Nihon Geka Gakkai zasshi最新文献

On December 16, 2015, the Supreme Court of Japan ruled that Article 750 of the Civil Code enforcing married couples to use the same surname does not violate the Constitution of Japan. It stated, “A husband and wife shall adopt the surname of the husband or wife in accordance with that which is decided at the time of marriage.” While the law does not stipulate which name married couples should adopt, invariably, in fact in 96.3％ of the cases, women adopt their husband’s surname, a reflection of Japan’s male-dominated society and the discrimination against women. With an increasing number of women in the workforce in recent times, those who adopt their husband’s surname face professional inconveniences. Women surgeons, in particular, find that changing their surname after marriage interferes with their career growth; their professional reputation and identity would have to be rebuilt, for example, while making presentations at academic events or publishing papers. In the modern era of individuality and diversity, men and women should have equal rights to pursue a career whether they are married or have children. Women surgeons, in particular, deserve the right to use their original surname to pursue their careers as surgeons and/or medical researchers.

Phrenic nerve injury often causes diaphragmatic dysfunction. Damage to the phrenic nerve may be caused by iatrogenic injury such as transection or crush during thoracic or neck surgery to treat bronchogenic, mediastinal, or neck tumors. Plication of the diaphragm is a procedure in which the flaccid hemidiaphragm is tautened by oversuturing it. Although it has been offered to patients with unilateral diaphragmatic paralysis who have severe dyspnea and other symptoms, the essential treatment should be restoration of the function to the paralyzed diaphragm. Established reconstructive techniques for peripheral nerves are indicated to treat some phrenic nerve injury cases. Muscle contraction and diaphragmatic function following nerve reconduction is recovered in many clinical cases, and favorable experimental results were seen in animal models. Reconstructive nerve procedures such as repair, graft, or transfer may be indicated in more cases of phrenic nerve injury to improve prognostic outcomes of surgery to treat locally advanced malignancies.

Surgical resection remains the only reliable curative method for lung cancer, and combined resection of the primary tumor and involved neighboring structures is performed when possible in patients with locally advanced disease. Lung cancers involving the chest wall and diaphragm are now classified as T3 lesions, and the surgical treatment for those tumors is generally accepted. However, the outcomes are frequently unsatisfactory, and the 5-year survival rates of patients with chest wall and diaphragmatic invasion were reported to be 30-40％ and 20-40％, respectively, with mortality rates of 1.8-7.8％ for chest wall resection and 0-2.0％ for diaphragm resection. In combined resection, a good surgical indication is N0-1 disease, and complete resection is essential. The indication for reconstruction of the chest wall is a large lesion in the caudal area which is not covered by the scapula. If the lesion area in the diaphragmatic muscle is smaller than fist size, it is possible to perform direct suturing with nonabsorbable bladed sutures. In cases of large lesions, diaphragmatic reconstruction using nonabsorbable material is necessary to prevent the herniation of abdominal organs. In the near future, it is hoped that multidisciplinary treatments including surgery will improve the outcomes of patients with those locally advanced lung cancer.

Malignant pleural mesothelioma (MPM) is a very aggressive tumor with poor prognosis. Unlike other solid malignancies, the aim of surgery for MPM is cytoreductive rather than radical. Surgery is performed as multimodality therapy in MPM, combining extrapleural pneumonectomy (EPP) and pleurectomy/decortication (P/D). An en-bloc resection of the pleura, lung, diaphragm, and pericardium is performed in EPP. P/D is a lung-sparing procedure that removes the pleura alone without the lung parenchyma. P/D is less invasive and preserves greater cardiopulmonary function compared with EPP, which leads to good postoperative quality of life (QOL). Tumor recurrence is more frequent after P/D, but it is possible to perform additional treatment because cardiopulmonary function is preserved and QOL is maintained. P/D is a feasible curative surgical treatment for MPM, and it will be performed more frequently in Japan.

To avoid a pneumonectomy procedure in patients with locally advanced lung cancer, extended resection including bronchovasculoplasty is an option to preserve the lung parenchyma. A triple-plasty operation involving the bronchus, pulmonary artery, and pulmonary vein is sometimes termed “auto-lung transplantation” and divided into two distinctive procedures. In one, “transposition” of the preserved lung is performed in an in vivo manner, while the other is a type of “bench surgery” performed in an ex vivo manner. To protect the lung graft from ischemic-reperfusion injury, the excised lung should be irrigated with lung preservation solution. Excision of the lung graft is easier with the bench surgery approach as compared with conventional surgery, and it was reported that there is no prolongation of operative time. This bench surgery method for lung cancer is a new, challenging surgical entity, and its utility is expected to be assessed in the near future.