Kyobu geka. The Japanese journal of thoracic surgery最新文献

Non-small cell lung cancer (NSCLC) remains a leading cause of cancer-related mortality worldwide, with high recurrence risk even after curative surgery. Perioperative treatment, including neoadjuvant and adjuvant strategies, has historically relied on platinum-based chemotherapy, which modestly improved survival outcomes. Recent advances have introduced immune checkpoint inhibitors (ICIs) and tyrosine kinase inhibitors (TKIs) as transformative options. Landmark trials, such as CheckMate 816, KEYNOTE-671, ADAURA, and ALINA, demonstrated significant improvements in pathological response, disease-free survival, and, in some cases, overall survival. ICIs have become a standard component for resectable stageⅡ-Ⅲ NSCLC, while osimertinib and alectinib established new standards for EGFR- and ALK-positive tumors, respectively. Remaining challenges include optimal patient selection, integration with surgery, and biomarker development. Future directions point to personalized strategies incorporating circulating tumor deoxyribonucleic acid (ctDNA) monitoring and novel therapies to further enhance prognosis in resectable NSCLC.

Primary cardiac malignant tumor is rare and is associated with poor survival. We report a case of primary cardiac intimal sarcoma. A 41-year-old man was admitted to our hospital with congestive heart failure. We performed tumor resection under emergency. The pathological diagnosis of the resected tumor was cardiac intimal sarcoma. There have been few reports of cardiac intimal sarcoma, and the frequency of its occurrence and prognosis are unknown. Surgery and postoperative radiation therapy may improve the prognosis.

A 50-year-old male was diagnosed with aortic annulus ectasia (AAE) and aortic valve regurgitation (AR), and was thus referred to our department for surgery. Computed tomography (CT) revealed a Valsalva aneurysm with a maximal diameter of 52 mm. Echocardiography revealed severe AR with left ventricular enlargement [left ventricular internal dimension in diastole (LVDd) 85 mm]. The creatinine (CRE) level was 0.97 mg/dl, and the C-reactive protein (CRP) level was 1.92 mg/dl. David's procedure was initiated as a therapeutic intervention; however, severe adhesion and enlargement of the ascending aorta were observed after it was exposed during cardiopulmonary bypass (CPB). Based on this finding, the patient was suspected of having Takayasu's arteritis, and thus a Bentall procedure, with ascending aorta replacement by selective cerebral perfusion (SCP) and systemic cooling, was performed. Pathological examination revealed an inflammatory reaction from the adventitia to the intima with mononuclear cell infiltration, leading to a histological diagnosis of Takayasu's arteritis. The postoperative course was uneventful, and the patient was discharged on postoperative day 21. Steroids were used to treat Takayasu's arteritis and to prevent its recurrence after discharge.

We report a case of successful surgical treatment of infected aortic valve endocarditis with intractable heart failure, multiple cerebral infarction, and subarachnoid hemorrhage. A 46-year-old man who had fever for two weeks and subsequent left hemiplegia was admitted to our hospital. Brain computed tomography (CT) and magnetic resonance imaging (MRI) revealed multiple cerebral infarction and subarachnoid hemorrhage. Echocardiography showed severe aortic regurgitation with a huge mobile vegetation. Despite medical treatment, chest X-ray revealed progressive pulmonary congestion. We performed aortic valve replacement three days after admission. Cerebral hematoma got slightly larger, but neurological symptom did not worsen. Postoperative course was uneventful. Perioperative antibiotic administration was continued and he was discharged on the postoperative day 46.

An 81-year-old woman was referred to our hospital due to anorexia and low-grade fever for the past two weeks, and was urgently hospitalized since a computed tomography (CT) scan revealed a thrombus in the greater curvature of the distal aortic arch and proximal descending aorta. However, because of her fraility and poor general condition, surgery was not indicated at the time of admission, and anticoagulation therapy was initiated awaiting recovery of her condition. Considering the patient's age and comorbidities, thoracic endovascular aortic repair (TEVAR) was selected after thorough consultation with the family. In this case, because the device had to be passed through the lesser curvature of the aortic arch to prevent thromboembolisms, the left fifth intercostal space was opened and a tug of wire was established between the apex of the heart and the right groin. By using this technique, device deploy could be carried out without thromboembolisms. The patient was discharged from hospital without any perioperative embolic complications and is currently followed-up at the outpatient clinic.

