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論文 - 宮島　正博

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Pulmonary vessels and bronchial anatomy of the left lower lobe.

Ryunosuke Maki, Masahiro Miyajima, Keishi Ogura, Makoto Tada, Yuki Takahashi, Wataru Arai, Hirofumi Adachi, Atsushi Watanabe

Surgery today 50 ( 9 ) 1081 - 1090 2020年09月 [国内誌]

PURPOSE: To identify and clarify the comprehensive anatomic patterns in the left lower lobe (LLL). METHODS: Using computed tomography (CT) imaging data, including that obtained using three-dimensional CT, we reviewed the anatomic patterns of the pulmonary vessels and bronchi in the left lungs of 539 patients, focusing on the LLL. RESULTS: The two-stem type in A6 was observed in 131 (24.7%) patients and the three-stem type in A6 was observed in 11 (2.1%) patients. The independent two-stem type in B6 was observed in four (0.75%) patients. The B7 with independent branching from the basal bronchi was observed in 42 (7.9%) patients. B* was observed in 129 (24.0%) patients and B* was accompanied by A* in all patients. An extrapericardial common trunk of the left pulmonary veins was identified in five patients (0.93%). CONCLUSION: We identified various bronchovascular patterns in the LLL of a large number of patients. Our results provide useful information for anatomic pulmonary resection, especially segmentectomy.

DOI PubMed

[Successful Robotic Resection of Left Upper Mediastinal Tumor].

Yuma Shindo, Masahiro Miyajima, Ryunosuke Maki, Yuki Takahashi, Koudai Tsuruta, Wataru Arai, Atsushi Watanabe

Kyobu geka. The Japanese journal of thoracic surgery 73 ( 9 ) 663 - 666 2020年09月 [国内誌]

A man was diagnosed with a left upper mediastinal mass. The mass was located near the left subclavian vein, phrenic nerve, vagus nerve, left subclavian artery, and left brachiocephalic vein. He underwent a robotic surgery without additional approaches such as cervical approach on transmanubrial approach. Robotic surgery enabled to remove the tumor safely due to the highly flexible robot forceps under a 3-dimensional visual field. Robotic surgery may be effective for tumors in the upper mediastinum, where important blood vessels and nerves are closely present.

PubMed

[Left Upper Lobectomy Followed by Left Lower Pulmonary Vein Reconstruction after Miscutting the Common Trunk of the Left Pulmonary Veins].

Yuma Shindo, Ryunosuke Maki, Wataru Arai, Yuki Takahashi, Masahiro Miyajima, Atsushi Watanabe

Kyobu geka. The Japanese journal of thoracic surgery 73 ( 8 ) 590 - 593 2020年08月 [国内誌]

PubMed

特集ロボット支援下肺葉切除術—Robot-assisted thoracic surgery for lung cancer

宮島正博, 槙龍之輔, 高橋有毅, 多田周, 鶴田航大, 新井航, 進藤悠真, 渡辺敦

北海道外科雑誌 = The Hokkaido journal of surgery / 北海道外科雑誌編集委員会編 ( 北海道外科学会 ) 65 ( 1 ) 14 - 17 2020年06月

CiNii

Pulmonary metastasectomy is associated with prolonged survival among patients with bone and soft tissue sarcoma.

Junya Shimizu, Makoto Emori, Yasutaka Murahashi, Tomoko Sonoda, Taijiro Mishina, Masahiro Miyajima, Atsushi Watanabe, Shintaro Sugita, Kohichi Takada, Kazuyuki Murase, Tadashi Hasegawa, Toshihiko Yamashita

Molecular and clinical oncology 12 ( 5 ) 429 - 434 2020年05月 [国際誌]

The aim of the present study was to evaluate the survival impact of surgical resection among patients with pulmonary metastases from bone and soft tissue sarcomas. A total of 34 consecutive patients with ≤5 pulmonary metastases from bone and soft tissue sarcomas were retrospectively reviewed. The patients included 19 men and 15 women, with a median age of 64.0 years and a median follow-up of 14.5 months. The oncological outcome was compared between patients who underwent surgical and non-surgical treatment. A total of 22 patients underwent surgery and 12 patients did not undergo surgery. The surgery group had 3- and 5 year overall survival rates of 62 and 53%, respectively. None of the patients in the non-surgery group survived to 3 years. Compared with the non-surgery group, surgery achieved significantly better 3- and 5 year overall survival rates. Pulmonary metastasectomy was associated with significantly improved survival among patients who were aged <64 years (P=0.0155), as well as those who were aged ≥64 years (P=0.0444), which indicated that age was not associated with a difference in survival between the two groups. Therefore, pulmonary metastasectomy may improve the prognosis of patients with pulmonary metastases from bone and soft tissue sarcomas.

