General Thoracic and Cardiovascular Surgery

Our medical research library holds 17 studies published in General Thoracic and Cardiovascular Surgery (2010–2022). Each entry links to the study's record on PubMed and, where there is one, to the publisher's page and a free full text. 17 have an abstract, the authors' own summary as PubMed records it: open "Abstract" to read it.

About the journal

• Publisher: Springer Japan
• Published: 2007 to the present, Japan
• Language: English
• ISSN: 1863-6705 (print), 1863-6713 (electronic)
• Continues: Japanese Journal of Thoracic and Cardiovascular Surgery
• Its record in the NLM Catalog

2020s

• Staged removal of artificial patches for thoracic empyema after extrapleural pneumonectomy for diffuse malignant pleural mesothelioma. M. Sonobe, Y. Kou, N. Yamazaki, et al. 2022;70(2):193-196. Case report PubMed · Publisher

  Abstract

  A 69-year-old man with occupational exposure to asbestos was referred to our hospital with right diffuse malignant pleural mesothelioma. He underwent extrapleural pneumonectomy with reconstruction of the pericardium and diaphragm using elongated polytetrafluoroethylene patches, followed by postoperative chemotherapy and chest wall irradiation. One year later, he was hospitalized because of a right empyema caused by Escherichia coli infection. As chest drainage and systemic antibiotics did not eliminate the abscess around the artificial patches, a Clagett window was created. To avoid mediastinal and liver overshift into the right thoracic cavity, we only performed partial resection of the diaphragm patch and incision of the artificial pericardium. After 19 days of irrigation and dressing change, the artificial patches were completely removed. Two months later, the patient provided a culture-negative sample and had an improved nutritional status; we therefore performed closure of the Clagett window with thoracoplasty. He did not experience recurrence of empyema.

  © 2021. The Japanese Association for Thoracic Surgery.

• Non-incisional pleurectomy/decortication for malignant pleural mesothelioma. F. Tanaka, M. Takenaka, N. Imanishi, et al. 2021;69(9):1320-1325. PubMed · Publisher

  Abstract

  Objective: Pleurectomy/decortication has been preferably employed as a curative-intent surgery for malignant pleural mesothelioma. However, visceral pleurectomy during pleurectomy/decortication provides technical challenges. For visceral pleurectomy, pleural incisions are commonly made to create a dissection plane between the visceral pleura and the lung parenchyma, which may cause tumor dissemination and may not allow en bloc complete resection of the entire pleura. To overcome such potential disadvantages, we have developed a novel surgical technique without any pleural incision (non-incisional pleurectomy/decortication) to achieve en bloc removal of the entire pleura.

  Methods: A total of 36 consecutive patients who underwent non-incisional pleurectomy/decortication for malignant pleural mesothelioma from January 2017 through December 2020 in our institute were retrospectively reviewed to assess the feasibility.

  Results: Macroscopic complete resection was achieved in 31 patients (86.1%) with non-incisional pleurectomy/decortication. In the majority of patients (n = 29), en bloc complete resection of the entire pleura was achieved (without pleural laceration in 10 and with some pleural laceration in 19 patients). The total operation time and the duration of visceral pleurectomy were significantly shorter as compared with those for conventional pleurectomy/decortication (median, 350 versus 506 min [P = 0.011], and 43 versus 97 min [P < 0.001], respectively). Among 36 patients who underwent non-incisional pleurectomy/decortication, postoperative complications developed in 13 patients (36.1%), and one patient died on the postoperative day 95 caused by aggressive tumor progression of residual tumor.

  Conclusions: Non-incisional pleurectomy/decortication is a fast and feasible technique to achieve en bloc macroscopic complete resection for malignant pleural mesothelioma.

  © 2021. The Japanese Association for Thoracic Surgery.

• Clinical feature of diagnostic challenging cases for pleural biopsy in patient with malignant pleural mesothelioma. M. Hashimoto, A. Sato, A. Kuroda, et al. 2020;68(8):820-827. PubMed · Publisher

  Abstract

  Objective: Pleural biopsy through video-assisted thoracic surgery (VATS pleural biopsy) is the most reliable diagnostic procedure for malignant pleural mesothelioma (MPM). However, definitive diagnosis of MPM is occasionally difficult to establish. This study aims to investigate clinicopathological features of MPM patients who failed diagnosis by the first VATS pleural biopsy.

