Sublobar resection for metachronous stage I second primary non-small cell lung cancer: A single-centre experience

INTRODUCTION

More patients are developing second primary lung cancer (SPLC). This study aimed to evaluate the impact of the extent of SPLC resection on outcomes.

MATERIAL AND METHODS

We retrospectively investigated 1,895 patients with lung cancer who underwent pulmonary resection from 2011 to 2018. SPLC was diagnosed using the criteria of Martini and Melamed. Patients with pathological stage I SPLC who underwent lobectomy for first primary lung cancer (FPLC) were included in the study. Outcomes and clinical factors that could affect survival were evaluated.

RESULTS

Fifty-four patients were eligible for the study. Lobectomy, segmentectomy, or wedge resection was performed for 10, 32, and 12 patients, respectively. Neither overall nor relapse-free survival was significantly different based on the extent of resection for stage I SPLC. Multivariate analysis revealed that interval between FPLC and SPLC of less than 5 years was an independent risk factors for worse relapse-free survival after SPLC resection (interval: hazard ratio, 0.28; P = 0.048). The median interval from prior resection to secondary resection was 68 months.

CONCLUSIONS

Sublobar resection might be a realistic option for stage I SPLC. To realize early detection of SPLC that can undergo radical sublobar resection, the surveillance period after prior resection of FPLC is worth reconsidering.

[Surgical Procedure and Perioperative Outcomes of Three-port Video-assisted Thoracoscopic Surgery Thymectomy for Thymoma, Including en-bloc Resection of Adjacent Organs]

This report discusses the treatment and outcomes of three-port video-assisted thoracoscopic surgery (VATS) thymectomy for thymoma. We reviewed perioperative results of 159 thymoma cases( excluding thymic carcinoma) over 16 years. Thoracoscopic surgery was indicated for Masaoka stagesⅠ to Ⅲ, tumor diameter up to 12 cm, and resection of surrounding organs up to the lung, pericardium+reconstruction, internal thoracic artery and vein, left brachiocephalic vein, and phrenic nerve+reconstruction. The mean age of patients was 56.9±12.7, with 71 males and 88 females. The surgical approach was right-sided in 110 cases, left-sided in 47 cases, and bilateral in 2 cases. Total thymectomy was performed in 141 cases, with total thymectomy plus combined resection of other organs (lungs, pericardium, and phrenic nerve) ±reconstruction in 18 cases. The World Health Organization( WHO) classification( 5th edition) was type A/AB/B1/B2/B3/micronodular thymoma with lymphoid stroma (MNTLS) = 20/49/32/45/11/2, and Masaoka classification was stageⅠ/Ⅱ/Ⅲ=69/86/4. The three-port VATS technique offers several advantages, including its applicability to other surgeries, avoidance of contralateral thoracic cavity opening, safety in thymectomy without open conversion, and a mean postoperative hospital stay of 3 days.

Anomalous systemic arterial supply to the left basal lung with a calcified abnormal vessel: a case report

Background

Anomalous systemic arterial supply to the normal basal segment of the left lower lobe is a congenital abnormality of the lung, frequently and is generally diagnosed at a young age. Surgery is generally recommended if symptoms such as blood sputum or fever are observed. Resection of the abnormal artery is often performed at an early age, with only few reports of surgery being performed at an older age. In addition, to the best of our knowledge, there are no reports on surgical treatment of abnormal calcified vessels to date. Herein, we have presented a case in which a calcified aberrant vessel of lung was resolved surgically.

Case presentation

A 65-year-old female, previously diagnosed with anomalous systemic arterial supply to the left normal basal segment of the left lung lower lobe of lung was under observation on the basis of being asymptomatic.

The patient presented to the emergency room with the chief complaint of blood in the sputum and she was referred to our hospital for a surgery. Computed tomography showed circumferential calcification of the intima of the abnormal vessel, which might have contributed to incomplete resection of the artery if automatic sutures were used. Thus, the abnormal vessel was ligated and dissected using pledgeted 4–0 polypropylene sutures and vessel clips under open thoracotomy followed by left lower lobectomy. The patient was discharged seven days after surgery without any serious surgical complications.

