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H Asamura

Publications and source records attributed to H Asamura.

At least 55 records · Page 3Linked to original sources
PubMed1998

[Surgical treatment for metastatic lung tumors].

Surgical treatment for metastatic lung tumors has been reported to be efficacious in selected patients by many authors. Most of these reports are retrospective studies. In our hospital, metastatic lung tumors were resected in 624 patients, and the 5- and 10-year survival rates after pulmonary metastatectomy were 38.3% and 26.6%, respectively. There are many long-time survivors without recurrence after thoracotomy. However, pulmonary metastatectomy seems to offer no survival benefit in some cancers, e.g., gastric cancer, even if the patients satisfy the criteria for surgery. Prospective studies for each type of primary cancer are needed to determine the true efficacy of pulmonary metastatectomy.

Humans↗
PubMed1997

A VATS lobectomy for lung cancer in a patient with an anomalous pulmonary vein: report of a case.

A video-assisted right upper lobectomy was successfully performed on a 58-year-old man with an anomalous segmental pulmonary vein. The tumor was a peripherally located adenocarcinoma. The anomalous vein behind the right main bronchus was identified and safely divided. This case emphasized that to perform this procedure successfully, (1) a careful preoperative evaluation of the anatomy, including the presence of any possible vascular and/or bronchial anomalies, is necessary, and (2) if any anatomical structures cannot be determined intraoperatively, a conversion into an open procedure must immediately be undertaken.

Adenocarcinoma↗
PubMed1997

Thoracoscopic evaluation of histologically/cytologically proven or suspected lung cancer: a VATS exploration.

To evaluate the diagnostic value of video-assisted thoracic surgery (VATS), VATS exploration was performed in 135 patients with histologically/cytologically proven or suspected lung cancer. In 31 patients with pulmonary nodules suspected to be lung cancer, VATS exploration was intended to determine their histology by wedge resection. A histological diagnosis was made in all of the patients: 12 lung cancers (38.7%), 12 inflammatory granulomas (38.7%), four hamartomas (12.9%), and three others. VATS exploration (staging) was performed in 116 surgical candidates with documented lung cancer, including the 12 patients diagnosed by VATS wedge resection. Inoperable factors were demonstrated by this procedure in five patients (4.3%): malignant effusion without dissemination in three, malignant effusion with extensive dissemination in one, and extensive dissemination without effusion in one. Furthermore, N2 nodal metastasis at Botallo's ligament was demonstrated by this procedure in two patients, which met the eligibility criteria for a clinical study. Although the documented number of patients was relatively small, VATS exploration obviated the need for painful thoracotomy, selecting better treatment and for evaluating eligibility criteria for prospective clinical trials. The results suggest that this procedure is useful in candidates for lung cancer surgery.

Biopsy, Needle↗
PubMed1997

Video-assisted lobectomy in the elderly.

STUDY OBJECTIVES: Video-assisted lobectomy for pulmonary malignancy seems to have potential merits, especially in compromised patients such as the elderly. This study was undertaken to assess the feasibility of this new approach in this special age group. PATIENTS: Video-assisted lobectomy was attempted in eight patients older than 78 years of age with preoperatively diagnosed T1N0 or T2N0 lung carcinomas of peripheral origin. In one patient with squamous cell carcinoma, the tumor was diagnosed after surgery as metastasis from tongue carcinoma. The patients ranged in age from 78 to 85 years (average, 81.3 years). RESULTS: The procedure was completed successfully in six patients (75%), while the other two patients underwent lobectomy after conversion to open thoracotomy because of bleeding from the pulmonary artery at the hilum in one and extensive pleural adhesions in another. Among the six patients who underwent video-assisted lobectomy, there were no operative deaths or serious complications attributable to this technique, although two patients had prolonged air leakage for 7 and 11 days, respectively. CONCLUSIONS: This approach, which is feasible even in patients older than 80 years, is likely to offer a benefit to such patients if they are selected properly. During this procedure, the possibility of wound extension in case of an intraoperative accident must always be borne in mind, especially in elderly patients. The advantage of this approach remains undetermined in this special age group.

Aged↗
PubMed1997

Implications of staging in lung cancer.

