Thoracic surgeons perform a wide variety of cancer operations, which are often associated with high morbidity and mortality. Thus, thoracic surgery involves many special challenges that require ...innovative solutions. The increased utilization of minimally invasive practices, poor overall cancer survival, and significant morbidity of critical operations remain key obstacles to overcome. Fluorescence imaging technology (FIT), involving the implementation of fluorescent dyes and imaging systems, is currently used as an adjunct for general thoracic surgery in many situations and includes sentinel lymph node mapping, pulmonary intersegmental plane identification, pulmonary nodule identification, pulmonary bullous lesion detection, evaluation of the anastomotic perfusion after tracheal surgery, and thoracic duct imaging for postoperative chylothorax. This technology enhances the surgeon’s ability to perform operations, and has specific advantages. We review some of the key studies that demonstrate the applications of FIT in the field of general thoracic surgery, focusing on the use of indocyanine green.
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EMUNI, FIS, FZAB, GEOZS, GIS, IJS, IMTLJ, KILJ, KISLJ, MFDPS, NLZOH, NUK, OILJ, PNG, SAZU, SBCE, SBJE, SBMB, SBNM, UKNU, UL, UM, UPUK, VKSCE, ZAGLJ
Since 1990s, video-assisted thoracoscopic surgery (VATS) lobectomy has become a standard procedure for early-stage non-small cell lung cancer. However, VATS lobectomies are less common, and no ...randomized controlled trial of VATS versus conventional open lobectomy for early-stage lung cancer has been performed in Japan. Furthermore, VATS lobectomy procedures are not standardized in Japan, and may vary by institution or by practitioner, which complicates their evaluation. Although VATS procedures (such as pneumonectomy, bronchoplasty, and chest wall resection) have been reportedly performed for patients with advanced disease, whether VATS could be a standard modality for advanced lung cancer is unclear from an oncological perspective. Until recently, VATS lobectomies commonly used three or four ports to conduct systemic lymph node dissection; however, VATS lobectomies with reduced port have been recently reported. This article reviews current trends in VATS lobectomy procedures.
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EMUNI, FIS, FZAB, GEOZS, GIS, IJS, IMTLJ, KILJ, KISLJ, MFDPS, NLZOH, NUK, OBVAL, OILJ, PNG, SAZU, SBCE, SBJE, SBMB, SBNM, UKNU, UL, UM, UPUK, VKSCE, ZAGLJ
Differentiation of primary lung cancers and pulmonary metastases may present a diagnostic dilemma given overlapping CT findings.
The purpose of this study was to compare the utility of ringlike ...peripheral increased iodine concentration and conventional findings for differentiating primary lung cancers from pulmonary metastases on dual-energy CT (DECT).
This retrospective study included 93 patients (64 men, 29 women; median age, 70 years) who underwent resection of a primary lung cancer (
= 68) or pulmonary metastasis (
= 25) corresponding to a solid lesion on preoperative contrast-enhanced DECT performed between April 2020 and March 2021. Venous phase 120-keV single-energy images, equilibrium phase 66-keV virtual monoenergetic images, and iodine concentration maps were reconstructed. Two radiologists independently assessed lesions for spiculated margins, air bronchograms, rim enhancement, and thin ringlike peripheral high iodine concentration; differences were resolved by consensus. Inter-reader agreement and diagnostic performance were assessed. Multivariable logistic regression analysis incorporated additional patient and lesion characteristics.
Interobserver agreement, expressed as kappa, was 0.26 for spiculated margins, 0.60 for air bronchograms, 0.56 for rim enhancement, and 0.80 for ringlike peripheral high iodine concentration. Pulmonary metastases, compared with primary lung cancers, exhibited significantly higher frequency of ringlike peripheral high iodine concentration (52% vs 19%;
= .004) but no significant difference in frequency of spiculated margins (49% vs 32%;
= .17), air bronchograms (36% vs 51%;
= .24), or rim enhancement (4% vs 4%;
> .99). Sensitivity and specificity for diagnosing pulmonary metastasis were 68% and 49% for absence of spiculated margins, 64% and 51% for absence of air bronchograms, 4% and 96% for presence of rim enhancement, and 52% and 81% for presence of ringlike peripheral high iodine concentration. In multivariable analysis including smoking history, lesion diameter, multiple resected lesions, and ringlike peripheral high iodine concentration, the only independent significant predictor of pulmonary metastasis was ringlike peripheral high iodine concentration (OR, 7.81 95% CI, 2.28-29.60);
= .001).
Ringlike peripheral high iodine concentration had excellent interobserver agreement and high specificity (albeit poor sensitivity) for differentiating pulmonary metastasis from primary lung cancer and was independently predictive of pulmonary metastasis.
