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Matsunaga T, Suzuki K, Hattori A, Fukui M, Takamochi K. Risk factors for bronchopleural fistula based on surgical procedure and sex in 4794 consecutive patients undergoing anatomical pulmonary resection. Surg Today 2024; 54:617-626. [PMID: 37924339 DOI: 10.1007/s00595-023-02761-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2023] [Accepted: 10/03/2023] [Indexed: 11/06/2023]
Abstract
PURPOSE Bronchopleural fistula (BPF) is a lethal complication, even in the modern era. Therefore, we investigated the details of patients with BPF to select an appropriate surgical strategy. METHODS This retrospective study included 4794 consecutive patients who underwent anatomical pulmonary resection between 2008 and 2022. We evaluated the predictors of BPF using a multivariable analysis and investigated the mortality and clinical course after BPF in detail. RESULTS BPF was observed in 32 patients (0.67%). In the multivariable analysis, the predictors for BPF were male sex (odds ratio [OR], 6.91), the body mass index (OR, 2.40), the vital capacity (%VC) (OR, 2.93), surgery performed (right lower lobectomy [OR, 10.92], right middle and lower lobectomy [OR, 6.97], and right pneumonectomy [OR, 16.68]), and additional resection of surrounding organs (OR, 3.47). Among the risk factors, surgery performed and male sex were very strong risk factors, with the frequency itself very low in females (0.1%). The 90-day mortality was 15.6%, and the 5-year overall survival in patients with BPF was 28.1%. CONCLUSION Our study revealed that independent risk factors and consideration of the surgical methods and sex might help determine whether or not special attention should be given to the bronchial stump, which will be of great help in surgical strategies.
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Affiliation(s)
- Takeshi Matsunaga
- Department of General Thoracic Surgery, Juntendo University School of Medicine, 1-3, Hongo 3-Chome, Bunkyo-ku, Tokyo, 113-8431, Japan.
| | - Kenji Suzuki
- Department of General Thoracic Surgery, Juntendo University School of Medicine, 1-3, Hongo 3-Chome, Bunkyo-ku, Tokyo, 113-8431, Japan
| | - Aritoshi Hattori
- Department of General Thoracic Surgery, Juntendo University School of Medicine, 1-3, Hongo 3-Chome, Bunkyo-ku, Tokyo, 113-8431, Japan
| | - Mariko Fukui
- Department of General Thoracic Surgery, Juntendo University School of Medicine, 1-3, Hongo 3-Chome, Bunkyo-ku, Tokyo, 113-8431, Japan
| | - Kazuya Takamochi
- Department of General Thoracic Surgery, Juntendo University School of Medicine, 1-3, Hongo 3-Chome, Bunkyo-ku, Tokyo, 113-8431, Japan
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Development of a novel material to promote wound healing at bronchial defects. Ann Thorac Surg 2022:S0003-4975(22)00934-1. [PMID: 35798283 DOI: 10.1016/j.athoracsur.2022.06.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2022] [Revised: 05/12/2022] [Accepted: 06/11/2022] [Indexed: 11/17/2022]
Abstract
BACKGROUND Bronchopleural fistula (BPF) is a critical complication that may progress to pneumonia and empyema, but optimal treatment remains uncertain. Our purpose was to develop a novel material for bronchial occlusion that can be used to treat BPF by blocking airflow and promoting wound healing. METHODS Sponges were prepared in concentrations of 25, 40, and 50 mg/dL of silk-elastin by hydrophobic processing. Five adult Beagle dogs underwent right anterior lobectomy, and 5 underwent left posterior lobectomy. Silk-elastin sponges were placed at bronchial stumps of 8 dogs, and silicone plugs were placed at the stumps of 2 dogs as a control. RESULTS Postoperative complications were not observed, except in 1 dog in which the silicone plug had been placed and which had massive subcutaneous emphysema at 4 weeks after operation. Histologic examination revealed that stumps were covered with connective tissue and that there was more regeneration of airway epithelium in the silk-elastin sponge group than in the silicone plug group. There were increased numbers of myofibroblasts around the bronchial stump occluded by silk-elastin sponges at 2 weeks after placement, which completely disappeared after 2 months, during which abundant neovascularization occurred. CONCLUSIONS We showed that silk-elastin sponges can manage and promote regeneration of bronchial epithelium. Our results demonstrate that bronchial occlusion with a silk-elastin sponge is a promising option for treatment of BPF.
