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大学院医学系研究科（医学専攻等） 医学専攻 腫瘍制御医学系 胸部外科学講座 |
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Using CT to evaluate mediastinal great vein invasion by thymic epithelial tumors: measurement of the interface between the tumor and neighboring structures
Shoji Kuriyama, Kazuhiro Imai, Koichi Ishiyama, Shinogu Takashima, Maiko Atari, Tsubasa Matsuo, Yoshiaki Ishii, Yuzu Harata, Yusuke Sato, Satoru Motoyama, Kyoko Nomura, Manabu Hashimoto, Yoshihiro Minamiya
European Radiology 2022年09月 [査読有り]
単著
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A case of right middle lobectomy for primary lung cancer in a patient with heterotaxy syndrome.
Ryo Demura, Kazuhiro Imai, Shinogu Takashima, Nobuyasu Kurihara, Shoji Kuriyama, Haruka Suzuki, Yuzu Harata, Yoshihiro Minamiya
General Thoracic and Cardiovascular Surgery Cases 3 ( 1 ) 52 - 52 2024年11月
研究論文（学術雑誌）
BACKGROUND: Anatomical abnormalities in the pulmonary vessels have long aroused great interest among thoracic surgeons, and numerous variations of pulmonary vessels have been reported. Heterotaxy syndrome is an anatomical abnormality in which typically asymmetrical organs, including the lungs, develop symmetrically. We report the case of a 71-year-old man with heterotaxy syndrome undergoing radical lobectomy in the treatment of non-small cell lung cancer. CASE PRESENTATION: Computed tomography (CT) revealed an irregular nodule 25 mm in diameter in the right middle lobe. Two months later, at his first visit to our University Hospital, CT revealed a rapidly growing tumor 60 mm in diameter. In addition, three-dimensional (3D) CT revealed the upper and middle lobar bronchi forming a common trunk with the mediastinal type of the right pulmonary artery (PA). The patient underwent video-assisted right middle lobectomy + systematic complete hilar and mediastinal lymph node dissection. The interlobar fissure between the right upper and middle lobes was incomplete, and the common trunk formed by the upper-middle bronchus emerged from an area between the right PA (A1+3) and the right superior pulmonary vein. CONCLUSION: The finding of A4+5 branching from the right main PA and descending posterior to the right upper-middle bronchus, which formed a common trunk, resembled a mirror image of the normal left lung. To our knowledge, a common trunk with the mediastinal type of the right PA has never been reported during video-assisted right middle lobectomy. In patients with heterotaxy syndrome, 3D-CT to preoperatively understand their anatomy is essential.
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Tracheal bifurcation repair for blunt thoracic trauma in a patient with COVID-19.
Shoji Kuriyama, Kazuhiro Imai, Kasumi Tozawa, Shinogu Takashima, Ryo Demura, Haruka Suzuki, Yuzu Harata, Tatsuki Fujibayashi, Sumire Shibano, Yoshihiro Minamiya
Surgical case reports 9 ( 1 ) 108 - 108 2023年06月
研究論文（学術雑誌）
BACKGROUND: Tracheobronchial injury (TBI) is a rare but potentially life-threatening trauma that requires prompt diagnosis and treatment. We present a case in which a patient with COVID-19 infection was successfully treated for a TBI through surgical repair and intensive care with extracorporeal membrane oxygenation (ECMO) support. CASE PRESENTATION: This is the case of a 31-year-old man transported to a peripheral hospital following a car crash. Tracheal intubation was performed for severe hypoxia and subcutaneous emphysema. Chest computed tomography showed bilateral lung contusion, hemopneumothorax, and penetration of the endotracheal tube beyond the tracheal bifurcation. A TBI was suspected; moreover, his COVID-19 polymerase chain reaction screening test was positive. Requiring emergency surgery, the patient was transferred to a private negative pressure room in our intensive care unit. Due to persistent hypoxia and in preparation for repair, the patient was started on veno-venous ECMO. With ECMO support, tracheobronchial injury repair was performed without intraoperative ventilation. In accordance with the surgery manual for COVID-19 patients in our hospital, all medical staff who treated this patient used personal protective equipment. Partial transection of the tracheal bifurcation membranous wall was detected and repaired using 4-0 monofilament absorbable sutures. The patient was discharged on the 29th postoperative day without postoperative complications. CONCLUSIONS: ECMO support for traumatic TBI in this patient with COVID-19 reduced mortality risk while preventing aerosol exposure to the virus.