Conclusions

Vascular congenital anomalies of the lung are often operated at a young age presenting due to the associated symptoms. However, even if the disease is discovered incidentally and does not cause any symptoms or calcification in the aberrant artery, early surgical intervention is important due to the possibility of calcification occuring in the future. This can help minimize the degree of surgical invasion.

Outcomes of Video-Assisted Thoracic Surgical Lung Biopsy for Interstitial Lung Diseases

Purpose: Surgical lung biopsy (SLB) is an important diagnostic tool for interstitial lung disease (ILD), yet the risk factors for SLB are still debatable and long-term outcomes remain unknown.

Methods: We retrospectively reviewed the records of 85 consecutive patients with ILD who underwent SLB by video-assisted thoracic surgery (VATS) from 2008 to 2019. Risk factors for complications and differences of outcomes between idiopathic pulmonary fibrosis (IPF) and other ILDs were examined.

Results: All patients who underwent VATS had no mortality or acute exacerbation of ILD within 90 days of SLB. The rate of complication was 9.4%, and there were no statistically significant risk factors for complications. While the IPF group was not significantly different from the non-IPF group with regard to surgical parameters or complications, patients with IPF had significantly higher rates of mortality (50% vs. 9% in 5 years; p <0.001) and readmission due to acute exacerbation (75% vs. 8% in 5 years; p <0.001).

Conclusion: VATS lung biopsy for ILD can be a safe approach regardless of underlying phenotypes. An accurate diagnosis of IPF via SLB may be beneficial for correct patient management.

[The Strategy and Outcome of Three-port Thoracoscopic Surgery for Synchronous and Metachronous Multiple Lung Cancer]

The treatment contents and the outcome of three-port thoracoscopic surgery for multiple lung cancer are studied and discussed in this report. 239 cases of synchronous or metachronous multiple lung cancer (11.5%) out of 2,076 cases of primary lung cancer resected in our department from the year of 2010 to 2018 are subjected to this study. There are 158 cases of synchronous multiple lung cancer and 81 cases of the metachronous. The pathological findings for both synchronous and metachronous multiple lung cancer are adenocarcinoma for 194 cases. The pathological stages for the both are stageⅠfor 208 cases. For the synchronous group, there are 156 cases, in which the patients underwent one-stage surgery was performed. For metachronous group, lobectomy was performed for the first surgery in 69 cases. For the second surgery, bilateral lobectomy was performed in the 13 cases, and there was one case of right completion pneumonectomy. There was no intraoperative death or critical postoperative complication. The five-year survival rates are 84.9% for the synchronous group, and 75.2% for the metachronous group. Above all, three-port thoracoscopic surgery for multiple lung cancer was carried out safely. Bilateral lobectomy and completion pneumonectomy are also possible for metachronous multiple lung cancer if a patient has a decent lung function and good performance status. Especially for stageⅠcases, we could expect a good prognosis, and therefore surgical treatment should actively be performed.

[Indication and Results of 3-port Thoracoscopic Limited Resection for Lung Cancer]

The tumors with the size of 15 mm or less and less than 50 percent of solid component have been eligible for our radical surgical indication of 3-port thoracoscopic limited resection. The objective is to evaluate the indication. Between 2010 and 2015, we reviewed 206 segmentectomy and 87 partial resection. In those patients, non-radical limited resections included 129 segmentectomy and 29 partial resection. As for imaging findings, the maximum tumor diameter were 16.7 mm vs 10.8 mm and the consolidation/tumor (C/T) ratio were 0.54 vs 0.39. At a mean follow up of 48 months, 5-year overall survival (OS) were 91.4% vs 93.1%, and 5-year recurrent free survival (RFS) were 88.6% vs 93.1%. Overall recurrence(10 patients vs 6 patients) happened in the patients with non-radical limited resections for pure or part solid tumors, therefore it is necessary to consider an indication of limited resection for solid tumors carefully.