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Clinicopathological features of male patients with breast cancer based on a nationwide registry database in Japan. Breast Cancer 2022; 29:985-992. [PMID: 35733033 PMCID: PMC9587939 DOI: 10.1007/s12282-022-01378-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2022] [Accepted: 05/29/2022] [Indexed: 11/02/2022]
Abstract
BACKGROUND Male breast cancer (MBC) is rare; however, its incidence is increasing. There have been no large-scale reports on the clinicopathological characteristics of MBC in Japan. METHODS We investigated patients diagnosed with breast cancer in the Japanese National Clinical Database (NCD) between January 2012 and December 2018. RESULTS A total of 594,316 cases of breast cancer, including 3780 MBC (0.6%) and 590,536 female breast cancer (FBC) (99.4%), were evaluated. The median age at MBC and FBC diagnosis was 71 (45-86, 5-95%) and 60 years (39-83) (p < 0.001), respectively. MBC cases had a higher clinical stage than FBC cases: 7.4 vs. 13.3% stage 0, 37.2 vs. 44.3% stage I, 25.6 vs. 23.9% stage IIA, 8.8 vs. 8.4% stage IIB, 1.9 vs. 2.4% stage IIIA, 10.1 vs. 3.3% stage IIIB, and 1.1 vs. 1.3% stage IIIC (p < 0.001). Breast-conserving surgery was more frequent in FBC (14.6 vs. 46.7%, p = 0.02). Axillary lymph node dissection was more frequent in MBC cases (32.9 vs. 25.2%, p < 0.001). Estrogen receptor(ER)-positive disease was observed in 95.6% of MBC and 85.3% of FBC cases (p < 0.001). The HER2-positive disease rates were 9.5% and 15.7%, respectively (p < 0.001). Comorbidities were more frequent in MBC (57.3 vs. 32.8%) (p < 0.001). Chemotherapy was less common in MBC, while endocrine therapy use was similar in ER-positive MBC and FBC. Perioperative radiation therapy was performed in 14.3% and 44.3% of cases. CONCLUSION Japanese MBC had an older age of onset, were more likely to be hormone receptor-positive disease, and received less perioperative chemotherapy than FBC.
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Moriyama M, Matsumoto K, Taniguchi D, Machino R, Tsuchiya T, Nakayama K, Nagayasu T. Successful use of bio plugs for delayed bronchial closure after pneumonectomy in experimental settings. Interact Cardiovasc Thorac Surg 2021; 34:660-667. [PMID: 34738099 PMCID: PMC9026198 DOI: 10.1093/icvts/ivab306] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2021] [Accepted: 09/26/2021] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES Cell therapies, such as stem cell suspension injection, are used to treat bronchopleural fistula. Although it is safe and effective, injected cells cannot remain within the bronchioles of the fistula due to cell leakage into the thoracic cavity. Here, we inserted a 'bio plug' into the fistula, produced using cells and a bio-3D printer, to examine the effectiveness of bio plugs for the closure of bronchopleural fistulas, the optimal cell source and the closure mechanism. METHODS Bio plugs were made with mesenchymal stem (stromal) cells derived from bone marrow (MSCBM), fibroblasts and rat lung micro-vessel endothelial cells using a bio-3D printer with different cell mixing ratios. Six groups, according to the presence or absence and the type of bio plugs, were compared. The plugs were inserted into the bronchi of F344 rats. The obstruction ratio and histological and immunohistochemical findings were evaluated. RESULTS MSCBM+ rat lung micro-vessel endothelial cell group exhibited a higher obstruction ratio among all groups excluding the MSCBM group (P = 0.039). This group had fibrosis and CD31-positive cells and fewer CD68-positive cells than MSCBM and MSCBM+ fibroblast groups. CONCLUSIONS Bio plugs with mixed cells, including stem cells, contribute to bronchial closure in the current experimental setting. Endothelial cells effectively maintain the structure in this model. Although bronchial closure for bronchopleural fistula could not be described as clinical conditions were not reproduced, we collected essential data on bronchial closure; however, further experiments are warranted.