  Methods: Four hundred consecutive patients with suspected MPM who received VATS pleural biopsy between March 2004 and July 2017 were enrolled in this retrospective study. Patients, whose histological diagnoses were not definitive in the first VATS pleural biopsy, were followed up as atypical mesothelial proliferation (AMP) or non-specific pleuritis (NSP). Re-examination was performed in cases strongly suspected of having MPM.

  Results: Of the 400 patients, 267 (66.8%) were pathologically diagnosed with MPM, 25 with metastatic carcinoma and 6 with benign pleural disease by the first VATS pleural biopsy. Of the remaining 102 patients diagnosed with AMP or NSP, 10 patients (9.8%) were subsequently diagnosed with MPM. Analysis of the clinical course revealed that only insufficient tissue for diagnosis was obtained via VATS pleural biopsy in all cases and that it was caused by very early stage without visible tumour in 4 patients, intrathoracic inflammation in 4 and desmoplastic MPM in 2.

  Conclusions: In our review, 9.8% of patients diagnosed with AMP or NSP in first VATS pleural biopsy were subsequently diagnosed with MPM due to insufficient tissue for diagnosis. Definitive diagnosis via VATS pleural biopsy is sometimes challenging in following situation; very early stage, intrathoracic inflammation and desmoplastic MPM.

• Conversion surgery for locally advanced malignant pleural mesothelioma. Y. Terada, M. Isaka, H. Murakami, et al. 2020;68(12):1547-1550. Case report PubMed · Publisher

  Abstract

  Two women in their sixties were diagnosed with inoperable locally advanced epithelioid malignant pleural mesothelioma, c-stage IIIB. Post-chemotherapy, the tumors down-staged to yc-stage IA, and pleurectomy/decortication were performed. The pathological diagnoses were p-stages II and IA. One patient had tumor recurrence 6 months after surgery; she is currently undergoing fourth-line chemotherapy and is alive 30 months postoperatively. The second patient had tumor recurrence 4 months after surgery and died 2 months later. Conversion surgery for advanced malignant mesothelioma does not improve progression-free survival but might have a chance to extend overall survival in selected patients without deteriorating performance status.

• Heterologous sarcomatoid pleural mesothelioma with osteosarcomatous differentiation: a report of autopsy case that accomplished trimodality therapy and review of the literature. H. Itano, T. Takeda, T. Yamada, et al. 2020;68(8):871-879. Case report · Review PubMed · Publisher

  Abstract

  Heterologous mesothelioma is a very rare subtype of sarcomatoid mesothelioma characterized by the presence of malignant heterologous elements. A 69-year-old man with a strong history of asbestos exposure presented with a 5-cm mass in his chest wall, destroying the right 5th rib and spreading along the parietal pleura, on a CT. Biopsy revealed heterologous mesothelioma with osteosarcomatous elements, following which left extrapleural pneumonectomy was performed with combined resection of pericardium, hemidiaphragm, and 4th, 5th, and 6th costal segments. A small cytokeratin-positive epithelioid component in the resected tumor definitively confirmed the diagnosis. Post-operative chemotherapy and intensity-modulated radiotherapy were undertaken. After 12-month disease-free period post treatment, rapid intraperitoneal recurrence resulted in death. Autopsy revealed no tumors in the left thorax. We present here a case of heterologous osteosarcomatous pleural mesothelioma that followed a unique clinical course after trimodality therapy. In addition, literature of 54 cases of the similar heterologous mesothelioma was reviewed.

• Treatment of bronchial fistula after extraplural pneumonectomy using flexible bronchoscopy with the administration of OK432, fibroblast growth factor basic and fibrin glue sealant. N. Kondo, M. Hashimoto, T. Takuwa, et al. 2020;68(12):1562-1564. PubMed · Publisher

  Abstract

  Treatment options for bronchial fistula (BF) after pneumonectomy are often limited and carry significant morbidity and mortality. The patient underwent right extrapleural pneumonectomy for malignant pleural mesothelioma had BF without macroscopic fistula found by bronchography. We treated this minor BF using bronchoscopy with the administration of OK-432, fibroblast growth factor basic, and fibrin glue sealant. Two weeks after this treatment, we confirmed the improvement of the fistula by bronchography. Bronchoscopic therapy for BF was useful for a small, early fistula without infection.

