Association between perioperative cholesterol level and analgesia after video-assisted thoracoscopic surgery / 대한마취과학회지

BACKGROUND@#Cholesterol plays an important role in the action of opioid analgesics, but its association with postoperative pain has not been clarified. Our study examined the association of pre- and postoperative total serum cholesterol (TSC), and change between the pre- and postoperative TSC levels with postoperative pain outcomes in patients with non-small cell lung cancer (NSCLC) who underwent video-assisted thoracoscopic surgery (VATS) lobectomy.@*METHODS@#We retrospectively reviewed medical records of patients with NSCLC who underwent VATS lobectomy at the Seoul National University Bundang Hospital in South Korea. We sought to determine the association between preoperative TSC, TSC on postoperative day (POD) 0–1, and pre- and postoperative changes in TSC by comparing numeric rating scale (NRS) scores on POD 0, 1, and 2 and total morphine equivalent consumption on POD 0–2. Multivariate linear regression analyses were used, and P 0.05). In addition, the changes in TSC, preoperative TSC, and postoperative TSC were not associated with postoperative NRS pain score on POD 0, 1, and 2 (P > 0.05).@*CONCLUSIONS@#Our results indicated that no significant association was observed between pre- and postoperative TSC level and postoperative pain outcome after VATS lobectomy of the lung.

Association between perioperative cholesterol level and analgesia after video-assisted thoracoscopic surgery / 대한마취과학회지

BACKGROUND: Cholesterol plays an important role in the action of opioid analgesics, but its association with postoperative pain has not been clarified. Our study examined the association of pre- and postoperative total serum cholesterol (TSC), and change between the pre- and postoperative TSC levels with postoperative pain outcomes in patients with non-small cell lung cancer (NSCLC) who underwent video-assisted thoracoscopic surgery (VATS) lobectomy. METHODS: We retrospectively reviewed medical records of patients with NSCLC who underwent VATS lobectomy at the Seoul National University Bundang Hospital in South Korea. We sought to determine the association between preoperative TSC, TSC on postoperative day (POD) 0–1, and pre- and postoperative changes in TSC by comparing numeric rating scale (NRS) scores on POD 0, 1, and 2 and total morphine equivalent consumption on POD 0–2. Multivariate linear regression analyses were used, and P 0.05). In addition, the changes in TSC, preoperative TSC, and postoperative TSC were not associated with postoperative NRS pain score on POD 0, 1, and 2 (P > 0.05). CONCLUSIONS: Our results indicated that no significant association was observed between pre- and postoperative TSC level and postoperative pain outcome after VATS lobectomy of the lung.

Prognostic Implications of Postoperative Infectious Complications in Non-Small Cell Lung Cancer

BACKGROUND@#Few studies have evaluated the long-term impact of postoperative infectious complications in patients with non-small cell lung cancer (NSCLC). We aimed to determine the impact of infectious complications on long-term outcomes after surgical resection for NSCLC.@*METHODS@#We performed a retrospective study of 1,380 eligible patients who underwent pulmonary resection for NSCLC from 2003 to 2012. Complications were divided into infectious complications and non-infectious complications. Kaplan-Meier survival analysis was used to compare unadjusted 5-year cancer-specific survival (CSS) rates and recurrence-free survival (RFS) rates. Cox regression was used to determine the impact of infectious complications on 5-year CSS and RFS.@*RESULTS@#The rate of total complications and infectious complications was 24.3% and 4.3%, respectively. In the node-negative subgroup, the 5-year CSS and RFS rates were 75.9% and 57.1% in patients who had infectious complications, compared to 87.9% and 78.4% in patients who had no complications. Infectious complications were a negative prognostic factor for 5-year RFS (hazard ratio, 1.92; 95% confidence interval, 1.00–3.69; p=0.049). In the node-positive subgroup, the 5-year CSS rate and RFS were 44.6% and 48.4% in patients who had infectious complications, compared to 70.5% and 48.4% for patients who had no complications.@*CONCLUSION@#Postoperative infectious complications had a negative impact on CSS and RFS in node-negative NSCLC. Our findings may help improve risk assessment for tumor recurrence after pulmonary resection for node-negative NSCLC.