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Affiliation(s)
- Masaaki Moriyama
- Department of Surgical Oncology, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan.,Medical-Engineering Hybrid Professional Development Program, Nagasaki University, Nagasaki, Japan
| | - Keitaro Matsumoto
- Department of Surgical Oncology, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan.,Medical-Engineering Hybrid Professional Development Program, Nagasaki University, Nagasaki, Japan
| | - Daisuke Taniguchi
- Department of Surgical Oncology, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan.,Medical-Engineering Hybrid Professional Development Program, Nagasaki University, Nagasaki, Japan
| | - Ryusuke Machino
- Department of Surgical Oncology, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan.,Medical-Engineering Hybrid Professional Development Program, Nagasaki University, Nagasaki, Japan
| | - Tomoshi Tsuchiya
- Department of Surgical Oncology, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Koichi Nakayama
- Department of Regenerative Medicine and Biomedical Engineering Faculty of Medicine, Saga University, Saga, Japan
| | - Takeshi Nagayasu
- Department of Surgical Oncology, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan.,Medical-Engineering Hybrid Professional Development Program, Nagasaki University, Nagasaki, Japan
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Tsukioka T, Izumi N, Komatsu H, Inoue H, Matsuda Y, Ito R, Kimura T, Miki Y, Nishiyama N. Changes in pedicle pericardial fat tissue around the anastomotic site after tracheobronchoplasty. Surg Today 2021; 52:414-419. [PMID: 34468845 DOI: 10.1007/s00595-021-02370-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2021] [Accepted: 06/10/2021] [Indexed: 11/24/2022]
Abstract
PURPOSE Pericardial fat is appropriate tissue to cover the bronchial anastomotic site because its harvesting is minimally invasive. We investigated the changes in pericardial fat tissue around the anastomotic site after pulmonary resection with tracheobronchoplasty. METHODS The subjects of this study were 43 lung cancer patients who underwent pulmonary resection with tracheobronchoplasty. We measured the maximum cross-sectional area and average computed tomography (CT) values of the pedicle pericardial fat pad around the anastomotic site 1 week and then 6 months after the operation. RESULTS The average volume of the residual pedicle pericardial fat pad 6 months postoperatively was 61%. A body mass index (BMI) < 21.2 kg/m2 (P = 0.031) and a blood albumin level < 3.4 g/dl (P = 0.005) were significant predictors of pedicle flap shrinkage. Patients with fat tissue shrinkage had significantly elevated CT values 6 months postoperatively (P = 0.029), whereas those without shrinkage maintained low CT values. CONCLUSIONS Preoperative nutritional conditions, reflected in high BMI and blood albumin levels, correlated with a high residual pedicle pericardial fat pad. Conversely, patients with pedicle flap shrinkage had significantly increased CT values, suggesting that the fat might have taken on another form such as scar tissue.
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Affiliation(s)
- Takuma Tsukioka
- Department of General Thoracic Surgery, Osaka City University, 1-4-3 Asahimachi, Abeno-ku, Osaka, 545-8585, Japan.
| | - Nobuhiro Izumi
- Department of General Thoracic Surgery, Osaka City University, 1-4-3 Asahimachi, Abeno-ku, Osaka, 545-8585, Japan
| | - Hiroaki Komatsu
- Department of General Thoracic Surgery, Osaka City University, 1-4-3 Asahimachi, Abeno-ku, Osaka, 545-8585, Japan
| | - Hidetoshi Inoue
- Department of General Thoracic Surgery, Osaka City University, 1-4-3 Asahimachi, Abeno-ku, Osaka, 545-8585, Japan
| | - Yumi Matsuda
- Department of General Thoracic Surgery, Osaka City University, 1-4-3 Asahimachi, Abeno-ku, Osaka, 545-8585, Japan
| | - Ryuichi Ito
- Department of General Thoracic Surgery, Osaka City University, 1-4-3 Asahimachi, Abeno-ku, Osaka, 545-8585, Japan
| | - Takuya Kimura
- Department of General Thoracic Surgery, Osaka City University, 1-4-3 Asahimachi, Abeno-ku, Osaka, 545-8585, Japan
| | - Yukio Miki
- Department of Diagnostic and Interventional Radiology, Osaka City University Graduate School of Medicine, 1-4-3 Asahimachi, Abeno-ku, Osaka, 545-8585, Japan
| | - Noritoshi Nishiyama
- Department of General Thoracic Surgery, Osaka City University, 1-4-3 Asahimachi, Abeno-ku, Osaka, 545-8585, Japan
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Hashimoto M, Yamamoto H, Endo S, Okada M, Miyata H, Hasegawa S, Chida M. Japanese Current Status of Curative-Intent Surgery for Malignant Pleural Mesothelioma. Ann Thorac Surg 2021; 113:1348-1353. [PMID: 33930356 DOI: 10.1016/j.athoracsur.2021.04.042] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2020] [Revised: 03/26/2021] [Accepted: 04/15/2021] [Indexed: 11/26/2022]
Abstract
BACKGROUND Few reports about surgical outcomes in malignant pleural mesothelioma (MPM) were based on reliable nationwide databases. Here we analyzed the incidence, surgical outcome, and operative risk factors using Japanese nationwide database. METHODS Characteristics and perioperative data from 622 patients who underwent curative-intent surgery for MPM between January 2014 and December 2017 were recorded from National Clinical Database of Japan. We analyzed the incidence, surgical outcomes, and risk factors for surgical complications after two surgical procedures (extrapleural pneumonectomy, EPP; and pleurectomy/decortication, P/D). RESULTS During 4 years, EPP was performed in 279 patients and P/D in 343. EPP was more frequently performed in less-MPM-experienced institutions, while P/D was more frequently performed in well-MPM-experienced institutions (P < .001), especially in high-volume centers with more than 10 cases during this period. P/D was more frequently performed, especially in high-volume centers. The morbidity rates were 45.2% in EPP and 35.9% in P/D. Heart failure and pneumonia were most frequent in EPP, while prolonged air leakage was most frequent in P/D. Thirty-day- and in-hospital mortality rates were 1.1% and 3.2% (EPP) and 1.2% and 3.2% (P/D), respectively. Regression analyses revealed that higher age (>65 years) was associated with operative complications in EPP (odds ratio, OR: 3.56 [1.26-8.56]), whereas no risk factor was observed in P/D. CONCLUSIONS In Japanese nationwide annual database, P/D was more frequently performed, especially in high-volume centers. Morbidity was higher in EPP than P/D; however, the mortality rates were quite low in Japan regardless surgical procedures.
