Nihon Geka Gakkai zasshi最新文献

On April 25th, 2015, a massive 7.8-Mw earthquake occurred 77 km northwest of Kathmandu, the capital of Nepal. Disaster relief medical teams from the Japan International Cooperation Agency (JICA) were sent to Nepal on April 28th. The primary medical team consisted of 46 people, including two trauma surgeons. A meeting was held in Kathmandu by the Nepal Government Ministry of Health and Population and the World Health Organization for the foreign medical teams. The JICA team was asked to provide hub hospital services in Barhabise in the District of Sindhupalchok where some of the greatest damage had occurred. It was not until May 4th that medical supplies for our large medical tents and surgeries arrived in Kathmandu; the supplies were then sent on to Barhabise by road that same day. Our field hospital for both surgery and patient beds was finally operational on May 5th. This was the first time that a Japanese team performed surgery using general anesthesia in a Japanese field hospital. The surgery was for a left Lisfranc joint dislocation with open fracture in a 37-year-old woman. We had patients stay in the field hospital overnight after their surgeries. As the quantity of supplies increases, response times are affected because we have no transportation means such as the armed forces. These problems need to be considered in the future.

Bronchoplasty for patients with lung cancer is basically designed to achieve radical cure with the preservation of lung function. Functional lung parenchyma can be preserved, and the reimplanted lobes contribute to postoperative quality of life. Pneumonectomy is associated with a higher occurrence of postoperative complications, poor quality of life, and cardiopulmonary dysfunction as compared with lobectomy. In addition, long-term complications (i.e., late pulmonary hypertension, respiratory failure, or so-called postpneumonectomy syndrome) are sometimes seen after pneumonectomy but seldom after lobectomy. Thus pneumonectomy itself is considered a disease. Sleeve lobectomy, or lobectomy with bronchoplasty, which allows the preservation of functional lung parenchyma with the possible advantages of lower mortality and morbidity rates, is a valid alternative to pneumonectomy and has recently been accepted as a standard treatment in noncompromised patients with lung cancer. Atypical bronchoplasties such as double-sleeve and extended-sleeve lobectomy, and sleeve segmentectomy are also performed at present. This article describes the surgical techniques for bronchoplastic procedures and compares the surgical outcomes of sleeve lobectomy with those of pneumonectomy reported in the literature.

Plastic procedures for intrathoracic vessels are required for the preservation of pulmonary parenchyma. “Pneumonectomy itself is a disease” is one of the most famous concepts in thoracic oncology, and the preservation of lung function is obviously important. However, recent cases of lung cancer seen are generally small-sized early lesions, and the opportunity for performing such complex procedures is rare for modern thoracic surgeons. Thus the aim of this paper is to explain the importance of the procedures in detail, especially pulmonary arterioplasty. Plastic procedures of the pulmonary artery are most commonly required for left upper lobectomy for the treatment of lung cancer, due to the anatomic relations between the bronchial structure and pulmonary artery. The pulmonary artery is much longer than the bronchus, resulting in easy resection and reconstruction of the vessels. The types of reconstruction are direct running sutures, pericardial patch, and end-to-end anastomosis. Additionally, the pericardial conduit or pulmonary vein conduit has recently been reported to be useful in plastic procedures of the pulmonary artery. The details are discussed.

Lobectomy has been and remains the standard surgical treatment for peripheral cT1aN0M0 lung cancer because of the conclusion of the randomized controlled trial performed by the Lung Cancer Study Group in 1995, and limited resection (segmentectomy and wedge resection) is still not the standard treatment for patients who are candidates for lobectomy; limited resection compared with lobectomy was statistically associated with a significantly greater incidence of local recurrence, although no statistically significant difference was identified in overall survival. In 2002, a Japanese prospective single-arm study of peripheral cT1aN0M0 lung cancer revealed no significantly different outcomes between segmentectomy and lobectomy with aggressive lymph node examination using frozen sections and wide surgical margins; the 5-year survival rate was 81.8％ and local recurrence rate was 1.8％. Recently, two clinical trials conducted by the Japan Clinical Oncology Group (JCOG) have completed patient enrollment: JCOG0802, a phase III randomized trial of lobectomy versus segmentectomy for small peripheral non-small cell lung cancer; and JCOG0804, a nonrandomized confirmatory study of limited surgical resection for peripheral early lung cancer as defined based on thoracic thin-section computed tomography. The results will be published in the near future, and the standard treatment for peripheral cT1aN0M0 lung cancer may change.

Postoperative infections are classified into surgical site infections and remote infections. The risk factors associated with postoperative infections are related to medical practice, the patient, and bacteria. Postoperative infections not only prolong hospitalizations and increase patient burden but also affect prognosis. It is therefore important to conduct surveillance of postoperative complications at each facility to elucidate the risk factors for infection and to implement and evaluate infection control measures. Moreover, with the aging of the population, more surgeries are being performed in elderly individuals. However, the elderly tend to have age-related declines in the function of major organs as well as comorbidities, and surgeries in them carry a high risk despite advances in operative techniques and perioperative management. It is therefore important to determine surgical indications carefully by sufficiently assessing the risk preoperatively and performing appropriate perioperative management.