Prognostic Implications of Postoperative Infectious Complications in Non-Small Cell Lung Cancer / 대한흉부외과학회지

BACKGROUND: Few studies have evaluated the long-term impact of postoperative infectious complications in patients with non-small cell lung cancer (NSCLC). We aimed to determine the impact of infectious complications on long-term outcomes after surgical resection for NSCLC. METHODS: We performed a retrospective study of 1,380 eligible patients who underwent pulmonary resection for NSCLC from 2003 to 2012. Complications were divided into infectious complications and non-infectious complications. Kaplan-Meier survival analysis was used to compare unadjusted 5-year cancer-specific survival (CSS) rates and recurrence-free survival (RFS) rates. Cox regression was used to determine the impact of infectious complications on 5-year CSS and RFS. RESULTS: The rate of total complications and infectious complications was 24.3% and 4.3%, respectively. In the node-negative subgroup, the 5-year CSS and RFS rates were 75.9% and 57.1% in patients who had infectious complications, compared to 87.9% and 78.4% in patients who had no complications. Infectious complications were a negative prognostic factor for 5-year RFS (hazard ratio, 1.92; 95% confidence interval, 1.00–3.69; p=0.049). In the node-positive subgroup, the 5-year CSS rate and RFS were 44.6% and 48.4% in patients who had infectious complications, compared to 70.5% and 48.4% for patients who had no complications. CONCLUSION: Postoperative infectious complications had a negative impact on CSS and RFS in node-negative NSCLC. Our findings may help improve risk assessment for tumor recurrence after pulmonary resection for node-negative NSCLC.

Curative Resection for Metachronous Pulmonary Metastases from Colorectal Cancer: Analysis of Survival Rates and Prognostic Factors / Journal of the Korean Cancer Association, 대한암학회지

PURPOSE: Prognostic factors in patients with pulmonary metastases (PM) from colorectal cancer (CRC) are still controversial. This study assessed oncologic outcomes and prognostic factors in patients with metachronous PM from CRC. MATERIALS AND METHODS: Between June 2003 and December 2011, 122 patients with CRC underwent curative resection of PM detected at least 4 months after CRC resection. Clinico-pathological factors selected from the prospectively maintained database were analyzed retrospectively. RESULTS: The median disease-free interval (DFI) between resection of the primary tumor and detection of PM was 22.0 months (range, 4 to 85 months). Solitary PM were detected in 77 patients (63.1%), with a median maximal tumor diameter of 12.0 mm (range, 2 to 70 mm). Of 52 patients who underwent mediastinal lymph node (LN) dissection, eight patients had LN involvement. Five-year overall survival and disease-free survival (DFS) rates after initial pulmonary metastasectomy were 66.4% and 50.9%, respectively. DFI, mediastinal LN involvement, and the number and distribution of PM were significantly prognostic factors for DFS. In multivariable analysis DFI ≥ 12 months, solitary lesion, and absence of mediastinal LN involvement were independently prognostic for DFS. Of the 122 patients, 48 patients (39.3%) developed recurrent PM a median 13.0 months after initial pulmonary metastasectomy. Recurrent DFI was independently prognostic of DFS in patients who underwent repeated pulmonary metastasectomy. CONCLUSION: There is a potential survival benefit for patients with metachronous PM from CRC who undergo pulmonary metastasectomy, even those with recurrent PM. Pulmonary metastasectomy should be considered in selected patients, particularly those with longer DFI, solitary lesions, and absence of mediastinal LN involvement.