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Affiliation(s)
- Masaki Hashimoto
- The Japanese Association for Chest Surgery, Kyoto, Japan; Department of Thoracic Surgery, Hyogo College of Medicine, Nishinomiya, Japan.
| | - Hiroyuki Yamamoto
- The Japanese Association for Chest Surgery, Kyoto, Japan; Health Policy and Management, School of Medicine, Keio University, Tokyo, Japan; Department of Healthcare Quality Assessment, Graduate School of Medicine, University of Tokyo, Tokyo, Japan
| | - Shunsuke Endo
- The Japanese Association for Chest Surgery, Kyoto, Japan; Department of General Thoracic Surgery, Saitama Medical Center, Jichi Medical University, Saitama, Japan
| | - Morihito Okada
- The Japanese Association for Chest Surgery, Kyoto, Japan; Department of Surgical Oncology, Hiroshima University, Hiroshima, Japan
| | - Hiroaki Miyata
- The Japanese Association for Chest Surgery, Kyoto, Japan; Department of Healthcare Quality Assessment, Graduate School of Medicine, University of Tokyo, Tokyo, Japan
| | - Seiki Hasegawa
- The Japanese Association for Chest Surgery, Kyoto, Japan; Department of Thoracic Surgery, Hyogo College of Medicine, Nishinomiya, Japan
| | - Masayuki Chida
- The Japanese Association for Chest Surgery, Kyoto, Japan; Department of General Thoracic Surgery, Dokkyo Medical University, Tochigi, Japan
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Yoshimine S, Ueno K, Murakami J, Saito T, Suzuki R, Asai Y, Ikeda E, Tanaka T, Hamano K. Autologous Multilayered Fibroblast Sheets Can Reinforce Bronchial Stump in a Rat Model. Semin Thorac Cardiovasc Surg 2021; 34:349-358. [PMID: 33711463 DOI: 10.1053/j.semtcvs.2021.03.010] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2021] [Accepted: 03/04/2021] [Indexed: 12/31/2022]
Abstract
Bronchopleural fistula is one of the most serious postoperative complications caused by the incomplete healing of a bronchial stump. Fibroblasts play an important role in wound healing by facilitating connective tissue formation and inducing angiogenesis. We developed a method for production of multilayered fibroblast sheets that secreted some growth factors and promoted wound healing. The present study aimed to assess the treatment effect of multilayered fibroblast sheets on bronchial stump healing. In this rat model, left pneumonectomy was performed, and multilayered fibroblast sheets derived from autologous oral mucosal tissues were transplanted to the bronchial stump. The changes in the bronchial stump were examined macroscopically, histologically, and mechanically. The fibroblast sheets promoted the formation of thick connective tissues around the bronchial stump. The formed connective tissues were accompanied by new blood vessels, and fibrosis was observed over time. Then, 7 days after the transplantation of the fibroblast sheets, the bronchial wall became significantly thicker, and the area of the blood vessels for the bronchial wall tissues was significantly larger in the experimental group than in the control group. In addition, the burst pressure in the bronchial stump was significantly higher in the experimental group than in the control group. Bronchial stumps were reinforced by the transplantation of multilayered fibroblast sheets derived from autologous oral mucosal tissues.
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Affiliation(s)
- Sota Yoshimine
- Department of Surgery and Clinical Science, Yamaguchi University Graduate School of Medicine, Ube, Yamaguchi, Japan
| | - Koji Ueno
- Department of Surgery and Clinical Science, Yamaguchi University Graduate School of Medicine, Ube, Yamaguchi, Japan.
