclusions: Our results suggest that adjuvant UFT therapy have the potential to improve postoperative outcomes even in patients with p-stage IIA disease, as classified according to the 8th edition of the TNM staging system.

DOI： 10.21037/jtd.2019.07.05

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記述言語：英語  

DOI： 10.21037/jtd.2017.07.77

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

INTRODUCTION: Systematic lymph node dissection (SND) is the standard procedure in surgical treatment for NSCLC, but the value of this approach for survival and nodal staging is still uncertain. In this study, we evaluated the potential of lobe-specific lymph node dissection (L-SND) in surgery for NSCLC by using a propensity score matching method. METHODS: From 2005 to 2007, 565 patients with cT1a-2b N0-1 M0 NSCLC underwent lobectomy with lymph node dissection at our 10 affiliated hospitals. Patients were classified into groups that underwent nodal sampling, L-SND, and systematic dissection SND on the basis of pathological data for the number and extent of nodal resection. A total of 77 patients with insufficient pathological data were excluded from the study. RESULTS: Overall, survival did not differ significantly among the groups (p = 0.552), but the rate of detection of pN2 in the SND group (13.1%) was significantly higher than in the nodal sampling (3.3%) and L-SND (9.0%) groups (p = 0.010). However, given the many confounding factors in the patient characteristics in each group, outcomes were reevaluated using a propensity score matching method for the L-SND and SND groups. After matching, the two groups had no significant differences in 5-year overall survival (73.5% for L-SND versus 75.3% for SND, p = 0.977) and pN2 detection (8.2% in both groups, p = 0.779). CONCLUSIONS: These results suggest that lobe-specific lymph node dissection has the potential to be a standard procedure in surgical treatment for NSCLC.

DOI： 10.1016/j.jtho.2016.08.127

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記述言語：日本語   出版者・発行元：(NPO)日本肺癌学会  

背景.限局性悪性胸膜中皮腫は、組織学的および免疫組織化学的にびまん性悪性胸膜中皮腫と類似した所見を示すが、生物学的特徴が異なる稀な腫瘍と報告されている。症例.59歳女性、アスベスト曝露歴なし。関節リウマチで近医通院中に、胸部異常陰影を認め当院を紹介受診した。CTで左肺尖部に5.5cmの腫瘤を認め、肺尖部胸壁浸潤肺癌の疑いであった。CTガイド下生検で、非小細胞肺癌(cT3N2M0、stage IIIA)の診断となり、化学放射線療法を施行後に左上葉切除と胸壁合併切除を施行した。病理組織学的に、低分化な上皮様異型細胞が充実性に増殖しており、腫瘍は臓側胸膜と壁側胸膜の間に存在していた。肺実質への浸潤は認めなかった。免疫染色では、中皮腫マーカーが陽性、肺癌マーカーが陰性であった。腫瘍の胸膜へのびまん性進展は認めず、限局性悪性胸膜中皮腫と診断した。術後8ヵ月現在無再発生存中である。結論.限局性悪性胸膜中皮腫はびまん性悪性胸膜中皮腫とは異なる病態である可能性がある。今回の治療法の可否の検討のためにも、今後症例の積み重ねによる病態の解明が大きな課題である。(著者抄録)

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その他リンク： https://search.jamas.or.jp/index.php?module=Default&action=Link&pub_year=2016&ichushi_jid=J01244&link_issn=&doc_id=20170317350007&doc_link_id=%2Fec7jaluc%2F2016%2F005607%2F007%2F1040-1045%26dl%3D0&url=https%3A%2F%2Fwww.medicalonline.jp%2Fjamas.php%3FGoodsID%3D%2Fec7jaluc%2F2016%2F005607%2F007%2F1040-1045%26dl%3D0&type=MedicalOnline&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00004_2.gif

記述言語：英語   掲載種別：研究論文（学術雑誌）  

BACKGROUND: A partial anomalous pulmonary venous connection is a rare congenital defect in which blood from the pulmonary vein is returned to the right atrium. Asymptomatic patients with a partial anomalous pulmonary venous connection with a small left-to-right shunt do not require surgical treatment. If such patients require a major lung resection, the surgical procedure could precipitate fetal right heart failure if the anomalous venous connection remains uncorrected. CASE PRESENTATION: A 59-year-old man was found to have an abnormal shadow on chest roentgenogram. Chest computed tomography imaging showed a mass in the right upper lobe. At the same time, we incidentally found an anomalous vessel. We diagnosed the abnormality as a partial anomalous pulmonary venous connection. Because the mass may have been lung cancer, a right upper lobectomy was performed using video-assisted thoracoscopic surgery. The right upper lobe vein drained into the superior vena cava. The anomaly was not corrected and the surgery was successful. His postoperative course was uneventful without cardiac failure. CONCLUSIONS: Before performing a major lung resection, surgeons should be aware of this rare anomaly and carefully interpret clinical images of all pulmonary veins.

DOI： 10.1186/s13019-016-0527-7

PubMed

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記述言語：英語  

DOI： 10.1093/ejcts/ezw010

PubMed

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

OBJECTIVES: Our study was designed to visually represent recurrence patterns after surgery for non-small-cell lung cancer (NSCLC) with the use of event dynamics and to clarify postoperative follow-up methods based on the times of recurrence. METHODS: A total of 829 patients with NSCLC who underwent complete pulmonary resection from 2005 to 2007 in 9 hospitals affiliated with the Yokohama Consortium of Thoracic Surgeons were studied. Event dynamics, based on the hazard rate, were evaluated. Only first events involving the development of distant metastases, local recurrence or both were considered. The effects of sex, histological type, pathological stage and age were studied. RESULTS: The hazard rate curve displayed an initial surge that peaked about 6-8 months after surgery. The next distinct peak was noted at the end of the second year of follow-up. On non-parametric kernel smoothing, the maximum peak was found 6-8 months after surgery in men. In women, the highest peak occurred 22-24 months after surgery, which was about 16 months later than the peak in men. The peak timing of the hazard curve was not affected by histological type, pathological stage or age in either sex. CONCLUSIONS: Our results suggest that the timing of recurrence after surgery for lung cancer is characterized by a bimodal pattern, and the times with the highest risk of recurrence were suggested to differ between men and women. Postoperative follow-up strategies should be based on currently recommended follow-up programmes, take into account the recurrence patterns of lung cancer, and be modified as required to meet the needs of individual patients.

DOI： 10.1093/ejcts/ezv462

PubMed

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

OBJECTIVES: Although the prognostic implications of visceral pleural invasion (VPI) are well established, it remains controversial whether the extent of VPI affects survival in patients with completely resected non-small-cell lung cancer (NSCLC). In addition, the impact of VPI according to nodal status is unclear. We evaluated the influence of the extent of pleural invasion on survival by analysing a multicentre retrospective database of patients who had undergone surgery for NSCLC. METHODS: We retrospectively reviewed the clinicopathological characteristics and outcomes of 639 patients with NSCLC who underwent anatomic complete resection from 2005 to 2007 at nine hospitals affiliated with the Yokohama Consortium of Thoracic Surgeons. RESULTS: The median follow-up was 65.0 months. The extent of pleural invasion was PL0 in 462 patients, PL1 in 135 and PL2 in 42. The 5-year overall survival rate was significantly higher in patients with PL0 tumours (75.9%) than in those with PL1 (63.6%) or PL2 tumours (54.1%). On subgroup analysis according to nodal status, PL0 was associated with a higher survival rate than that of PL1 or PL2 tumours in patients with N0 or N1 metastasis, but not in those with N2 metastasis. There was no difference between PL1 and PL2 in any subgroup. CONCLUSIONS: Our results suggest that the presence of VPI, rather than the extent, has an impact on postoperative survival in patients with NSCLC who have N0 or N1 metastasis. Because very few previous studies have addressed the effects of VPI in patients with N1 disease, further re-evaluation of the prognostic impact of VPI is necessary in this subgroup of patients.

