Thoracic Surgery Division

Clinical Activities

The Division of Thoracic Surgery has three missions: surgical treatment, surgical resident training, and clinical research.
Thoracic surgeries involve the treatment of thoracic neoplasms, primary and metastatic lung tumors, and mediastinal, pleural, and chest wall tumors. The Division specializes in the surgical treatment of pulmonary carcinomas. Routine carcinoma surgical treatment modalities include limited resection (wedge or segmental resection) and simple resection (lobectomy or pneumonectomy) with or without systematic lymph node dissection. Thoracoscopic assistance is almost always used. Non-routine surgical procedures involve complex approaches such as bronchoplasty, combined resection with adjacent structures, and perioperative adjuvant treatment.
The Division of Thoracic Surgery, National Cancer Center Hospital East ranks second in Japan following the National Cancer Center Tokyo in providing surgical treatment of primary lung cancer. Since its establishment in 1992, the Division has been one of the most active leaders in the field of lung cancer in Japan. It has also been an active participant in international and national scientific venues. This year, in addition to 5 published scientific papers in English, the Division made 28 presentations: 5 international, 16 national, and 7 regional.

Routine Activities

Presently, the Division has 4 consultant surgeons and 4 or 5 residents. Since the Division chief, Dr. Nagai, was promoted to hospital management in 2006 and he has been engaged mostly in administrative duties, the Division needs more consultant surgeons to maintain its leadership position.
The Division has adopted a team approach in patient treatment and resident training. Potential surgical intervention candidate cases are presented every Tuesday evening at a multidisciplinary team conference of thoracic surgeons, oncology physicians, radiologists, pathologists, and residents. Each case is thoroughly and vigorously reviewed and discussed. To improve the English fluency of staff members and residents in preparation for international presentations, and to better involve visiting physicians from other countries, treatment modality discussions are conducted in English. Moreover, selected patients’ records are radiologically and cyto-pathologically reviewed every Friday morning. These reviews are conducted to improve interpretation of radiologic indications to pathology findings, accurately evaluate surgical indications, and learn more of rare histologies. The Division believes that these activities improve the knowledge base, treatment indications, and surgical treatment.
For non-small cell histology, primary pulmonary carcinomas in clinical stages I/II, and IIIA without bulky mediastinal nodes, and small cell primary pulmonary carcinomas in clinical stage I, surgical resection is indicated for cure. Optimum treatment modalities are being sought via clinical trials, attempting to improve the poor prognosis of patients with bulky, or clinically and histologically proven, mediastinal lymph node metastases, with disease invading the neighboring vital structures, or with small cell cancers in clinical stage II and later.
Metastatic lung tumor resection is attempted based on modified Thomfold’s criteria after consultation with the patient. The majority of these cases are metastases from colorectal carcinomas, while most of the mediastinal tumors are thymic epithelial tumors.
The Division’s surgical procedures have generally remained similar for the past several years. Fifteen percent of the surgeries are completed via a 3-port access, and 80% of the surgeries are thoracoscopically assisted. Although some attempt thoracoscopic surgical resection, the Division deems such an approach as inappropriate due to the limited access and little difference in surgical invasiveness. To date, the average postoperative hospital stays of patients in the Division have improved and became shorter, 3 days being the shortest with an average of 7 days for primary lung cancer cases. These shorter hospital stays are achieved with a slightly better complication rate than the normal rate. This year, no 30-day operative mortality occurred.

● J. Yoshida, K. Nagai ●

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