Naoki Ozeki

Background: Excessive oxygen administration during surgery may induce lung damage via oxidative stress; however, limited evidence exists on how intraoperative oxygen usage and preoperative pulmonary function predict acute exacerbation (AE) in patients with interstitial lung disease (ILD). This study evaluated whether intraoperative oxygen use and preoperative pulmonary function could predict postoperative AEs in patients with ILD who underwent lung surgery. Methods: We retrospectively analyzed 78 patients with ILD who underwent lung surgery between 2014 and 2022. Clinical variables, including intraoperative oxygen usage and preoperative pulmonary function tests, were assessed for their association with AEs occurring within 1 month (1mAE) and 1 year (1yAE) postoperatively using Firth’s bias-reduced logistic regression. Results: Eight patients (10%) had 1mAE, and 14 (18%) had 1yAE. Multivariable analysis showed that lower %vital capacity (%VC) consistently predicted both 1mAE and 1yAE, whereas lower %diffusing capacity for carbon monoxide (%DLCO) significantly predicted only 1yAE. Notably, total oxygen administration > 990 L exhibited a marginal association with 1mAE (OR 2.12, 95% CI: 0.93–4.99, p = 0.071). Even after adjusting for operative and anesthesia durations, total oxygen volume remained a significant independent predictor for 1yAE (OR 2.29, 95% CI: 1.09–4.93, p = 0.029). No significant associations were found between AEs and factors such as the mean fraction of inspired oxygen (FiO ₂ ), forced expiratory volume in 1 s, sex, preoperative steroid use, computed tomography patterns, serum Krebs von den Lungen-6 levels, or surgical procedures. Conclusions: Cumulative intraoperative oxygen administration (rather than mean FiO2) serves as an independent predictor of long-term postoperative AEs in patients with ILD. These findings suggest that cumulative oxygen exposure may contribute to long-term postoperative risk through mechanisms related to oxidative stress. Trial registration: Aichi Medical University 2025-011.

Objective This study aimed to demonstrate to the involved departments the goal of increasing the number of robotic-assisted thoracic surgery (RATS) cases/surgeons and acceptable surgery times. Methods This retrospective study included 1572 patients who underwent thoracic surgery from fiscal year (FY) 2018 to FY 2021. The factors evaluated included the number of surgery cases and actual and scheduled surgery times. Results The total number of RATS and total surgery cases increased after the quality indicator (QI) setting (n = 363, 360, 417, and 432 in FY 2018, 2019, 2020, and 2021, respectively). In FY 2020, 93.3% of the QI target was achieved, while in FY 2021, 88% was achieved. The number of RATS lobectomy/segmentectomy increased as the FY progressed (n = 31, 47, 58, and 116 in FY 2018, 2019, 2020, and 2021, respectively). The mean surgical time by RATS starters decreased in FY 2020 and 2021 (171.4 min.; 74 cases; seven RATS starters) compared with those in FY 2018 and 2019 (198.0 min.; 57 cases; six RATS starters) (P = 0.002). Conclusions The goal of increasing the number of surgery cases and RATS cases/surgeons within the given framework was achieved by setting the QI.

Original Article Skeletal muscle and related protein expression as prognostic factors in thymic squamous cell carcinoma Keita Nakanishi, Naoki Ozeki, Hisashi Tateyama, Yuka Kadomatsu, Harushi Ueno, Masaki Goto, Shota Nakamura, Koichi Fukumoto, Toyofumi Fengshi Chen-Yoshikawa

Background: Empyema is a serious complication of lung surgery. Case presentation: We report a case of Streptococcus anginosus empyema complicated by descending necrotizing fasciitis after surgery. Ten days after the initial surgery, the patient presented with arrhythmia and hypotension with septic shock. Pleural fluid analysis led to the diagnosis of empyema, and surgical debridement (second surgery) was performed. One week after the emergency surgery, a palpable pink erythematous skin change was observed on the ipsilateral iliac crest. Hence, the second emergency surgery (third surgery) was performed to debride the subcutaneous and intramuscular abscesses. Conclusions: The possibility of descending abscess and necrotizing fasciitis should be considered when Streptococcus anginosus is detected.

Background: Postoperative loss of exercise capacity and pulmonary function is a major concern among lung cancer patients. In this study, the time for a stair‐climbing to 12‐m height was used to investigate whether preoperative chest 3D‐computed tomography (CT) could be a useful tool for predicting postoperative variations in exercise capacity and pulmonary function.Methods: Seventy‐eight patients undergoing lobectomy for suspected stage I lung cancer were prospectively enroled. Preoperatively, lobe volume and low attenuation volume (LAV) were evaluated using the SYNAPSE VINCENT system. Preoperative data on stair‐climbing time, spirometry and diffusing capacity of the lung for carbon monoxide (DL_CO) at baseline and 6‐month postoperative data were used to evaluate variations in exercise capacity and pulmonary function. Maximal oxygen uptake (VO₂t) was evaluated based on the stair‐climbing time.Results: Significant differences in the variation of exercise capacity at 6 months postoperatively were found between the groups categorized by target lobe volume and LAV status: The large volume/LAV (+) group had a greater decline in VO₂t. Mean loss of VO₂t was −6.2%, −1.4%, −1.6% and −0.1% in the large volume/LAV (+), large volume/LAV (−), small volume/LAV (+) and small volume/LAV (−) groups, respectively. The large volume/LAV (−) group had a greater decline in forced expiratory volume in 1 s. The small volume/LAV (+) group showed a reduced decline in the DL_CO.Conclusions: Analysis of chest 3D‐CT scans is a potential tool for predicting the loss of exercise capacity and pulmonary function after lung lobectomy.

