|
所属 |
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 |
学位論文 【 表示 ／ 非表示 】
-
Harmonization across programmed death ligand1(PD-L1) assays for lung cancer by immunohistochemistry using noncontact alternating current electric field mixing
Tsubasa Matsuo, Kazuhiro Imai, Hiroshi Nanjo, Shinogu Takashima, Yuko Hiroshima, Maiko Atari, Shoji Kuriyama, Yoshiaki Ishii, Yuki Wakamatsu, Yusuke Sato, Satoru Motoyama, Yuki Matsumura, Hiroyuki Suzuki, Kyoko Nomura, Yoshihiro Minamiya
Thoracic cancer 12 1187 - 1194 2022年09月 [査読有り]
研究等業績 【 表示 ／ 非表示 】
-
Perioperative strategies and management of giant anterior mediastinal tumors: a narrative review.
Kengo Tani, Daisuke Kimura, Tsubasa Matsuo, Takahiro Sasaki, Shuta Kimura, Chisaki Muto, Masahito Minakawa
Mediastinum (Hong Kong, China) 8 34 - 34 2024年
研究論文（学術雑誌）
BACKGROUND AND OBJECTIVE: Giant anterior mediastinal tumors sometimes may cause circulatory collapse and respiratory failure, known as mediastinal mass syndrome (MMS). The prediction and prevention of MMS is challenging. The aim of this study is to summarize the evaluation methods for MMS and formulate treatment strategies for giant anterior mediastinal tumors. METHODS: We performed a thorough analysis of recent international literature on giant anterior mediastinal tumors (>10 cm in diameter) and MMS published in the PubMed database. The search spanned the duration of the preceding 10 years from August 19, 2023, and only studies published in English were included. KEY CONTENT AND FINDINGS: Mature teratomas and liposarcomas are the most common giant anterior mediastinal tumors and MMS develops most frequently in case of malignant lymphomas. Here, we propose a new treatment strategy for giant anterior mediastinal tumors. Based on imaging findings, giant anterior mediastinal tumors can be classified as cystic or solid and further blood investigation data are useful for a definitive diagnosis. When malignant lymphoma or malignant germ cell tumor is highly suspected, the first choice of treatment is not surgery but chemotherapy and radiotherapy. Moreover, image-guided drainage may be effective if giant cystic anterior tumors develop into MMS. The risk classification of MMS is important for treating giant anterior mediastinal tumors. If the MMS risk classification is 'unsafe' or 'uncertain', the intraoperative management deserves special attention. The surgical approach should however be based on tumor localization and invasion of surrounding tissues. Multidisciplinary team coordination is indispensable in the treatment of giant anterior mediastinal tumors. CONCLUSIONS: When giant anterior mediastinal tumors are encountered, it is important to follow the appropriate treatment strategy, focusing on the development of MMS based on imaging findings and symptoms.
-
Wallenberg syndrome in a patient after pulmonary resection: a case report.
Tsubasa Matsuo, Daisuke Kimura, Kengo Tani, Takahiro Sasaki, Masahito Minakawa
General thoracic and cardiovascular surgery cases 2 ( 1 ) 48 - 48 2023年08月
研究論文（学術雑誌）
BACKGROUND: Cerebral infarction after pulmonary resection is a minor but critical complication. We report a rare case of postoperative complication of Wallenberg syndrome caused by cerebral infarction in the posterior inferior cerebral artery after the left upper lobectomy. CASE PRESENTATION: A 72-year-old man developed cerebral infarction 2 days after a left upper lobectomy for lung cancer. Magnetic resonance imaging indicated right vertebral artery occlusion following an early ischemic area on the right lateral side of the medulla oblongata and cerebellum. Contrast-enhanced computed tomography revealed no thrombus in the left superior pulmonary vein stump. The patient was diagnosed with Wallenberg syndrome, and prompt anticoagulation therapy was initiated. The patient was discharged and transferred to another hospital for rehabilitation on postoperative day 16. CONCLUSIONS: We present a rare case of Wallenberg syndrome occurring in the posterior inferior cerebral artery area due to vertebral artery occlusion after lobectomy. Because cerebral infarction of the posterior circulation has many similar symptoms due to the side effects of anesthetic drugs, careful physical examination is required to determine Wallenberg syndrome.
-
Rescue computed tomography-guided drainage of a giant mediastinal mature teratoma causing airway obstruction prior to surgical resection: a case report.
Kengo Tani, Daisuke Kimura, Tsubasa Matsuo, Yoshiaki Saito, Kageaki Taima, Shinya Kakehata, Akira Kurose, Masahito Minakawa
Surgical case reports 9 ( 1 ) 59 - 59 2023年04月
研究論文（学術雑誌）
BACKGROUND: Giant mediastinal mature teratomas may cause airway obstruction or decreased venous return due to the mass effect. Preoperative stabilization of the respiratory and circulatory systems is important for perioperative management to safely perform surgery, including general anesthesia. However, to the best of our knowledge, there are only a few reports regarding the preoperative computed tomography (CT)-guided drainage of mediastinal tumors. CASE PRESENTATION: A 30-year-old woman was admitted to the emergency room with sudden dyspnea. CT findings revealed a giant cystic mass in the anterior mediastinum compressing the trachea and the right main bronchus. The patient was intubated and CT-guided drainage of the fluid content of the cyst was performed to decompress the airway obstruction. Thereafter, the mediastinal tumor was resected during elective surgery and pathologically diagnosed as a mature teratoma. CONCLUSIONS: Rescue preoperative CT-guided drainage of a giant mediastinal mature teratoma allowed safe general anesthesia and surgery by releasing the airway obstruction.