Lung cancer staging, based on anatomic extent of disease and described by the TNM staging system (T, primary tumor; N, regional lymph nodes; M, distant metastasis), is an important parameter for determining the clinical course of this disease. To evaluate the prognostic importance of TNM staging for lung cancer, we conducted a retrospective study analyzing survival rates according to TNM staging in 2,382 patients who had pulmonary resection for non-small cell lung cancer. Postoperatively, 3 patients were classified in stage 0, 796 in stage I, 304 in stage II, 719 in stage IIIA, 233 in stage IIIB, and 327 in stage IV. The 5-year survival rates for these patients were as follows: stage I, 68.5%; stage II, 46.9%; stage IIIA, 26.1%; stage IIIB, 9.0%; and stage IV, 11.2% (including ipsilateral, intrapulmonary metastases); 5-year survival rates for 140 patients with stage IV disease with intrapulmonary metastases in either the same lobe or another ipsilateral lobe were 17.8% and 8.3%, respectively. There was prognostic significance between stage I and stage II disease, stage II and stage IIIA disease, and stage IIIA and stage IIIB disease, but not between stage IIIB and stage IV disease. Only a few modifications will be required for the TNM staging system, which at present accurately reflects the prognosis of patients with lung cancer and is helpful in determining treatment.

Adult↗
PubMed1997

[State of the art treatment of lung cancer: non-small cell lung cancer--surgical treatment].

Surgery is defined as purely a local treatment modality. In the treatment of non-small cell lung cancer, surgery remains the first-line treatment of choice for local diseases. Thus, stages I, II, and a part of IIIA disease are definite indications for surgical therapy. The standard operative mode in curative intent for such local diseases is the resection of the entire lobe or lung where the cancer is located. The prognostic significance of hilar/mediastinal lymph node dissection remains controversial, although it can provide the most accurate information regarding the metastatic status of hilum and mediastinum. For locally advanced diseases of stages IIIA and IIIB, the surgical approach still remains investigational in a combined modality setting. For N2 diseases (with mediastinal node metastasis), the prognostic benefit of both preoperative and postoperative chemo (-radio) therapy has not been definitively demonstrated yet, although several reports suggested their potential benefits. They await further evaluation by clinical trials in a phase III setting. Although aggressive surgical approaches for tumors invading surrounding vital structures (IIIB disease) have been reported, it is also still uncertain whether their results can really exceed those obtained by chemoradiotherapy.

Adenocarcinoma↗
PubMed1996

Pulmonary resection for metastatic colorectal cancer: experiences with 159 patients.

We reviewed the clinical courses of 159 patients between February 1967 and May 1995 for the purpose of examining the survival of patients who had pulmonary resection for metastatic colorectal cancer. The cumulative survivals at 5 years and 10 years were 40.5% and 27.7%, respectively. Fifteen patients (10%) were alive more than 10 years after the thoracotomy without any evidence of recurrence. The cumulative survival at 5 years for 39 patients who had hepatic metastases before thoracotomy was 33%. There was a statistically significant difference in survival between patients with extrapulmonary metastases and those with only intrapulmonary metastases before thoracotomy. The number of pulmonary metastases and the presence of hilar or mediastinal lymph node metastases affected postthoracotomy survival. There was no significant difference in survival on the basis of sex, age, location of the primary cancer, size of the pulmonary tumors, mode of operation, or disease-free interval. Surgical treatment for pulmonary metastases from colorectal cancer in selected patients, even those who had hepatic metastases before thoracotomy, might improve prognosis.

Adult↗
PubMed1996

Lymph node involvement, recurrence, and prognosis in resected small, peripheral, non-small-cell lung carcinomas: are these carcinomas candidates for video-assisted lobectomy?

