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国立がん研究センター 中央病院

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Department of Thoracic Surgery

 

Shun-ichi Watanabe, Kazuo Nakagawa, Yukihiro Yoshida, Masaya Yotsukura, Yu Okubo

 

Training Program for Doctors

The National Cancer Center Hospital (NCCH) is a leading hospital for cancer treatment in Japan. We conducted 595 operations and 154 segmentectomies for primary lung cancer in 2018. The number of segmentectomies at NCCH has been increasing due to the frequent detection of small lung adenocarcinoma in the periphery with ground-glass opacity on high-resolution computed tomography. Visitors are also able to learn sophisticated techniques of lymph node dissection for primary lung cancer. We have also been accepting thoracic surgeons who want to view our surgery and study surgical techniques with us. In 2018, we had 74 visitors from other hospitals, including two doctors from abroad. One-day visits are also welcome.

If you want to visit our hospital, or if you have any questions, please contact the Office of International Affairs: https://www.ncc.go.jp/en/about/training_prog/index.html

Voices from Visitors

 From Dr HOU, Guangjie

Dear my NCC friends

On the first day of 2020, I wanna say happy new year to all my NCC friends.During my three months’visit to NCC, I received warm-hearted greeting and help, I am really grateful for that.

Thanks to my tutors Dr. Daiko and Dr. Watanabe, who gave me key instructions and showed wonderful skills in esophagus and thoracic surgery.Also, thanks to Dr. Kanamori, Dr. Okubo, they are young but really good-skilled surgeons.
Special thanks to Dr. Yoshida, who were my best friend in Japan and helped me a lot in my learning and gave me much deeper understanding in Japanese medical system and  treatment guideline of lung cancer .I will always cherish my experiences at NCC, Japan. I will always cherish friendships with all my Japanese tutors and friends. And Best wishes to them.

Hope I will revisit Japan in near future.u

Sincerely

Dr. Guangjie Hou

Dr HOU, Guangjie

Henan Provincial People's Hospital, China

(Department of Esophageal Surgery: March 11 to April 5, 2019)

(Department of Thoracic Surgery: April 8 to June 6, 2019)

 From Dr. Percy Enrique Serrano Carvajal

I want to thank very much the hospitality of the entire thoracic surgery service of the NCC, I have felt very well and very welcome all the time that I have been an observer, I am infinitely grateful to all the doctors especially with Dr. Yoshida, the human quality Your staff is unique, their professionalism is an example, I can't find words to express my gratitude.

As a fifth-year resident of the thoracic surgery specialty, I saw it as an incomparable opportunity to ask them to accept me as an observer, my goal was fundamentally to learn the best way to perform sublobar pulmonary resections (anatomical segmentectomies). Start by reviewing the Illustrated Anatomical Segmentectomy

For Lung Cancer, a book from your country, inform me through a specialty partner, is Lorena from the Gregorio Marañon hospital in Madrid who went to your hospital in 2018.

In this year 2020 I finish the specialization in Spain and I will probably return to my country Bolivia to practice the profession, with this I want to tell you that the knowledge that I have acquired when attending the NCC is of great value to me, to exercise the profession taken as a great example of work to such magnificent professionals as Dr. Watanabe, Dr. Yoshida and the entire thoracic surgery team. Many of the knowledge that I have learned with you I am currently applying in my daily practice. In addition, I have been able to transmit everything I have learned to my colleagues from my current service at the Ramón y Cajal hospital. The gratitude I have for all of you is infinite, to know Japan, a wonderful country, with a unique human quality, has been an experience that I will never forget, I hope to return one day, I hope with all my heart to see the team members again. Please send an affectionate solution to everyone. What I have learned from you is invaluable to me.

Thank you ¡¡¡

Dr. Percy Enrique Serrano Carvajal

University Hospital Ramón y Cajal Thoracic Surgery Service, Madrid, Spain

(October 1 to 31, 2019)

From  Dr. Lorena Martin-Albo Caballero

NCC is a world reference center in the surgical treatment of lung cancer.

I have always been interested in surgical advances in the treatment of lung cancer, in fact I knew about the clinical trías JCOG 0802 and I wanted to see the performance of segmentectomy in live and nobody better than Dr. Watanabe's team.

It has been a wonderful experience, I have learned a lot and I hope to visit you again in the near future.