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Inferior pulmonary ligament division during left upper lobectomy causes pulmonary dysfunction
Shoji Kuriyama, Kazuhiro Imai, Hajime Saito, Shinogu Takashima, Nobuyasu Kurihara, Ryo Demura, Haruka Suzuki, Yuzu Harata, Yusuke Sato, Katsutoshi Nakayama, Kyoko Nomura, Yoshihiro Minamiya
Interdisciplinary cardiovascular and thoracic surgery 2023年05月 [査読有り]
研究論文（学術雑誌） 単著
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Kuriyama S.
European Radiology ( European Radiology ) 32 ( 3 ) 1891 - 1901 2022年03月 [査読有り]
研究論文（学術雑誌）
OBJECTIVES: For thymic epithelial tumors, simple contact with adjacent structures does not necessarily mean invasion. The purpose of our study was to develop a simple noninvasive technique for evaluating organ invasion using routine pretreatment computed tomography (CT). METHODS: This retrospective study analyzed the pathological reports on 95 mediastinal resections performed between January 2003 and June 2020. Using CT images, the length of the interface between the primary tumor and neighboring structures (arch distance; Adist) and maximum tumor diameter (Dmax) was measured, after which Adist/Dmax (A/D) ratios were calculated. Receiver operating characteristic (ROC) curves were used to analyze the Adist and A/D ratios. RESULTS: An Adist cut-off of 37.5 mm best distinguished between invaded and non-invaded mediastinal great veins based on ROC curves. When Adist > 37.5 mm was used for diagnosis of invasion of the brachiocephalic vein (BCV) or superior vena cava (SVC), the sensitivity, specificity, positive predictive value, negative predictive value, accuracy, and area under the ROC curve for diagnosis of invasion were 61.9%, 92.5%, 81.25%, 82.2%, 81.97%, and 0.76429, respectively. Moreover, there were significant differences between BCV/SVC Adist > 37.5 mm and ≤ 37.5 mm for 10-year relapse-free survival and 10-year overall survival (p < 0.01). CONCLUSIONS: When diagnosing invasion of the mediastinal great veins based on Adist > 37.5 mm, we achieved a higher performance level than the conventional criteria such as irregular interface with an absence of the fat layer. Measurement of Adist is a simple noninvasive technique for evaluating invasion using CT. Key Points • Simple contact between the primary tumor and adjacent structures on CT does not indicate direct invasion. • Using CT images, the length of the interface between the primary tumor and neighboring structures (arch distance; Adist) is a simple noninvasive technique for evaluating invasion. • Adist > 37.5 mm can be a supportive tool to identify invaded mediastinal great veins and surgical indications for T3 and T4 invasion by thymic epithelial tumors.
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[Surgical Resection of the Rib Fragment to Prevent Lung Injury in a Patient with Chest Trauma:Report of a Case].
Shoji Kuriyama, Daisuke Kimura, Shunsuke Kubota
Kyobu geka. The Japanese journal of thoracic surgery 74 ( 5 ) 397 - 400 2021年05月
研究論文（学術雑誌）
An 82-year old man was admitted for a left fifth rib fracture with traumatic pneumothorax. Computed tomography showed a sharp rib fragment protruding into the thoracic cavity. Thoracic drainage was not performed before surgery to avoid lung injury by the rib fragment. At surgery, fifth rib fragment protruding into the thoracic cavity was found, but lung injury was not present. The bone fragment was removed, and the patient's postoperative course was uneventful.