| | - Junichi Murakami
- Department of Surgery and Clinical Science, Yamaguchi University Graduate School of Medicine, Ube, Yamaguchi, Japan
| | - Toshiro Saito
- Department of Surgery and Clinical Science, Yamaguchi University Graduate School of Medicine, Ube, Yamaguchi, Japan
| | - Ryo Suzuki
- Department of Surgery and Clinical Science, Yamaguchi University Graduate School of Medicine, Ube, Yamaguchi, Japan
| | - Yoshiyuki Asai
- Department of Systems Bioinformatics, Yamaguchi University Graduate School of Medicine, Ube, Yamaguchi, Japan
| | - Eiji Ikeda
- Department of Pathology, Yamaguchi University Graduate School of Medicine, Ube, Yamaguchi, Japan
| | - Toshiki Tanaka
- Department of Surgery and Clinical Science, Yamaguchi University Graduate School of Medicine, Ube, Yamaguchi, Japan
| | - Kimikazu Hamano
- Department of Surgery and Clinical Science, Yamaguchi University Graduate School of Medicine, Ube, Yamaguchi, Japan
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Iwasaki M, Shimomura M, Ii T. Negative-pressure wound therapy in combination with bronchial occlusion to treat bronchopleural fistula: a case report. Surg Case Rep 2021; 7:61. [PMID: 33651250 PMCID: PMC7922724 DOI: 10.1186/s40792-021-01144-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2020] [Accepted: 02/24/2021] [Indexed: 12/25/2022] Open
Abstract
Background Bronchopleural fistula, which usually accompanies bronchial fistula and empyema, is a severe complication of lung cancer surgery. Negative-pressure wound therapy can enhance drainage and reduce the empyema cavity, potentially leading to early recovery. This therapy is not currently indicated for bronchopleural fistulas because of the risk of insufficient respiration due to air loss from the fistula. Case presentation A 73-year-old man, who was malnourished because of peritoneal dialysis, was referred to our hospital for the treatment of lung cancer. Right lower lobectomy with mediastinal lymph node dissection was performed via posterolateral thoracotomy, and the bronchial stump was covered with the intercostal muscle flap. His postoperative course was uneventful and he was discharged. However, he was readmitted to our hospital because of respiratory failure and diagnosed as having bronchopleural fistula on the basis of the bronchoscopic finding of a 10-mm hole at the membranous portion of the inlet of the remnant lower lobe bronchus. Thus, thoracotomy debridement and open window thoracostomy were immediately performed. After achieving infection control, bronchial occlusion was performed using fibrin glue and a polyglycolic acid sheet was inserted through a fenestrated wound. Bronchial fistula closure was observed on bronchoscopy; therefore, a negative-pressure wound therapy system was applied to close the fenestrated wound. The collapsed lung was re-expanded and the granulation tissue around the wound increased; therefore, thoracic cavity size decreased and thoracoplasty using the latissimus dorsi was performed. Conclusions This bronchopleural fistula was treated successfully after a right lower lobectomy using an extra-pleural bronchial occlusion and negative-pressure wound therapy.
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Affiliation(s)
- Masashi Iwasaki
- Department of General Thoracic Surgery, Ayabe City Hospital, 20-1 Otsuka, Aono-cho, Ayabe, Kyoto, 623-0011, Japan.
| | - Masanori Shimomura
- Department of General Thoracic Surgery, Ayabe City Hospital, 20-1 Otsuka, Aono-cho, Ayabe, Kyoto, 623-0011, Japan.,Division of Thoracic Surgery, Department of Surgery, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, 465 Kajii-cho, Kawaramachi-Hirokoji, Kamigyo, Kyoto, 602-8566, Japan
| | - Tsunehiro Ii
- Department of General Thoracic Surgery, Ayabe City Hospital, 20-1 Otsuka, Aono-cho, Ayabe, Kyoto, 623-0011, Japan
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Preoperative Cumulative Smoking Dose on Lung Cancer Surgery in a Japanese Nationwide Database. Ann Thorac Surg 2021; 113:237-243. [PMID: 33600791 DOI: 10.1016/j.athoracsur.2021.01.055] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2020] [Revised: 01/29/2021] [Accepted: 01/31/2021] [Indexed: 11/22/2022]
Abstract
BACKGROUND Smoking is a known risk factor for postoperative mortality and morbidity. However, the significance of cumulative smoking dose in preoperative risk assessment has not been established. We examined the influence of preoperative cumulative smoking dose on surgical outcomes after lobectomy for primary lung cancer. METHODS A total of 80,989 patients with primary lung cancer undergoing lobectomy from 2014 to 2016 were enrolled. Preoperative cumulative smoking dose was categorized by pack-years (PY): nonsmokers, PY = 0; light smokers, 0 < PY < 10; moderate smokers, 10 ≤ PY < 30; and heavy smokers, 30 ≤ PY. The risk of short-term outcomes was assessed according to PY by multivariable analysis adjusted for other covariates. RESULTS Postoperative 30-day mortality, as well as pulmonary, cardiovascular, and infectious complications, increased with preoperative PY. Multivariable analysis revealed that the odds ratios (ORs) for postoperative mortality compared with nonsmokers were 1.76 for light smokers (P = .044), 1.60 for moderate smokers (P = .026), and 1.73 for heavy smokers (P = .003). The ORs for pulmonary complications compared with nonsmokers were 1.20 for light smokers (P = .022), 1.40 for moderate smokers (P < .001), and 1.72 for heavy smokers (P < .001). Heavy smokers had a significantly increased risk of postoperative cardiovascular (OR, 1.26; P = .002) and infectious (OR, 1.39; P = .007) complications compared with nonsmokers. CONCLUSIONS The risk of mortality and morbidity after lung resection could be predicted according to preoperative cumulative smoking dose. These findings contribute to the development of strategies in perioperative management of lung resection patients.