The bioavailability of magnesium from Wakame (Undaria pinnatifida) and Hijiki (Hijikia fusiforme) and the effect of alginic acid on magnesium utilization of rats

The bioavailability of magnesium from Wakame and Hijiki, and the effects of alginic acid on absorption of dietary magnesium were examined in five groups of rats fed either control, Wakame, Hijiki, AW (containing the same amount of alginate as in the Wakame) and AH (containing the same amount of alginate as in the Hijiki) diets, and animals fed a low magnesium diet (LMg) (twentieth amount of magnesium in the original mineral mixtures as the control). Food intake and body weight gain were decreased by adding sodium alginate to the diets. A large amount of calcium accumulated only in the kidneys of the rats fed the LMg diet. Serum magnesium concentration decreased only in the LMg group. The magnesium content in the defatted left femurs did not differ between the control and Wakame fed animals and also among the animals eating Wakame, Hijiki and AW diets. The breaking force of the right femurs did not differ among all the groups except the LMg group. The ratio of apparent magnesium absorption (%) of the control, LMg, Wakame, Hijiki, AW and AH groups was 82.2, 72.7, 66.9, 50.8, 69.3 and 54.2 in the first experimental period, and was 75.3, 52.1, 57.7, 46.9, 62.6 and 60.5 in the second experimental period, respectively. It was clear that the bioavailability of magnesium in the Wakame fed rats was higher than in those eating the Hijiki. Large amounts of sodium alginate lowered magnesium absorption from the diet.

The bioavailability of magnesium in spinach and the effect of oxalic acid on magnesium utilization examined in diets of magnesium-deficient rats

Spinach was evaluated for its bioavailability of magnesium in the experiment with magnesium-deficient rats. The effect of oxalic acid on absorption of dietary magnesium was also examined in the same experiment. After there were significant differences in the body weight of the rats between the control group and the magnesium-deficient group, and after the number of dead rats increased, the magnesium-deficient rats were divided into six groups. They were pair-fed for 8 days on the magnesium-deficient diet, magnesium-deficient diet supplemented with raw powdered spinach (R-sp), boiled powdered spinach (B-sp), or fried powdered spinach (F-sp), control diet supplemented with oxalic acid (Ox-C), and control diet (+Mg). On the 10th day, there was no significant difference in the food intake of the rats between the control group and magnesium-deficient group. However, the body weight, and body weight gain of the rats increased more significantly in the control group than in those of the magnesium-deficient group. Also, the contents of calcium and phosphorus in the liver and kidneys, and serum calcium content increased significantly in the magnesium-deficient rats compared with those of the control rats. However, the serum magnesium content decreased significantly in the magnesium-deficient rats. An especially large amount of calcium was accumulated in the kidneys of the magnesium-deficient rats. At the end of the experimental period, there were no significant differences in the food intake, body weight and body weight gain of the rats among the control group and each of the spinach-added groups. The body weight and body weight gain of the Ox-C rats decreased significantly in comparison with those of the control group and each of the spinach-added groups. Although, there were no significant differences in the concentrations of serum minerals (Mg, Ca and P) among each of the groups, kidney magnesium, calcium and phosphorus, and liver magnesium and phosphorus were significantly higher in each of the spinach added groups than those of the control, Ox-C and +Mg groups. A large amount of calcium was accumulated in the kidneys of the rats fed on the R-sp, B-sp, F-sp and Ox-C diets. However, the kidney calcium of each of the spinach-added groups markedly decreased in comparison with kidney calcium of the magnesium-deficient rats on the 10th day, when the magnesium-deficient rats were separated. There was no significant difference in the magnesium content of the left tibiae among each of the spinach-added groups. Also, the magnesium contents of the left tibiae of each of the additional groups did not reach the level of those of the control rats. The contents of calcium and phosphorus of the left tibiae were not significantly different among any of the groups except for both the R-sp and Ox-C groups, and decreased significantly in the R-sp and Ox-C groups compared with those of the other groups. A highly positive correlation between bone calcium and bone strength was not observed in this study; the breaking force of the left femurs of the B-sp and F-sp rats increased significantly in comparison with that of the Ox-C group. The rate of magnesium absorbed by the rats receiving the control, R-sp, B-sp, F-sp, Ox-C, and +Mg diets was 88.9, 80.2, 88.4, 90.4, 88.1, and 87.7%, respectively. The rate of apparent absorption of calcium from the control, Mg-deficient, R-sp, B-sp, F-sp, Ox-C and +Mg diet was 87.0, 84.1, 57.3, 66.4, 66.2, 53.3 and 83.5%, respectively. The data indicate that oxalic acid remained in spinach after cooking of boil or frizzle was not deleterious to magnesium availability, and that spinach is one of the most promising sources of magnesium.

