Evaluation of sleeve segmentectomy for early hilar lung cancer

Roentgenographically occult lung cancers (ROLCs) are rare but are usually curable if they are properly diagnosed and treated. Between 1977 and 2000, we treated 51 patients with early hilar lung cancer (as defined by the Japan Lung Cancer Society) of ROLC form. If the occurrence of cancer is confined to segmental bronchi, we preserve the lung tissue as far as possible by using a sleeve segmentectomy. Eight of the 51 patients underwent sleeve segmentectomy. All 8 of these patients were men who were heavy smokers and had a mean age of 64.9 years (range, 59-74 years). The cancerous locations were R-B6 in 4 patients, L-B(1+2+3) in 2 patients, L-B(4+5) in 1 patient, and L-B6 in 1 patient. Two patients had double cancers (synchronous in one case and metachronous in the other). All 8 of the patients had squamous cell carcinoma, 3 of whose lesions were carcinoma in situ. The segments resected were R-S(6) in 3 patients, L-S(1+2+3) in 2 patients, L-S(4+5) in 1 patient, L-S(6) in 1 patient, and R-S6 combined with the middle lobe in 1 patient. There were no cases of morbidity or mortality. However, 1 patient who had undergone a left lower lobectomy for synchronous advanced squamous cell carcinoma 4 months before R-S(6) sleeve segmentectomy for contralateral early hilar lung cancer died of recurrence in the mediastinal lymph nodes 63 months after the first operation. Two patients died of other causes: one of pneumonia 61 months after L-S(4+5) sleeve segmentectomy and the other of myelopathy 36 months after L-S(1+2+3) sleeve segmentectomy. The remaining 5 patients are alive and well 178, 121, 109, 94, and 14 months after surgery. Sleeve segmentectomy is a curative operation for early stage squamous cell carcinoma of the segmental bronchus that preserves pulmonary function and should be used to treat patients carefully selected for the correct indications.     

Successful salvage of a long-standing collapsed lung by bronchoplasty in three children

Background: The authors report successful salvage of the ipsilateral lung by a bronchoplastic procedure in 3 patients with a long-standing, totally collapsed lung. Methods: The 3 patients were 1, 5, and 6 years of age, and the left lung had been collapsed totally for periods of 13 months to 5 years. The origin of atelectasis was congenital in 2 patients and traumatic in one patient. Bronchoscopy showed complete obstruction of the left main bronchus. In each patient, the left lung was small and appeared as a liverlike organ. Entire length of the main bronchus was resected. The left lung was not aerated in spite of aggressive bagging through an endotracheal tube inserted into the distal bronchial stump. The bifurcation of the upper and lower segmental bronchi was anastomosed to the trachea by interrupted sutures. Histology of the resected bronchus in the cases of congenital origin showed bronchial rings represented by islands of immature cartilage. Results: Chest x-ray showed complete aeration of the left lung at 3, 4, and 5 months, respectively, after surgery in the 3 children. Bronchoscopy disclosed a well-reconstructed airway in all patients. Two of the 3 patients have been free from respiratory distress during a 3- to 4-year follow-up. The latest patient to have this surgery is undergoing home ventilation because of chronic lung disease. Conclusions: A long-standing collapsed lung in children may reexpand if bronchial continuity is restored. Insufficient inflation of the lung at surgery is not an indication for pneumonectomy. When at all possible, a child's lung should be preserved.     

Right lower lobectomy with flap bronchoplasty for primary lung cancer

A 59-year-old man was referred to our hospital for further investigation of an abnormal chest shadow. A chest computed tomography( CT) revealed a tumor shadow originating in the superior segment( S6)of the right lower lobe. Bronchoscopy showed no visible tumor, but adenocarcinoma cells were detected in brush cytology samples. We diagnosed primary lung cancer, classified as cT2aN0M0, and planned a radical operation. Intraoperatively, since the tumor had invaded the outer wall of intermediate bronchus, we considered a flap bronchoplasty to preserve the middle lobe. The right lower lobectomy and partial resection of intermediate bronchus were made with preserving unaffected ventral wall of lower bronchus. The lower bronchus remnant was used as a flap to cover the defect in the intermediate bronchus. The postoperative course was uneventful, and bronchoscopic findings revealed good healing of the suture line and sufficient airway patency.     