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Certified thoracic surgeons in Japan: a national database survey on risk-adjusted mortality associated with lung resection. Surg Today 2021; 51:1268-1275. [PMID: 33515364 DOI: 10.1007/s00595-021-02227-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2020] [Accepted: 11/26/2020] [Indexed: 10/22/2022]
Abstract
PURPOSE We investigated the association between the number of certified general thoracic surgeons (GTSs) and the mortality after lung cancer surgery, based on the data from the National Clinical Database (NCD). METHODS We analyzed the characteristics and operative and postoperative data of 120,946 patients who underwent lung cancer surgery in one of the 905 hospitals in Japan. The number of GTSs in each hospital was categorized as 0, 1-2, or 3 or more. Multivariable analysis was applied to adjust the patients' preoperative risk factors, as identified in a previous study. We calculated 95% confidence intervals (CI) for the mortality rate based on the odds ratios (ORs). RESULTS The patients' characteristics were distributed almost uniformly regardless of the number of GTSs. Crude mortality according to the number of GTSs of 0, 1-2, or 3 or more was 0.9%, 0.8%, and 0.7%, respectively (p = 0.03). However, after adjustment, the ORs for 1-2 and 3 or more GTSs (reference: 0) were 0.86 (p = 0.23, 95% CI: 0.67-1.10) and 0.84 (p = 0.18, 95% CI: 0.64-1.09), respectively. The number of GTSs did not have a significant association with mortality. Similar results were observed for patients in the lobectomy cohort. CONCLUSION Low surgical mortality was consistent, regardless of the number of GTSs in each hospital.
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Fukui M, Takamochi K, Suzuki K, Ando K, Matsunaga T, Hattori A, Oh S, Suzuki K. Advantages and disadvantages of corticosteroid use for acute exacerbation of interstitial pneumonia after pulmonary resection. Gen Thorac Cardiovasc Surg 2020; 69:472-477. [PMID: 32939629 DOI: 10.1007/s11748-020-01487-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2020] [Accepted: 09/04/2020] [Indexed: 10/23/2022]
Abstract
OBJECTIVES Acute exacerbation of interstitial pneumonia (AE-IP) is the top cause of 30-day mortality in surgery for lung cancer patients. The general treatment for AE-IP is corticosteroid; however, there are some disadvantages of corticosteroid use after surgery. This study was conducted to report the clinical course of AE-IP after surgery and evaluate the effect of corticosteroid use. METHODS This retrospective study was performed on 337 patients with interstitial pneumonia who underwent surgical resection for lung cancer at our institute between 2009 and 2018. AE-IP were observed in 14 patients (4.2%) and their management and clinical outcome were investigated. RESULTS All patients received methylprednisolone pulse therapy. Six patients (42.9%) became convalescent after pulse therapy and eight (57.1%) died within 90 days after surgery due to lack of therapeutic efficacy. Oxygenation and ground-glass opacities of the survivors improved within 3 days after starting pulse therapy. Patients who responded to the first pulse also responded to the second pulse. Four patients developed complications including two with bronchopulmonary fistulas that may be related to steroid treatment. Even if the corticosteroid was effective, all AE-IP patients died within 1 year after surgery. CONCLUSIONS Corticosteroid therapy is effective for AE-IP after surgery; however, it may lead to severe complications after surgery.
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Affiliation(s)
- Mariko Fukui
- Departments of General Thoracic Surgery, Juntendo University School of Medicine, 1-3, Hondo 3-chome, Bunkyo-ku, Tokyo, 113-8431, Japan.