DOI PubMed

Quality assessment using EQ-5D-5L after lung surgery for non-small cell lung cancer (NSCLC) patients.

Ryo Koide, Ami Kikuchi, Masahiro Miyajima, Taijiro Mishina, Yuki Takahashi, Miho Okawa, Izumi Sawada, Junko Nakajima, Atsushi Watanabe, Toru Mizuguchi

General thoracic and cardiovascular surgery 67 ( 12 ) 1056 - 1061 2019年12月 [国内誌]

OBJECTIVES: Aim of this study was to elucidate an alteration of quality of life (QOL) score before and after video-assisted thoracoscopic surgery (VATS) for non-small cell lung cancer (NSCLC) patients using the 5-level EuroQol-5D questionnaire (EQ-5D-5L). We also investigated how the preoperative QOL scores affected the postoperative clinical outcome prospectively. METHODS: Between July 2018 and December 2018, 24 consecutive NSCLC patients who underwent VATS were recruited. The EQ-5D-5L for Japanese was used with face-to-face interviews to estimate the utility values of QOL. RESULTS: QOL scores were significantly declined after surgery (0.81 ± 0.19 vs. 0.74 ± 0.11: P = 0.049). The levels of EQ-5D-5L questionnaire were not significantly different before and after surgery except Q4 (pain control). The levels of Q4 were significantly worsened after surgery (1.33 ± 0.56 vs. 1.88 ± 0.61, P < 0.001). Operation time and bleeding in the preoperative low-QOL score group (N = 13) was longer (215.4 ± 52.3 min. vs. 173.5 ± 42.3 min., respectively: P = 0.045) and more (116.2 ± 152.7 ml vs. 22.7 ± 20.1 ml, respectively: P = 0.049) than those in the high-QOL score group (N = 11). CONCLUSIONS: QOL survey for lung cancer patients using EQ-5D-5L is simple and useful to identify the issue facing at the medical team. Preoperative low QOL score could be a predicting factor for the longer operation time and more bleeding.

DOI PubMed

Treatment outcome of chest wall soft tissue sarcomas: Analysis of prognostic factors.

Naoya Nakahashi, Makoto Emori, Hiroyuki Tsuchie, Hiroyuki Nagasawa, Tomoko Sonoda, Kohichi Takada, Masahiro Miyajima, Atsushi Watanabe, Yoichi Shimada, Toshihiko Yamashita

Journal of surgical oncology 120 ( 7 ) 1235 - 1240 2019年12月 [国際誌]

BACKGROUND: Primary soft tissue sarcomas (STSs) involving the chest wall are uncommon. The aim of this study was to identify factors that influence the prognosis of patients with primary chest wall STS. METHODS: The records of 38 patients (23 men and 15 women) who were treated at our institutions during 2002 to 2018 were reviewed. The following variables were evaluated as potential prognostic factors: sex, tumor size, chemotherapy, and completeness of surgical margins. Multivariate analysis was conducted to identify predictors of overall survival (OS) and disease-free survival (DFS). RESULTS: Of the 38 included patients, 5 had low-grade tumors and 33 had high-grade tumors. Five patients required chest wall reconstruction including rib resection. Thirty patients (79%) underwent R0 resection. The 5-year OS and DFS rates were 45% and 27%, respectively. Local recurrence developed in 7 patients. Multivariate analysis identified tumor size (hazard ratio [HR]: 4.13; 95% confidence interval [CI]: 1.05-16.24; P = .04) and R1/2 resection (HR: 3.92; 95% CI: 1.12-13.66; P = .03) as predictors of OS. CONCLUSIONS: Prognostic factors for survival included tumor size and completeness of surgical margins. Complete tumor excision is desirable, particularly in cases of early detection.

DOI PubMed

Left upper pulmonary vein connected to the persistent left superior vena cava and the left atrium.