DOI： 10.1093/ejcts/ezu515

PubMed

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記述言語：日本語   出版者・発行元：(NPO)日本呼吸器外科学会  

症例は13歳、男性。身長180cm、体重59kg。突然の呼吸困難にて来院し右高度、左中等度肺虚脱を有する同時両側気胸の診断で一期的手術を施行。両側ともBulla切除後、断端に酸化セルロースシートを貼付した。身体的特徴からマルファン症候群を疑い退院後、専門施設で遺伝子解析中であった。しかし術後4ヵ月目、再び突然の胸痛、呼吸困難が出現し胸部X線にて右は高度、左は軽度肺虚脱を認め同時両側術後再発気胸と診断。両側一期的に再手術を施行した。両側とも前回staple line近傍に気瘻を有する新生Bullaを認めたためこれらを自動縫合器で切除し、今度はポリグリコール酸シートで断端を被覆した。再手術後21ヵ月現在、明らかな再発なく経過観察中である。両側手術後の同時両側再発はまれであり、また近年主流となりつつある酸化セルロースシート断端被覆法は気胸再発予防に適さない可能性もあり文献的考察も交え報告する。(著者抄録)

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その他リンク： https://search.jamas.or.jp/index.php?module=Default&action=Link&pub_year=2015&ichushi_jid=J02256&link_issn=&doc_id=20151005280006&doc_link_id=10.2995%2Fjacsurg.29.706&url=https%3A%2F%2Fdoi.org%2F10.2995%2Fjacsurg.29.706&type=J-STAGE&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00007_3.gif

記述言語：英語   掲載種別：研究論文（学術雑誌）  

OBJECTIVE: Thus far, very few studies have assessed the efficacy and outcome of resection of pulmonary metastases originating from primary oral cancer and/or head and neck cancer. METHODS: We retrospectively reviewed 13 cases that had metastases from primary oral cancers and/or head and neck cancers, and had undergone metastasectomy in our hospital from January 2000 through March 2011. RESULTS: Twelve patients were male and one was female. The median disease-free interval from the time of treatment of their primary cancer was 12 (range 1-73) months. Eleven cases underwent partial resection, one underwent segmentectomy, and one underwent lobectomy. The overall 5-year survival rate after last pulmonary metastasectomy was 45.7 %, and the median survival time was 23 months. Factors predicting a poor prognosis according to univariate analysis were a disease-free interval of <12 months and a diagnosis of stage IV primary cancer, but multivariate analysis revealed no significant prognostic factors. CONCLUSIONS: Pulmonary metastasectomy would give a chance for long-term survival in patients with oral and/or head and neck cancers.

DOI： 10.1007/s11748-015-0554-7

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記述言語：日本語   出版者・発行元：日本気胸・嚢胞性肺疾患学会  

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記述言語：英語  

DOI： 10.1111/pin.12269

PubMed

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記述言語：日本語   出版者・発行元：(株)フォレストプリンコム  

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記述言語：日本語   出版者・発行元：日本気胸・嚢胞性肺疾患学会  

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

Polymyositis and myocarditis very rarely develop during chemotherapy for thymoma. Most reported cases of myocarditis and polymyositis associated with thymoma were found at autopsy of patients who died of acute progression of myocarditis. We describe our experience with a 64-year-old man who had recurrent thymoma accompanied by polymyositis and myocarditis. Lower-extremity myalgia and palpitations developed on day 25 of chemotherapy with weekly paclitaxel. Steroid pulse therapy was effective for the management of polymyositis and myocarditis associated with thymoma. Polymyositis and myocarditis after paclitaxel monotherapy have not been documented previously. Whether paclitaxel induced polymyositis and myocarditis is unclear and these symptoms might have been a paraneoplastic phenomenon associated with thymoma. However, our experience suggested that patients with thymoma who received paclitaxel-based chemotherapy should be carefully observed for polymyositis and myocarditis. If such patients have high serum creatine phosphokinase and troponin levels, steroid pulse therapy should be considered without delay. © 2013 The Authors.

DOI： 10.1016/j.ctrc.2013.03.001

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記述言語：日本語   出版者・発行元：(NPO)日本呼吸器外科学会  

2000年1月より2011年3月までの約10年間に、当院にて口腔・頭頸部癌からの肺転移巣を切除した13症例14切除術をretrospectiveに検討した。男性12例、女性1例、平均年齢63.5歳で原発巣治療後から再発までの期間の中央値は12ヵ月(範囲:1-73)であった。11例に部分切除術、1例に区域切除術、1例に肺葉切除術を施行した。13症例の肺切除後5年全生存率は45.7%、生存期間中央値は23ヵ月と文献的な肺転移非切除群と比較して良好な結果であった。各因子別の全生存率を比較すると12ヵ月未満のDFIおよび原発巣の病期IV期が有意な予後不良因子であったが多変量解析では独立した予後因子は同定できなかった。大腸癌などと同様に口腔・頭頸部癌肺転移に対しても転移巣切除術が予後を改善する可能性が示唆された。(著者抄録)

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

Insulin-like growth factor-1 receptor (IGF-1R) and matrix metalloproteinase-7 (MMP-7) have been reported to be related to tumor invasion and metastasis in various malignancies. The aim of this study was to evaluate the expression levels of IGF-1R and MMP-7 in resected non-small cell lung cancer (NSCLC) and to examine the relationship of such levels to clinical characteristics and survival. Expression was measured immunohistochemically. The percentage of stained cells was multiplied by the staining intensity. The sample was classified as high when the score was equal or higher than the median value or was otherwise considered to be low. High IGF-1R expression was associated with nodal metastasis and recurrence (P=0.034 and 0.006, respectively). High IGF-1R expression was associated with significantly poorer overall survival than low IGF-1R expression (P=0.011). MMP-7 expression did not significantly correlate with any clinicopathological factor. There was a trend toward slightly, but not significantly poorer survival in patients with MMP-7-high tumors than in those with MMP-7-low tumors (P=0.220). There was no significant correlation between IGF-1R expression and MMP-7 expression (P=0.184). Upon multivariate analysis, IGF-1R expression was independently related to the outcomes of patients with NSCLC. Overexpression of IGF-1R may be a useful predictor of lymph node metastasis, recurrence and post-surgical outcomes in patients with NSCLC.

PubMed

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記述言語：日本語   出版者・発行元：(NPO)日本呼吸器外科学会  

症例は65歳、女性。右頸部リンパ節腫脹を主訴に来院。胸部CTで前縦隔に55mm大の内部不均一な造影効果を有する腫瘤と右頸部、縦隔リンパ節腫大を認め、前縦隔腫瘍(胸腺腫疑い)、頸部・縦隔リンパ節転移の診断で手術を施行した。病理組織診の結果、大細胞神経内分泌癌(LCNEC)と小細胞癌が混在する胸腺原発低分化神経内分泌癌と診断された。術後8ヵ月で再発を来たし化学療法を施行したが術後34ヵ月に永眠された。胸腺原発の低分化神経内分泌癌は極めてまれな疾患であり、文献的考察とともに報告する。(著者抄録)

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その他リンク： https://search.jamas.or.jp/index.php?module=Default&action=Link&pub_year=2012&ichushi_jid=J02256&link_issn=&doc_id=20120405180018&doc_link_id=10.2995%2Fjacsurg.26.203&url=https%3A%2F%2Fdoi.org%2F10.2995%2Fjacsurg.26.203&type=J-STAGE&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00007_3.gif

記述言語：英語   掲載種別：研究論文（学術雑誌）  

PURPOSE: to evaluate the efficacy and safety of intrapleural analgesia (IPA) using ropivacaine after thoracoscopic surgery, compared with thoracic epidural analgesia (TEA) using ropivacaine. METHODS: forty patients undergoing thoracoscopic bullectomy for spontaneous pneumothorax were randomly assigned to one of two groups. IPA group (n = 20) received intermittent bolus injection of 0.375% ropivacaine into intrapleural space two times; at the end of operation and one more time as the pain increased. TEA group (n = 20) received continuous epidural analgesia with 0.375% ropivacaine. Transrectal diclofenac was administered as an additional analgesic. Pain was assessed on the basis of additional analgesics requirements and by using a visual analog scale (VAS). RESULTS: the time courses of VAS scores along the postoperative time course were not significantly different (p = 0.175). Consumption of transrectal diclofenac was significantly smaller in IPA group (p = 0.025). No major complications appeared in both groups, and incidence of adverse symptoms was not different. CONCLUSIONS: in IPA group, pain was managed with less consumption of additional analgesics. IPA could be one of the good choices after thoracoscopic surgery for its efficacy, safety, and benefit of easy placement of the catheter.

