• Journal of Chest Surgery
• /
• v.54 no.5
• /
• pp.342-347
• /
• 2021

Thoracic surgeons need to be aware of several important points regarding intraoperative lymph node dissection during surgery for non-small cell lung cancer with ground-glass opacities. The first point relates to the need for lymph node dissection during sublobar resection. Since even patients undergoing sublobar resection may benefit from lymph node dissection, it should be selectively performed according to adequate indications, which require further study. Second, there seems to be no difference in postoperative morbidity between systematic sampling and systematic dissection, but the survival benefit from systematic dissection remains unclear. The results of randomized controlled trials on this topic are conflicting, and their evidence is jeopardized by a high risk of bias in terms of the study design. Therefore, further randomized controlled trials with a sound design should investigate this issue. Third, more favorable survival outcomes tend to be positively associated with the number of examined lymph nodes. Minimum requirements for the number of examined lymph nodes in non-small cell lung cancer should be defined in the future. Finally, lobe-specific lymph node dissection does not have a negative prognostic impact. It should not be routinely performed, but it can be recommended in selected patients with smaller, less invasive tumors. Results from an ongoing randomized controlled trial on this topic should be awaited.

• Journal of Chest Surgery
• /
• v.54 no.4
• /
• pp.239-245
• /
• 2021

Video-assisted thoracoscopic surgery (VATS) has been established as the surgical approach of choice for lobectomy in patients with early-stage non-small cell lung cancer (NSCLC). Patients with clinical stage I NSCLC with no lymph node metastasis are considered candidates for VATS lobectomy. To rule out the presence of metastasis to lymph nodes or distant organs, patients should undergo meticulous clinical staging. Assessing patients' functional status is required to ensure that there are no medical contraindications, such as impaired pulmonary function or cardiac comorbidities. Although various combinations of the number, size, and location of ports are available, finding the best method of port placement for each surgeon is fundamental to maximize the efficiency of the surgical procedure. When conducting VATS lobectomy, it is always necessary to comply with the following oncological principles: (1) the vessels and bronchus of the target lobe should be individually divided, (2) systematic lymph node dissection is mandatory, and (3) touching the lymph node itself and rupturing the capsule of the lymph node should be minimized. Most surgeons conduct the procedure in the following sequence: (1) dissection along the hilar structure, (2) fissure division, (3) perivascular and peribronchial dissection, (4) individual division of the vessels and bronchus, (5) specimen retrieval, and (6) mediastinal lymph node dissection. Surgeons should obtain experience in enhancing the exposure of the dissection target and facilitating dissection. This review article provides the basic principles of the surgical techniques and practical maneuvers for performing VATS lobectomy easily, safely, and efficiently.

• Journal of Chest Surgery
• /
• v.38 no.3 s.248
• /
• pp.253-257
• /
• 2005

The patients with primary lung cancer who have symptoms of angina pectoris commonly have underwent coronary artery bypass grafting (CABG) prior to lung resection. Recently, there are attempts to conduct simultaneous operation of CABG and lung resection to reduce disadvantages of staged operation, such as repeated general anesthesia, two wound incisions and delay of lung operation. These attempts generally report good results. Three patients underwent lung resection and CABG simultaneously, and had good post operative status without recurrence of cancer and angina pectoris. We conceive these as worthy cases to report.

• Journal of Chest Surgery
• /
• v.39 no.5 s.262
• /
• pp.419-422
• /
• 2006

Benign symmetric lipomatosis (BSL), also called Madelung's disease, is a rare disease in middle-aged chronic alcohol user. The cause of BSL is unknown. A 63 year-old man with rapid growing lesions in both shoulders for 2 months visited our hospital. Except for cosmetic problem, no abnormal finding was found in blood cell analysis and chemistry; however, excessive fat deposition was found on radiographic findings. Lipoma was revealed in pathologic examination and BSL was diagnosed clinically. Patient is being followed up without any specific problem.

• Journal of Chest Surgery
• /
• v.45 no.1
• /
• pp.1-10
• /
• 2012

Background: ${\alpha}$-Lipoic acid (${\alpha}$-LA) has been studied as an anticancer agent as well as a therapeutic agent for diabetes and obesity. We performed this study to evaluate the anticancer effects and mechanisms of ${\alpha}$-LA in a lung cancer cell line, A549. Materials and Methods: ${\alpha}$-LA-induced apoptosis of A549 cells was detected by fluorescence-activated cell sorting analysis and a DNA fragmentation assay. Expression of apoptosis-related genes was analyzed by western blot and reverse transcription.polymerase chain reaction analyses. Results: ${\alpha}$-LA induced apoptosis and DNA fragmentation in A549 cells in a dose- and time-dependent manner. ${\alpha}$-LA increased caspase activity and the degradation of poly (ADP-ribose) polymerase. It induced expression of endoplasmic reticulum (ER) stress-related genes, such as glucose-regulated protein 78, C/EBP-homologous protein, and the short form of X-box binding protein-1, and decreased expression of the anti-apoptotic protein, X-linked inhibitor of apoptosis protein. Reactive oxygen species (ROS) production was induced by ${\alpha}$-LA, and the antioxidant N-acetyl-L-cysteine decreased the ${\alpha}$-LA-induced increase in expression of apoptosis and ER stress-related proteins. Conclusion: ${\alpha}$-LA induced ER stress-mediated apoptosis in A549 cells via ROS. ${\alpha}$-LA may therefore be clinically useful for treating lung cancer.

