Is lung resection appropriate for late octogenarians? Surgical outcomes of patients aged ≥ 80 years with lung cancer

Purpose This study aimed to determine the outcomes and prognostic factors associated with octogenarians who underwent pulmonary resection for lung cancer. Methods/patients From 2009 to 2018, 76 octogenarians underwent pulmonary surgery for lung cancer at the Kanazawa Medical University, Japan. They were divided into two groups (early and late octogenarians), and their clinicopathological characteristics and outcomes were investigated. Overall survival rates and recurrence-free survival rates were determined using Kaplan–Meier curves. Univariate and multivariate analyses were performed to identify prognostic factors. Results Limited surgery was performed more often in the late octogenarian group; however, most perioperative factors were not significantly different between the two groups. The 3-year overall survival and recurrence-free survival rates were 61.2% and 52.8%, respectively. The median observation period was 37.5 (8.9–112.3) months postoperatively. Kaplan–Meier curves showed that age ≥ 85 years (late octogenarian), smoking history, and squamous cell carcinoma on histology were associated with worse survival rates. Multivariate analysis identified age ≥ 85 years (late octogenarian) (p = 0.011) and cigarette smoking (p = 0.025) as unfavorable prognostic factors for overall survival and recurrence-free survival, respectively. Conclusions Most octogenarians with an indication for surgery can tolerate pulmonary surgery. However, owing to the limitations of this retrospective, single-center study, future studies involving multiple-institutions are required to confirm our findings (AU)

Is lung resection appropriate for late octogenarians? Surgical outcomes of patients aged ≥ 80 years with lung cancer.

PURPOSE: This study aimed to determine the outcomes and prognostic factors associated with octogenarians who underwent pulmonary resection for lung cancer. METHODS/PATIENTS: From 2009 to 2018, 76 octogenarians underwent pulmonary surgery for lung cancer at the Kanazawa Medical University, Japan. They were divided into two groups (early and late octogenarians), and their clinicopathological characteristics and outcomes were investigated. Overall survival rates and recurrence-free survival rates were determined using Kaplan-Meier curves. Univariate and multivariate analyses were performed to identify prognostic factors. RESULTS: Limited surgery was performed more often in the late octogenarian group; however, most perioperative factors were not significantly different between the two groups. The 3-year overall survival and recurrence-free survival rates were 61.2% and 52.8%, respectively. The median observation period was 37.5 (8.9-112.3) months postoperatively. Kaplan-Meier curves showed that age ≥ 85 years (late octogenarian), smoking history, and squamous cell carcinoma on histology were associated with worse survival rates. Multivariate analysis identified age ≥ 85 years (late octogenarian) (p = 0.011) and cigarette smoking (p = 0.025) as unfavorable prognostic factors for overall survival and recurrence-free survival, respectively. CONCLUSIONS: Most octogenarians with an indication for surgery can tolerate pulmonary surgery. However, owing to the limitations of this retrospective, single-center study, future studies involving multiple-institutions are required to confirm our findings.

[Intracavity drainage under local anesthesia for giant emphysematous bulla and infected bulla].

We performed a retrospective review of 9 patients who underwent intracavity drainage under local anesthesia for emphysematous bulla and infected bulla between 1996 and 2010. Three patients with giant emphysematous bulla were treated intracavity drainage. Pneumothorax occurred and was treated by chest tube in all cases. Radiographic and symptomatic improvement occurred in all patients. After that, bullectomy was performed safely in 2 patients and intrabullar suction with fibrin glue was performed in 1. There were 6 cases with infected bulla that was not improved by the administration of antibiotics. After intracavity drainage, control of infection was achieved, and all but 1 patient were discharged without drain and complications. Intracavity drainage under local anesthesia is a safe and effective treatment for giant emphysematous bulla and infected bulla.

[Successful perioperative management with plasma exchange for elderly patient with myasthenia gravis; report of a case].

A 75-years-old woman was presented with nonthymomatous myasthenia gravis. She was treated with anticholinesterase which did not improve her outcome. The clinical classification of the Myasthenia Gravis Foundation of America (MGFA) was IVa. Before thymectomy, her bulbar symptoms got worse, but rapid improvement was obtained by plasma exchange. She had undergone transsternal extended thymectomy and there was no critical event after thymectomy. She had been treated with prednisolone for 12 months and pharmacological remission was recorded.

[Single-stage operation for synchronous bilateral multiple lung cancer through median sternotomy].

An asymptomatic 65-year-old woman was incidentally found to have abnormal shadows on a chest X-ray during a medical examination. A chest computed tomography (CT) scan showed a pulmonary nodule in both right and left lung. Those were diagnosed as synchronous cStage IA bilateral lung cancer, and right upper lobectomy and segmentectomy of the left lung with lymphoadenectomy were sequentially performed through median sternotomy. The patient showed a favorable course after surgery, and was discharged on postoperative day 12. The pathological diagnosis was synchronous lung cancer and both were adenocarcinoma. The pathological stage was IA on the right side and IB on the left. A single-stage operation through median sternotomy was a useful surgical procedure for treating this case of synchronous bilateral lung cancer.