| | - Kazuya Takamochi
- Departments of General Thoracic Surgery, Juntendo University School of Medicine, 1-3, Hondo 3-chome, Bunkyo-ku, Tokyo, 113-8431, Japan
| | - Kazuhiro Suzuki
- Departments of Radiology, Juntendo University School of Medicine, Tokyo, Japan
| | - Katsutoshi Ando
- Department of Respiratory Medicine, Juntendo University School of Medicine, Tokyo, Japan
| | - Takeshi Matsunaga
- Departments of General Thoracic Surgery, Juntendo University School of Medicine, 1-3, Hondo 3-chome, Bunkyo-ku, Tokyo, 113-8431, Japan
| | - Aritoshi Hattori
- Departments of General Thoracic Surgery, Juntendo University School of Medicine, 1-3, Hondo 3-chome, Bunkyo-ku, Tokyo, 113-8431, Japan
| | - Shiaki Oh
- Departments of General Thoracic Surgery, Juntendo University School of Medicine, 1-3, Hondo 3-chome, Bunkyo-ku, Tokyo, 113-8431, Japan
| | - Kenji Suzuki
- Departments of General Thoracic Surgery, Juntendo University School of Medicine, 1-3, Hondo 3-chome, Bunkyo-ku, Tokyo, 113-8431, Japan
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Okada S, Shimomura M, Tsunezuka H, Ishihara S, Ishikawa N, Kameyama K, Kitaoka S, Inoue M. One-stage closure of large bronchopleural fistula with pedicled latissimus dorsi muscle flap after preemptive antibiotics: A case report. Int J Surg Case Rep 2020; 74:257-259. [PMID: 32898734 PMCID: PMC7486421 DOI: 10.1016/j.ijscr.2020.08.035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2020] [Accepted: 08/23/2020] [Indexed: 11/22/2022] Open
Abstract
Bronchopleural fistula (BPF) often needs two-stage closure after fenestration. This case highlights one-stage surgical closure of a large BPF with a muscle flap. Pedicled latissimus dorsi muscle flap would be useful even for 3-cm sized BPF. Preemptive antibiotics minimized local infection in ischemic bronchitis before BPF. Minimum infection with a limited-size space may be a key for one-stage closure.
Introduction Bronchopleural fistula (BPF) after lung cancer surgery is a life-threatening complication and often needs two-stage closure after fenestration. Although one-stage closure of BPF is challenging, it would provide shorter treatment time and lower patient physical burden than two-stage closure. However, there have been few reports of one-stage closure of a large BPF. Presentation of case A 53-year-old man underwent robotic right lower lobectomy with systematic lymph node dissection. Postoperative bronchoscopy revealed an ischemic change in the bronchial stump, which progressed to a large BPF. However, under the preemptive antibiotic treatment without chest drainage, local infection was controlled within a limited pleural space. We successfully performed one-stage closure of a 3-cm sized BPF with pedicled latissimus dorsi (PLD) muscle flap. Discussion Early diagnosis of ischemic bronchitis and appropriate preceding antibiotic treatment could minimize the local infection around the fistula. To our knowledge, our case represented the largest BPF that was successfully treated by one-stage procedure using preemptive antibiotics and the PLD muscle flap. Conclusion One-stage closure using the PLD muscle flap may be a treatment option even for a 3-cm sized BPF, wherein infection is controlled and the relevant pleural cavity is limited.
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Affiliation(s)
- Satoru Okada
- Division of Thoracic Surgery, Department of Surgery, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, 465 Kajii-cho, Kawaramachi-Hirokoji, Kamigyo-ku, Kyoto 602-8566, Japan.
| | - Masanori Shimomura
- Division of Thoracic Surgery, Department of Surgery, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, 465 Kajii-cho, Kawaramachi-Hirokoji, Kamigyo-ku, Kyoto 602-8566, Japan
| | - Hiroaki Tsunezuka
- Division of Thoracic Surgery, Department of Surgery, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, 465 Kajii-cho, Kawaramachi-Hirokoji, Kamigyo-ku, Kyoto 602-8566, Japan
| | - Shunta Ishihara
- Division of Thoracic Surgery, Department of Surgery, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, 465 Kajii-cho, Kawaramachi-Hirokoji, Kamigyo-ku, Kyoto 602-8566, Japan
| | - Narumi Ishikawa
- Division of Thoracic Surgery, Department of Surgery, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, 465 Kajii-cho, Kawaramachi-Hirokoji, Kamigyo-ku, Kyoto 602-8566, Japan
| | - Kenji Kameyama
- Division of Thoracic Surgery, Department of Surgery, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, 465 Kajii-cho, Kawaramachi-Hirokoji, Kamigyo-ku, Kyoto 602-8566, Japan
| | - Shuta Kitaoka
- Division of Thoracic Surgery, Department of Surgery, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, 465 Kajii-cho, Kawaramachi-Hirokoji, Kamigyo-ku, Kyoto 602-8566, Japan
| | - Masayoshi Inoue
- Division of Thoracic Surgery, Department of Surgery, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, 465 Kajii-cho, Kawaramachi-Hirokoji, Kamigyo-ku, Kyoto 602-8566, Japan
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Tokunaga Y, Kita Y, Okamoto T. Analysis of Risk Factors for Bronchopleural Fistula after Surgical Treatment of Lung Cancer. Ann Thorac Cardiovasc Surg 2020; 26:311-319. [PMID: 32224595 PMCID: PMC7801181 DOI: 10.5761/atcs.oa.20-00010] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
PURPOSE Bronchopleural fistula (BPF) is a potential serious complication of lobectomy or more radical surgery for non-small-cell lung cancer (NSCLC). We aimed to evaluate the risk factors for BPF. METHODS The study cohort comprised 635 patients who had undergone lobectomy or more radical surgery for NSCLC from March 2005 to December 2017. We examined the following risk factors for BPF: surgical procedure, medical history, preoperative treatment, and surgical management. RESULTS In all, 10 patients (1.6%) had developed postoperative BPFs. Univariate logistic regression analysis showed that surgical procedure, medical history (arteriosclerosis obliterans [ASO]), and bronchial stump reinforcement were significant risk factors. Multivariate analysis showed that only surgical procedure (right lower lobectomy, p = 0.011, odds ratio = 17.4; right middle lower lobectomy, p = 0.003, odds ratio = 59.4; right pneumonectomy, p <0.001, odds ratio = 166.0) was a significant risk factor. Multivariate analysis confined to the surgical procedure of lobectomy showed that right lower lobectomy (p = 0.011, odds ratio = 36.5) and diabetes (HbA1c ≥8.0) (p = 0.022, odds ratio = 31.7) were significant risk factors. CONCLUSION When lobectomy or more radical surgery is performed for NSCLC, right lower lobectomy, middle lower lobectomy, and right pneumonectomy are significant risk factors for postoperative BPF. Thoracic surgeons should acquire the techniques of bronchoplasty and angioplasty to avoid such invasive procedures.