VATS right apical segmentectomy for lung cancer in a patient with tracheal bronchus

IntroductionA tracheal bronchus is rarely observed, occurring in only 1% of all patients who undergo thoracic surgeries. We rarely encounter lung cancer in a patient with a tracheal bronchus; however, it is essential to know the distinctive perioperative management strategy for patients with a tracheal bronchus.Case presentationWe report a 72-year-old man with lung cancer located in the right apical segment supplied by a tracheal bronchus. Annual chest computed tomography performed as follow-up after colon cancer resection showed an enlarging pulmonary nodule with pure ground-glass opacity, which was suspected to be lung adenocarcinoma. The nodule was located in the right apical segment. The apical segment was independently supplied by a single pulmonary artery superior trunk and a tracheal bronchus that branched directly from the trachea at 1.2 cm above the carina. The pulmonary vein branching pattern was uncommon in that the central vein that usually runs through B2 (posterior bronchus) and B3 (anterior bronchus) was missing. The patient underwent video-assisted thoracoscopic apical segmentectomy under one-lung ventilation using a left-sided double-lumen tube.DiscussionAnomalous venous return accompanied with tracheal bronchus has been described in some reports. Since pulmonary vein is important during segmentectomy, the surgeon should pay particular attention to the venous return.ConclusionPreoperative three-dimensional graphic imagery helped us accurately identify the anatomical anomaly to enable the successful segmentectomy in a patient with a tracheal bronchus. We review the relevant literature regarding the perioperative management of patients with a tracheal bronchus.     

Extended bronchoplasty and angioplasty with a right upper-middle bilobectomy and S6 segmentectomy for lung cancer: a novel technique for anastomosis

In the lung cancer case described here, we resected the right upper lobe, right middle lobe, and superior segment of the right lower lobe with concomitant resection of the pulmonary artery and bronchoplastic and pulmonary arterial reconstruction. The basal segmental bronchus was anastomosed to the right main stem bronchus using a novel, specific technique: The tumor was extirpated with division of the upper and middle lobe bronchus and the superior segmental bronchus. Parts of the middle bronchus and superior segmental bronchus on the distal side were used to expand their orifice. The cut end of the pulmonary artery was sutured, reversing the long and short axes, to shorten and adjust the pulmonary artery.     

Clinical analysis of tracheoplasty and bronchoplasty in primary lung cancer

In our department, there were 482 thoracic surgeries for primary lung cancer between 1994 and 2007. We clinically reviewed cases that underwent tracheoplasty or bronchoplasty (n = 22, 4.6%). The patients consisted of 21 males and 1 female (66.5 +/- 12.0 years-old). All patients were smokers. The tissue forms were 19 squamous cell carcinomas, 2 adenocarcinomas, 1 large cell carcinoma, 1 adenoid cystic carcinoma and 1 carcinoid, including 2 multiple carcinomas. Sleeve resections involved the trachea in 1, upper lobes in 13, lower lobes in 3, upper-middle lobes in 2 and intermediate bronchus in 1. Wedge resections were performed in the upper lobes in 2. Fourteen reconstructions were performed. We ordinarily sutured the trachea and bronchus in any case, using a single outside knot. There was no leakage at the anastomosis. There were 2 hospital deaths. There were 4 cancer deaths, including 2 local recurrences. There were 4 patients demonstrating stenosis post operatively. There were 3 stenoses among 4 preoperative radiation therapies. We considered that radiation therapy disturbed the repair of the anastomosis. There were 8 pneumonia patients who developed post operatively. There were 2 operative hospital deaths among 3 angio-bronchoplasties without coverage. Recently, we have routinely covered the anastomosis at the reconstruction site and have not experienced any major complications.     

Comparison of postoperative lung function between segmentectomy and lobectomy in patients with lung carcinoma

BACKGROUND: To determine any potential advantages of segmentectomy, we compared preoperative and postoperative lung function of patients who underwent segmentectomy with those in patients who underwent lobectomy. PATIENTS & METHODS: Between September 2001 and November 2003, preoperative and postoperative lung function, including DLco, was assessed in 43 patients with primary lung carcinoma. Of these 43 patients, 33 underwent single lobectomy (group L) and 10 underwent segmentectomy (group S). Both groups were examined for differences in lung volume through VC and FEV1.0 data, and all postoperative examinations were performed at 2 weeks after surgery. Changes in DLco (deltaDLco), VC (deltaVC) and FEV1.0 (deltaFEV1.0) were calculated and we compared the data for group L with those of group S. RESULTS: Mean values for deltaVC, deltaFEV1.0 and deltaDLco in group L were 31.8 +/- 9.3, 29.6 +/- 10.9 and 27.2 +/- 14.0%, respectively, while these values in group S were 22.9 +/- 7.9, 20.1 +/- 9.6 and 13.9 +/- 11.6%, respectively. deltaVC, deltaFEV1.0 and deltaDLco were significantly smaller in group S than in group L (p < 0.01, p < 0.05 and p < 0.05, respectively). CONCLUSION: Segmentectomy was superior to lobectomy with regard to preservation of lung function in the early postoperative period.     