Ringlike peripheral high iodine concentration could help guide management of patients with known cancer and an indeterminate solitary nodule.
Purpose
Postoperative complications have a significant impact on perioperative outcomes; however, their association with the long-term prognosis remains unclear. We evaluated the impact of ...postoperative complications on the long-term outcomes after curative surgery in lung cancer patients.
Methods
This study included 1129 patients with primary lung cancer who underwent lobectomy between April 2011 and March 2017. Univariate and multivariate analyses were performed to assess the association of postoperative complications with the overall and recurrence-free survival.
Results
Postoperative complications were observed in 147 (13.0%) patients over a median follow-up period of 5-years. Compared to patients without complications, those with complications showed had worse long-term outcomes, including the 5-year overall survival (75.3% vs. 86.1%,
p
< 0.001) and 5-year recurrence-free survival (64.2% vs. 74.4%,
p
= 0.004). A multivariate analysis revealed that the incidence of postoperative complications was significantly associated with the overall survival (hazard ratio = 1.665,
p
= 0.006) and recurrence-free survival (hazard ratio = 1.416,
p
= 0.025) in all patients. The prognostic influence was greater in patients with pathological stages II and III cancer (overall survival: hazard ratio = 2.019,
p
= 0.005; recurrence-free survival: hazard ratio = 1.90,
p
= 0.001) than in those with pathological stage I cancer.
Conclusion
Postoperative complications are independent predictors of the overall and recurrence-free survival in lung cancer patients, especially advanced-stage cancer patients.
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EMUNI, FIS, FZAB, GEOZS, GIS, IJS, IMTLJ, KILJ, KISLJ, MFDPS, NLZOH, NUK, OILJ, PNG, SAZU, SBCE, SBJE, SBMB, SBNM, UKNU, UL, UM, UPUK, VKSCE, ZAGLJ
We developed a surgical support system that visualises important microanatomies using artificial intelligence (AI). This study evaluated its accuracy in recognising the thoracic nerves during lung ...cancer surgery. Recognition models were created with deep learning using images precisely annotated for nerves. Computational evaluation was performed using the Dice index and the Jaccard index. Four general thoracic surgeons evaluated the accuracy of nerve recognition. Further, the differences in time lag, image quality and smoothness of movement between the AI system and surgical monitor were assessed. Ratings were made using a five-point scale. The computational evaluation was relatively favourable, with a Dice index of 0.56 and a Jaccard index of 0.39. The AI system was used for 10 thoracoscopic surgeries for lung cancer. The accuracy of thoracic nerve recognition was satisfactory, with a recall score of 4.5 ± 0.4 and a precision score of 4.0 ± 0.9. Though smoothness of motion (3.2 ± 0.4) differed slightly, nearly no difference in time lag (4.9 ± 0.3) and image quality (4.6 ± 0.5) between the AI system and the surgical monitor were observed. In conclusion, the AI surgical support system has a satisfactory accuracy in recognising the thoracic nerves.
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IZUM, KILJ, NUK, PILJ, PNG, SAZU, UL, UM, UPUK
In this era of endoscopic surgery, feedback from recorded surgical videos is useful and efficient; therefore, effective methods of obtaining this feedback are needed. We analyzed surgical videos ...using motion analysis software and verified the usefulness of visualizing and objectively evaluating surgical procedures. We measured the grasping and traction angles of the vascular sheath when using forceps and the trajectory of the forceps tip for the upper pulmonary vein during right upper lobectomy during video‐assisted thoracoscopic surgery performed by three trainers and trainees. Compared with the trainers, the trainees exhibited insufficient traction of the vascular sheath, performed many slow and unnecessary manipulations, and sometimes performed sudden and fast movements. By visualizing the surgical procedures, the trainee will be better able to identify dangerous or futile movements. It may also make it easier to objectively recognize improvements in one's technique. Motion analysis software could allow for efficient surgical education and self‐learning.