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Affiliation(s)
- Yoshimasa Tokunaga
- Department of General Thoracic Surgery, Kochi Health Sciences Center, Kochi, Kochi, Japan
| | - Yusuke Kita
- Department of General Thoracic Surgery, Kochi Health Sciences Center, Kochi, Kochi, Japan
| | - Taku Okamoto
- Department of General Thoracic Surgery, Kochi Health Sciences Center, Kochi, Kochi, Japan
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Nagashima T, Ito H, Samejima J, Nemoto D, Eriguchi D, Nakayama H, Woo T, Masuda M. Postoperative changes of the free pericardial fat pad for bronchial stump coverage. J Thorac Dis 2020; 11:5228-5236. [PMID: 32030240 DOI: 10.21037/jtd.2019.11.81] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Background Bronchopleural fistula (BPF) remains a serious complication after surgery for lung cancer with bronchial resection. A free pericardial fat pad (FPFP) is applied in high-risk cases to reduce BPF frequency. BPF may occur 6 months after surgery. Thus, we evaluated the residual FPFP volume at 6 months after surgery to estimate the residual FPFP ratio and determine the amount of FPFP to be harvested during surgery. Methods We retrospectively investigated 40 patients who underwent lobectomy with bronchial stump coverage using FPFP. During surgery, the volume of the harvested FPFP was measured and the FPFP was affixed to the bronchial stump. Further, 6 months after surgery, the residual volume of the installed FPFP was analyzed using a three-dimensional volume analyzer and the residual ratio was calculated. We also evaluated clinicopathological factors influencing the resected FPFP and residual ratio. Results The median resected FPFP volume was 11 [3-40] mL. During multivariate analysis, body mass index and surgical approach were found to be significant factors associated with the resected FPFP volume. The median residual FPFP volume was 4.3 (0.4-15.5) mL. The median residual ratio was 0.39 (0.13-0.66). The resected FPFP volume was significantly associated with the residual volume (P<0.001) but not with the residual ratio (P=0.811). No factor was associated with the residual ratio. Conclusions In all cases, residual FPFP was confirmed at 6 months after surgery and the residual ratio was 40%. It is necessary to determine the volume of FPFP to be harvested while carefully considering the shrinkage ratio.
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Affiliation(s)
- Takuya Nagashima
- Department of Thoracic Surgery, Kanagawa Cancer Center, Yokohama, Japan.,Department of Surgery, Yokohama City University, Yokohama, Japan
| | - Hiroyuki Ito
- Department of Thoracic Surgery, Kanagawa Cancer Center, Yokohama, Japan
| | - Joji Samejima
- Department of Thoracic Surgery, Kanagawa Cancer Center, Yokohama, Japan
| | - Daiji Nemoto
- Department of Thoracic Surgery, Kanagawa Cancer Center, Yokohama, Japan
| | - Daisuke Eriguchi
- Department of Thoracic Surgery, Kanagawa Cancer Center, Yokohama, Japan
| | - Haruhiko Nakayama
- Department of Thoracic Surgery, Kanagawa Cancer Center, Yokohama, Japan
| | - Tetsukan Woo
- Department of Surgery, Yokohama City University, Yokohama, Japan
| | - Munetaka Masuda
- Department of Surgery, Yokohama City University, Yokohama, Japan
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Oki M, Seki Y. A customized, covered metallic stent to repair a postoperative bronchopleural fistula: a promising endobronchial approach. J Thorac Dis 2019; 11:1088-1090. [PMID: 31179047 DOI: 10.21037/jtd.2019.02.81] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Masahide Oki
- Departement of Respiratory Medicine, Nagoya Medical Center, Nagoya, Japan
| | - Yukio Seki
- Departement of Thoracic Surgery, Nagoya Medical Center, Nagoya, Japan
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