PubMed

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記述言語：日本語   出版者・発行元：日本外科系連合学会  

症例は49歳,男性.既往歴,虫垂炎(保存的).検診で便潜血陽性を指摘され,大腸内視鏡で盲腸に粘膜下腫瘍様隆起を認めた.注腸検査で盲腸から上行結腸に腸重積を認めた.送気にて軽快したが,盲腸に壁外圧排像を認めた.CTでは盲腸から連続する嚢胞性腫瘤として,腹部超音波検査では壁の厚い類円形腫瘤とこれに連続する内腔が低エコーで管腔構造物として描出された.腫瘍マーカーは正常であった.虫垂粘液嚢胞腺腫と診断し2009年12月腹腔鏡補助下盲腸部分切除術を行った.経過は順調で術後5日目に退院となった.切除した虫垂は棍棒状(147×30×30mm)で淡黄白色調の粘液を内包し組織学的に粘液嚢胞腺腫と確診された.若干の文献的考察を加え報告する.(著者抄録)

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その他リンク： https://search-tp.jamas.or.jp/index.php?module=Default&action=Link&pub_year=2011&ichushi_jid=J01066&link_issn=&doc_id=20111007130015&doc_link_id=10.4030%2Fjjcs.36.658&url=https%3A%2F%2Fdoi.org%2F10.4030%2Fjjcs.36.658&type=J-STAGE&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00007_3.gif

記述言語：日本語   出版者・発行元：(NPO)日本呼吸器外科学会  

原発性自然気胸の再発が予測できるかについて検討するために、初発時に保存的治療を行った218症例を、その後再発した群(74症例)としなかった群(144症例)とに分け、再発に関わる因子について分析した。患者背景は平均年齢24.5歳、男/女199/19症例、対側の気胸の既往あり/なし21/197症例、喫煙歴あり/なし/不明93/75/50症例であった。単変量解析では、25歳未満(再発率42%)、女性(63%)、対側気胸の既往あり(57%)、喫煙歴なし(55%)の症例で有意に再発率が高かった。多変量解析では、喫煙歴がないことのみが独立した再発の予測因子であった(p=0.006、odds比2.410)。以上から、非喫煙者の原発性自然気胸は再発率が高いので、初発時でも患者の意向を考慮した上で手術を検討しても良いと考える。また、非喫煙者と喫煙者とでは自然気胸の発生のメカニズムが異なると推測される。(著者抄録)

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その他リンク： https://search.jamas.or.jp/index.php?module=Default&action=Link&pub_year=2011&ichushi_jid=J02256&link_issn=&doc_id=20110628130004&doc_link_id=10.2995%2Fjacsurg.25.367&url=https%3A%2F%2Fdoi.org%2F10.2995%2Fjacsurg.25.367&type=J-STAGE&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00007_3.gif

記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：LIPPINCOTT WILLIAMS & WILKINS  

DOI： 10.1097/JTO.0b013e3181fb5100

Web of Science

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記述言語：日本語   出版者・発行元：(株)南江堂  

多発原発性肺癌(多発肺癌)14例(男7例、女7例、平均年齢64.5歳)を対象に手術適応・術式・適応について検討した。同時性多発肺癌8例、異時性多発肺癌6例であった。同時性多発肺癌の8例中、片側のみの病変は3例、両側は5例であった。片側性の症例には全例一期的に縮小手術を施行した。3例とも無再発生存中であった。両側性病変には二期的手術を施行した。当初1病変のみの手術を考慮した3例には初回は肺葉切除術で2回目は縮小手術、当初から全病変に対する手術を考慮した2例には両回とも縮小手術を施行した。無再発生存中2例、癌死2例で1例は経過観察脱落であった。異時性多発肺癌では初回手術は全例に肺葉切除以上の標準手術式、2回目は縮小手術を施行した。無再発生存中4例、癌死2例であった。多発肺癌全体の最終術後の5年生存率は59.0%であった。予後に関して、同時性と異時性の両群間に有意差は認めず、病変の組織型では腺癌のみ群が非腺癌を有する群より有意差はないが良い傾向を示した。以上より術前に多発肺癌を疑う症例は手術による完全切除を考慮し、初発の早期肺癌には肺機能温存を考慮した積極的な縮小手術も導入すべきと考えた。

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その他リンク： https://search.jamas.or.jp/index.php?module=Default&action=Link&pub_year=2010&ichushi_jid=J00349&link_issn=&doc_id=20100430010001&doc_link_id=40017107471&url=https%3A%2F%2Fci.nii.ac.jp%2Fnaid%2F40017107471&type=CiNii&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00003_1.gif

記述言語：日本語   出版者・発行元：日本気胸・嚢胞性肺疾患学会  

原発性自然気胸に対する保存的治療の成績を検討した。対象は2002年4月〜2006年2月までに来院した原発性自然気胸初発例202例(男性170例、女性32例、平均年齢29.6歳)であった。1)保存的治療法は安静療法37例、外来通院の携帯型気胸ドレナージデバイス(TV)療法135例、入院での持続ドレナージ療法30例であり、初期治療で一度終診できたのは安静療法34例(91.9%)、TV療法80例(59.3%)、持続ドレナージ療法18例(60%)であった。2)平均治療期間は安静療法13.1日、TV療法5.3日、持続ドレナージ療法15.2日でTV療法と他の治療法とに有意差が認められた。3)再発率は安静療法20.6%(7例)、TV療法30%(24例)、持続ドレナージ療法27.8%(5例)であり、原則として胸腔鏡下手術が行われた。また、再発までの平均期間は安静療法213日、TV療法155日、持続ドレナージ療法54日であった。尚、最終的に保存的療法のみでの軽快は100例(49.5%)であった。

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記述言語：日本語   出版者・発行元：(NPO)日本呼吸器外科学会  

27歳、女性。妊娠19週後半に突然の右胸痛を自覚し当院受診。右III°自然気胸の診断で持続吸引ドレナージによる保存的加療をおこなったが気漏停止しないため妊娠21週に胸腔鏡下右肺部分切除術を施行した。術後経過は順調で術後3日目に軽快退院。以降再発なく正期産で健児を出産した。妊娠中の自然気胸治療に関しては、胎児への影響を考え妊娠時期を問わず保存的に加療すべきとの報告もあるが、分娩時怒責による分娩中再発や長期ドレーン留置に伴う感染が原因で流産・早産などに至るリスクもあり、特に長期気漏持続症例、再発症例では妊娠中でも時期・術式・使用薬剤を考慮した手術が望ましいと考える。(著者抄録)

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その他リンク： https://search.jamas.or.jp/index.php?module=Default&action=Link&pub_year=2009&ichushi_jid=J02256&link_issn=&doc_id=20090925260010&doc_link_id=10.2995%2Fjacsurg.23.833&url=https%3A%2F%2Fdoi.org%2F10.2995%2Fjacsurg.23.833&type=J-STAGE&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00007_3.gif

記述言語：日本語   出版者・発行元：(株)癌と化学療法社  

症例は74歳、男性。肺腺癌(c-T3N2M0、stage IIIA)に対し、初回治療としてpaclitaxel(70mg/m2=110mg day 1,8,15)とcarboplatin(AUC5=500mg day 1)併用化学療法を施行したところday 6より腹痛が出現し、day 7に血圧70台と低下した。消化管穿孔による敗血症の診断で発症から33時間後、緊急手術を施行した。手術所見は腹腔内広範囲に便汁が貯留しており、直腸(Rs)後壁に1.7cm大の穿孔部位を認めた。Hartmann手術を施行し、術後経過は良好であった。病理組織検査では穿孔の原因となる所見は認めず、抗癌剤投与が直腸穿孔に関与していると考えられた。化学療法施行後の急性腹症では腸管穿孔を念頭におき、迅速な診断と治療が求められる。(著者抄録)

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その他リンク： https://search-tp.jamas.or.jp/index.php?module=Default&action=Link&pub_year=2009&ichushi_jid=J00296&link_issn=&doc_id=20090223480028&doc_link_id=%2Fab8gtkrc%2F2009%2F003602%2F029%2F0301-0304%26dl%3D0&url=https%3A%2F%2Fwww.medicalonline.jp%2Fjamas.php%3FGoodsID%3D%2Fab8gtkrc%2F2009%2F003602%2F029%2F0301-0304%26dl%3D0&type=MedicalOnline&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00004_2.gif

記述言語：日本語   掲載種別：研究論文（学術雑誌）  

A 74-year old man was treated with first-cycle chemotherapy of paclitaxel (70 mg/m2=110 mg day 1, 8, 15) and carboplatin (AUC5=500 mg day 1) for lung cancer (c-T3N2M0, stage III A). On day 6 abdominal pain appeared, while on day 7 abdominal CT showed a perforation of the digestive tract. Thirty-three hours after the onset he underwent Hartmann operation during which we recognized a perforation 1.7 cm in size in the rectum. Although the cause of the perforation was unknown from the pathological findings, anticancer agents were suspected to be involved. Perforation should be taken into consideration in connection with acute abdominal disease after chemotherapy.