To determine the clinicopathologic characteristics of peripheral non-small-cell carcinomas, the cases of 337 patients undergoing major pulmonary resection with complete lymphadenectomy were retrospectively reviewed with regard to lymph node involvement, recurrence, and prognosis. All of the tumors were 3.0 cm or less in diameter and were categorized as T1 (318 patients) or T2 (19). Eighty-eight patients (26.1%) had lymph node involvement: 32 (9.5%) at N1 nodes, 55 (16.3%) at N2 nodes, and 1 (0.3%) at N3 nodes. Although the prevalence of lymph node involvement did not differ significantly with tumor histologic type, it was quite low in squamous cell carcinomas 2.0 cm or less in diameter. Of the 56 N2/3 metastases, 14 (25%) occurred in a "skipping" manner, and all but one had a nonsquamous histologic makeup. Of the 213 patients with a follow-up period of 5 years or more, 59 patients (27.7%) showed cancer recurrence. This occurred at a distant site in 67.8% of the cases. Five-year survival rates based on nodal status were 91.9% (NO), 61.8% (N1), 44.5% (N2), and 0% (N3). Because of the relatively high prevalence of lymph node involvement, complete hilar/mediastinal lymphadenectomy should be routinely done regardless of tumor histologic type and size, as long as patients are at good risk. However, in squamous cell histologic types, mediastinal lymphadenectomy might be dispensable if the tumor is less than 2.0 cm in diameter, or if the hilar node is proved to be tumor-free on pathologic examination of the frozen section during operation. Although video-assisted major pulmonary resection currently has limited application, this new technique may represent a surgical option in resection without complete lymphadenectomy.

Adenocarcinoma↗
PubMed1996

AFP-producing squamous cell carcinoma of the lung in an adolescent.

We report a case of primary lung cancer in a 16-year-old boy. A histologic diagnosis of squamous cell carcinoma was made by bronchoscopic biopsy before surgery. The serum alphafetoprotein (AFP) level was markedly elevated at 193 ng/dl. Preoperative and postoperative evaluation revealed no evidence of scrotal mass. We performed right pneumonectomy with combined resection of the invaded portion of the left atrium under extracorporeal circulation. Despite the rapid improvement in the patient's general condition after surgery, the AFP level continued to increase without a transient decrease and reached 3160 ng/ml on the 23rd postoperative day. When the patient was readmitted because of dyspnea and headache on the 36th postoperative day, hypercalcemia of 13.9 mg/dl was noted, and this was resistant to subsequent treatment. The patient died on the 46th postoperative day.

Adolescent↗
PubMed1994

Malignant germ cell tumor of the mediastinum: a multimodality therapeutic approach.

Twenty-five patients with a malignant germ cell tumor of the mediastinum were treated at the National Cancer Center Hospital, Tokyo. Three patients had pure seminomas while 22 had a nonseminomatous histology. The treatment modalities consisted of surgery alone in 7 patients, surgery with chemotherapy and/or radiation in 14, and chemotherapy and/or radiation without surgery in 4. Cisplatin-based chemotherapy was administered in nine patients, one of whom successfully underwent high-dose chemotherapy with autologous bone marrow transplantation after resection of the tumor. A complete response was achieved in only five patients. The overall survival rate at 5 years was 33.5% and the median survival time was 51 weeks. Eight patients (32%), all of whom underwent surgery either with or without chemotherapy and/or radiation, were free of disease with a mean follow-up period of 439 weeks (72-1,120 weeks). The median survival times for 14 patients undergoing combined modality treatment, 7 patients undergoing surgery alone, and 4 patients undergoing chemotherapy and/or radiation were 83, 16, and 18 weeks, respectively.

Adolescent↗
PubMed1994

Extended resection of the left atrium, great vessels, or both for lung cancer.

One hundred one patients with locally advanced lung cancer underwent combined resection of the lung and the left atrium with or without the great vessels. A single additional organ was resected in 92 patients, two organs in 8 patients, and three organs in 1 patient. The left atrium was resected in 44 patients, the superior vena cava in 32, the adventitia of the aorta in 21, the aorta in 7, and the pulmonary artery in 7. The most important factors affecting survival defined by multivariate analysis were postoperative pneumonia, complete resection, postoperative bleeding, and lymph node metastasis (p < 0.05). Thirteen patients survived 3 years or more and 10 of the 13 survived 5 years or more. The 5-year survival rate for all patients, including 8 with operative death, was 13%, and the median survival time was 9.2 months. The 5-year survival and median survival time were 19% and 13.8 months after complete resection and 0% and 6.5 months after incomplete resection (p < 0.01). The 5-year survival and median survival time for patients with pathologic stage IIIA, IIIB, and IV were 16.8% and 16.8 months; 18.3% and 9.8 months; and 0% and 5.4 months, respectively. There was a significant difference between stages IIIA plus IIIB and stage IV (p < 0.05). The 5-year survival after left atrium resection was 22%. Extended resection was worthwhile for the patients undergoing complete resection and without postoperative complications.