2010s

• Extended pleurectomy decortication for thymoma with pleural dissemination. N. Imanishi, Y. Nabe, M. Takenaka, et al. 2019;67(9):814-817. Case report PubMed · Publisher

  Abstract

  Complete resection is the mainstay of treatment for thymoma. Even for advanced-stage thymoma with pleural dissemination, complete resection with extrapleural pneumonectomy may provide a favorable prognosis. Pleurectomy decortication, a lung-sparing surgery, has been preferably employed in recent years as an alternative surgical procedure for malignant pleural mesothelioma. However, little has been reported about pleurectomy decortication for other malignant tumors with pleural dissemination. Here, we present the first case of thymoma with pleural dissemination for which complete en bloc resection was achieved with extended pleurectomy decortication.

• Mesothelioid reaction following talc pleurodesis: a case report. T. Faynberg, N. Patel, A.P. Nayar, et al. 2017;65(11):667-669. PubMed · Publisher

  Abstract

  Introduction: Talc pleurodesis is a well-established procedure performed to obliterate the pleural space to prevent recurrent pleural effusion and/or recurrent pneumothorax. Pleurodesis is commonly accomplished by draining the pleural fluid, if present, followed by either a mechanical procedure, such as abrasion, pleurectomy, or instillation of a chemical irritant into the pleural space, which results in inflammation and fibrosis which obliterates the pleural space. The reported complications of talc pleurodesis are hypoxemia, hypotension, tachycardia, dyspnea, chest pain, and fever.

  Case Presentation: Herein, we present a case of a 43-year-old female patient who developed an intense mesothelioid reaction which occurred 7 years following talc pleurodesis.

  Conclusion: This case represents a unique mesothelioid reaction which became manifested several years after recurrent talc pleurodesis. Such a mesothelioid reaction can clinically and radiographically mimic malignant mesothelioma. We conclude that Talc pleurodesis played a causative role in this patient developing an intense mesothelioid reaction. A mesothelioid reaction should be included in the differential diagnosis in patients with pleural thickening/pleural plaque formation who have previously been treated with talc pleurodesis.

• Interim results of pleurectomy/decortication and intraoperative intrapleural hyperthermic cisplatin perfusion for patients with malignant pleural mesothelioma intolerable to extrapleural pneumonectomy. H. Ishibashi, M. Kobayashi, C. Takasaki, et al. 2015;63(7):395-400. PubMed · Publisher

  Abstract

  Objective: Surgical procedure for malignant pleural mesothelioma (MPM) remains controversial. We reviewed our protocol including pleurectomy/decortication (P/D) for patients with malignant pleural mesothelioma who were intolerable to extrapleural pneumonectomy (EPP).

  Patients And Methods: From June 2010 to April 2014, 14 patients with MPM were intended to treat with multimodality therapy including surgery. Four patients who were intolerable to EPP received a protocol consisting of P/D and intraoperative intrapleural hyperthermic cisplatin perfusion, followed by systemic chemotherapy. Ten patients received trimodality treatment of EPP, systemic chemotherapy, and intensity modulated radiation therapy for hemithorax. Surgical outcomes of acute operative results and interim survivals were examined and compared between the groups.

  Results: All patients obtained macroscopic complete resection and received multimodality treatment in P/D and EPP groups. Operation time was longer in P/D group; however, there were no differences in ICU stays or hospitalizations. Four patients in P/D group and seven patients in EPP group experienced postoperative complications; however, there was no operative morality. EPP group suffered from cardiac complications and P/D group had prolonged airleak. Full walk recovery was obtained earlier in P/D group. One patient in P/D group had a local recurrence 11 months after surgery, while the other three patients survived 23-41 months with no evidence of diseases.

  Conclusions: P/D and intraoperative intrapleural cisplatin perfusion achieved a favorable macroscopic resection in patients with MPM who were intolerable to EPP. Postoperative complications were manageable and survival could be promising. Further study warrants with a larger number of patients.

• Extrapleural pneumonectomy or pleurectomy/decortication for malignant pleural mesothelioma. S. Hasegawa. 2014;62(9):516-21. Review PubMed · Publisher · Free full text

  Abstract

  Malignant pleural mesothelioma (MPM) is associated with a very poor prognosis. Unlike other solid tumors, any type of planned surgery for MPM would be cytoreductive rather than radical. There are two types of surgery for MPM. Extrapleural pneumonectomy (EPP) involves en bloc resection of the lung, pleura, pericardium, and diaphragm. Pleurectomy/decortication (P/D) is a lung-sparing surgery that removes only parietal/visceral pleura. In comparison with EPP, P/D is theoretically less radical but is associated with less perioperative mortality/morbidity and less postoperative deterioration of cardiopulmonary function. It still remains unclear which surgical technique is superior in terms of the risk/benefit ratio. In this context, selection between EPP and P/D has been a matter to debate.