PubMed

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記述言語：日本語   出版者・発行元：(NPO)日本肺癌学会  

背景.びまん性特発性肺神経内分泌細胞過形成(diffuse idiopathic pulmonary neuroendocrine cell hyperplasia:DIPNECH)は肺の稀な前浸潤性病変であり、末梢型カルチノイドおよびtumorletを合併することがある。症例.症例は52歳女性。胸部X線写真で異常影を指摘され当科を受診した。胸部CTでは左肺下葉に多発する小結節影、左肺上葉に1個の小結節影を認めた。胸腔鏡下に左肺上葉および左肺S8部分切除を行った。迅速病理診断で左肺上葉の病変は線維化と診断され、左肺S8の病変は腺癌が疑われたため左肺下葉切除を行った。永久標本において、左肺S8の結節は定型カルチノイドと診断された。切除した左肺下葉には定型カルチノイド、tumorlet、異型腺腫様過形成が混じて散在していた。また、クロモグラニンA陽性の微小な細胞増生巣が気管支粘膜内に散在性に存在し、DIPNECHと診断された。結論.神経内分泌細を起源とするDIPNECH、tumorlet、定型カルチノイドを合併した稀な症例を経験した。(著者抄録)

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その他リンク： https://search.jamas.or.jp/index.php?module=Default&action=Link&pub_year=2008&ichushi_jid=J01244&link_issn=&doc_id=20080708310009&doc_link_id=%2Fec7jaluc%2F2008%2F004803%2F009%2F0215-0220%26dl%3D0&url=https%3A%2F%2Fwww.medicalonline.jp%2Fjamas.php%3FGoodsID%3D%2Fec7jaluc%2F2008%2F004803%2F009%2F0215-0220%26dl%3D0&type=MedicalOnline&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00004_2.gif

記述言語：日本語   出版者・発行元：(NPO)日本呼吸器外科学会  

DOI： 10.2995/jacsurg.22.510_4

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記述言語：日本語   出版者・発行元：(NPO)日本呼吸器外科学会  

DOI： 10.2995/jacsurg.22.401_3

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

DOI： 10.1016/j.jamcollsurg.2007.08.006

PubMed

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

DOI： 10.1159/000144654

PubMed

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掲載種別：研究論文（学術雑誌）  

DOI： 10.2482/haigan.48.215

Scopus

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記述言語：日本語   出版者・発行元：日本臨床外科学会  

進行・再発乳癌の皮膚浸潤による出血は圧迫止血やアルギン酸使用により一時的に止血しても頻回に再出血を起こし, 時として高度の貧血に陥ることもある. このため患者は日常生活の制限を余儀なくされQOLが低下することがみられる. 安定した止血を得るためには局所切除や放射線治療が必要であるが, 特に進行・再発乳癌では患者の全身状態や放射線の前治療歴によりこれらの治療を施すことが難しいことも多い.<br>今回, われわれは3%ホルマリン液を用いて出血病変を固定することにより安定した止血が得られた2症例を経験したので報告する. この方法はストーマ装具を用いて3%ホルマリン液に出血病変を浸透・固定するもので病棟にて簡便に行うことができ, 2症例とも短期的には大きな副作用もなく一回の固定で2カ月間の安定した止血を得ることができた. 以上より, 3%ホルマリン固定療法は進行・再発乳癌患者のQOLを向上させる有効な治療法と考えられた.

DOI： 10.3919/jjsa.68.2731

CiNii Books

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その他リンク： http://search.jamas.or.jp/link/ui/2008075561

記述言語：日本語   出版者・発行元：(NPO)日本心臓血管外科学会  

症例は76歳、女性。Stanford A型の急性大動脈解離に対し、GRF glueを用いて上行大動脈人工血管置換術を施行した。術後15ヵ月目に自宅で突然心原性ショックに陥り当院へ救急搬送された。検査所見より吻合部し開による大動脈基部仮性瘤、し開した上行大動脈グラフトの閉塞による心原性ショックと診断した。IABPを施行したところ循環動態は改善した。翌日、人工血管大動脈基部再吻合術を施行し術後32日目に軽快退院となった。本症例のような大動脈基部仮性瘤に伴う人工血管狭窄によるショック状態に対しIABPはただちにグラフト狭窄を改善し循環動態を安定させうることから、手術までの有効な補助手段であると思われた。(著者抄録)

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その他リンク： https://search-tp.jamas.or.jp/index.php?module=Default&action=Link&pub_year=2006&ichushi_jid=J01122&link_issn=&doc_id=20061122310015&doc_link_id=10.4326%2Fjjcvs.35.367&url=https%3A%2F%2Fdoi.org%2F10.4326%2Fjjcvs.35.367&type=J-STAGE&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00007_3.gif

記述言語：日本語   出版者・発行元：日本臨床外科学会  

甲状腺全摘後もhyperthyroidismが継続し,バセドウ病抗体(TRAb)が陽性であった甲状腺濾胞癌骨転移の1例を経験したので報告する.症例は58歳女性,左肩甲骨腫瘤と左上肢挙上困難を自覚し当院を受診した.既往で20歳代より甲状腺腫を指摘されていたが放置していた.病理学的検査で甲状腺濾胞癌骨転移と診断し甲状腺全摘術を施行.術後の131Iシンチグラフィーでは右肋骨,腸骨,腰椎に集積を認めたが肩甲骨部の集積はわずかであった.退院時,Levothyroxine投与中でありfT3,fT4ともわずかに上昇していたがその後も上昇を続け,TRAb・TSAbともに陽性のためバセドウ病による甲状腺機能亢進症と判断.Levothyroxine減量・Thiamazole投与を開始し甲状腺機能は正常範囲となった.肩甲骨転移腫瘍には増大傾向は見られず,CT上1cm程度の縮小も見られた.甲状腺全摘後バセドウ病は自験例も含め7例であり,極めて稀な疾患と考えられた(著者抄録)

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その他リンク： https://search.jamas.or.jp/index.php?module=Default&action=Link&pub_year=2004&ichushi_jid=J03156&link_issn=&doc_id=20040928010007&doc_link_id=10.3919%2Fjjsa.65.2319&url=https%3A%2F%2Fdoi.org%2F10.3919%2Fjjsa.65.2319&type=J-STAGE&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00007_3.gif

記述言語：日本語   出版者・発行元：(NPO)日本肺癌学会  

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記述言語：日本語   出版者・発行元：日本臨床外科学会  

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記述言語：日本語   出版者・発行元：(NPO)日本呼吸器外科学会  

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記述言語：日本語   出版者・発行元：(NPO)日本肺癌学会  

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記述言語：日本語   出版者・発行元：(NPO)日本肺癌学会  

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記述言語：日本語   出版者・発行元：(NPO)日本肺癌学会  

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記述言語：日本語   出版者・発行元：(NPO)日本呼吸器外科学会  

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記述言語：日本語   出版者・発行元：(NPO)日本肺癌学会  

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記述言語：日本語   出版者・発行元：(NPO)日本肺癌学会  

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記述言語：日本語   出版者・発行元：(NPO)日本呼吸器内視鏡学会  