Adenocarcinoma↗
PubMed1994

Computed tomography-guided coil injection and thoracoscopic pulmonary resection under roentgenographic fluoroscopy.

To remove a small, chest roentgenogram-negative, computed tomogram-positive nodule, we developed a novel technique of thoracoscopic pulmonary resection. This technique consists of the computed tomography-guided coil injection of a metallic coil and subsequent thoracoscopic resection under roentgenographic fluoroscopy. During the thoracoscopic resection, the fluoroscopic image was a valuable aid in determining the location of the nodule and in ensuring that the stapler was applied with a sufficient distance from the coil. Because this technique helps to determine the exact location of the nodule regardless of its depth from the pleural surface, even a minithoracotomy for direct palpation can be avoided.

Adenocarcinoma↗
PubMed1994

A review of 79 thymomas: modification of staging system and reappraisal of conventional division into invasive and non-invasive thymoma.

A clinicopathological study of surgically resected thymomas was performed using Masaoka's staging and modified Masaoka's staging systems, and the utility of these two staging systems was compared. The modification enabled adjustment for the disproportion in the number of cases between Stage I and Stage II. Analysis of survival rates, according to the tumor stage, indicated that the old classification should be reappraised, that is, division into non-invasive and invasive thymomas, although staging may contribute to the indication for postoperative radiotherapy, especially for Stage II disease. Analysis of the cases showed a wide spectrum of aggressiveness, varying from cases showing slow progression with a relatively favorable prognosis, such as the spindle cell type, to cases with rapid progression leading to tumor death in a relatively short time, such as the epithelial cell predominant and polygonal cell type. The pathological stage at the time of first surgical resection would reflect the degree of aggressiveness of thymoma in many instances. Therefore, not only staging the tumor extent but also grading of its aggressiveness are needed in order to predict the prognosis of patients with thymoma. For the latter, histology and cytopathology are helpful.

Adolescent↗
PubMed1994

[Video-assisted thoracic surgery (VATS) for intrathoracic tumors].

Owing to the advent of new thoracoscopic instrument and technique, video-assisted thoracic surgery (VATS) has become a new standard in the resection of intrathoracic tumors. Thoracoscopy can be used as both exploratory and therapeutic means. Included as the indication for VATS resection are as follows: benign and malignant lung tumors such as lung cancer, metastatic lung tumor, and etc., benign mediastinal tumors, and benign pleural tumors. Still the indication for VATS resection for malignant disease, especially for lung cancer, is not defined. Further improvement is required in the resectional technique and instruments.

Endoscopy↗
PubMed1993

Thoracoscopy for staging of lung cancer.

The recent advancements in diagnosis and treatment of thoracic disease have been made mostly in line with advancements in endoscopic equipment design and refinement of thoracoscopic surgery techniques. Between March 1992 and February 1993, video thoracoscopic procedures were performed in 50 patients. Twelve of the 50 patients were diagnosed with lung cancer. Thoracic staging was performed in 6 patients (clinical diagnosis of suspicious intrapulmonary metastasis, 3 patients; intrapulmonary metastasis and/or lymph node metastasis, 1 patient; interlobar pleural effusion, 1 patient; and pleural dissemination, 1 patient). There were no complications or mortality associated with these procedures. Our initial experience has indicated that thoracoscopic staging for lung cancer is a safe and effective procedure.

Adenocarcinoma↗
PubMed1993

Prognostic significance of pleural lavage cytology immediately after thoracotomy in patients with lung cancer.

Pleural lavage cytology immediately after thoracotomy was performed in 467 patients with lung cancer who had little or no pleural effusion. Forty-two patients (9.0%) had positive results. The positivity of pleural lavage cytology was significantly related to the degree of pleural extension of the tumor, microscopic pleural dissemination, cytologic results of minimal pleural effusion, pathologic stage, presence of lymphatic permeation or vascular invasion, and cell type (adenocarcinoma was predominant). The 3-year survival of the patients having negative and positive results of cytology were 68.7% and 22.9%, respectively. The prognosis of the group with positive results was as poor as that of patients with stage IIIB or IV disease. Pleural lavage cytology is an important prognostic factor that indicates microscopic exfoliation of cancer cells into the pleural cavity, that is, subclinical malignant pleural effusion.

Humans↗