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Biomedical subjects

T Naruke

Publications and source records attributed to T Naruke.

At least 73 records · Page 4Linked to original sources
PubMed1990

Prognosis for resected lung cancer patients with tumors greater than ten centimeters in diameter.

During the period 1962-1986, 43 lung cancer patients, 2.3% of the 1,832 patients who underwent pulmonary resections at the National Cancer Center Hospital, Tokyo, had tumors greater than 10 cm in diameter. These 43 cancers were classified postsurgically according to the 1987 guidelines for TNM classification of malignant tumors established by Union Internationale Contre le Cancer (UICC), and included 35 cases (81.0%) in stages IIIA, IIIB and IV. The histological tumor types were adenocarcinoma in 18 cases (41.9%), squamous cell carcinoma in 13 (30.2%), large cell carcinoma in 11 (25.6%) and adenosquamous cell carcinoma in one (2.3%). Twenty-two patients underwent pneumonectomy and 21, lobectomy. In terms of the radical extent of surgery, 16 patients underwent a curative operation (37.2%) and 27 received non-curative surgery (62.8%). Excluding one patient who died of an unknown postoperative cause, the overall cumulative five-year survival rate was 19.7%. There was, however, no significant difference in five-year survival rates between the patients who underwent a curative operation (21.5%) and those who received non-curative surgery (18.8%). There was no significant difference in five-year survival rates between patients with adenocarcinoma (21.2%), those with squamous cell carcinoma (15.4%) and those with large cell carcinoma (27.3%). There was little difference in five-year survival rates between patients with postoperative stage I or stage II tumors (25.0%), patients with stage IIIA tumors (9.5%), patients with stage IIIB tumors (30.0%) and patients with stage IV tumors (20.0%), while the five-year survival rates for patients with postoperative N0 disease were 33.3%, N1 disease 28.9% and N2 disease 0%. Among the 42 patients the survival study, there were eight long-term survivors (greater than 5 yr), all of whom had been in N0 or N1 stage and four of whom had undergone curative surgery. Two were classified as being in stage T4 with malignant pleural effusions, and the other two as being in stage M1 with intrapulmonary metastasis. Patients with N2 disease have an unfavorable prognosis and may be considered suitable for studies on adjuvant therapy, although the relative influence of other prognostic factors must be considered. Classifying the tumors according to whether or not they had reached 10 cm in diameter was of no importance.

Adult↗
PubMed1990

[Resection of chondrosarcoma of anterior chest wall with pleural dissemination].

A 52-year-old woman admitted with difficulty of breathing and had an anterior chest wall tumor. Primary lesion of the chest wall tumor invading the inferior one third of sternum, right third to sixth ribs, a part of the right middle lobe, the pericardium and a part of the diaphragma and small nodules on the parietal pleura were resected, and a diagnosis of chondrosarcoma of the right fifth or sixth rib and pleural dissemination of the tumor was established. The defect of pericardium was repaired with artificial dura mater and the defect of bony chest wall was repaired with a double layer of Marlex mesh. Although the resection was palliative because of pleural dissemination, she is now working as a housewife without difficulty of breathing.

Chondrosarcoma↗
PubMed1990

[Completion pneumonectomy--a review of 29 cases].

From 1962 through 1988, a total of 29 consecutive patients had completion pneumonectomy (CP). Indications for initial pulmonary resection were primary lung cancer in 27 patients, metastatic lung tumor in 1, and mediastinal tumor with pulmonary invasion in 1. Indications for CP were lung cancer (including local recurrence, pulmonary metastasis from the first lung cancer, and second primary lung cancer) in 21 patients, complications after initial operations in 7, and pulmonary arterial injury during second operation in 1. Severe adhesion of the residual lung and the hilar structures made operative procedures extremely difficult. Injury of pulmonary arteries occurred in 6 patients. Especially, in cases the left upper lobe had been resected previously, deviation of the lower lobe and hilar adhesion lead to operative difficulty. Post-CP bronchial fistula occurred more frequently in what the bronchi had been dissected at more peripheral level than main bronchus, because of some severe hilar adhesions. Operative mortality was 13.8% (9.5% for second lung cancer, 28.5% for post-operative complication). Five-year survival for patients with lung cancer was 32.9% according to the Kaplan-Meier method. We conclude that the indications for CP are clinically resectable lung cancer and bronchial stenosis with residual pulmonary organic changes following bronhoplastic procedure. Postoperative bronchofistulae should be managed by other operative procedure.