改良支气管成形术治疗中心型肺癌

目的 简化支气管成形术的手术操作，缩短手术时间，吻合口并发症的发生。方法 对76例中心型肺癌患者(其中合并肺功能不良者48例，合并心功能不良者14例)，应用改良支气管成形术进行治疗。结果 1例术后3周因吻合口漏死亡，3例术后1周左右发生吻合口周围感染征象，治疗后痊愈，其余患者均痊愈出院。术后42例随访10～48个月，均无刺激性咳嗽症状。结论 改良支气管成形术有效地解决了近远端支气管管径大小不一及管壁厚薄不均的问题。同时简化了手术操作，缩短手术时间，减少了术后吻合口并发症，取得了满意的疗效。     

Detection of early hilar lung cancers with fluorescence bronchoscopy

The development of fluorescence bronchoscopy has made it possible to diagnose locally superficial hilar lung cancers such as carcinoma in situ, and in some cases atypical squamous metaplasia thought to be precancerous lesions. The selection of a treatment modality can be difficult for early hilar lung cancers due to problems associated with multiple lung carcinomas and the large number of heavy smokers afflicted. Many patients also have decreased pulmonary function. If carcinoma in situ and microinvasive carcinomas can be detected early, it may be possible to treat them radically with a less invasive method than surgery, such as endoscopic laser therapy. Centrally arising squamous cell carcinoma of the tracheobronchial tree, especially in heavy smokers, is thought to develop in multiple stages from squamous metaplasia, to atypical squamous metaplasia, followed by carcinoma in situ, and finally invasive cancer. However, it is hoped that preventive medicine for lung cancer will be established whereby patients with localized atypical squamous metaplasia detected by fluorescence bronchoscopy can be carefully monitored and motivated to stop smoking, and also administered chemopreventive agents.     

Successful chemotherapy in a patient with recurrent carcinoma of the urachus

Urachal neoplasm generally has a poor prognosis, because of long latency period, extravesical progression and pathological predominant pattern of adenocarcinomas. We report a case of recurrent poorly differentiated carcinoma of urachal remnant, which responded well to combination systemic chemotherapy (methotrexate, vinblastine, doxorubicin and cisplatin: M-VAC). Our case was possibly of transitional cell origin. The patient has been symptom-free even 13 months after the first chemotherapy course.     

Successful second kidney transplantation in a patient with focal glomerulosclerosis. A case report

We report a woman who developed renal failure due to focal glomerulosclerosis (FGS). This disease recurred immediately in a kidney transplant from her brother resulting in removal of that graft. She subsequently received a cadaver kidney transplant, and FGS has not recurred after 24 months. This is the first report of nonrecurrence in a second kidney graft, when the first was lost due to recurrent FGS. Whether timing or tissue typing of the second graft in relationship to the first is important is not known. Recurrence of FGS in a first kidney graft should not, however, preclude future transplantation.     

Successful treatment of bronchial mucoepidermoid carcinoma in an 11-year-old boy by bronchoplasty: Report of a case

We report herein the rare case of an 11-year-old boy in whom mucoepidermoid carcinoma of the right upper lobe bronchus was successfully treated by bronchoplasty. The patient underwent bronchoscopy to investigate the cause of relapsing respiratory infections over the past 2 years, which revealed a tumor at the orifice of the right upper lobe bronchus. Thus, a right upper sleeve lobectomy was effectively carried out, preserving right pulmonary function. The tumor was observed to partially invade the bronchial wall, but not the lung parenchyma. Histological examination confirmed a diagnosis of mucoepidermoid carcinoma, classified as grade 2 by Conlan's classification. The patient has been well and free of recurrence for 3 years postoperatively.     

Mucoepidermoid carcinoma in a young man treated by bronchoplasty

A 17-year-old man in whom mucoepidermoid carcinoma of the left upper lobe bronchus was successfully treated by bronchoplasty. The patient has been suffered from relapsing respiratory infections over the past 2 years. Bronchoscopic examination revealed a tumor at the orifice of the left upper lobe bronchus. Thus, left upper sleeve lobectomy was carried out. The tumor was 18 x 15 x 14 mm in size and obstructed left upper bronchus with mucoid impaction peripherally. Hystological examination confirmed a diagnosis of low grade malignant mucoepidermoid carcinoma without lymph node metastasis. The patient has been well and free from recurrence for 4 years postoperatively.     

Successful gemcitabine-nedaplatin therapy in a hemodialysis patient with ureteral carcinoma after bilateral nephroureterectomy

A 79-year-old male, who received hemodialysis due to bilateral nephroureterectomy and cysto-prostateurethrectomy. Five months later, an enlarged lymph node was found in the left of inguinal area. Abdominal computed tomography revealed a low density mass from the para-aortic lymph node to the left of inguinal area, suggesting lymph node metastasis of ureteral carcinoma. After 3 cycles of gemcitabinenedaplatin therapy, the size of lymph node metastasis decreased. This is a report of successful treatment of ureteral carcinoma with hemodialysis.