• FDG PET/CT is useful for detecting infiltration to the port site in patients with malignant pleural mesothelioma. K. Kawaguchi, T. Taniguchi, N. Usami, et al. 2014;62(3):157-62. PubMed · Publisher

  Abstract

  Objective: One reason for the poor outcomes of multimodality therapies, including macroscopic complete resection, in patients with malignant pleural mesothelioma (MPM) is the difficulty of correctly staging the disease, which can result in incomplete resection. The purpose of this study was to investigate the aspects of tumor infiltration to the port site and the usefulness of preoperative FDG PET/CT for diagnosing MPM.

  Methods: Between June 2007 and May 2013, 21 patients who underwent surgical treatment with curative intent for MPM that had been previously diagnosed on a video-assisted thoracic surgery (VATS) biopsy were included in this study.

  Results: There were 17 males and four females, with a mean age of 63 years. The accumulation of FDG at the port site was observed in all nine patients with tumor infiltration to the port site, whereas this feature was not noted in 15 patients without tumor extension to the port site. There were more positive lymph node cases in the infiltration group than in the non-infiltration group (p = 0.02). No significant differences in survival were observed between the patients with and without tumor infiltration to the port site.

  Conclusions: FDG PET/CT is useful for detecting tumor infiltration of MPM to the port site and may help to prevent local recurrence, especially port site relapse, following macroscopic complete resection. However, this condition is related to tumor aggressiveness; therefore, performing careful staging and determining the appropriate treatment strategy are required in such patients.

• Bilateral dissemination of malignant pleural mesothelioma via iatrogenic buffalo chest: a rare route of disease progression. K. Ikezoe, E. Tanaka, K. Tanizawa, et al. 2012;60(9):595-8. Case report PubMed · Publisher

  Abstract

  Buffalo chest refers to the pleuro-pleural communication that results in a single pleural cavity. Iatrogenic buffalo chest can occur following heart or heart-lung transplantation and other major thoracic surgeries. We present the case of malignant pleural mesothelioma in which iatrogenic buffalo chest after extended thymectomy caused bilateral pneumothoraces and contralateral dissemination of the disease. The free communication between bilateral pleural cavities had facilitated the rapid progression of tumor and the consequent bilateral malignant pleural effusions had made the management of disease much more difficult, leading to the early fatal outcome. To our knowledge, this is the first case of buffalo chest that was associated with bilateral malignant pleural effusions.

• Huge malignant solitary fibrous tumor of the pleura. W.A. Arab, D. Lamoth, V. Echavé, et al. 2012;60(6):397-400. Case report PubMed · Publisher

  Abstract

  Introduction: Solitary fibrous pleural tumors are rare mesenchymal tumors that can be mistaken for mesothelioma. A positive staining of vimentin, negative staining of cytoplasmic keratin, and expression of the CD34 antigen can confirm their diagnosis. These tumors should be surgically excised although they are benign because they have malignant potential and tendency for recurrence.

  Patients And Methods: We present here a 63-year-old patient who had an inconclusive biopsy of a huge right intrathoracic lesion. Further testing after radical surgical resection revealed a malignant solitary fibrous pleural tumor. Surgery was complicated with injury of the thoracic duct. Patient was re-operated upon for ligation of the thoracic duct. He is doing well with no recurrence after 18 months of follow-up.

  Conclusion: In conclusion, definitive treatment for solitary fibrous tumor is radical surgical resection with close follow-up for the recurrences. Follow-up of this tumor is essential especially when it showed malignant features on pathological examination.

• Induction chemotherapy, extrapleural pneumonectomy, and adjuvant radiotherapy for malignant pleural mesothelioma: experience of Guy's and St Thomas' hospitals. A. Bille, E. Belcher, H. Raubenheimer, et al. 2012;60(5):289-96. PubMed · Publisher

  Abstract

  Purpose: The treatment of malignant pleural mesothelioma (MPM) remains controversial. We present a prospective study of patients treated at our institution with neoadjuvant chemotherapy, extrapleural pneumonectomy (EPP), and radical radiotherapy.