Adenocarcinoma↗
PubMed1990

Resection of tracheal carina for lung cancer. Procedure, complications, and mortality.

We studied 20 patients with lung cancer that invaded the tracheal carina who were operated on during a recent 12-year period. Fifteen patients underwent sleeve pneumonectomy, two had pneumonectomy, one had lobectomy with wedge resection of the carina, and two patients had sleeve resection of the carina followed by reconstruction of the carina. There were two patients with postsurgical stage IIIA lung cancer, 15 with stage IIIB, and three with stage IV disease that involved intrapulmonary metastases. However, the operations of 13 patients were curative resections in which the surgical margin was negative for disease. Sleeve pneumonectomy was performed only in the last 3 years of the study period, after we had confirmed the safety and good results of bronchoplastic surgery by our experience of 100 cases of sleeve lobectomy. Hence, the period of follow-up in this group is too short to assess long-term survival. Eleven patients are alive, three died within 1 month after operation (15%), three died in the hospital beyond 1 month after the operation, and three died after discharge from hospital. Nine of the 11 surviving patients have no evidence of disease 1 month to 2 1/2 years after the operation, but two are alive with supraclavicular lymph node metastases. The 1-year and 2-year survival rates for 17 cases (excluding the three operative deaths) were both 59% by the Kaplan-Meier method. Two different methods were used to adjust the difference of calibers of the trachea and the bronchus. The first method involved the shift of the edge of the cartilagonous portion of the bronchus against the edge of the cartilaginous portion of the trachea and the other involved cutting the tracheal wall as a wedge-shaped piece to shorten the diameter of the tracheal caliber. To prevent complications after resection of the tracheal carina in 11 recent cases with sleeve pneumonectomy, anastomoses were protected by a pedicle fat flap nourished by internal thoracic artery and vein. No postoperative complications of anastomoses developed in any of these cases.

Adult↗
PubMed1989

[Thin-slice CT analysis of localized inflammatory pulmonary lesions--pathologic-CT correlation].

In order to evaluate thin-slice CT findings of localized inflammatory pulmonary lesions, 5 granulomatous lesions without preoperative pathological diagnosis were examined. On thin-slice CT, fifth order bronchi and vessels were detected, and inflammatory lesions were observed in margins of pulmonary veins. Of involved bronchi, thick walls were detected in 3 cases, central convergence in 2 cases, mucoid impaction in 3 cases. The characteristics of inflammatory nodules, strand-like shadow and concave margin of lesion contiguous to normal lung, were demonstrated on thin-slice CT. Thin-slice CT can be effective to differentiate localized inflammatory pulmonary lesion.

Aged↗
PubMed1989

Surgical resection of pulmonary metastases from colorectal cancer. 10-year follow-up.

Pulmonary resection of metastatic lesions from colorectal cancer was performed in 62 patients, and their cumulative 5-year and 10-year survival rates were 42% and 22%, respectively. The overall median survival was 24 months. The survival curve decrease even after 5 years after pulmonary resection; four of 13 patients who survived more than 5 years subsequently died of metastatic disease and only two patients survived more than 10 years. The number and size of the pulmonary metastases were significantly correlated with postthoracotomy survival. Solitary metastases less than 3.0 cm in diameter were good indicators of favorable postthoracotomy survival. There were no significant differences in survival based on Dukes' classification or location of the primary lesion. Sex, age, disease-free interval between the primary tumor and appearance of metastasis, and extent of pulmonary resection had no influence on survival. It is impossible to say from our experience that surgical resection of pulmonary metastases increased the cure rate. Presumably a good 5-year survival rate after thoracotomy would be a reflection of a length bias caused by the biologic behavior of the metastatic pulmonary lesions.