 

Dr Lorena Martin-Albo Caballero
Gregorio Marañón General Hospital, Spain
(June 1 to August 1, 2018)

Introduction

The Department of Thoracic Surgery deals with various kinds of neoplasms and allied diseases in the thorax, with the exception of the esophagus. These include both primary and metastatic lung tumors, mediastinal tumors, pleural tumors (mesotheliomas), and chest wall tumors. The surgical management of lung cancer patients has been the main clinical activity of our department, as well as the subject of most of its research activities. In addition to continuing to improve procedures, such as the combined resection of neighboring vital structures and minimally invasive techniques (video-assisted thoracic surgery, VATS), it has become increasingly important to define the role of surgery in multimodality treatment for patients with a poor prognosis.  

Our team and what we do

Our department has four attending surgeons. Attending surgeons and residents
perform all of the inpatient care, operations, examinations, and outpatient
care. In 2018, we performed a total of 776 operations; for lung cancer in 595
patients, metastatic tumor in 76, mediastinal tumor in 49, and others in 56
(Tables 1 and 2).

Table 1. Number of patients in 2018

Primary   lung cancer

595

Metastatic   lung tumor

76

Mediastinal   tumor

49

Pleural   disease

10

Chest   wall tumor

19

Benign   lung nodule

19

Others

8

Total

776

Table 2. Type of procedures in 2018

Pulmonary   resection

693

Lobectomy

356

Pneumonectomy

7

Segmentectomy

174

Wedge resection

156

Tracheal   resection

0

Surgery   for mediastinal tumors

47

Surgery   for pleural tumors

12

Surgery   for chest wall tumors

18

Others

6

Total

776

 

 

The treatment strategy for patients with lung cancer is based on tumor histology (nonsmall cell vs. small cell), extent of disease (clinical stage), and physical status of the patient. In lung cancer patients, surgical resection is usually indicated for clinical stages I, II, and some IIIA with non-small cell histology and clinical stages I with small cell histology. However, to improve the poor prognosis of patients with clinically and histologically proven mediastinal lymph node metastasis or with invasion to the neighboring vital structures, optimal treatment modalities are sought in a clinical trial setting. Recently, adjuvant chemotherapy is often given to the patient with advanced lung cancer even after complete pulmonary resection. For metastatic lung tumors, resection has been attempted on the basis of Thomford’s criteria: eligible patients are those who are at good risk, with no extrathoracic disease, with the primary site in control, and with completely resectable lung disease. Metastasis from colorectal carcinomas is the most common disease. For mediastinal tumors, thymic epithelial tumors are most commonly encountered for resection. In the mediastinum, where a variety of tumor histologies can arise, the treatment must be carefully determined by the cytologic/histologic diagnosis before surgery. For patients with thymoma, we have already adopted video-assisted resection (VATS) of the tumor. VATS resection of mediastinal tumor is indicated exclusively for small thymomas. As for meetings, there are two department meetings. One is for the preoperative evaluation and postoperative inpatient review on Friday, and the other is for the journal club on Tuesday. In addition, on Thursday, the chest group holds a plenary meeting to share basic information about current issues for diagnosis and treatment of patients with lung malignancy.

Research activities

 

Lymph node dissection for lung cancer has been a major issue in lung cancer treatment and has been extensively studied in our department. We continue to improve the surgical technique of dissection based on oncological and surgical considerations: a more effective and less invasive lymph node dissection called “selective mediastinal/ hilar dissection” according to the location of the primary tumor by the lobe. Minimally invasive open surgery (MIOS) with the thoracoscope for thoracic malignancies is also an important challenge in our department. In particular, indications and surgical techniques of video-assisted surgery for early lung cancer are of special interest because of the increased incidence of such minute tumors due to improvements in CT devices and CT screening.

Clinical trials

 

Due to the advent of new technologies in CT scanning, small-sized lung cancers are being found in screening settings, and also by chance. They are usually present as “ground-glass opacity (GGO)” on CT, and pathologically are considered as early adenocarcinoma. The surgical management of such GGO-type lung cancer remains undetermined in terms of the extent of pulmonary parenchymal resection and lymph node dissection. Some cases might be followed up with careful monitoring by CT, since indolent tumors are known to exist. We are seeking the appropriate way to manage these patients. A clinical trial to determine the appropriateness of limited resection for early adenocarcinoma had been planned in the Japan Clinical Oncology Group (JCOG) - Lung Cancer Surgical Study Group, and two clinical trials (a phase III trial, JCOG 0802; a phase II trial, JCOG 0804) have been conducted since the end of 2009. In addition, another phase II trial (JCOG 1211), a confirmatory trial of segmentectomy for clinical T1N0 lung cancer dominant with GGO, was started in 2013. The accrual of these three trials that investigated the appropriateness of limited resection is complete and has achieved the planned number of patients. We are now waiting for the maturation of follow-up data regarding recurrence and prognosis. As for lymph node dissection, a randomized phase III trial of lobe-specific versus systematic nodal dissection for c-stage I/II nonsmall cell lung cancer (JCOG 1413) opened to accrual in January 2017. More recently, sublobar resection versus lobectomy for patients with resectable stage I nonsmall cell lung cancer with idiopathic pulmonary fibrosis: a phase III study evaluating survival (JCOG1708) opened to accrual in May 2018. As for postoperative adjuvant therapy, a phase III clinical trial to compare the effectiveness of UFT with that of TS-1 for stage IA of more than 2 cm, and IB NSCLC planned in JCOG (JCOG 0707) has been conducted since 2008. This trial completed the full accrual of 960 patients in 2013. A phase III clinical trial (JCOG 1205) to compare Irinotecan/Cisplatin with Etoposide/Cisplatin for adjuvant chemotherapy of resected pulmonary high-grade neuroendocrine carcinoma was started in 2013.