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その他リンク： https://search.jamas.or.jp/index.php?module=Default&action=Link&pub_year=2014&ichushi_jid=J00298&link_issn=&doc_id=20140415290377&doc_link_id=%2Fcf0brond%2F2014%2F0036s1%2F17a%2F5250-5250%26dl%3D0&url=https%3A%2F%2Fwww.medicalonline.jp%2Fjamas.php%3FGoodsID%3D%2Fcf0brond%2F2014%2F0036s1%2F17a%2F5250-5250%26dl%3D0&type=MedicalOnline&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00004_2.gif

記述言語：日本語   出版者・発行元：(NPO)日本呼吸器外科学会  

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記述言語：日本語   出版者・発行元：(NPO)日本肺癌学会  

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その他リンク： https://search.jamas.or.jp/index.php?module=Default&action=Link&pub_year=2008&ichushi_jid=J01244&link_issn=&doc_id=20081016270593&doc_link_id=%2Fec7jaluc%2F2008%2F004805%2F251%2F0555-0555%26dl%3D0&url=https%3A%2F%2Fwww.medicalonline.jp%2Fjamas.php%3FGoodsID%3D%2Fec7jaluc%2F2008%2F004805%2F251%2F0555-0555%26dl%3D0&type=MedicalOnline&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00004_2.gif

記述言語：日本語   出版者・発行元：日本胸部外科学会-関東甲信越地方会  

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記述言語：日本語   出版者・発行元：(一社)日本胸部外科学会  

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記述言語：日本語   出版者・発行元：(NPO)日本肺癌学会  

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記述言語：日本語   出版者・発行元：(公社)日本医学放射線学会  

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記述言語：日本語   出版者・発行元：(一社)日本呼吸器外科学会  

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記述言語：日本語   出版者・発行元：(一社)日本呼吸器外科学会  

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記述言語：日本語   出版者・発行元：(一社)日本呼吸器外科学会  

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記述言語：日本語   出版者・発行元：(一社)日本呼吸器外科学会  

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記述言語：日本語   出版者・発行元：(一社)日本胸部外科学会  

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記述言語：日本語   出版者・発行元：(一社)日本胸部外科学会  

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記述言語：日本語   出版者・発行元：(一社)日本胸部外科学会  

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記述言語：日本語   出版者・発行元：(NPO)日本肺癌学会  

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記述言語：日本語   出版者・発行元：(NPO)日本肺癌学会  

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記述言語：日本語   出版者・発行元：(NPO)日本肺癌学会  

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記述言語：日本語   出版者・発行元：(株)南江堂  

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その他リンク： https://search.jamas.or.jp/default/link?pub_year=2023&ichushi_jid=J00349&link_issn=&doc_id=20230629040015&doc_link_id=issn%3D0021-5252%26volume%3D76%26issue%3D7%26spage%3D556&url=http%3A%2F%2Fwww.pieronline.jp%2Fopenurl%3Fissn%3D0021-5252%26volume%3D76%26issue%3D7%26spage%3D556&type=PierOnline&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00005_2.gif

記述言語：日本語   出版者・発行元：(一社)日本呼吸器外科学会  

J-GLOBAL

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記述言語：日本語   出版者・発行元：(一社)日本呼吸器外科学会  

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記述言語：日本語   出版者・発行元：(一社)日本呼吸器外科学会  

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記述言語：日本語   出版者・発行元：(一社)日本呼吸器外科学会  

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記述言語：日本語   出版者・発行元：(一社)日本呼吸器外科学会  

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記述言語：日本語   出版者・発行元：(一社)日本呼吸器外科学会  

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記述言語：日本語   出版者・発行元：(一社)日本呼吸器外科学会  

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記述言語：日本語   出版者・発行元：(一社)日本呼吸器外科学会  

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記述言語：日本語   出版者・発行元：(一社)日本呼吸器外科学会  

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記述言語：日本語   出版者・発行元：(一社)日本呼吸器外科学会  

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記述言語：日本語   出版者・発行元：(NPO)日本肺癌学会  

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記述言語：日本語   出版者・発行元：(NPO)日本肺癌学会  

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記述言語：日本語   出版者・発行元：(NPO)日本肺癌学会  

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記述言語：日本語   出版者・発行元：(NPO)日本肺癌学会  

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記述言語：日本語   出版者・発行元：(一社)日本外科学会  

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記述言語：日本語   出版者・発行元：日本胸部外科学会-関東甲信越地方会  

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記述言語：日本語   出版者・発行元：(株)南江堂  

当院で肺悪性腫瘍に対して、肺動脈灌流域をもとに、3Dシミュレーションとインドシアニングリーン(ICG)静注法を用いて胸腔鏡下肺区域切除術を行った50例(男性22例、女性28例、平均年齢70歳)について検討した。その結果、ICGによる区域間は46例(92%)で良好に描出された。病理学的に切除断端陽性例は認めず、AMD中央値は1.7cmで、腫瘍径または2cm以上のマージンを確保できていた症例は34例(68%)であった。AMD/PMD中央値は0.73であり、PMDとAMDの間には相関が認められた。尚、多変量解析の結果、AMD(短い)に影響する要因は、PMD(短い)、腫瘍隣接亜区域気管支切離(なし)の2因子であることが判明した。

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記述言語：日本語   出版者・発行元：(NPO)日本肺癌学会  

J-GLOBAL

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記述言語：日本語   出版者・発行元：(一社)日本呼吸器外科学会  

J-GLOBAL

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記述言語：日本語   出版者・発行元：(一社)日本呼吸器外科学会  

J-GLOBAL

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記述言語：日本語   出版者・発行元：日本胸部外科学会-関東甲信越地方会  

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記述言語：日本語   出版者・発行元：(NPO)日本肺癌学会  

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記述言語：日本語   出版者・発行元：(NPO)日本肺癌学会  

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記述言語：日本語   出版者・発行元：日本胸部外科学会-関東甲信越地方会  

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記述言語：日本語   出版者・発行元：(NPO)日本肺癌学会  

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記述言語：日本語   出版者・発行元：(NPO)日本肺癌学会  

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記述言語：日本語   出版者・発行元：(NPO)日本肺癌学会  

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記述言語：日本語   出版者・発行元：(NPO)日本肺癌学会  

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記述言語：日本語   出版者・発行元：(NPO)日本肺癌学会  

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記述言語：日本語   出版者・発行元：(一社)日本胸部外科学会  

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記述言語：日本語   出版者・発行元：日本臨床外科学会  

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記述言語：日本語   出版者・発行元：(一社)日本胸部外科学会  

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記述言語：日本語   出版者・発行元：日本臨床外科学会  

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記述言語：日本語   出版者・発行元：(NPO)日本肺癌学会  

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記述言語：日本語   出版者・発行元：(NPO)日本肺癌学会  

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記述言語：日本語   出版者・発行元：(NPO)日本肺癌学会  

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記述言語：日本語   出版者・発行元：(一社)日本呼吸器外科学会  

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記述言語：日本語   出版者・発行元：(一社)日本呼吸器外科学会  

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記述言語：日本語   出版者・発行元：(一社)日本呼吸器外科学会  

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記述言語：日本語   出版者・発行元：(一社)日本呼吸器外科学会  

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記述言語：日本語   出版者・発行元：(一社)日本呼吸器外科学会  

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記述言語：日本語   出版者・発行元：(NPO)日本呼吸器内視鏡学会  

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記述言語：日本語   出版者・発行元：(一社)日本外科学会  

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記述言語：日本語   出版者・発行元：日本胸部外科学会-関東甲信越地方会  

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記述言語：日本語   出版者・発行元：(一社)日本胸部外科学会  

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記述言語：日本語   出版者・発行元：(一社)日本胸部外科学会  

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記述言語：日本語   出版者・発行元：日本臨床外科学会  

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記述言語：日本語   出版者・発行元：(NPO)日本肺癌学会  

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記述言語：日本語   出版者・発行元：(NPO)日本肺癌学会  

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記述言語：日本語   出版者・発行元：(NPO)日本肺癌学会  

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記述言語：日本語   出版者・発行元：(NPO)日本肺癌学会  

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記述言語：日本語   出版者・発行元：(NPO)日本肺癌学会  