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FZAB, GIS, IJS, KILJ, NLZOH, NUK, OILJ, SAZU, SBCE, SBMB, UL, UM, UPUK
Objective Small bronchioloalveolar carcinoma showing pure ground-glass opacity on high-resolution computed tomographic scans is commonly multifocal. Surgical treatment for these lesions is ...controversial. We discuss the efficacy of video-assisted thoracic surgery for multifocal bronchioloalveolar carcinoma in patients at our institution. Methods Twenty-seven patients with multifocal bronchioloalveolar carcinoma lesions less than or equal to 20 mm in diameter (105 lesions) underwent video-assisted thoracic surgery pulmonary resection between 2000 and 2006. Their clinicopathologic features were investigated retrospectively. Results Twenty-seven patients (10 male and 17 female) with a median age of 64 years (range, 41–78 years) had 91 ground-glass opacity lesions on high-resolution computed tomography. Sixteen patients (59%) were women with no history of smoking. The distribution of bronchioloalveolar carcinoma lesions was unilateral in 14 patients and bilateral in 13 patients. Ten patients underwent wedge resection. Seventeen patients underwent single-stage segmentectomy or lobectomy (alone or with wedge resection) for technical reasons. All lesions were completely resected. One patient underwent conversion to thoracotomy for bleeding. Histologic diagnoses showed 62 bronchioloalveolar carcinoma type A lesions, 28 type B lesions, and 15 type C lesions according to Noguchi’s classification, and atypical adenomatous hyperplasia in 43 lesions (13 patients). All patients had N0 disease. The median postoperative observation period was 46 months. All patients have survived to date, but new lesions have developed in 7 (26%). Patients with new lesions had a higher incidence of bronchioloalveolar carcinoma lesions of 3 mm or less in diameter ( P = .0254) and atypical adenomatous hyperplasia ( P = .011). Conclusion Video-assisted thoracic surgery management of multifocal bronchioloalveolar carcinoma yielded satisfactory results. However, the appearance of new lesions remains a problem.
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GEOZS, IJS, IMTLJ, KILJ, KISLJ, NLZOH, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UILJ, UL, UM, UPCLJ, UPUK, ZAGLJ, ZRSKP
Purpose
Most robot-assisted thoracoscopic surgery (RATS) is performed from the vertical view. This study evaluates the initial outcomes of our novel confronting RATS technique, in which the patient ...was viewed horizontally, as in open thoracotomy.
Methods
We reviewed data on patients who underwent thoracoscopic lobectomy between January, 2019 and April, 2022. Perioperative outcomes were compared between RATS and video-assisted thoracoscopic surgery (VATS), using propensity-score matching.
Results
RATS and VATS were performed for 83 and 571 patients, respectively. After propensity-score matching, data on 81 patients from each of the two groups were retrieved. The operative time was significantly longer for RATS than for VATS (199 ± 44 min vs. 173 ± 37 min,
p
< 0.001). There was no mortality or conversion to thoracotomy in either of the groups. The rates of overall complications and prolonged air leak did not differ significantly between the groups. The serum creatine phosphokinase level on postoperative day 4 was higher after RATS than after VATS. The number of resected lymph nodes and the rates of nodal upstaging did not differ significantly between the groups.
Conclusion
The initial perioperative outcomes of RATS using the confronting settings were comparable to those of VATS.
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EMUNI, FIS, FZAB, GEOZS, GIS, IJS, IMTLJ, KILJ, KISLJ, MFDPS, NLZOH, NUK, OILJ, PNG, SAZU, SBCE, SBJE, SBMB, SBNM, UKNU, UL, UM, UPUK, VKSCE, ZAGLJ
This report describes a rare case of osteosarcoma of the right distal femur and secondary spontaneous pneumothorax in a 13-year-old girl. Secondary spontaneous pneumothorax complicating metastatic ...osteosarcoma is a rare but well-known phenomenon, with several suggested hypotheses for its pathogenesis. However, these hypotheses have not been confirmed. In the present case, the pathogenesis of secondary spontaneous pneumothorax complicating metastatic osteosarcoma was determined grossly, radiologically, and histopathologically. These findings may help to clarify further the pathogenesis of secondary spontaneous pneumothorax complicating metastatic osteosarcoma.
The number of surgeries for elderly patients with lung cancer is increasing. In our institute, thoracoscopic lobectomy and hilar lymph node dissection are the standard procedure for octogenarian ...patients with clinical N0 non-small-cell lung cancer. The aim of this study was to determine the outcome of our strategy for octogenarian patients.
Seventy octogenarian patients with clinical N0 non-small-cell lung cancer who underwent surgery were enrolled (O group). As a control group, 205 septuagenarian patients were also enrolled (S group). We compared several clinicopathological factors and outcomes.
The median age of the O group was 82. There was no significant difference in the comorbidity ratio between the two groups. The 5-year overall survival ratio for the O group (72.8%) was significantly worse than that for the S group (88.3%). However, multivariate analysis proved age was not an independent predictor of outcome. The rates of recurrences involving ipsilateral mediastinal lymph nodes were equal in the two groups. After propensity score matching, clinical T1 patients were dominant (85%) in two matched group and no statistically significant differences were observed in the 5-year overall survival between the two groups.
Our strategy for octogenarian patients with non-small-cell lung cancer, including omission of mediastinal lymph node dissection, was determined to be feasible, in particularly with cT1N0 disease.
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