-
手術の工夫 クラムシェル開胸および胸骨下部部分切開で切除した巨大縦隔脂肪肉腫
谷 建吾, 木村 大輔, 松尾 翼, 佐々木 嵩洋, 山口谷 健, 木村 脩太, 一戸 千咲, 加藤 翼, 皆川 正仁
胸部外科 ( 南江堂 ) 78 ( 12 ) 1007 - 1012 2025年11月
-
Imai K.
General Thoracic and Cardiovascular Surgery ( General Thoracic and Cardiovascular Surgery ) 73 ( 7 ) 506 - 513 2025年07月
OBJECTIVES: Tumors caused by failure of the DNA-mismatch repair system generally show microsatellite instability (MSI). High-frequency MSI cancers have been shown to be susceptible to immuno-oncology therapies. The aim of this study was to evaluate the clinical reliability of a rapid immunohistochemistry (IHC) technique for intraoperatively assessing molecular status through detection of tumoral deficiencies in the expression of mismatch repair proteins (dMMR; MLH1, MSH2, MSH6, and PMS2). METHODS: The rapid IHC method uses non-contact alternating current (AC) mixing to achieve more rapid/stable staining within a minimum of 13 min during surgery. Sixteen formalin-fixed paraffin-embedded (FFPE) tumor samples from 3 dMMR patients with Lynch syndrome and 6 FFPE samples from 6 dMMR-cancer patients were collected to establish an IHC protocol for MMR proteins. Next, 26 surgical patients treated and whose MSI status was determined using PCR-based tests were retrospectively analyzed. The concordance of dMMR diagnoses for thoracic tumors between the conventional (frozen section (FS)- and FFPE-IHCs) and rapid AC-mixing IHC with FSs were compared. RESULTS: A rapid IHC protocol using primary antibodies against four MMR proteins (mixed 5-10 min) was established (entire process within 40 min). The concordance rate for MMR-IHC between the conventional and rapid IHC was 100%. dMMR diagnoses including an MSI-high pulmonary sarcoma patient entirely matched between FS- and FFPE-IHC. CONCLUSION: Rapid MMR-IHC could potentially serve as a clinical tool for intraoperative determination of tumor MSI/dMMR status. AC-mixing technology will contribute to improving pathological diagnostic capability through the development of an original and innovative rapid IHC.
-
Takashima S.
Thoracic Cancer ( Thoracic Cancer ) 16 ( 8 ) e70077 2025年04月
BACKGROUND: As the population ages, the number of elderly lung cancer patients has been increasing. While surgery is the best treatment for resectable lung cancer, elderly patients often have multiple comorbidities, making accurate preoperative risk assessment crucial when formulating an appropriate treatment plan. This study aims to explore how psoas muscle volume relates to postoperative outcomes in elderly lung cancer patients. METHODS: This single-center, retrospective study included 344 elderly (≥ 75) patients who underwent complete surgical resection for non-small cell cancer between 2010 and 2023. The psoas muscle volume index (PVI, cm3/m3) was measured using a 3-dimensional imaging workstation based on preoperative computed tomography images and grouped based on the median value for each gender. Postoperative complications and survival rates were then compared between the groups. RESULTS: The median PVI was 60.5 cm3/m3 for males and 47.7 cm3/m3 for females. The PVI-high group had significantly fewer complications (15.6%) than the PVI-low group (37.1%) (p < 0.001). The 5-year overall survival (OS) rate was higher in the PVI-high group (80.5%) than in the PVI-low group (66.7%) (p = 0.01). Multivariate analyses showed that PVI-high was an independent predictor of lower complication risk (odds ratio 0.28, p < 0.001) and an independent factor that improved OS (hazard ratio 0.60, p = 0.042). CONCLUSIONS: PVI in elderly lung cancer patients is associated with postoperative complications and survival.
-
Kuriyama S.
Surgery Today ( Surgery Today ) 2025年
PURPOSE: Predicting perioperative complications in high-risk elderly patients with lung cancer has become increasingly important as the population ages. This study investigated the relationship between preoperative diaphragmatic thickness (DT) and perioperative complications. METHODS: We enrolled 101 patients ≥ 75 years old who had undergone radical resection for primary lung cancer between 2013 and 2018. Bilateral DT was measured on axial and coronal computed tomography, and the mean DT (MDT) was calculated based on these measurements. Outcomes were assessed based on postoperative complications, defined as Clavien-Dindo classification ≥ 2. RESULTS: The MDT was 3.51 ± 1.00 mm. Thirteen patients who experienced postoperative respiratory complications had a significantly lower MDT than a higher MDT (p = 0.0390). Multivariate logistic regression analyses revealed that an MDT ≤ 3.63 mm was an independent factor associated with postoperative complications (odds ratio, 5.559). CONCLUSIONS: Patients with a low MDT are at an increased risk of postoperative complications. Therefore, these patients require careful perioperative management.
-
当院における胸腺上皮性腫瘍手術の変遷と成績
松尾翼, 今井一博, 高嶋祉之具, 栗山章司, 岩井英頌, 鈴木陽香, 藤林立吉, 柴野菫, 南谷佳弘
日本呼吸器外科学会総会(Web) 42nd 2025年