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記述言語：日本語   出版者・発行元：日本臨床外科学会  

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記述言語：日本語   出版者・発行元：(一社)日本胸部外科学会  

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記述言語：日本語   出版者・発行元：日本胸部外科学会-関東甲信越地方会  

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記述言語：日本語   出版者・発行元：(NPO)日本呼吸器外科学会  

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記述言語：日本語   出版者・発行元：(NPO)日本呼吸器外科学会  

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記述言語：日本語   出版者・発行元：(NPO)日本呼吸器外科学会  

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記述言語：日本語   出版者・発行元：(NPO)日本呼吸器外科学会  

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記述言語：日本語   出版者・発行元：(NPO)日本呼吸器外科学会  

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記述言語：日本語   出版者・発行元：(NPO)日本肺癌学会  

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記述言語：日本語   出版者・発行元：(NPO)日本肺癌学会  

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記述言語：日本語   出版者・発行元：(NPO)日本肺癌学会  

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記述言語：日本語   出版者・発行元：(NPO)日本肺癌学会  

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記述言語：日本語   出版者・発行元：日本胸部外科学会-関東甲信越地方会  

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記述言語：日本語   出版者・発行元：(NPO)日本肺癌学会  

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記述言語：日本語   出版者・発行元：(NPO)日本肺癌学会  

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記述言語：日本語   出版者・発行元：(NPO)日本肺癌学会  

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記述言語：日本語   出版者・発行元：(NPO)日本肺癌学会  

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記述言語：日本語   出版者・発行元：(NPO)日本肺癌学会  

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記述言語：日本語   出版者・発行元：(一社)日本胸部外科学会  

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記述言語：日本語   出版者・発行元：(NPO)日本呼吸器外科学会  

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記述言語：日本語   出版者・発行元：(NPO)日本呼吸器外科学会  

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記述言語：日本語   出版者・発行元：(NPO)日本呼吸器外科学会  

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記述言語：日本語   出版者・発行元：日本臨床外科学会  

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記述言語：日本語   出版者・発行元：(NPO)日本呼吸器外科学会  

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記述言語：日本語   出版者・発行元：(NPO)日本呼吸器外科学会  

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記述言語：日本語   出版者・発行元：(一社)日本内視鏡外科学会  

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記述言語：日本語   出版者・発行元：(NPO)日本肺癌学会  

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記述言語：日本語   出版者・発行元：日本気胸・嚢胞性肺疾患学会  

【はじめに】気胸治療の処置の一つに、タルクによる胸膜癒着術がある。当施設で滅菌したタルク原末を用いて、自然気胸に対して胸腔鏡下にタルク散布を併施した症例についてまとめたので報告する。【対象】2009年1月から2014年12月までの6年間で、自然気胸に対して手術を施行した全196例のうち、タルク散布を行った17例を対象とした。【結果】対象疾患は続発性気胸の17例、原疾患は慢性閉塞性呼吸器疾患が16例、間質性肺炎が1例であった。気胸発症時の年齢は66歳(以降数値は症例数もしくは中央値)、手術時間は123分、術式はタルク散布のみが4例、肺部分切除術+タルク散布が13例であった。術後発熱の最高値は37.5℃、術後白血球値の最高値は12800/μl、術後CRP最高値は17.5mg/dLであった。術後胸痛の訴えがあったのは6例、再発は1例であった。【結論】胸腔鏡下のタルクによる胸膜癒着術は、続発性自然気胸の治療の一選択肢となりうる。(著者抄録)

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記述言語：日本語   出版者・発行元：(NPO)日本呼吸器外科学会  

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記述言語：日本語   出版者・発行元：(NPO)日本呼吸器外科学会  

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記述言語：日本語   出版者・発行元：(NPO)日本呼吸器外科学会  

症例1は37歳、女性。近医歯科で左下智歯の抜歯治療直後に顔面腫脹を自覚し、帰宅後に増悪したため当院救急外来を受診した。頭頸部の皮下気腫、血液検査で炎症所見の上昇、胸部CTで縦隔気腫を認め、経過観察目的に緊急入院した。安静と抗菌薬の予防投与で気腫や自覚症状の改善を認め独歩退院し、その後も増悪や再燃は認めていない。症例2は68歳女性。近位歯科で右下第5歯の治療中に呼吸苦が出現し、当院救急外来を受診した。頭頸部と前胸部の皮下気腫と胸部CTで縦隔気腫も認め、経過観察目的に緊急入院となった。安静と抗菌薬予防投与で気腫と自覚症状は改善し退院した。その後も増悪や再燃は認めなかった。縦隔気腫は外傷や自然気胸などで多くみられ、呼吸器疾患を対象とする医師には広く知られている疾患であるが、原因として歯科治療があることはあまり知られておらず、文献的考察を加えて報告する。(著者抄録)

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その他リンク： https://search.jamas.or.jp/index.php?module=Default&action=Link&pub_year=2018&ichushi_jid=J02256&link_issn=&doc_id=20180319450006&doc_link_id=10.2995%2Fjacsurg.32.160&url=https%3A%2F%2Fdoi.org%2F10.2995%2Fjacsurg.32.160&type=J-STAGE&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00007_3.gif

記述言語：日本語   出版者・発行元：(NPO)日本呼吸器内視鏡学会  

背景.術後肺瘻は時として難治性であり、内視鏡的な治療が選択されることもある。症例.74歳男性。右上葉肺癌に対して、右上葉切除術を施行した。術後肺瘻が遷延し、自己血癒着療法や再手術を施行するも消失しなかった。気管支鏡検査で責任気管支が右B4であることを同定し、気管支鏡下フィブリン支散布とEndobronchial Watanabe Spigot(EWS)充填術を施行し、肺瘻は消失した。しかし、EWSが脱落し、肺瘻の再燃を来した。EWSやポリグリコール酸(polyglycolic acid、PGA)シートとフィブリン糊を用いた気管支塞栓術を計6回施行するも、奏功しなかった。そこでフィブリン糊とPGAシートに加えN-butyl-2-cyanoacrylate(NBCA)を併用して気管支塞栓術を施行し、肺瘻を消失させることができた。術後3年が経過しているが、肺瘻の再燃は認めていない。結論.NBCAを併用した気管支塞栓術は、術後の難治性肺瘻に対しても有用な手段であると考えられた。(著者抄録)

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その他リンク： https://search.jamas.or.jp/index.php?module=Default&action=Link&pub_year=2018&ichushi_jid=J00298&link_issn=&doc_id=20180215170003&doc_link_id=%2Fcf0brond%2F2018%2F004001%2F004%2F0007-0010%26dl%3D0&url=https%3A%2F%2Fwww.medicalonline.jp%2Fjamas.php%3FGoodsID%3D%2Fcf0brond%2F2018%2F004001%2F004%2F0007-0010%26dl%3D0&type=MedicalOnline&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00004_2.gif

記述言語：日本語   出版者・発行元：(NPO)日本肺癌学会  

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記述言語：日本語   出版者・発行元：(NPO)日本呼吸器外科学会  

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記述言語：英語   掲載種別：研究発表ペーパー・要旨（国際会議）   出版者・発行元：ELSEVIER SCIENCE INC  

DOI： 10.1016/j.jtho.2016.11.231

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J-GLOBAL

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記述言語：日本語   出版者・発行元：(NPO)日本肺癌学会  

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記述言語：日本語   出版者・発行元：日本臨床外科学会  

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記述言語：日本語   出版者・発行元：日本臨床外科学会  

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記述言語：英語   掲載種別：速報，短報，研究ノート等（学術雑誌）   出版者・発行元：OXFORD UNIV PRESS INC  

DOI： 10.1093/ejcts/ezw010

Web of Science

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記述言語：日本語   出版者・発行元：(NPO)日本呼吸器内視鏡学会  

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記述言語：日本語   出版者・発行元：(NPO)日本呼吸器外科学会  

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記述言語：日本語   出版者・発行元：(NPO)日本呼吸器外科学会  

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記述言語：日本語   出版者・発行元：日本胸部外科学会-関東甲信越地方会  

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記述言語：日本語   出版者・発行元：日本胸部外科学会-関東甲信越地方会  