Ryunosuke Maki, Masahiro Miyajima, Taijiro Mishina, Atsushi Watanabe

General thoracic and cardiovascular surgery 67 ( 8 ) 723 - 725 2019年08月 [国内誌]

DOI PubMed

MCL1 inhibition enhances the therapeutic effect of MEK inhibitors in KRAS-mutant lung adenocarcinoma cells.

Makoto Tada, Toshiyuki Sumi, Yusuke Tanaka, Sachie Hirai, Miki Yamaguchi, Masahiro Miyajima, Toshiro Niki, Hiroki Takahashi, Atsushi Watanabe, Yuji Sakuma

Lung cancer (Amsterdam, Netherlands) 133 88 - 95 2019年07月 [国際誌]

OBJECTIVES: MCL1 is an anti-apoptotic BCL2 family member that is highly expressed in various malignant tumors. However, little is known about the role of MCL1 in KRAS-mutant lung adenocarcinomas. In this study, we aimed to clarify whether MCL1 could be a therapeutic target in KRAS-mutant lung adenocarcinomas for which no effective molecular targeted drugs are available. MATERIALS AND METHODS: We examined to what extent MCL1 knockdown either alone or in combination with MEK inhibitor trametinib suppressed growth or induced apoptosis in the KRAS-mutant lung adenocarcinoma cell line H441 and EGFR-mutant lung adenocarcinoma cell line H1975. Furthermore, we investigated the therapeutic effects of dual inhibition of MCL1 and Bcl-xL, another anti-apoptotic BCL2 family member, in these two cell lines. RESULTS: MCL1 knockdown alone did not induce apoptosis in H441 or H1975 cells. However, MCL1-depleted H441 and H1975 cells underwent apoptosis and decreased in number in the presence of trametinib. We also confirmed that combined therapy by MCL1 knockdown and trametinib almost completely suppressed the growth of H441 cells in vivo. Moreover, dual knockdown of MCL1 and Bcl-xL induced extensive apoptosis in H441 and H1975 cells. CONCLUSION: These findings suggest that combined treatments of MCL1 knockdown and trametinib or dual inhibition of MCL1 and Bcl-xL would be effective therapies for lung adenocarcinomas including the KRAS-mutant subtype.

DOI PubMed

Outcomes of completion lobectomy long after segmentectomy.

Yuki Takahashi, Masahiro Miyajima, Makoto Tada, Ryunosuke Maki, Taijiro Mishina, Atsushi Watanabe

Journal of cardiothoracic surgery 14 ( 1 ) 116 - 116 2019年06月 [国際誌]

BACKGROUND: Completion lobectomy long after segmentectomy in the same lobe is extremely difficult because of severe adhesions around hilar structures, especially in cases involving video-assisted thoracoscopic surgery (VATS) completion lobectomy. We report and compare the surgical outcomes of patients who underwent VATS or thoracotomy completion lobectomy long after radical segmentectomy for lung cancer. METHODS: We retrospectively evaluated the surgical outcomes of completion lobectomies performed at our institute long after radical segmentectomies for lung cancer in the same lobe. The efficacy and safety of VATS completion lobectomy was compared to that of thoracotomy completion lobectomy. RESULTS: Ten of 228 patients who underwent radical segmentectomy for lung cancer between 2009 and 2018 underwent completion lobectomy at least a month after segmentectomy; five patients underwent VATS completion lobectomy. None of the patients underwent VATS left upper completion lobectomy, and conversion to thoracotomy was required in one patient. There were no significant differences between VATS and thoracotomy completion lobectomies in the median operative times (VATS 295 min, thoracotomy 339 min, p = 0.55), intraoperative blood loss volumes (VATS 350 mL, thoracotomy 500 mL, p = 0.84), intervals between initial segmentectomy and completion lobectomy (VATS 40 months, thoracotomy 48 months, p = 0.55), and number of patients with pulmonary artery injury (VATS 1, thoracotomy 2, p = 0.49). There was no operation-related mortality. CONCLUSIONS: VATS completion lobectomy long after segmentectomy for lung cancer could be performed without fatal complications unless severe adhesions are observed around each main pulmonary artery.