List of papers published in January 2017 - March 2018

Journal

1. Tsuruoka K, Horinouchi H, Goto Y, Kanda S, Fujiwara Y, Nokihara H, Yamamoto N, Asakura K, Nakagawa K, Sakurai H, Watanabe SI, Tsuta K, Ohe Y. PD-L1 expression in neuroendocrine tumors of the lung. Lung Cancer, 108:115-120, 2017

2. Aokage K, Saji H, Suzuki K, Mizutani T, Katayama H, Shibata T, Watanabe S, Asamura H. A non-randomized confirmatory trial of segmentectomy for clinical T1N0 lung cancer with dominant ground glass opacity based on thin-section computed tomography (JCOG1211). Gen Thorac Cardiovasc Surg, 65:267-272, 2017

3. Yoshida A, Kobayashi E, Kubo T, Kodaira M, Motoi T, Motoi N, Yonemori K, Ohe Y, Watanabe SI, Kawai A, Kohno T, Kishimoto H, Ichikawa H, Hiraoka N. Clinicopathological and molecular characterization of SMARCA4-deficient thoracic sarcomas with comparison to potentially related entities. Mod Pathol, 30:797- 809, 2017

4. George J, Saito M, Tsuta K, Iwakawa R, Shiraishi K, Scheel AH, Uchida S, Watanabe SI, Nishikawa R, Noguchi M, Peifer M, Jang SJ, Petersen I, Buttner R, Harris CC, Yokota J, Thomas RK, Kohno T. Genomic Amplification of CD274 (PD-L1) in Small-Cell Lung Cancer. Clinical cancer research, 23:1220- 1226, 2017

5. Watanabe SI, Nakagawa K, Suzuki K, Takamochi K, Ito H, Okami J, Aokage K, Saji H, Yoshioka H, Zenke Y, Aoki T, Tsutani Y, Okada M. Neoadjuvant and adjuvant therapy for Stage III nonsmall cell lung cancer. Jpn J Clin Oncol, 47:1112-1118, 2017

6. Nakamura A, Watanabe SI, Watanabe Y, Asakura K, Nakagawa K. En Bloc Upper and Lower Lobe Trisegmentectomy Facilitated by Displaced Segmental Airway. Ann Thorac Surg, 104:e447-e449, 2017

7. Aokage K, Yoshida J, Hishida T, Tsuboi M, Saji H, Okada M, Suzuki K, Watanabe S, Asamura H. Limited resection for early- stage non-small cell lung cancer as function-preserving radical surgery: a review. Jpn J Clin Oncol, 47:7-11, 2017

8. Nakagawa K, Watanabe SI, Kunitoh H, Asamura H. The Lung Cancer Surgical Study Group of the Japan Clinical Oncology Group: past activities, current status and future direction. Jpn J Clin Oncol, 47:194-199, 2017

9. Okubo Y, Matsumoto Y, Nakai T, Tsuchida T, Asakura K, Motoi N, Watanabe SI. The new transbronchial diagnostic approach for the metastatic lung tumor from renal cell carcinoma-a case report. J Thorac Dis, 9:E762-E766, 2017

10. Nakagawa K, Takahashi S, Endo M, Ohde Y, Kurihara H, Terauchi T. Can (18)F-FDG PET predict the grade of malignancy in thymic epithelial tumors? An evaluation of only resected tumors. Cancer Manag Res, 9:761-768, 2017

11. Ohara K, Arai E, Takahashi Y, Ito N, Shibuya A, Tsuta K, Kushima R, Tsuda H, Ojima H, Fujimoto H, Watanabe SI, Katai H, Kinoshita T, Shibata T, Kohno T, Kanai Y. Genes involved in development and differentiation are commonly methylated in cancers derived from multiple organs: a single-institutional methylome analysis using 1007 tissue specimens. Carcinogenesis, 38:241-251, 2017 List of papers published in January 2017 - March 2018 Journal