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Extracorporeal Membrane Oxygenation-Assisted Thoracic Surgery: A Series of 10 Cases
Harata Yuzu, Imai Kazuhiro, Takashima Shinogu, Kuriyama Shoji, Iwai Hidenobu, Suzuki Haruka, Demura Ryo, Shibano Sumire, Minamiya Yoshihiro
Surgical Case Reports ( 一般社団法人 日本外科学会 ) 11 ( 1 ) n/a 2025年
<p><b>INTRODUCTION:</b> Extracorporeal membrane oxygenation (ECMO) is a type of extracorporeal circulation used to divert blood from and deliver blood to peripheral blood vessels. Recently, the use of ECMO has been reported in various non-transplant surgeries. Particularly in tracheal surgeries, ECMO provides an unobstructed surgical field and enables safe induction of general anesthesia in difficult intubation cases. Here, we report on 10 cases of thoracic surgery in which ECMO was employed at our institution.</p><p><b>CASE PRESENTATION:</b> These 10 cases comprise 4 tracheal cancer surgeries, 2 lung cancer surgeries, and 1 case each of surgery for thyroid cancer, mediastinal cancer, tracheomalacia, and tracheobronchial injury. Veno-venous (VV)-ECMO is most often selected, but veno-arterial (VA)-ECMO is chosen when recirculation with VV-ECMO is unacceptable, when pulmonary artery bleeding needs to be controlled, or when cardiac support is necessary. Among the 10 presented cases, VV-ECMO was used in 8, while VA-ECMO was employed in 2. Three of these cases involved ECMO bailout due to dyspnea caused by airway stenosis. Six of the patients did not receive heparin maintenance. Of those, 1 was maintained on nafamostat mesilate, 2 were maintained on nafamostat mesilate after receiving a single dose of heparin, and 3 received only a single dose of heparin. In none of those cases did ECMO fail to maintain flow due to thrombus formation. A postoperative hemothorax occurred as one of the ECMO-related complications in Case 4. There were no perioperative cardiopulmonary complications, in-hospital deaths, or deaths within 30 days after surgery. One patient died from metastatic recurrence of non-small cell lung cancer 5 months after surgery, another from progression of disease in mediastinal anaplastic cancer 4 months after surgery, and the 3rd from upper gastrointestinal bleeding 2 years after surgery. The other 7 patients remain alive.</p><p><b>CONCLUSIONS:</b> ECMO is useful in tracheal surgery and in cases where intubation is difficult or dangerous, because it facilitates safe and accurate surgery. We also believe that individualized anticoagulant strategies can be safely implemented.</p>
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Kuriyama S.
Pathobiology ( Pathobiology ) 91 ( 6 ) 383 - 392 2024年12月
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Imai K.
Cancer Imaging ( Cancer Imaging ) 24 ( 1 ) 69 - 69 2024年12月
BACKGROUND: Accurate clinical staging is crucial for selection of optimal oncological treatment strategies in non-small cell lung cancer (NSCLC). Although brain MRI, bone scintigraphy and whole-body PET/CT play important roles in detecting distant metastases, there is a lack of evidence regarding the indication for metastatic staging in early NSCLCs, especially ground-grass nodules (GGNs). Our aim was to determine whether checking for distant metastasis is required in cases of clinical T1N0 GGN. METHODS: This was a retrospective study of initial staging using imaging tests in patients who had undergone complete surgical R0 resection for clinical T1N0 Stage IA NSCLC. RESULTS: A total of 273 patients with cT1N0 GGNs (n = 183) or cT1N0 solid tumors (STs, n = 90) were deemed eligible. No cases of distant metastasis were detected on initial routine imaging evaluations. Among all cT1N0M0 cases, there were 191 incidental findings on various modalities (128 in the GGN). Most frequently detected on brain MRI was cerebral leukoaraiosis, which was found in 98/273 (35.9%) patients, while cerebral infarction was detected in 12/273 (4.4%) patients. Treatable neoplasms, including brain meningioma and thyroid, gastric, renal and colon cancers were also detected on PET/CT (and/or MRI). Among those, 19 patients were diagnosed with a treatable disease, including other-site cancers curable with surgery. CONCLUSIONS: Extensive staging (MRI, scintigraphy, PET/CT etc.) for distant metastasis is not required for patients diagnosed with clinical T1N0 GGNs, though various imaging modalities revealed the presence of adventitious diseases with the potential to increase surgical risks, lead to separate management, and worsen patient outcomes, especially in elderly patients. If clinically feasible, it could be considered to complement staging with whole-body procedures including PET/CT.
