Thoracic Surgery
Introduction
The Thoracic Surgery Division
deals surgically with various kinds of neoplasms in the thorax, including
lung tumors both primary and metastatic, and mediastinal, pleural (mesotheliomas),
and chest wall tumors. The surgical treatment of pulmonary carcinoma with
various surgical techniques has been the major challenge of the division.
The modes of surgical treatment for carcinoma range from simple resection
(wedge resection, segmentectomy, lobectomy, and pneumonectomy) to more complex
approaches such as combined resection with neighboring structures, perioperative
treatment, and thoracoscopic surgery.
The division includes four
attending staff surgeons, one senior resident, and two to four residents.
One of the two years of our senior residency program in general thoracic surgery
is dedicated to research work. One of the three years of our residency course
is devoted to the study of pathology, endoscopy, image diagnosis, and medical
oncology, depending on each resident's interest. This system of rotation in
the related oncological specialties provides our senior residents and residents
with a better understanding of these fields.
The number of patients who
undergo surgical intervention in our division makes us one of the three largest
thoracic surgery facilities in Japan, and we have been one of the most active
leaders in this field since the division's establishment in 1992.
Routine Activities
All possible candidates for
surgical intervention are presented at our conference with the thoracic oncology
group every Tuesday evening to determine their treatment modalities. Selected
patients of those who underwent resection are radiologically and pathologically
reviewed every Friday morning.
Pulmonary carcinomas of non-small-cell
histology in clinical stages I, II, and IIIA and of small-cell histology in
clinical stages I and II are usually indicated for surgical resection. However,
in an attempt to improve the poor prognosis of patients with clinically and
histologically proven mediastinal lymph node metastases, with invasion to
the neighboring vital structures or with small-cell cancer, the optimal treatment
modalities are sought in clinical trial settings. Resection of metastatic
lung tumors has been attempted based on Thomfold's criteria with a slight
modification upon consultation with the patient. Histologically, metastases
from colorectal carcinoma are the majority of the cases. The majority of mediastinal
tumors were thymic epithelial tumors, and we did not attempt to use a thoracoscopic
procedure in these patients.
New Developments
In an attempt to reduce the
surgical invasiveness, especially in elderly or high-risk patients, we are
attempting major or conservative pulmonary resection with thoracoscopic assistance
in a small number of patients.
Standard thoracotomy has changed
from cutting apart both the latissimus dorsi and serratus anterior muscles
to preserving the serrartus anterior muscle. The length of the thoracotomy
incision shortened from about 15 cm to 12 cm.
Research Activities
Ongoing Clinical Trials
1.Preoperative chemotherapy and irradiation followed
by surgery for superior sulcus tumor phase II.
2.Induction chemotherapy and irradiation for advanced
thymic epithelial tumor phase II.
3.Limited resection for small peripheral adeno-carcinoma
of Noguchi's types A and B phase II.
|
Number
of Patients (1996-1999) |
||||
|
1996 |
1997 |
1998 |
1999 |
|
|
Lung
carcinoma |
188 |
176 |
180 |
202 |
|
Metastatic
lung tumor |
14 |
23 |
28 |
30 |
|
Mediastinal
tumor |
19 |
18 |
20 |
20 |
|
Esophageal
carcinoma |
24 |
23 |
21 |
20 |
|
Others |
21 |
38 |
42 |
33 |
|
Total |
266 |
278 |
291 |
305 |
|
Operative
Methods for Primary Lung Carcinoma (1996-1999) |
||||
|
1996 |
1997 |
1998 |
1999 |
|
|
Lung
resection |
167 |
161 |
172 |
191 |
|
Pneumonectomy |
7 |
9 |
12 |
5 |
|
Lobectomy |
151 |
147 |
145 |
150 |
|
(Bronchoplasty) |
(3) |
(4) |
(11) |
(10) |
|
Conservative
resection |
9 |
5 |
15 |
36 |
|
Thoracoscopic
resection |
30 |
16 |
20 |
25 |
|
Others |
10 |
15 |
10 |
11 |
|
Survival
Rates for Resected Primary Lung Carcinoma |
|||
|
Stage |
3-Year
survival rate(%) |
5-Year
survival rate(%) |
|
|
Stage
IA |
93.1 |
87.1 |
|
|
IB |
85.0 |
77.0 |
|
|
IIA |
78.3 |
57.4 |
|
|
IIB |
59.5 |
47.2 |
|
|
IIIA |
54.6 |
34.7 |
|
|
IIIB |
40.4 |
31.9 |
|
(K. NAGAI, J. YOSHIDA)