Cartilage, bone and tooth induction during early embryonic mouse mandibular morphogenesis using serumless, chemically-defined medium

Studies were designed to test the hypothesis that plasma- and serum-deprived embryonic cells and tissues in vitro are capable of producing growth regulating factors which augment cartilage, bone and tooth induction during mouse mandibular process development. Embryonic mouse first branchial arch-derived mandibular processes (E11-E12, Theiler stages 18-19) or cap stage molar tooth (M1) organs (E15-E16, Theiler stage 23) expressed morphogenesis, histogenesis and cytodifferentiation (e.g., Meckel's cartilage and mandibular bone) when cultured as explants in permissive serumless and chemically-defined BGJB medium for periods up to 31 days in vitro. Organ cultures of early mandibular process explants in serumless conditions showed DNA synthesis comparable to the time- and position-restricted patterns characteristic for control in vivo development. As a paradigm for embryonic cell expression of putative growth factors, sense and antisense oligodeoxynucleotide probes corresponding to amino acids 1070-1081 for preproEGF, and antibodies directed against amino acids 348-691 of preproEGF, were used to identify and localize mRNA transcripts and translation products. Our preliminary evidence suggests that odontogenic epithelial and ectomesenchyme cells produce EGF-like products during instructive phases of tooth development. We suggest that plasma- and serum-deprived cells and tissues in vitro produce autocrine and/or paracrine growth factors which mediate embryonic mandibular morphogenesis, histogenesis and cytodifferentiation.

The bioavailability of calcium in spinach and calcium-oxalate to calcium-deficient rats

We estimated the utilization of calcium in spinach and calcium-oxalate to calcium-deficient rats, and the effect of oxalic acid on absorption of dietary calcium by using calcium-deficient rats. The body weight gain of the calcium-deficient rats for 8 days receiving a calcium-deficient diet supplemented with raw-powdered spinach (R-sp), boiled-powdered spinach (B-sp), or calcium-oxalate (Ca-ox), and a control diet supplemented with oxalic acid (OX-C) were 4.8, 2.8, 4.9, and 5.1 g, respectively. The calcium content in the liver and kidney of the rats receiving R-sp, B-sp, Ca-ox, and OX-C diets significantly increased as compared with the calcium-deficient rats. Significant differences in the liver calcium levels were not observed among the rats receiving various additional diets, though the content in the kidneys of the rats receiving R-sp, B-sp, Ca-ox, and OX-C diets were 28.0, 21.5, 0.11, and 0.59 mg, respectively. An especially large amount of calcium was accumulated in the kidneys of the rats receiving R-sp and B-sp diets. The calcium concentration in the serum of the rats receiving Ca-ox and OX-C diets was higher than the calcium concentration in the serum of the R-sp, B-sp, and calcium-deficient rats. The calcium content in the left tibiae of the rats receiving Ca-ox and OX-C diets was higher than that of the rats receiving R-sp and B-sp diets. The breaking force of the right tibiae of the rats was highest in the OX-C group, and higher in the R-sp and Ca-ox groups than the breaking force of the right tibiae of the rats fed on B-sp diet. The alkaline phosphatase activity in the small intestines of the rats rose in the order of the R-sp, B-sp, and Ca-ox groups, although significant differences of the activity were not observed between the Ca-ox and the OX-C groups. The calcium retention of the rats receiving the calcium-deficient, R-sp, B-sp, Ca-ox, and OX-C diets was -18.5, 35.2, 25.6, 41.6, and 45.8%, respectively. About 35% of the calcium in the spinach was absorbed by the calcium-deficient rats, and oxalic acid depressed the calcium absorption in the rats.