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Kuriyama S.
Thoracic Cancer ( Thoracic Cancer ) 15 ( 21 ) 1681 - 1684 2024年07月
When a mass occurs at the staple line following lung resection, it can be difficult to distinguish between local cancer recurrence and granuloma. We present a case of a staple-line granuloma with 18F-fluorodeoxyglucose-positron emission tomography uptake and elevated serum carbohydrate antigen 19-9 (CA19-9) in a patient with ovarian cancer lung metastasis. After granuloma resection, serum CA19-9 levels normalized, and CA19-9 positive cells were identified in the resected tumor. Therefore, serum CA19-9 elevation does not rule out a staple-line granuloma. Whereas granulomas on computed tomography (CT) scans tend to show smooth shadows along the staple line unilaterally, detailed CT evaluation may help diagnostic differentiation. Differentiation based on imaging and tumor markers has limitations. However, core needle biopsy has the risk of misdiagnosis and tumor cell dissemination, therefore surgical resection should be considered when comprehensive findings indicate a potential recurrence.
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再生検が有用であった再発胸腺上皮性腫瘍の経験
鈴木 陽香, 今井 一博, 高嶋 祉之具, 栗山 章司, 岩井 英頌, 出村 遼, 原田 柚子, 柴野 菫, 南谷 佳弘, 南條 博
日本呼吸器外科学会雑誌 ( (一社)日本呼吸器外科学会 ) 38 ( 3 ) MO55 - 4 2024年04月
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呼吸サルコペニアが肺癌周術期に与える影響の検討
若手研究
研究期間: 2024年04月 - 2027年03月 代表者: 栗山 章司
その他競争的資金獲得実績 【 表示 ／ 非表示 】
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呼吸サルコペニアが肺癌周術期に与える影響についての検討
提供機関: 秋田大学 秋田大学若手研究者支援事業
研究期間： 2023年08月 - 継続中
資金支給機関区分：その他
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COVID-19感染を伴う外傷性気管分岐部損傷に対してECMO下に修復術を施行した1例
栗山章司, 今井一博, 髙嶋祉之具, 栗原伸泰, 鈴木陽香, 出村遼, 原田柚子, 南谷佳弘
日本呼吸器外科学会総会 2023年05月 - 2023年05月
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The Postoperative Impacts of Inferior Pulmonary Ligament Division During Upper Lobectomy
Shoji Kuriyama, Kazuhiro Imai, Shinogu Takashima, Nobuyasu Kurihara, Ryo Demura, Haruka Suzuki, Yuzu Harata, Yoshihiro Minamiya
日本胸部外科学会定期学術集会 2022年11月 - 2022年11月
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マルチプレックス免疫染色法の術中迅速診断への応用
栗山章司, 今井一博, 髙嶋祉之具, 中麻衣子, 石井良明, 小林昭仁, 小林未来, 原田柚子, 南谷佳弘
日本呼吸器外科学会総会 2022年05月 - 2022年05月
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過剰気管気管支を有する右上葉に発生した肺癌の1切除例
栗山章司, 木村大輔, 今井一博, 髙嶋祉之具, 中麻衣子, 石井良明, 小林昭仁, 髙橋秀悟, 原田柚子, 皆川正仁, 南谷佳弘
日本肺癌学会学術集会 2021年11月 - 2021年11月
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Using CT to evaluate organ invasion by thymic epithelial tumors: measurement of the interface between the tumor and neighboring structures
Shoji Kuriyama, Kazuhiro Imai, Shinogu Takashima, Maiko Atari, Yoshiaki Ishii, Akihito Kobayashi, Shugo Takahashi, Yuzu Harata, Yoshihiro Minamiya
日本胸部外科学会定期学術集会 2021年10月 - 2021年11月