12. Seow WJ, Matsuo K, Hsiung CA, Shiraishi K, Song M, Kim HN, Wong MP, Hong YC, Wang Z, Chang IS, Wang JC, Chatterjee N, Tucker M, Wei H, Mitsudomi T, Zheng W, Kim JH, Zhou B, Caporaso NE, Albanes D, Shin MH, Chung LP, An SJ, Wang P, Zheng H, Yatabe Y, Zhang XC, Kim YT, Shu XO, Kim YC, Bassig BA, Chang J, Ho JCM, Ji BT, Kubo M, Daigo Y, Ito H, Momozawa Y, Ashikawa K, Kamatani Y, Honda T, Sakamoto H, Kunitoh H, Tsuta K, Watanabe S, Nokihara H, Miyagi Y, Nakayama H, Matsumoto S, Tsuboi M, Goto K, Yin Z, Shi J, Takahashi A, Goto A, Minamiya Y, Shimizu K, Tanaka K, Wu T, Wei F, Wong JYY, Matsuda F, Su J, Kim YH, Oh IJ, Song F, Lee VHF, Su WC, Chen YM, Chang GC, Chen KY, Huang MS, Yang PC, Lin HC, Xiang YB, Seow A, Park JY, Kweon SS, Chen CJ, Li H, Gao YT, Wu C, Qian B, Lu D, Liu J, Jeon HS, Hsiao CF, Sung JS, Tsai YH, Jung YJ, Guo H, Hu Z, Wang WC, Chung CC, Lawrence C, Burdett L, Yeager M, Jacobs KB, Hutchinson A, Berndt SI, He X, Wu W, Wang J, Li Y, Choi JE, Park KH, Sung SW, Liu L, Kang CH, Hu L, Chen CH, Yang TY, Xu J, Guan P, Tan W, Wang CL, Sihoe ADL, Chen Y, Choi YY, Hung JY, Kim JS, Yoon HI, Cai Q, Lin CC, Park IK, Xu P, Dong J, Kim C, He Q, Perng RP, Chen CY, Vermeulen R, Wu J, Lim WY, Chen KC, Chan JKC, Chu M, Li YJ, Li J, Chen H, Yu CJ, Jin L, Lo YL, Chen YH, Liu J, Yamaji T, Yang Y, Hicks B, Wyatt K, Li SA, Dai J, Ma H, Jin G, Song B, Wang Z, Cheng S, Li X, Ren Y, Cui P, Iwasaki M, Shimazu T, Tsugane S, Zhu J, Jiang G, Fei K, Wu G, Chien LH, Chen HL, Su YC, Tsai FY, Chen YS, Yu J, Stevens VL, Laird-Offringa IA, Marconett CN, Lin D, Chen K, Wu YL, Landi MT, Shen H, Rothman N, Kohno T, Chanock SJ, Lan Q. Association between GWAS-identified lung adenocarcinoma susceptibility loci and EGFR mutations in never-smoking Asian women, and comparison with findings from Western populations. Hum Mol Genet, 26:454-465, 2017

13. Masai K, Sakurai H, Sukeda A, Suzuki S, Asakura K, Nakagawa K, Asamura H, Watanabe SI, Motoi N, Hiraoka N. Prognostic Impact of Margin Distance and Tumor Spread Through Air Spaces in Limited Resection for Primary Lung Cancer. J Thorac Oncol, 12:1788-1797, 2017

14. Suzuki S, Sakurai H, Masai K, Asakura K, Nakagawa K, Motoi N, Watanabe SI. A Proposal for Definition of Minimally Invasive Adenocarcinoma of the Lung Regardless of Tumor Size. Ann Thorac Surg, 104:1027-1032, 2017

15. Nakamichi S, Horinouchi H, Asao T, Goto Y, Kanda S, Fujiwara Y, Nokihara H, Yamamoto N, Ito Y, Watanabe SI, Ohe Y. Comparison of Radiotherapy and Chemoradiotherapy for Locoregional Recurrence of Non-small-cell Lung Cancer Developing After Surgery. Clin Lung Cancer, 18:e441-e448, 2017

16. Nakagawa K. Validation of the latest WHO histological classification and the 8th TNM staging system for thymic epithelial tumors. Mediastinum, 2:14, 2018

17. Hishida T, Saji H, Watanabe SI, Asamura H, Aokage K, Mizutani T, Wakabayashi M, Shibata T, Okada M. A randomized Phase III trial of lobe-specific vs. systematic nodal dissection for clinical Stage I-II non-small cell lung cancer (JCOG1413). Jpn J Clin Oncol, 48:190-194, 2018