A Case Treated with Extracorporeal Membrane Oxygenation for Disseminated Cytomegalovirus Infection after Liver Transplantation / 대한이식학회지

Cytomegalovirus (CMV) is a clinically important pathogen in immunocompromised patients, especially after organ transplantation. However, there have been several reports of severe CMV infections in immunocompetent patients. This report presents a case of an immunocompetent patient who presented with fulminant hepatitis requiring liver transplantation. Because CMV was detected upon histopathologic review of the explanted liver, it was later assumed that CMV may be the primary cause of hepatitis. However, at the time of transplantation, we did not suspect CMV hepatitis. Following transplantation and initiation of immunosuppression, the patient developed viral sepsis with a disseminated CMV infection. Respiratory failure because of CMV pneumonia worsened despite antiviral therapy, and venovenous extracorporeal membrane oxygenation (ECMO) was initiated. Although ECMO has been traditionally contraindicated in patients with sepsis, this patient recovered and was successfully weaned off ECMO. CMV should be included in the differential diagnosis of fulminant hepatitis, even in immunocompetent patients, especially when liver transplantation is considered.

Effect of Adjuvant Chemotherapy after Complete Resection for Pathologic Stage IB Lung Adenocarcinoma in High-Risk Patients as Defined by a New Recurrence Risk Scoring Model / Journal of the Korean Cancer Association, 대한암학회지

PURPOSE: We conducted a retrospective analysis to determine if adjuvant chemotherapy prolongs overall survival in patients with pathologic stage IB lung adenocarcinoma who had undergone complete resection and were defined as high-risk by a newly developed recurrence risk scoring model. MATERIALS AND METHODS: Patients who underwent curative resection for stage IB lung adenocarcinoma were analyzed with a newly developed recurrence risk scoring model and divided into a low-risk group and a high-risk group. The patients in the high-risk group were retrospectively divided into two groups based on whether they underwent adjuvant chemotherapy or observation. Recurrence-free survival and overall survival were compared between these two groups. RESULTS: A total of 328 patients who underwent curative resection between 2000 and 2009 were included in this study, of whom 110 (34%) received adjuvant chemotherapy and 218 (67%) underwent observation without additional treatment. According to our risk model, 167 patients (51%) were high-risk and 161 (49%) were low-risk. The 5-year recurrence-free survival rates and overall survival were 84.4% and 91.5% in low-risk patients and 53.9% and 74.7% in high-risk patients (p < 0.001). In high-risk patients, the 5-year overall survival rates were 77% among patients who underwent observation and 87% among those who underwent adjuvant chemotherapy (p=0.019). CONCLUSION: Adjuvant chemotherapy prolonged overall survival among high-risk patients who had undergone complete resection for stage IB lung adenocarcinoma.

Single-Port Video-Assisted Thoracic Surgery for Secondary Spontaneous Pneumothorax: Preliminary Results

BACKGROUND: The aim of this study was to evaluate the feasibility of single-port video-assisted thoracic surgery (VATS) in the treatment of secondary spontaneous pneumothorax (SSP). METHODS: Twenty-four patients who were scheduled to undergo single-port VATS for SSP were studied. The medical records of the patients were retrospectively reviewed. The mean follow-up duration was 26.1+/-19.8 months. In order to evaluate the feasibility of single-port VATS for SSP, the postoperative results of single-port VATS (n=15) in patients with emphysema were compared with those of emphysematous patients who underwent three-port VATS (n=15) during the study period. RESULTS: Single-port VATS was feasible in 19 of 24 patients (79.2%), while an additional port was needed in five patients. In the single-port VATS patients, the median operation time, duration of chest tube drainage, and hospital stay were 84.0 minutes, one day, and two days, respectively. Postoperative complications included prolonged chest tube drainage for more than five days (n=1), wound infection (n=1), and vocal fold palsy (n=1). No recurrence of pneumothorax was observed during the follow-up period. The median operation time, duration of chest tube drainage, and hospital stay of the emphysematous patients who underwent single-port VATS were shorter than those who underwent three-port VATS group (p<0.05 for all parameters). CONCLUSION: Single-port VATS proved to be a feasible procedure in the treatment of patients with secondary spontaneous pneumothorax.