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記述言語：日本語   出版者・発行元：(一社)日本内視鏡外科学会  

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記述言語：日本語   出版者・発行元：日本臨床外科学会  

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記述言語：日本語   出版者・発行元：国家公務員共済組合連合会  

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記述言語：日本語   出版者・発行元：(NPO)日本肺癌学会  

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記述言語：日本語   出版者・発行元：日本気胸・嚢胞性肺疾患学会  

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記述言語：日本語   出版者・発行元：(NPO)日本呼吸器外科学会  

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記述言語：日本語   出版者・発行元：(NPO)日本呼吸器外科学会  

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記述言語：日本語   出版者・発行元：(NPO)日本呼吸器外科学会  

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記述言語：日本語   出版者・発行元：(NPO)日本呼吸器外科学会  

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記述言語：日本語   出版者・発行元：(NPO)日本呼吸器外科学会  

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記述言語：日本語   出版者・発行元：(公社)神奈川県医師会  

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記述言語：日本語   出版者・発行元：(一社)日本内視鏡外科学会  

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記述言語：日本語   出版者・発行元：(NPO)日本肺癌学会  

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記述言語：日本語   出版者・発行元：(NPO)日本肺癌学会  

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記述言語：日本語   出版者・発行元：日本気胸・嚢胞性肺疾患学会  

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記述言語：日本語   出版者・発行元：(NPO)日本肺癌学会  

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記述言語：日本語   出版者・発行元：(NPO)日本呼吸器外科学会  

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記述言語：日本語   出版者・発行元：(NPO)日本呼吸器外科学会  

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記述言語：日本語   出版者・発行元：(NPO)日本呼吸器外科学会  

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記述言語：日本語   出版者・発行元：(NPO)日本呼吸器外科学会  

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記述言語：日本語   出版者・発行元：(NPO)日本呼吸器外科学会  

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記述言語：英語   掲載種別：研究発表ペーパー・要旨（国際会議）   出版者・発行元：LIPPINCOTT WILLIAMS & WILKINS  

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記述言語：英語   掲載種別：研究発表ペーパー・要旨（国際会議）   出版者・発行元：LIPPINCOTT WILLIAMS & WILKINS  

Web of Science

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記述言語：日本語   出版者・発行元：国家公務員共済組合連合会  

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記述言語：日本語   出版者・発行元：国家公務員共済組合連合会  

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記述言語：日本語   出版者・発行元：(NPO)日本肺癌学会  

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記述言語：日本語   出版者・発行元：日本気胸・嚢胞性肺疾患学会  

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記述言語：日本語   出版者・発行元：(公社)神奈川県医師会  

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記述言語：日本語   出版者・発行元：(NPO)日本呼吸器内視鏡学会  

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その他リンク： https://search-tp.jamas.or.jp/index.php?module=Default&action=Link&pub_year=2013&ichushi_jid=J00298&link_issn=&doc_id=20130603320422&doc_link_id=%2Fcf0brond%2F2013%2F0035s1%2F423%2F5272-5272%26dl%3D0&url=https%3A%2F%2Fwww.medicalonline.jp%2Fjamas.php%3FGoodsID%3D%2Fcf0brond%2F2013%2F0035s1%2F423%2F5272-5272%26dl%3D0&type=MedicalOnline&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00004_2.gif

記述言語：日本語   出版者・発行元：(NPO)日本呼吸器内視鏡学会  

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その他リンク： https://search-tp.jamas.or.jp/index.php?module=Default&action=Link&pub_year=2013&ichushi_jid=J00298&link_issn=&doc_id=20130603320186&doc_link_id=%2Fcf0brond%2F2013%2F0035s1%2F187%2F5191-5191%26dl%3D0&url=https%3A%2F%2Fwww.medicalonline.jp%2Fjamas.php%3FGoodsID%3D%2Fcf0brond%2F2013%2F0035s1%2F187%2F5191-5191%26dl%3D0&type=MedicalOnline&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00004_2.gif

記述言語：日本語   出版者・発行元：(NPO)日本呼吸器外科学会  

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記述言語：日本語   出版者・発行元：(NPO)日本呼吸器外科学会  

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記述言語：日本語   出版者・発行元：(NPO)日本呼吸器外科学会  

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記述言語：日本語   出版者・発行元：(NPO)日本呼吸器外科学会  

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記述言語：日本語   出版者・発行元：(NPO)日本呼吸器外科学会  

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記述言語：日本語   出版者・発行元：(NPO)日本呼吸器外科学会  

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記述言語：日本語   出版者・発行元：(NPO)日本呼吸器外科学会  

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記述言語：日本語   出版者・発行元：(NPO)日本呼吸器外科学会  

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記述言語：日本語   出版者・発行元：(NPO)日本呼吸器外科学会  

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記述言語：日本語   出版者・発行元：(NPO)日本呼吸器外科学会  

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記述言語：日本語   出版者・発行元：(一社)日本外科学会  

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記述言語：日本語   出版者・発行元：国家公務員共済組合連合会  

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記述言語：日本語   出版者・発行元：日本臨床外科学会  

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記述言語：日本語   出版者・発行元：(NPO)日本肺癌学会  

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記述言語：日本語   出版者・発行元：(NPO)日本肺癌学会  

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記述言語：日本語   出版者・発行元：国家公務員共済組合連合会  

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記述言語：日本語   出版者・発行元：日本臨床外科学会  

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記述言語：日本語   出版者・発行元：国家公務員共済組合連合会  

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記述言語：日本語   出版者・発行元：日本臨床外科学会  

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記述言語：日本語   出版者・発行元：日本気胸・嚢胞性肺疾患学会  

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記述言語：日本語   出版者・発行元：(一社)日本消化器外科学会  

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記述言語：日本語   出版者・発行元：(NPO)日本呼吸器内視鏡学会  

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その他リンク： https://search.jamas.or.jp/index.php?module=Default&action=Link&pub_year=2012&ichushi_jid=J00298&link_issn=&doc_id=20120525370304&doc_link_id=%2Fcf0brond%2F2012%2F0034s1%2F304%2F5239-5239%26dl%3D0&url=https%3A%2F%2Fwww.medicalonline.jp%2Fjamas.php%3FGoodsID%3D%2Fcf0brond%2F2012%2F0034s1%2F304%2F5239-5239%26dl%3D0&type=MedicalOnline&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00004_2.gif

記述言語：日本語   出版者・発行元：日本外科系連合学会  

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記述言語：日本語   出版者・発行元：(NPO)日本呼吸器外科学会  

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記述言語：日本語   出版者・発行元：(NPO)日本呼吸器外科学会  

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記述言語：日本語   出版者・発行元：(NPO)日本呼吸器外科学会  

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記述言語：日本語   出版者・発行元：(一社)日本外科学会  

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記述言語：日本語   出版者・発行元：(一社)日本外科学会  

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記述言語：英語   出版者・発行元：ELSEVIER SCIENCE INC  

Pulmonary sequestration is a relatively rare condition in which a systemic artery supplies blood to an abnormal lung tissue. Pulmonary sequestration with an aneurysmal systemic artery is extremely rare. We describe the case of a 52-year-old man with intralobar pulmonary sequestration supplied by an aneurysmal systemic artery. Because the nomenclature of pulmonary sequestration is still not clear, we propose that type 1 intralobar pulmonary sequestration be called "systemic arterial supply to the normal lung," as named by many professionals, and for this to be distinguished from pulmonary sequestration. (Ann Thorac Surg 2012;93:319-22) (C) 2012 by The Society of Thoracic Surgeons

DOI： 10.1016/j.athoracsur.2011.05.103

Web of Science

PubMed

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記述言語：日本語   出版者・発行元：日本臨床外科学会  

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記述言語：日本語   出版者・発行元：(NPO)日本肺癌学会  

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記述言語：日本語   出版者・発行元：(NPO)日本肺癌学会  

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記述言語：日本語   出版者・発行元：(一社)日本乳癌学会  

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記述言語：日本語   出版者・発行元：(一社)日本癌治療学会  

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記述言語：日本語   出版者・発行元：(一社)日本消化器外科学会  