  Methods: Patients with MPM who were eligible for EPP and multimodality therapy were included in this study. Staging was through computed tomography and positron emission tomography and computed tomography (PET/CT) scanning, video-assisted thoracoscopic surgery (VATS), and mediastinoscopy. Our protocol involved three cycles of cisplatin-based neoadjuvant chemotherapy followed by extrapleural pneumonectomy and adjuvant radiotherapy (54 Gy). All patients were followed up every 3-6 months until death.

  Results: From March 2004 through October 2008, 25 patients were referred for EPP following neoadjuvant chemotherapy. EPP was performed in all but three patients, who were found to have T4 disease at surgery. Surgical complications included arrhythmias (28%), bronchopleural fistulas (12 %), reoperations for bleeding (8%), acute respiratory distress syndrome (4%), pneumonia (4%), septicemia (4%), vocal cord palsy (4%), and Horner's syndrome (4%). The 30-day mortality was 4%. Adjuvant radiotherapy was administered to 81% of patients after EPP. Radiotherapy toxicities included thrombocytopenia, radiation pneumonitis, pulmonary embolus, radiation hepatitis, herpes zoster, transverse myelitis, and late constrictive pericarditis. Median survival from diagnosis was 12.8 months (95% confidence interval 7.8-17.7 months). One-year survival was 54.5%; 2-year survival was 18.2%. Disease progression occurred in 77.3% of patients. Nodal status (N0 disease versus N1-N2) or histology (epithelioid versus biphasic) had no significant impact on survival.

  Conclusion: Despite recent advances in chemotherapy, surgery, and radiotherapy, survival rates remain low for patients with MPM completing multimodality therapy including EPP.

• Localized malignant pleural mesothelioma. T. Nakano, R. Hamanaka, K. Oiwa, et al. 2012;60(7):468-74. Case report PubMed · Publisher

  Abstract

  Localized malignant pleural mesothelioma (LMPM) is a rare tumor; previously only 52 cases have been reported in the English literature. This type of tumor should be distinguished from diffuse malignant pleural mesothelioma, because a good outcome may be obtained by surgical resection. We report a case of LMPM which grew rapidly within 1 year. Surgical resection was performed, and at present, 6 months since the operation, the patient remains free of the disease.

• Resection of a giant, invasive malignant solitary fibrous tumor of pleura. K. Imai, K. Hirayama, I. Matsuzaki, et al. 2012;60(12):859-62. Case report PubMed · Publisher

  Abstract

  Solitary fibrous tumor of pleura (SFTP) is a rare mesenchymal neoplasm that most commonly involves the pleura, is probably derived from fibroblasts, and has no relationship to malignant mesothelioma. Here, we report a case of complete resection of a giant malignant SFTP. A 61-year-old woman developed fever and left flank pain. Computed tomography revealed the tumor to be 13 cm in size and located in the left thoracic cavity, directly invading the left lower lobe of the lung. The patient underwent radical resection and left lower lobectomy. Immunohistochemical examination revealed a dense proliferation of spindle-shaped cells with ovoid nuclei and collagen fibers hyperplasia. The cells were positive for CD34 and vimentin, and were negative for cytokeratin AE1/AE3, calretinin, S-100 and smooth muscle α-actin. SFTPs have malignant potential, as 20-30 % of resected SFTPs reportedly contain malignant components. Careful long-term clinical follow-up is therefore required for all cases of SFTP.

• Minute localized malignant pleural mesothelioma coexisting with multiple adenocarcinomas. R. Maeda, N. Isowa, H. Onuma, et al. 2010;58(2):91-4. Case report PubMed · Publisher

  Abstract

  We report an extremely rare case of minute localized malignant pleural mesothelioma (LMPM) coexisting with multiple lung adenocarcinomas in a 64-year-old woman without a history of smoking or asbestos exposure. A computed tomography scan of the chest displayed total five ground-glass opacities in the lung. Transbronchial lung biopsy from a ground-glass opacity in the posterior segment revealed a bronchioloalveolar carcinoma. With a diagnosis of primary lung cancer, right upper lobectomy and wedge resection of the right lower lobe with systematic lymph node dissection was performed using video-assisted thoracoscopic surgery. Incidentally, a minute gray-white nodule measuring 6 mm was detected on the visceral pleural surface of the right upper lobe. The postoperative histological diagnosis was minute LMPM coexisting with multiple adenocarcinomas.

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