Background: Considering advances in current post‐recurrence treatment, we examined the prognostic significance of the number of risk factors for loss‐of‐exercise capacity (LEC) after lung cancer surgery, which were identified by our previous prospective observational study.Methods: Risk factors for LEC were defined as a short baseline 6‐min walk distance (n = 307, 193, 57, 7; Risk 0/I/II/III) who underwent lung cancer surgery were included in the study. The number of risk factors was associated with smoking status, predicted postoperative forced expiratory volume in 1 s, histology, pathological stage, and adjuvant therapy. In a multivariate Cox regression analysis, compared to Risk 0, Risk I/II/III showed significant associations with overall survival (hazard ratios: 1.92, 3.35, 9.21; 95% confidence interval: 1.27–2.92, 2.01–5.58, 3.64–23.35; Risk I/II/III, respectively). In 141 patients with recurrence, molecular targeted therapies (MTTs) or immune checkpoint inhibitors (ICIs) were included in 58%, 47%, 32%, and 0% (Risk 0/I/II/III) during the course of treatment. In patients with MTT/ICI treatment, the estimated 1‐year and 3‐year post‐recurrence survival rates were 88% and 58%, respectively.Conclusions: Risk classification for LEC was associated with survival after lung cancer surgery, as well as post‐recurrence treatment. The concept of physical performance‐preserving surgery may contribute to improving the outcomes of current lung cancer treatment.

患者は61歳 女性．胸部CTにて偶発的に前縦隔に腫瘤状陰影を指摘された．CTでは前縦隔に4.4 cm大の境界明瞭で辺縁不整な充実性腫瘤を認めた．PET-CTでは腫瘍に一致してSUVmax 12.07のFDG集積を認めた．重症筋無力症様症状はなく，抗アセチルコリンレセプター抗体は陰性であった．以上より，胸腺癌疑いにて手術を施行した．胸骨正中切開にて胸腺摘出術を施行し，浸潤が疑われた心膜は合併切除再建した．病理組織検査では，高円柱状の粘液産生性細胞が増殖しており，免疫染色ではCK7（－），CK20（＋），CDX-2（＋）であった．腫瘍は心膜及び胸膜浸潤を認め，リンパ節転移は認めなかった．消化管に腫瘍性病変を認めず，悪性疾患の既往もなかったため，病理診断は胸腺原発粘液腺癌pT2N0M0 StageII，正岡III期となった．極めて稀な胸腺原発粘液腺癌の1手術例を経験したので報告する．

Background: Despite the associations of both preoperative sarcopenia and physical performance with post‐operative mortality in non‐small‐cell lung cancer (NSCLC), there have been no comprehensive studies of the impact of physical status on prognosis. This study was performed to investigate the prognostic significance of preoperative sarcopenia and physical performance in NSCLC. Methods: This retrospective cohort study was performed in NSCLS patients undergoing curative lung resection at a university hospital between January 2014 and December 2017. The patients were divided into four groups according to the skeletal muscle index [sarcopenia (lowest sex‐specific tertile) and non‐sarcopenia] and 6 min walking distance (6MWD) [short distance (P < 0.001) and DFS (hazard ratio, 2.11; 95% confidence, 1.27–3.51; P = 0.004) compared with the non‐sarcopenia/long‐distance group on multivariate analyses. Although not significant, adding skeletal muscle index and 6MWD to the pre‐existing risk model increased the area under the curve on time‐dependent receiver operating characteristic curve analysis for OS and DFS, except within 2 years of surgery. Conclusions: The presence of both preoperative paraspinous muscle sarcopenia and short distance in 6MWD had an adverse effect on post‐operative prognosis in patients with NSCLC, suggesting that preoperative assessment of thoracic sarcopenia and physical performance may be useful for risk stratification of surgical candidates with potential for targeted interventions.

Objective Postoperative loss-of-exercise capacity is one of the main concerns for patients undergoing lung cancer surgery. This study was designed to identify the factors associated with loss-of-exercise capacity after lobectomy, using an easy surrogate measure: the 12-m stair-climbing time (SCt). Methods Ninety-eight patients undergoing lobectomy for suspected stage I lung cancer were prospectively enrolled. SCt and pulmonary function test were evaluated preoperatively as baseline and at 6 months postoperatively. At 6 months postoperatively, 20 patients dropped out. Loss-of-exercise capacity was defined as at least a 3.3% decline (lower quartile) in the estimated maximal oxygen uptake (VO₂t: 43.06 − 0.4 × SCt). Factors associated with loss-of-exercise capacity were analyzed. Results Median (interquartile range) baseline SCt was 31.5 (28.2–36.7) s. Baseline SCt was not significantly associated with complications. At 6 months postoperatively, SCt increased by + 4.4 (+ 3.2, + 6.8) s in patients with loss-of-exercise capacity. Sex, smoking status, lobe, procedure, and forced expiratory volume in 1 s showed no significant association with loss-of-exercise capacity. In the multivariable logistic regression, older age (≥ 73 years) (odds ratio: 5.25, 95% confidence interval: 1.50–18.43, p = 0.010) and lower baseline diffusing capacity of the lung for carbon monoxide (< 75%) (odds ratio: 9.23, 95% confidence interval: 1.94–43.93, p = 0.005) were significantly associated with loss-of-exercise capacity. Conclusion Age and the baseline diffusing capacity of the lung for carbon monoxide were identified as significant variables associated with variation of exercise capacity after lung cancer surgery, using pre- and postoperative SCt.