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記述言語：英語   掲載種別：研究発表ペーパー・要旨（国際会議）   出版者・発行元：LIPPINCOTT WILLIAMS & WILKINS  

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記述言語：日本語   出版者・発行元：(一社)日本外科学会  

CiNii Books

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記述言語：日本語   出版者・発行元：(一社)日本外科学会  

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記述言語：日本語   出版者・発行元：(NPO)日本呼吸器内視鏡学会  

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その他リンク： https://search.jamas.or.jp/index.php?module=Default&action=Link&pub_year=2011&ichushi_jid=J00298&link_issn=&doc_id=20110615200351&doc_link_id=%2Fcf0brond%2F2011%2F0033s1%2F354%2F5280-5280%26dl%3D0&url=https%3A%2F%2Fwww.medicalonline.jp%2Fjamas.php%3FGoodsID%3D%2Fcf0brond%2F2011%2F0033s1%2F354%2F5280-5280%26dl%3D0&type=MedicalOnline&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00004_2.gif

記述言語：日本語   出版者・発行元：(NPO)日本呼吸器外科学会  

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記述言語：日本語   出版者・発行元：日本胸部外科学会-関東甲信越地方会  

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記述言語：日本語   出版者・発行元：(一社)日本内視鏡外科学会  

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記述言語：日本語   出版者・発行元：(NPO)日本乳癌検診学会  

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記述言語：日本語   出版者・発行元：(一社)日本癌治療学会  

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記述言語：日本語   出版者・発行元：(一社)日本癌治療学会  

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記述言語：日本語   出版者・発行元：(NPO)日本呼吸器外科学会  

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記述言語：日本語   出版者・発行元：日本内科学会-関東地方会  

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記述言語：日本語   出版者・発行元：日本臨床外科学会  

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記述言語：日本語   出版者・発行元：日本臨床外科学会  

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記述言語：日本語   出版者・発行元：(NPO)日本呼吸器外科学会  

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記述言語：日本語   出版者・発行元：日本胸部外科学会-関東甲信越地方会  

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記述言語：日本語   出版者・発行元：(NPO)日本肺癌学会  

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その他リンク： https://search.jamas.or.jp/index.php?module=Default&action=Link&pub_year=2008&ichushi_jid=J01244&link_issn=&doc_id=20081016270699&doc_link_id=%2Fec7jaluc%2F2008%2F004805%2F2bb%2F0581-0581%26dl%3D0&url=https%3A%2F%2Fwww.medicalonline.jp%2Fjamas.php%3FGoodsID%3D%2Fec7jaluc%2F2008%2F004805%2F2bb%2F0581-0581%26dl%3D0&type=MedicalOnline&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00004_2.gif

記述言語：日本語   出版者・発行元：(一社)日本内視鏡外科学会  

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記述言語：日本語   出版者・発行元：日本気胸・嚢胞性肺疾患学会  

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記述言語：日本語   出版者・発行元：(一社)日本消化器外科学会  

CiNii Books

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記述言語：日本語   出版者・発行元：日本臨床外科学会  

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記述言語：日本語   出版者・発行元：(NPO)日本肺癌学会  

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その他リンク： https://search.jamas.or.jp/index.php?module=Default&action=Link&pub_year=2007&ichushi_jid=J01244&link_issn=&doc_id=20071019290615&doc_link_id=%2Fec7jaluc%2F2007%2F004705%2F615%2F0599-0599%26dl%3D0&url=https%3A%2F%2Fwww.medicalonline.jp%2Fjamas.php%3FGoodsID%3D%2Fec7jaluc%2F2007%2F004705%2F615%2F0599-0599%26dl%3D0&type=MedicalOnline&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00004_2.gif

記述言語：日本語   出版者・発行元：(一社)日本職業・災害医学会  

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記述言語：日本語   出版者・発行元：日本気胸・嚢胞性肺疾患学会  

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記述言語：日本語   出版者・発行元：日本気胸・嚢胞性肺疾患学会  

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記述言語：日本語   出版者・発行元：(一社)日本消化器外科学会  

CiNii Books

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記述言語：日本語   出版者・発行元：(一社)日本消化器外科学会  

CiNii Books

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記述言語：日本語   出版者・発行元：(一社)日本乳癌学会  

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記述言語：日本語   出版者・発行元：(一社)日本内分泌外科学会  

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記述言語：日本語   出版者・発行元：日本臨床外科学会  

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記述言語：日本語   出版者・発行元：日本臨床外科学会  

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記述言語：日本語   出版者・発行元：国家公務員共済組合連合会  

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記述言語：日本語   出版者・発行元：日本臨床外科学会  

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記述言語：日本語   出版者・発行元：日本臨床外科学会  

症例は70歳の女性.1年前より腹痛が断続的に続くため当院を受診.超音波検査で膵頭部に腫瘤を認めた.次第に食事摂取が困難となり,開腹術を施行.腫瘍は後腹膜に浸潤し,治癒切除は不可能であり,バイパス術および腫瘍生検を施行した.術後,KIT染色のみ行い,弱陽性であったためimatinib mesylate(グリベック)の投与を開始した.しかし効果なく,他の免疫染色を含め再検すると,KITは陰性,α-SMA・desminが陽性であり,平滑筋肉腫と判明した.すでに腫瘍は進行しており,有効な追加治療が行えぬまま術後3ヵ月目に原病死した.本症例は画像所見から確定診断することは困難で,治療方針の決定には組織採取が必要であったが,KIT弱陽性の腫瘍では鑑別に苦慮することがあり,その際はすみやかに他の免疫染色やc-kit mutation assayを追加するべきであると考えられた(著者抄録)

CiNii Books

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記述言語：日本語   出版者・発行元：日本胸部外科学会-関東甲信越地方会  

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記述言語：日本語   出版者・発行元：(NPO)日本血管外科学会  

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記述言語：日本語   出版者・発行元：(一社)日本外科学会  

CiNii Books

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記述言語：日本語   出版者・発行元：(一社)日本外科学会  

CiNii Books

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記述言語：日本語   出版者・発行元：(NPO)日本血管外科学会  

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記述言語：日本語   出版者・発行元：(NPO)日本心臓血管外科学会  

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記述言語：日本語   出版者・発行元：(NPO)日本心臓血管外科学会  

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記述言語：日本語   出版者・発行元：(NPO)日本心臓血管外科学会  

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記述言語：日本語   出版者・発行元：シュプリンガー・ジャパン(株)  

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記述言語：日本語   出版者・発行元：シュプリンガー・ジャパン(株)  

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記述言語：日本語   出版者・発行元：日本臨床外科学会  

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記述言語：日本語   出版者・発行元：シュプリンガー・ジャパン(株)  

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記述言語：日本語   出版者・発行元：日本臨床外科学会  

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記述言語：日本語   出版者・発行元：日本胸部外科学会-関東甲信越地方会  

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記述言語：日本語   出版者・発行元：日本胸部外科学会-関東甲信越地方会  

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記述言語：日本語   出版者・発行元：シュプリンガー・ジャパン(株)  

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記述言語：日本語   出版者・発行元：(一社)日本消化器外科学会  

内ヘルニアは比較的まれな疾患であり特徴的な所見に乏しく術前診断が困難であるが,しばしば絞扼性イレウスで発症する.今回われわれは絞扼性イレウズの診断に腹腔鏡が有用であった天網裂孔ヘルニアの1例を経験した.症例は26歳の男性で,上腹部痛にて当院内科入院.徐々に増悪したため翌日当科受診.腹部CT上,網嚢内に腸管を認め内ヘルニアを疑ったが確定診断には至らなかった.絞扼性イレウスの診断で緊急手術を施行.まず腹腔鏡で腹腔内を観察したところ,壊死腸管を認めたため開腹した.小腸が大綱の裂隙を通り綱嚢内へ嵌入し,約60cmの回腸が小網の裂孔により絞扼され壊死しており,小腸部分切除および裂孔閉鎖を施行した.本症では壊死腸管を認めたため開腹手術を行ったが,内ヘルニアを疑った場合,腹腔鏡は診断および治療に有用な方法であると思われた.

CiNii Books

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記述言語：日本語   出版者・発行元：日本臨床外科学会  

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記述言語：日本語   出版者・発行元：日本臨床外科学会  

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