Kenta Nakahashi

Background: The purpose of this study was to investigate better radiological prognostic factors in clinical T1 pure‐solid non‐small cell lung cancer (NSCLC).Methods: This study enrolled 284 patients with clinical T1 solid NSCLC who underwent anatomical lung resection. The Cox proportional hazard model was used to evaluate the prognostic impact of tumor volume doubling time (VDT) at disease‐free survival (DFS) and cancer‐specific survival (CSS).Results: The median VDT was 347 days. Age (hazard ratio (HR) = 1.04; 95% confidence interval (CI), 1.01–1.07) and standardized uptake value max (SUVmax) (>6.0) (HR = 2.61; 95% CI, 1.52–4.66) were identified as significantly independent worse prognostic factors for DFS in a multivariable analysis without VDT. Furthermore, a multivariable analysis without SUVmax identified age (HR = 1.06; 95% CI, 1.03–1.09), CEA (>5.0 ng/ml) (HR = 2.34; 95% CI, 1.30–4.02), tumor diameter on CT (>2.0 cm) (HR = 1.91; 95% CI, 1.18–3.13), and VDT (HR = 4.03; 95% CI, 2.41–6.93) as significantly independent worse prognostic factors for DFS.Conclusions: The VDT value could be a useful prognostic factor in clinical T1 solid NSCLC.

Background: The subcategory "solid component of tumor" is a new criterion of tumor categories in the updated eighth edition of the TNM classification. Nevertheless, the predictors of lymph node metastasis among patients with clinical T1 adenocarcinoma, based on the TNM classification 8th edition, remain unclear. This study aimed to identify the preoperative predictors of lymph node metastasis in clinical T1 adenocarcinoma by comparing clinicopathological characteristics between the groups with and without lymph node metastasis. Methods: We performed a retrospective observational single-center study at the Sendai Kousei Hospital. From January 2012 to September 2019, we included 515 patients who underwent curative lobectomy or segmentectomy and mediastinal lymph node dissection among those with clinical T1 adenocarcinoma according to the UICC-TNM staging 8th edition. They were divided into two groups: those with lymph node metastasis (positive group) and those without (negative group). The clinicopathological factors were retrospectively analyzed and compared between the groups. Results: In univariate analysis, carcinoembryonic antigen (>5.0 ng/mL) (P=0.0007), maximum standardized uptake (>3.5) (P<0.0001), clinical T factor (T1c) (P0.85)(P3.5) (odds ratio =10.4, P5.0) (P=0.048) was the only predictor of lymph node metastasis among patients of cTlb, while no parameters were identified as significant predictors among patients of cT1c. Conclusions: SUVmax and CEA are useful preoperative predictors of lymph node metastases in patients with clinical T1 adenocarcinoma, stratified to T1b and T1c, based on the 8th TNM classification.

In this study, we aimed to determine conditions associated with the development of air bubbles in the pulmonary veins during lung resection.

We present our method for video-assisted thoracic surgery (VATS) segmentectomy based on three-dimensional (3D) computed tomography (CT) surgical simulation especially about the left S3 segmentectomy. A 71-year-old woman was referred to our hospital for her ground-glass opacity nodule (GGN) that increased in size up to 1.0 cm in the S3 of her left lung during the postoperative follow-up after S9,10 thoracoscopic segmentectomy for right lung lower lobe adenocarcinoma in our hospital 10 years ago. As the nodule was deeply located thoracoscopic anatomical left S3 segmentectomy was performed. The operative time was 152 min, and the blood loss was 4 mL. Air leakage was not observed and the chest tube was removed on postoperative day 1. The final diagnosis was a lepidic adenocarcinoma, and she lives well without recurrence in this 43-month period after the surgery. The surgical procedure is presented.

A 64-year-old woman, with a history of hepatocellular carcinoma, developed recurrent metastatic lung nodules after lung metastasectomy 10 years ago. Computed tomography (CT) revealed tumors in the right middle, and left lower lobes. We planned a right middle lobectomy. Before operating, a contrast-enhanced CT in the pulmonary venous phase revealed a tumor in the pulmonary vein resembling a thrombus, indicating that the CT failed to facilitate accurate diagnosis. Following venous clamping and incision, the intravenous polypoid mass was surgically removed. As contrast-enhanced CT focuses on pulmonary arterial phases and might not detect venous lesions, we highlight the usefulness of venous phase contrast-enhanced CT for detecting pulmonary venous tumor thrombosis. Large lung metastatic carcinomas with venous extension may embolize to distant organs. Therefore, venous phase contrast-enhancement is essential for preoperative assessments of large or persisting metastatic lung tumors.