担当区分：最終著者   記述言語：日本語   出版者・発行元：General Thoracic and Cardiovascular Surgery Cases  

Background: Myasthenia gravis (MG) without thymoma is often treated with extended thymectomy to improve symptom control and reduce immunotherapy requirements. Schwannoma of the recurrent laryngeal nerve (RLN) is rare, and surgical resection is usually curative. However, operative manipulation carries a risk of temporary or permanent vocal fold paralysis. When these conditions coexist, choosing staged versus single-stage surgery is non-trivial. A synchronous operation can consolidate perioperative care and recovery but demands careful planning to prevent respiratory complications, particularly if RLN palsy or myasthenic crisis occur. Case presentation: A 65-year-old woman with generalized, thymoma-negative MG (acetylcholine-receptor antibody positive) had no hoarseness or dysphagia. Flexible laryngoscopy confirmed mobile vocal folds bilaterally. Chest radiography showed mediastinal widening without diaphragmatic paralysis. Contrast-enhanced CT and MRI revealed a right anterior mediastinal cystic lesion and a solid mass in the left tracheoesophageal groove abutting the RLN. ^18F-fluorodeoxyglucose positron emission tomography demonstrated uptake in the solid lesion (SUV_max 4.89). Transesophageal endoscopic ultrasound–guided fine-needle aspiration yielded spindle cells compatible with schwannoma, and the mass was considered RLN-derived. A single-stage median sternotomy was undertaken. Extended thymectomy was performed with bilateral phrenic exposure and en bloc removal of thymic/perithymic fat, followed by nerve-sparing enucleation of the left RLN tumor through a longitudinal epineurial window and meticulous intracapsular dissection, preserving macroscopic neural continuity. The postoperative intensive care unit course was uneventful: no dyspnea or dysphagia, normal voice, and laryngoscopy confirmed intact vocal fold mobility. A chest radiograph on postoperative day 5 was unremarkable, and the patient was discharged on day 7. Histopathology showed alternating Antoni A/B areas with virtually no mitoses; tumor cells were strongly S-100–positive, confirming schwannoma. Conclusions: In carefully selected patients with stable MG and no preoperative vocal fold dysfunction, single-stage median sternotomy enables safe concomitant extended thymectomy and RLN schwannoma enucleation. Success hinges on nerve-sparing technique and proactive perioperative planning for airway protection and potential MG crisis.

DOI： 10.1186/s44215-026-00248-3

Scopus

PubMed

記述言語：日本語   出版者・発行元：Surgery Today  

Purpose: Pleural lavage cytology (PLC) is a recognized prognostic marker in non-small cell lung cancer (NSCLC); however, the impact of serial intraoperative changes remains unclear. Methods: We retrospectively analyzed 439 patients who underwent curative NSCLC resection. PLC was performed at three intraoperative points: after thoracotomy (pre-PLC), after lung resection, and after lavage at chest closure (post-PLC). Associations between recurrence-free survival (RFS) and pleural dissemination were evaluated by a Kaplan–Meier analysis and Fine and Gray competing risks regression. Results: Forty-one patients had at least one positive PLC result. RFS was the lowest in pre-PLC(+)/post-PLC(+) (n = 10), intermediate in pre-PLC(–)/post-PLC(+) (n = 11), and best in post-PLC(−) (n = 20). Importantly, post-PLC(−) patients included 13 patients with pre-PLC positivity, yet their RFS matched that of consistently negative cases (n = 398). The cumulative incidence of pleural dissemination exhibited a similar pattern. In a multivariate analysis, post-PLC positivity, but not pre-PLC positivity, independently predicted poor RFS (hazard ratio, 3.06; p < 0.001). Conclusion: Post-PLC, but not pre-PLC, provides decisive prognostic information for recurrence and pleural dissemination, likely reflecting residual lavage-resistant tumor clusters. Importantly, combining pre- and post-PLC results refines risk stratification and identifies the poorest-outcome subgroup that may benefit from adjuvant therapy.

DOI： 10.1007/s00595-025-03159-y

Scopus

PubMed

担当区分：最終著者   記述言語：日本語   出版者・発行元：Respirology Case Reports  

Tracheal adenoid cystic carcinoma (ACC) often shows submucosal extension, leading to positive margins. A male patient presented with dyspnea due to an intraluminal tumour arising from the membranous mid-trachea. Rigid bronchoscopy debulking confirmed ACC. In a second-stage operation, circumferential resection of approximately 3.8 cm of trachea with end-to-end anastomosis achieved macroscopic clearance. Intraoperative frozen sections, however, revealed tumour cells within lymphatic channels of the tracheal sheath at the distal cartilaginous-side margin opposite the membranous lesion, precluding further resection because of the limit of safe tracheal length. The anastomosis was therefore completed with anticipated microscopic residual disease, and postoperative radiotherapy from the anastomosis to the carina was delivered. The patient remains recurrence-free at follow-up. This case highlights circumferential extramural lymphatic spread of tracheal ACC and underlines the importance of systematic intra- and postoperative pathological assessment and of considering tracheal sheath and peritracheal tissue in defining resection and adjuvant strategies.

DOI： 10.1002/rcr2.70513

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PubMed

担当区分：最終著者   記述言語：日本語   出版者・発行元：Interdisciplinary Cardiovascular and Thoracic Surgery  

Objectives The recent increase in sublobar resections has been driven by favourable long-term outcomes and advances in stapling devices. However, maintaining an adequate resection margin remains a critical oncological requirement. This study aimed to investigate whether deep wedge resection induces subpleural alveolar injury that could lead to margin overestimation by creating undetectable internal cavities. Methods We retrospectively analysed 33 consecutive patients who underwent wedge resection and CT imaging of resected lung specimens between December 2018 and February 2025. CT was performed on inflated specimens to better visualize internal lung architecture. We assessed the presence of an “empty space” adjacent to the staple line and correlated it with clinical factors, including depth of wedge resection (WR). Additionally, ex vivo porcine lung models were used to simulate deep WR, analyse compression effects, and identify histological damage caused by stapler compression. Results CT imaging revealed empty spaces adjacent to the staple line in 10 of 33 specimens (30.3%), with a mean cavity length of 8.25±3.2 mm. This artifact was significantly associated with deeper WR (≥26.3 mm) and increased stapler cartridge usage (median: 4 vs 3, P=.0298). In porcine experiments, compression to 2 mm thickness resulted in internal parenchymal rupture without pleural tearing, replicating the clinical findings. Conclusions This study identified a potential mechanism by which deep wedge resection may lead to overestimation of the pathological margin due to stapler-induced parenchymal rupture. Further large-scale studies integrating oncological outcomes are warranted to clarify how wedge resection and segmentectomy should be appropriately selected for deep peripheral lung lesions.

DOI： 10.1093/icvts/ivag021

Scopus

PubMed

記述言語：英語   掲載種別：研究論文（学術雑誌）  

DOI： doi:10.1016/j.cllc.2024.04.010

開催年月日： 2026年3月

記述言語：日本語   会議種別：口頭発表（一般）  

開催地： 沖縄市  

開催年月日： 2026年3月

記述言語：日本語   会議種別：口頭発表（一般）  

開催地： 沖縄市  

開催年月日： 2026年3月

記述言語：日本語   会議種別：口頭発表（一般）  

開催地： 北九州市  

開催年月日： 2026年3月

記述言語：日本語   会議種別：口頭発表（一般）  

開催地： 北九州市  

開催年月日： 2026年2月

記述言語：日本語   会議種別：口頭発表（一般）  

開催地： 鹿児島市