Terminology Issues in Thoracoscopic Surgery

No abstract available.

Alteration of the E-Cadherin/beta-Catenin Complex Is an Independent Poor Prognostic Factor in Lung Adenocarcinoma

BACKGROUND: Epithelial-mesenchymal transition (EMT) is an important step in the invasion and progression of cancer and in the development of chemoresistance by cancer cells. METHODS: To address the clinical significance of the EMT pathway in lung adenocarcinoma and the association of the pathway with histological subtype, we examined 193 surgically resected lung adenocarcinoma samples for the expression of representative EMT-related proteins (E-cadherin, beta-catenin, and vimentin) by immunohistochemistry. Histological subtypes were classified according to the 2011 International Association for the Study of Lung Cancer/American Thoracic Society/European Respiratory Society classification. The results for EMT-related protein expression were analyzed for correlation with clinicopathological features and with survival. RESULTS: The loss of E-cadherin expression and aberrant beta-catenin expression were significantly associated with larger tumor size, pleural invasion, lymphatic/vascular invasion, and advanced pathological stage (p<0.05). The alteration of the E-cadherin/beta-catenin complex was least frequently observed in the lepidic-predominant group, but these associations were not statistically significant. In the multivariate analysis, altered E-cadherin/beta-catenin complex expression was found to be an independent poor prognostic factor (p=0.017; hazard ratio, 1.926; 95% confidence interval, 1.119 to 3.314). CONCLUSIONS: The alteration of the expression of the E-cadherin/beta-catenin complex was associated with aggressive tumor behavior in lung adenocarcinoma.

Loss of PTEN Expression is an Independent Poor Prognostic Factor in Non-small Cell Lung Cancer

BACKGROUND: Alterations in the phosphatase and tensin homolog (PTEN) are correlated with tumor progression. Downregulation of PTEN is related to drug resistance of epidermal growth factor receptor (EGFR) tyrosine kinase inhibitors in non-small cell lung cancer (NSCLC). The aim of this study was to evaluate the prognostic significance of PTEN in patients with NSCLC and its correlation with EGFR. METHODS: Two hundred eighty eight surgically resected NSCLC samples, including 168 adenocarcinomas (ADCs), 99 squamous cell carcinomas (SCCs) and 21 other NSCLCs were analyzed for the PTEN. The results were correlated with other clinicopathological variables including EGFR amplification and mutation. RESULTS: Loss of PTEN was detected in 42.4% of NSCLCs, specifically 28.6% of ADCs, 66.7% of SCCs, and 38.1% of others. Loss of PTEN was significantly associated with SCC, smoking, male gender, and higher stage. In a multivariate analysis, loss of PTEN was significantly associated with short progression-free survival (p=0.037). No association between PTEN and EGFR was observed. CONCLUSIONS: These results suggest that loss of PTEN results in shorter progression-free survival in patients with NSCLC, and loss of PTEN is more associated with SCC, smoking, male gender, and higher T stage by the 7th tumor, node and metastasis staging system but not EGFR status.

Clinicopathologic Implications of ALK Gene Copy Number Gain in Non-small Cell Lung Cancer