DOI PubMed

今月の話題パラフィン充塡術40年後に起きた脊髄麻痺

新井航, 大川美穂, 高橋有毅, 多田周, 槙龍之介, 三品泰二郎, 宮島正博, 渡辺敦

胸部外科 ( 南江堂 ) 72 ( 5 ) 344 - 347 2019年05月

DOI

[Paraffinoma with Spinal Paralysis 40 Years After Pleural Plombage for Tuberculosis].

Wataru Arai, Miho Ohkawa, Yuki Takahashi, Makoto Tada, Ryunosuke Maki, Taijiro Mishina, Masahiro Miyajima, Atsushi Watanabe

Kyobu geka. The Japanese journal of thoracic surgery 72 ( 5 ) 344 - 347 2019年05月 [国内誌]

Paraffin had been used for pleural plombage in the treatment of tuberculosis. However, paraffin use has been reported to cause late postoperative complications. A 79-year-old man was presented with an extramedullary tumor and spinal paralysis. Forty-seven years ago, he had undergone pleural plombage using paraffin for the treatment of pulmonary tuberculosis. Since the extramedullary tumor was found to be paraffinoma, paraffin in the vertebral canal and thoracic cavity was removed surgically. All the paraffin in the vertebral canal and thoracic cavity was removed. After surgery, the patient remains well, without spinal paralysis.

PubMed

臨床経験膵液瘻に伴う膿気胸に対する外科治療

大川美穂, 新井航, 髙橋有毅, 槇龍之輔, 多田周, 三品泰二郎, 宮島正博, 渡辺敦

胸部外科 ( 南江堂 ) 72 ( 3 ) 209 - 212 2019年03月

DOI CiNii

[Surgical Treatment for Pneumopyothorax Secondary to Pancreatic Fistula].

Miho Ohkawa, Wataru Arai, Yuki Takahashi, Ryunosuke Maki, Makoto Tada, Taijiro Mishina, Masahiro Miyajima, Atsushi Watanabe

Kyobu geka. The Japanese journal of thoracic surgery 72 ( 3 ) 209 - 212 2019年03月 [国内誌]

A 46-year-old woman with cervical cancer with multiorgan metastasis visited our hospital. She underwent a total gastrectomy, splenectomy, distal pancreatectomy, left adrenalectomy, and left partial diaphragmatic resection. Postoperatively, she developed pleural effusion with high level of amylase secondary to a pancreatic ﬁstula, consequently causing left-sided empyema. She developed acute respiratory distress syndrome. Urgent surgical treatment was scheduled, and left lower lobectomy, with diaphragmatic partial resection were performed under the venovenous extracorporeal membrane oxygenation. After surgery, intensive care for 45 days was necessary and she was discharged home 6 months post operatively.

PubMed

Thoracoscopic Right Basilar Segmentectomy After Right Upper Lobectomy.

Makoto Tada, Masahiro Miyajima, Taijiro Mishina, Yuki Takahashi, Ryunosuke Maki, Atsushi Watanabe

The Annals of thoracic surgery 107 ( 2 ) e123-e125 2019年02月 [国際誌]

This report describes a case of thoracoscopic right basilar segmentectomy after upper lobectomy. A 76-year-old man who underwent right upper lobectomy for lung tuberculosis 50 years earlier had a diagnosis of squamous cell carcinoma, stage IB (T2a N0 M0), in the right lower lobe and underwent right basilar segmentectomy for limited resection. The postoperative course was uneventful. The patient showed no recurrence clinically, and the 1-year postoperative chest computed tomographic scan showed adequate volume of the middle and residual right lower lobe without emphysematous changes.

DOI PubMed

特異な病態を呈した孤立性線維性腫瘍の3例

髙橋有毅, 宮島正博, 辻脇光洋, 多田周, 槙龍之輔, 渡辺敦

日本呼吸器外科学会雑誌 ( 特定非営利活動法人日本呼吸器外科学会 ) 33 ( 1 ) 37 - 41 2019年01月

Solitary fibrous tumor（SFT）は，間葉系細胞由来の稀な腫瘍である．今回，特異な病態を呈した3例を経験した．症例1は76歳男性，右肺上葉中枢側に60 mm大の腫瘤影を認め，原発性肺癌の疑いで右上葉切除を行った．病理診断は肺原発SFTであった．症例2は46歳女性，右下葉肺原発悪性SFTに対する下葉切除術後4年目に右中葉肺転移，胸膜播種をきたした．このため中葉切除と胸膜播種巣切除術，胸腔内化学療法を行った．その後，再発し初回手術から77ヵ月後に原病死した．症例3は63歳女性，CTで右胸腔に190 mm大の一部石灰化と血管新生を伴う巨大な腫瘤を認め，Chronic Expanding Hematomaの疑いで手術目的に当科紹介となった．術中出血低減目的に肋間動脈，内胸動脈塞栓術を施行した後手術を行い，病理診断はSFTであった．