[Bronchoplastic procedures for lung cancer].

Bronchoplastic procedures for patients with lung cancer are designed to achieve radical cure with preservation of functioning lung parenchyma. The operative results of 139 cases of lung cancer who underwent bronchoplasty between 1963 through 2007 were reviewed. The mean age of the patients was 62.5 years (range, 20 to 78 years). Sleeve lobectomy (SL) was performed in 119 cases, wedge lobectomy (WL) in 10 cases, sleeve segmentectomy (SS) in 5 cases, wedge segmentectomy (WS) in 2 cases, sleeve resection (SR) in 2 cases, and wedge resection (WR) in 1 case. Squamous cell carcinoma was the most frequently encountered histological type of disease (78%), followed by adenocarcinoma (12%) and other histological types (10%). The tumor was central in 125 patients (90%) and peripheral with nodal involvement in 14 patients (10%). Vascular resection and reconstruction was performed in 16 patients. Early major bronchial anastomotic complications occurred in 6 patients (4.3%). The 5-year survival rate in the patients with squamous cell carcinoma was 63.2%, and in patients with adenocarcinoma was 26.3%. SS for patients with early-stage squamous cell carcinoma of the segmental bronchus is a curative operation with preservation of the pulmonary function. Bronchoplasty without lung resection (SR, WR) is a reliable method for patients with low-grade malignant polypoid tumors arising from the bronchus. Patients with adenocarcinoma, N2 disease or major bronchial anastomotic complication show a worse prognosis.

[Successful perioperative management with non-invasive positive pressure ventilation in muscular dystrophy with thymoma; report of a case].

We report a case of muscular dystrophy with thymoma that was detected by chance at the examination of his fatal arrhythmia. He has hypercapnea and restrictive pulmonary disfunction, but non-invasive positive pressure ventilation (NPPV) had not been introduced. Thymo-thymectomy was performed through reversed L-shaped mediansternotomy. NPPV was effective in his perioperative management.

[Castleman disease arising from cardiophrenic angle; report of a case].

We report the first case of Castleman disease arising from cardiophrenic angle. The patient was referred to our hospital to treat his mediastinal tumor. Computed tomography (CT) showed a well-enhanced mass arising from the right cardiophrenic angle. We speculated the tumor to be a Castleman disease or hemangioma. Right thoracotomy was performed, and the tumor was removed after the ligation of the feeding artery and drainage vein. The histological findings of the tumor led to a diagnosis of Castleman disease hyaline vascular type.

Crush and imprint cytology of subependymoma: a case report.

BACKGROUND: There are few descriptions of the cytologic features of subependymoma because this neoplasm is rare and most commonly encountered incidentally at autopsy. Here we report a surgical case of subependymoma occurring in the lateral ventricle and provide the first documentation of the crush cytologic features of this tumor. CASE: A 34-year-old woman was found to have a tumorous lesion in the right lateral ventricle. At surgery, a 2-cm-diameter tumor was detected in the anterior horn. Histologic examination during surgery revealed that the mass was composed of loose,fibrillary networks and clusters of nuclei showing mild pleomorphism. A number of microcystic formations were evident. Histologically, the neoplasm was considered benign--specifically, a subependymoma. Papanicolaou- or Giemsa-stained crush specimens and imprint smears were also prepared. The cytologic morphology was fundamentally the same as the histologic. In the crush specimens, microcystic formations were readily visible. Moreover, details of the cellular morphology were more easily recognized in the cytologic slides than in the frozen sections. CONCLUSION: Cytologic examination, particularly crush cytology, appears to be useful for the rapid diagnosis of subependymoma during surgery in combination with the examination of frozen histologic sections.

Immunohistochemical study of CA 19-9 and SPan-1 in cases of hydronephrosis.

Although the serum level of carbohydrate antigen (CA) 19-9 is reportedly increased in patients with hydronephrosis, virtually no immunohistochemical studies of this condition have been performed. Therefore, we examined immunohistochemically 11 hydronephrotic kidneys and 3 normal control kidneys using antibodies against CA 19-9 and SPan-1, another sialylated carbohydrate antigen. Immunoreactivity for CA 19-9 was seen in the transitional and tubular epithelia in most of the hydronephrotic kidneys (9 of the 11 cases), and also detected in 2 of the 3 control specimens, although there the distribution appeared to be limited. SPan-1 immunoreactivity showed the same trend. CA 19-9 and SPan-1 immunoreactivity in hydronephrosis appeared to be more widely distributed than in controls, although its mechanism remains unclear.