PURPOSE: The anaplastic lymphoma kinase (ALK) gene is a potential molecular target in non-small cell lung carcinoma (NSCLC). The clinicopathologic implication of a change in the ALK gene copy number (GCN) is unclear. MATERIALS AND METHODS: A total of 434 primary NSCLC samples were analyzed by fluorescence in situ hybridization (FISH) for ALK GCN. RESULTS: Ninety-six cases (22.1%) showed ALK GCN gain with amplification in 16 (3.7%) cases. The cases with ALK GCN gain consisted of 47 adenocarcinomas (49.0%), 41 squamous cell carcinomas (42.7%), 5 adenosquamous carcinomas (5.2%) and 3 other NSCLCs (3.1%). ALK gene amplification was identified in 7 adenocarcinomas (43.7%) and 9 squamous cell carcinomas (56.3%). There was no significant difference between ALK GCN gain/amplification and histologic subtypes. Univariate survival analysis revealed that patients with ALK GCN gain/amplification showed shorter progression-free survival durations and decreased overall survival rates (p<0.001). However, multivariate analysis proved that ALK GCN gain/amplification is not an independent prognostic factor for progression-free survival or overall survival. CONCLUSION: ALK GCN gain is frequently identified in NSCLCs and the incidence is similar among histologic subtypes. Although ALK GCN gain/amplification is not an independent prognostic marker, it is associated with tumor progression in NSCLC.

Outcome of Limited Resection for Lung Cancer

BACKGROUND: Up to now, lobectomy, bilobectomy and pneumonectomy combined with extensive lymph node dissection have been regarded as the standard procedures for non-small cell lung cancer (NSCLC). In high-risk patients, however, limited resection (LR) has been attempted as a salvage procedure, and, recently, indication for LR has been extended to selected cases with early-stage NSCLC. MATERIAL AND METHODS: Among the 773 patients who underwent surgical procedures for NSCLC in Seoul National University Bundang Hospital from May 2003 to December 2008, 43 patients received LR. Medical records of these patients were retrospectively reviewed. RESULTS: Mean age at operation was 66.0+/-12.4 years, and there were 30 males. Twenty-five patients underwent conservative limited resection (CLR) and 18 underwent intentional limited resection (ILR). Indications for CLR were multiple primary lung cancer in 9 (9/25, 36%) and severe concomitant diseases in 5 (5/25, 20%). Of these, 6 patients underwent segmentectomy and 19 received wedge resection. During the follow-up period of 28.0+/-17.8 months, 15 patient developed recurrent lung cancer. ILR was selectively performed in lesions almost purely composed of ground glass opacity (> or =95%), or in small solid lesions (< or =2 cm). Of these, 11 patients underwent segmentectomy and 7 underwent wedge resection. During the follow-up period of 31.7+/-11.6 months, no patient developed recurrence. CONCLUSION: Intermediate-term outcome of LR for early-stage lung cancer is comparable to that of standard operation. For the delineation of the indications and appropriate surgical techniques for LR, prospective randomized multi-institutional study may be expedient.

ERCC1 Predicts a Poorer Platinum-based Chemotherapy Outcome but a Better Outcome for Uracil-Tegafur in the Resected Stage I-II NSCLC

BACKGROUND: The role of excision repair cross-complementation group 1 (ERCC1) has been controversial in non-small cell lung cancer (NSCLC) patients who received adjuvant chemotherapy with a platinum agent. We investigated ERCC1 expression in stage I-II NSCLC to clarify its significance for adjuvant chemotherapy. METHODS: The ERCC1 expression profile was evaluated by immunohistochemistry and compared according to adjuvant chemotherapeutic agents in 146 patients who underwent surgical resection for stage I-II NSCLC. The patients were divided into 3 groups; adjuvant chemotherapy with a platinum based agent (18.5%, 27/146); adjuvant chemotherapy with uracil-tegafur (UFT) (40.4%, 59/146); surgery-alone (41.1%, 60/146). RESULTS: Nuclear ERCC1 expression was detected in 71.9% (105/146) of NSCLC and was significantly associated with a shortened survival period in the group 1 patients who received the platinum based regimen after surgery. The group 2 patients who received UFT showed the longest survival period, followed by the surgery-alone group (overall survival, p=0.049; disease-free survival [DFS], p<0.001). CONCLUSIONS: These results suggest that stage I-II NSCLC patients with ERCC1 expression experience a shorter DFS period with adjuvant chemotherapy with a platinum based regimen and may benefit from adjuvant chemotherapy with UFT, instead of platinum after surgery.