Colonic Neoplasms↗
PubMed1989

Pleural lavage cytology immediately after thoracotomy as a prognostic factor for patients with lung cancer.

Pleural lavage cytology was examined in 230 lung cancer patients just after opening the chest. There were 16 cases (7.0%) of positive pleural lavage cytology, and the results of pleural lavage cytology were related to the presence of pleural involvement by cancer, microscopical pleural dissemination and lymphatic permeation of the cancer cells. If the cancer involves the pleura or lymphatics of the submesothelial layer, being covered with visceral mesothelium, positive cytology may still be obtained. Pleural lavage cytology at opening of the chest seems to be available as a premonitory indicator for exfoliation and dissemination into the pleural cavity or subpleural lymphatic extension of cancer cells, and it was suggested that positive pleural lavage cytology has an influence on postoperative survival.

Humans↗
PubMed1989

An esophagobronchopleural fistula successfully treated by a surgical procedure combined with conservative therapy after resection for lung cancer.

The patient was a 43-year-old woman, who had undergone a right middle and lower lobectomy for adenocarcinoma of the lung. An esophagobronchopleural fistula developed two months after the operation. It was treated by a combined procedure consisting of pedicle flap closure of the fistula and thoracoplasty. The esophagobronchopleural fistula recurred two days later, however, and another pedicle flap closure with fenestration of the chest wall were performed in a third operation. A bronchopleural fistula then recurred, after which it was treated by conservative therapy including intravenous hyperalimentation, frequent dressing changes and systemic administration of appropriate antibiotics. It closed spontaneously 23 days after surgery, in spite of this being a very rare but serious complication very difficult to treat and cure. From our experience with this particular case, we recommend, for treating esophagobronchopleural fistulas, proper drainage, antibiotic therapy, intravenous hyperalimentation and packing of the empyema space, together with closure of the fistula using a muscle or pleural flap.

Adenocarcinoma↗
PubMed1989

[A case of tracheal stenosis following surgery of esophageal cancer].

A case of 54-year-old man with tracheal stenosis following surgery for thoracic esophageal cancer was reported. It was considered that the stenosis had occurred due to the tracheal ischemia after esophagectomy and lymph node dissection. Importance of preservation of tracheal blood supply was again noticed. On tracheal reconstruction, application of pedicled pleural flap was recognized to be useful in order to repair the leakage from membranous portion that could not be closed by suture.

Anastomosis, Surgical↗
PubMed1989

[Surgical treatment in pulmonary metastases of colorectal cancer].

From 1962 to 1987, 72 patients with primary colorectal cancer underwent surgical treatment for pulmonary metastases. The overall cumulative 5 year survival rate was 41.3%. But the cumulative 1 year survival rate of patients with incomplete resection was 20.0%. Reduction surgery should not be employed. Twenty-nine of 66 patients with complete resection have recurred. The most of first manifested recurrences were in the lung and within 18 months after thoracotomy. This tendency was remarkable in patients with multiple pulmonary metastases and all recurrences of them were within 18 months and 80% were multiple in bilateral lung. Almost all multiple pulmonary metastases seemed to be only one manifestation of generalized metastatic disease. So indication of surgical treatment for them should be cautious. Type of pulmonary resection had no influence on post-thoracotomy survival rate. But in patients with partial resection, 7 recurrences at surgical margin and one recurrence on regional lymph nodes were doubted. Four metastatic lesions less than 3cm in maximum diameter had metastases to the regional lymph nodes. To resect more curatively, lobectomy and systemic lymphadenectomy should be recommended as the standard operation for pulmonary metastases of colorectal cancer.

Adult↗
PubMed1988

Solitary mast cell tumor of the lung.