A 50-year-old woman underwent total arch replacement for Stanford type A acute aortic dissection. Postoperatively, she became delirious and experienced difficulty maintaining rest, so haloperidol was used. Due to persistent high fever and markedly elevated serum levels of creatinine kinase, neuroleptic malignant syndrome was suspected. We discontinued haloperidol and started dantrolene. During the same period, we ruled out infections, central nervous system disorders, and organ ischemia due to dissection. Administration of dantrolene achieved a good outcome, with reduction of fever and improvement of creatinine kinase levels. Neuroleptic malignant syndrome after aortic dissection surgery is very rare and includes numerous differential diagnoses. However, prompt action is important because delays in diagnosis and treatment can lead to deterioration in the general condition of the patient.

According to the guidelines for thymic tumors, surgical resection is recommended for clinical stage Ⅳ thymic epithelial tumors if completely resectable. A 38-year-old woman presented with fever, chest pain, and back pain. Computed tomography (CT) revealed a mediastinal tumor, which was diagnosed as thymoma type B3 through CT-guided biopsy. Intraoperatively, using 4K three-dimensional (3D) endoscopy, tumor invasion into the left upper lobe and pleural dissemination on the parietal pleura and diaphragm were observed. To preserve the possibility of future re-resection, operation was thoracoscopically performed and the tumor was removed, including partial resection of the left upper lobe. All visible pleural dissemination lesions were also resected, including part of the left diaphragm. The diaphragmatic defect was reconstructed using a Gore-Tex Patch. There is no established treatment strategy for thymoma with incidental pleural dissemination, and the 4K 3D endoscopy may contribute to the successful completion of such a complex operation.

A 67-year-old man was performed total thyroidectomy for stage ⅣC papillary thyroid carcinoma with multiple lymph node and lung metastases. Five years and two months later, treatment with lenvatinib was started. Chest computed tomography (CT) six years and four months after the start of treatment revealed left pleural effusion. A pleural biopsy was performed under thoracoscopy. Histopathological findings showed papillary thyroid carcinoma, and the patient was diagnosed with pleural dissemination of thyroid cancer. Genetic test showed a positive BRAF V600E gene mutation. Treatment with dabrafenib and trametinib was initiated nine days after lenvatinib was discontinued.

We report a case of a 50-year-old man with anomalous aortic origin of the right coronary artery (AAORCA) and hypertrophic obstructive cardiomyopathy (HOCM), who was treated with modified unroofing and septal myectomy. The patient presented with exertional syncope. Echocardiography revealed systolic anterior motion (SAM)-associated severe mitral regurgitation (MR) and HOCM. Coronary computed tomography (CT) showed AAORCA with an inter-arterial course and occlusion of the left anterior descending artery (LAD). Intraoperative findings confirmed intramural segment of the anomalous coronary artery was near the commissure of the aortic valve. To preserve native aortic valve function, modified unroofing technique was employed to establish a new right coronary ostium. Septal myectomy was performed to relieve left ventricular outflow tract obstruction, and coronary artery bypass grafting using the left internal thoracic artery was conducted to revascularize the LAD. Postoperatively, myocardial ischemia was resolved, and MR disappeared. The patient was discharged on postoperative day 10 without complications and has remained free of syncope during three years of follow-up.

It is often difficult to remove long-standing foreign bodies by bronchoscopy. The patient was a 57-year-old woman who accidentally aspirated a dental instrument during dental treatment. Two years later, an abnormal shadow was noted on chest imaging, and she was referred to our hospital. Chest computed tomography (CT) revealed a 2-cm foreign body in the left lower lobe. Bronchoscopy was performed, but the foreign body could not be removed. Thoracoscopic partial resection of the left lower lobe was undertaken for removal of the foreign body.