Superior Vena Cava Resection and Reconstruction in Thoracic Malignancy / 대한흉부외과학회지

BACKGROUND: The benefit of superior vena cava (SVC) resection in thoracic malignancies remains controversial. We analyzed the results of extended resection in patients with thoracic malignancy involving the SVC. MATERIAL AND METHOD: From March 2000 to March 2009, we performed surgical resection and reconstruction in 18 thoracic malignancies involving the SVC. Ten male and 8 female enrolled and their mean age was 56 years. RESULT: SVC reconstruction was performed in 9 patients with polytetrafluoroethylene (PTFE) graft. Primary closure was possible in 6 patients by partially clamping the SVC. Patch angioplasty was performed in 3 patients with PTFE or autologous pericardial patch. Three-year survival was 58.0% and median survival time was 24.5 months. Disease specific survival and recurrence free survival were not significantly different between lung cancer and mediastinal malignancy. Obstruction of graft was detected in 4 patients during follow-up; SVC graft obstruction in 1 patient, and accessory graft between the innominate vein and right atrium in 3 patients. CONCLUSION: Extended resection of thoracic malignancies involving the SVC was a feasible method in selected patients. Although the morbidity rate was relatively high, mid-term survival was acceptable when complete resection was possible.

Aorto-esophageal Fistula That Developed after Endovascular Stent-grafting of a Mycotic Aneurysm: A case report / 대한흉부외과학회지

A 74-year-old woman presented at our hospital with hemoptysis. Three months ago, she had endovascular stent-grafting done by a general surgeon for a saccular thoracic aneurysm that was found accidentally following an episode of fever and chills. Despite a lasting fever after the procedure, she was discharged without further treatment and follow-up. She was subsequently admitted to the hospital for evaluation and several exams were performed. Chest CT scans and an esophagoscopy identified an aorto-esophageal fistula at the level of the aorta that was covered by a previous stent-graft. After extensive administration of antibiotics, surgery was done - esophagectomy, cervical esophago-gastrostomy and replacement of the thoracic aorta. She was later discharged uneventfully.

Retrograde Autologous Priming: Is It Really Effective in Reducing Red Blood Cell Transfusions during Extracorporeal Circulation? / 대한흉부외과학회지

BACKGROUND: Retrograde autologous priming (RAP) is known to be useful in decreasing the need of transfusions in cardiac surgery because it prevents excessive hemodilution due to the crystalloid priming of cardiopulmonary bypass circuit. However, there are also negative side effects in terms of blood conservation. We analyzed the intraoperative blood-conserving effect of RAP and also investigated the efficacy of autotransfusion and ultrafiltration as a supplemental method for RAP. MATERIAL AND METHOD: From January 2005 to December 2007, 117 patients who underwent isolated coronary artery bypass operations using cardiopulmonary bypass (CPB) were enrolled. Mean age was 63.9+/-9.1 years (range 36~83 years) and 34 patients were female. There were 62 patients in the RAP group and 55 patients in he control group. Intraoperative autotransfusion was performed via the arterial line. RAP was done just before initiating CPB using retrograde drainage of the crystalloid priming solution. Both conventional (CUF) and modified (MUF) ultrafiltrations were done during and after CPB, respectively. The transfusion threshold was less than 20% in hematocrit. RESULT: Autotransfusions were done in 79 patients (67.5%) and the average amount was 142.5+/-65.4 mL (range 30~320 mL). Homologous red blood cell (RBC) transfusion was done in 47 patients (40.2%) and mean amount of transfused RBC was 404.3+/-222.6 mL. Risk factors for transfusions were body surface area (OR 0.01, 95% CI 0.00~0.63, p=0.030) and cardiopulmonary bypass time (OR 1.04, 95% CI 1.01~1.08, p=0.019). RAP was not effective in terms of the rate of transfusion (34.5% vs 45.2%, p=0.24). However, the amount of transfused RBC was significantly decreased (526.3+/-242.3ml vs 321.4.+/-166.3 mL, p=0.001). Autotransfusion and ultrafiltration revealed additive and cumulative effects in decreasing transfusion amount (one; 600.0+/-231.0 mL, two; 533.3+/-264.6 mL, three; 346.7+/-176.7 mL, four; 300.0+/-146.1 mL, p=0.002). CONCLUSION: Even though RAP did not appear to be effective in terms of the number of patients receiving intraoperative RBC transfusions, it could conserve blood in terms of the amount transfused and with the additive effects of autotransfusion and ultrafiltration. If we want to maximize the blood conserving effect of RAP, more aggressive control will be necessary - such as high threshold of transfusion trigger or strict regulation of crystalloid infusion, and so forth.