An extremely rare solitary mast cell tumor of the lung was studied histologically, immunohistochemically, and ultrastructurally. The histologic features of the tumor included nodular growth of well-differentiated mast cells and clear cells with no granules. The current case is the third case of a solitary mast cell tumor (granuloma) of the lung in the literature. Clinicopathologic features of this tumor are compared with the other two cases reported previously in the international literature, and the nature of the clear cells is discussed.

Antigens, Neoplasm↗
PubMed1988

The importance of surgery to non-small cell carcinoma of lung with mediastinal lymph node metastasis.

In the past 25 years, 1,654 patients with non-small cell cancer underwent resection at National Cancer Center Hospital, Tokyo. A comparative study has been made of 5-year survival of patients who had pulmonary resection with and without mediastinal lymph node dissection. There were 426 patients (25.8% of the total) with N2 M0 disease. Of these, 345 underwent pulmonary resection with mediastinal lymph node dissection. The 5-year survival in this group was 15.9% (T1 N2 M0, 30.0%; T2 N2 M0, 14.5%; and T3 N2 M0, 12.9%). In the remaining 81 patients, who did not have mediastinal lymph node dissection, 5-year survival was 6.7%. Of the 426 patients with N2 M0 disease, 242 were select patients who underwent a curative operation with an overall 5-year survival of 19.2%. Sixty-six of them had squamous cell carcinoma and a 5-year survival of 30.8%; 153 had adenocarcinoma and a survival of 16.0%; 14 had large cell carcinoma and a survival of 12.8%; and 9 had adenosquamous cell carcinoma, and none survived 5 years. To improve the end results, it is important to perform as many curative operations with mediastinal lymph node dissection as possible. Histological cell type and tumor status must be taken into consideration.

Adult↗
PubMed1988

Close correlation between restriction fragment length polymorphism of the L-MYC gene and metastasis of human lung cancer to the lymph nodes and other organs.

Restriction length fragment polymorphism of the L-MYC gene was examined in DNAs from lung cancer tissues and normal tissues of 51 Japanese patients with lung cancer. In individual patients, no difference was seen between the restriction length fragments of the two alleles of L-MYC [6-kilobase (kb) and 10-kb fragments in EcoRI digests] in lung cancer tissues and normal tissues. But a striking correlation was found between the restriction length fragment polymorphism pattern of L-MYC and the extent of metastasis, particularly to the lymph nodes at the time of surgery: Patients with only the L band (10 kb) had few lymph node metastatic lesions, whereas patients with either the S band (6 kb) or the S and L bands almost always had lymph node metastatic lesion. A similar correlation was found between the presence of the S band and metastases to other organs. This correlation was particularly marked in cases of adenocarcinoma. These results indicate a clear genetic influence on metastases and a consequent poor prognosis for certain patients of lung cancer; L-MYC restriction length fragment polymorphism is thus shown to be a useful marker for predicting the metastatic potential of human lung cancer.

Adult↗
PubMed1988

[The role of surgery in the management of patients with small cell lung cancer].

Fifty-seven patients with small cell lung cancer were operated on at the National Cancer Center Hospital, Tokyo, between 1962 and 1986. Twenty-seven patients had oat cell type and thirty had intermediate cell type. The five-year survival rate of patients who were treated before 1979 (the first term) was only 11%, whereas the rate for patients treated after 1980 (the latter term) was 53%. No patient with oat cell type small cell lung cancer, treated in the first term, survived for three years after the operation. However, four patients with oat cell type lung cancer, treated in the latter term, survived for five years or more after surgery. The five-year survival rate of the patients with oat cell type lung cancer, who were treated after 1980, was 64%. The five-year survival rates for patients with intermediate cell type were 20% in the first term and 41% in the latter term. We have introduced CT and echography for the preoperative evaluation of patients and also perioperative intensive chemotherapy. Improvement of preoperative evaluation and intensive chemotherapy have yielded good results.

Adult↗