• Journal of Chest Surgery
• /
• v.35 no.7
• /
• pp.568-572
• /
• 2002

We present a case of a 47-year-old woman with benign solitary fibrous tumor of the pleura originated in the diaphragm which was discovered incidentally on a chest radiograph. Chest radiograph, sonograph, computed tomographic scan and magnetic resonance image studies proved a well circumscribed and lobulated fibrous tumor of the pleura. During the subsequent right thoracotomy, the tumor was found to be encapsulated and consisted of firm mass. It was connected to the diaphragm with $5{\times}4$cm area by pedicle. Most of the tumor was free of adhesion. It was excised completely together with attached diaphragm. The tumor measured $23.5{\times}13.5{\times}8.0$cm and the pathologic diagnosis was benign solitary fibrous tumor and the attached diaphragm was free of disease.

• Journal of Chest Surgery
• /
• v.37 no.1
• /
• pp.102-104
• /
• 2004

Inflammatory myofibroblastoma is a solid tumor, occurring mainly to children and young adults, and occupying 0.7% of total isolated pulmonary nodules. Since 1973, several cases about inflammatory myofibroblastoma have been reported. Firstly, this tumor was found in lungs. Then, tumors have been founded and reported in mesentery or cardioesophageal region. Histologically, this tumor can be classified as a benign tumor. However, since this tumor has two characteristics showing malignancy, that is, local invasion and recurrence, malignancy can not be completely excluded. Recently, a patient with pulmonary inflammatory myofibroblastoma underwent surgical resection without any signs or symptoms of recurrence.

• Journal of Chest Surgery
• /
• v.55 no.1
• /
• pp.20-29
• /
• 2022

Background: Patients with high-risk (HR) operable non-small cell lung cancer (NSCLC) may have unique prognostic factors. This study aimed to evaluate surgical outcomes in HR patients and to investigate prognostic factors in HR patients versus standard-risk (SR) patients. Methods: In total, 471 consecutive patients who underwent curative lung resection for NSCLC between January 2012 and December 2017 were identified and reviewed retrospectively. Patients were classified into HR (n=77) and SR (n=394) groups according to the American College of Surgeons Oncology Group criteria (Z4099 trial). Postoperative complications were defined as those of grade 2 or higher by the Clavien-Dindo classification. Results: The HR group comprised more men and older patients, had poorer lung function, and had more comorbidities than the SR group. The patients in the HR group also experienced more postoperative complications (p≤0.001). More HR patients died without disease recurrence. The postoperative complication rate was the only significant prognostic factor in multivariable Cox regression analysis for HR patients but not SR patients. HR patients without postoperative complications had a survival rate similar to that of SR patients. Conclusion: The overall postoperative survival of HR patients with NSCLC was more strongly affected by postoperative complications than by any other prognostic factor. Care should be taken to minimize postoperative complications, especially in HR patients.

• Journal of Chest Surgery
• /
• v.57 no.2
• /
• pp.152-159
• /
• 2024

Background: Anastomotic leakage (AL) following esophagectomy represents a serious complication that often results in prolonged hospitalization and necessitates repeated interventions, including nothing-by-mouth (NPO) restriction, endoscopic vacuum therapy (EVT), or surgical repair. In this study, we evaluated the patterns and outcomes of AL treatment. Methods: We retrospectively reviewed the medical records of patients who underwent esophagectomy for esophageal cancer at a single center between 2003 and 2020. Of 3,096 examined cases, 181 patients (5.8%) with AL were included in the study: 114 patients (63%) with cervical anastomosis (CA) and 67 (37%) with intrathoracic anastomosis (TA). Results: The incidence of AL was 11.9% in the CA and 3.2% in the TA group (p<0.001). Among patients with CA who developed AL, 87 (76.3%) were managed with NPO, 15 (13.2%) with EVT, and 12 (10.5%) with surgical repair. Over 90% of patients with cervical AL resumed an oral diet by the time of discharge, regardless of treatment method. Among patients with TA and AL, 36 (53.7%) received NPO, 25 (37.7%) underwent EVT, and 6 (9%) required surgery. Of these, 34 patients who were managed with NPO and 19 with EVT could resume an oral diet. However, only 2 patients who underwent surgery resumed an oral diet, and 2 patients required additional EVT. Conclusion: Although patients with CA displayed a higher incidence of AL, their rate of successful oral intake exceeded that of those with TA, regardless of treatment method. Among patients exhibiting AL with TA, EVT was more commonly employed than in CA cases, and it appears effective.

• Journal of Chest Surgery
• /
• v.41 no.3
• /
• pp.369-372
• /
• 2008

A primary malignant lymphoma that originates in the heart is extremely rare. A 68-year-old male patient was admitted due to aggravated dyspnea. After echocardiography and chest computed tomography evaluation, a huge mass in the right atrium and the right ventricle was detected. We decided to perform emergency surgery due to a high risk of infarction and hemodynamic disturbance. After the near total removal of the huge mass in the right cardiac chamber, the interatrial septum and antero-lateral part of the right atrium were reconstructed by the use of a bovine pericardial patch. The final pathological diagnosis was a primary malignant lymphoma. The patient and his guardians refused chemotherapy (including radiotherapy), and the patient was discharged to his home, where the prognosis was hopeless.