Video-Assisted Thoracic Surgery Lobectomy for Non-SmallCell Lung Cancer: Experience of 133 Cases / 대한흉부외과학회지

BACKGROUND: We evaluated the feasibility and the efficacy of Video-Assisted Thoracic Surgery (VATS) lobectomy for treating patients with non-small cell lung cancer (NSCLC) and we compared the outcomes of VATS lobectomy with those of open lobectomy. MATERIAL AND METHOD: From 2003 to March 2008, 133 NSCLC patients underwent VATS lobectomy. The patients were selected on the basis of having clinical stage I disease on the chest CT and PET scan. The outcomes of 202 patients who underwent open lobectomy (OL group) for clinical stage I NSCLC were evaluated to compare their results with those of the patients who underwent VATS lobectomy (the VL group). RESULT: The number of females and the number of patients with adenocarcinoma and stage IA disease were greater in VL group (p<0.05). There was no operative mortality or major complications in the VL group. Conversion to thoracotomy was needed in 8 cases (6%), which was mostly due to bleeding. The chest tube indwelling time and the length of the postoperative hospital stay were significantly shorter in the VL group (p<0.001). The number of dissected lymph nodes and the size of tumor were significantly smaller in the VL group (p<0.001). For the pathologic stage I patients, there was no significant difference in the three-year survival rates between the two groups (p=0.15). CONCLUSION: VATS lobectomy is a safe procedure with low operative mortality and morbidity. VATS lobectomy is feasible for early stage NSCLC and it provides outcomes that are comparable to those for open lobectomy. Further long-term data are needed

Carinal Resection and Reconstruction for Carinal Tumor / 대한흉부외과학회지

Carinal resection is technically demanding and the surgical risk is relatively high. When tumor is confined around the carina, then lung parenchymal sparing surgery is technically feasible in selected cases. We performed carinal resection and reconstruction without pulmonary resection for a patient suffering with squamous cell carcinoma that involved the carina and this patient had undergone right upper lobectomy 19 months previously due to lung cancer.

Primary Mediastinal Synovial Sarcoma

We report a rare case of a primary mediastinal synovial sarcoma. A 44-year-old man had a well-defined tumor in the left posterior mediastinum involving the left lower lobe of the lung, as detected on chest computed tomography, and underwent an en bloc excision and a left lower lobectomy. Grossly, the tumor measured 8.0 cm in the greatest diameter, with a solid and tan-white cut surface. Histologically, the tumor was mainly composed of spindle-shaped cells with a few foci of epithelial differentiation. Immunohistochemical studies were focally positive for cytokeratin, and diffusely positive for vimentin and bcl-2. Epithelial membrane antigen, S-100 protein, desmin, smooth muscle actin, calretinin, and CD34 were all negative. The SYT-SSX1 gene fusion transcript was detected by a reverse transcription- polymerase chain reaction, which was diagnostic of primary synovial sarcoma of the mediastinum. We also reviewed the literature with regard to the clinicopathologic, immunohistochemical, and molecular studies of primary intrathoracic synovial sarcoma