DOI CiNii

A Case of Ankylosing Spinal Hyperostosis with Massive Hemothorax Due to Thoracic Vertebral Fracture Caused by Minor Trauma.

Ryosuke Hirota, Hideto Irifune, Nobuyuki Takahashi, Makoto Emori, Atsushi Teramoto, Mitsunori Yoshimoto, Masahiro Miyajima, Atsushi Watanabe, Toshihiko Yamashita

Spine surgery and related research 3 ( 3 ) 274 - 276 2019年 [国内誌]

DOI PubMed

左肺全摘後，体外式肺補助下に胸腔鏡下右肺区域切除を行った1例

多田周, 高橋有毅, 槙龍之輔, 三品泰二郎, 宮島正博, 渡辺敦

肺癌 ( 特定非営利活動法人日本肺癌学会 ) 58 ( 4 ) 298 - 302 2018年08月

背景．異時性多発肺癌に対する3回以上の解剖学的肺切除や，片肺全摘後の残肺解剖学的切除例の報告はいまだ少ない．症例．66歳男性．50歳時に左上葉肺癌（肺癌取扱い規約第8版：微小浸潤性腺癌，stage IA1）に対して左上葉切除術，61歳時に左下葉異時性多発肺癌（微小浸潤性腺癌，stage IA1）に対して左下葉切除術の既往があった．定期検診で胸部異常陰影を指摘された．術前残存肺呼吸機能は肺活量2.32 l，1秒量1.59 lであった．組織学的な確定診断は得られなかったが，CT所見から原発性肺癌が強く疑われたため，体外式肺補助（ECLA）下に胸腔鏡下右S⁶区域切除を施行した．術後合併症はなく，術後14日目に退院した．組織学的診断は上皮内腺癌であった．結論．ECLAの使用により，左肺全摘後，右肺に出現した異時性肺癌（3重癌）に対し，安全に胸腔鏡下区域切除を施行することが可能であった．

DOI DOI2 CiNii

Thoracoscopic one-stage lobectomy and diaphragmatic plication for T3 lung cancer.

Yuki Takahashi, Masahiro Miyajima, Taijiro Mishina, Ryunosuke Maki, Makoto Tada, Kodai Tsuruta, Atsushi Watanabe

Journal of cardiothoracic surgery 13 ( 1 ) 86 - 86 2018年07月 [国際誌]

BACKGROUND: Combined resection of a phrenic nerve is occasionally required in T3 primary lung carcinomas invading the phrenic nerve to completely remove a malignant tumour, resulting in diaphragmatic paralysis. We describe the first case of thoracoscopic lobectomy and diaphragmatic plication as a one-stage surgery for lung cancer invading the phrenic nerve. CASE PRESENTATION: A 56-year-old woman with a T3N0M0 primary adenosquamous carcinoma in the left upper lobe presented with suspicious invasion to the anterior mediastinal fat tissue and left phrenic nerve and underwent left upper lobectomy, node dissection, and partial resection of the anterior mediastinal fat tissue with the left phrenic nerve. Furthermore, thoracoscopic diaphragmatic plication was performed as a concomitant procedure. The patient's postoperative course was favourable, without any complications, and respiratory function was preserved for 1 year postoperatively. CONCLUSIONS: Thoracoscopic one-stage lobectomy and diaphragmatic plication for T3 lung cancer invading the phrenic nerve is effective for preservation of postoperative pulmonary function.

DOI PubMed

症例 p40陰性肺類基底細胞型扁平上皮癌の1例

槙龍之輔, 杉田真太朗, 小野祐輔, 宮島正博, 多田周, 高橋有毅, 三品泰二郎, 渡辺敦

胸部外科 ( 南江堂 ) 71 ( 7 ) 547 - 550 2018年07月

DOI CiNii

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