Selective lobar blockade for lung resection : A report of two cases

There are cases in which one-lung ventilation is difficult due to contralateral lung resection or low lung function. Selective lobar blockade can improve oxygenation compared with one-lung ventilation and secure a good operative field by inducing partial collapse. We report two cases of lung resection involving selective lobar blockade. （Case１） An ８０-year-old female had previously undergone right upper and middle lobectomy for multiple lung tumors. Surgery was scheduled to remove a ７‐mm ground glass opacity from the upper left lobe. Oral intubation was performed （inner diameter of intubation tube：８mm）. Next, the left upper lobe bronchus was blocked with a７Fr Arndt blocker under bronchoscopy, and partial resection of the left upper lobe was conducted. （Case２） A ７５-year-old male had previously undergone right upper lobectomy for pulmonary tuberculosis and had developed right chronic empyema. Surgery was scheduled to remove a ２２-mm nodule from the left lingular segment. Oral intubation was performed（inner diameter of intubation tube：８．５mm）. Next, the left lingual bronchus was blocked with a７Fr Arndt blocker under bronchoscopy. Left lingular segmentectomy was carried out under thoracoscopic assistance. Intraoperative oxygenation was maintained in both cases, and the release of the block due to hypoxemia was not required in either case

A feasibility study of postoperative adjuvant chemotherapy with fluoropyrimidine S-1 in patients with stage II-IIIA non-small cell lung cancer

Background : Adjuvant chemotherapy with uracil tegafur (UFT) improved survival among patients with completely resected stage I lung adenocarcinoma. S-1, an oral dihydropyrimidine dehydrogenase (DPD)- inhibitory 5-fluorouracil, is a more potent DPD inhibitor than UFT ; therefore, we hypothesized that postoperative adjuvant chemotherapy with S-1 would be effective for advanced non-small cell lung cancer (NSCLC). We conducted a feasibility study of S-1 as postoperative adjuvant chemotherapy in patients with curatively resected pathological stage II and IIIA NSCLC. Methods : Adjuvant chemotherapy consisted of 9 courses (4-week administration, 2-week withdrawal) of S-1 at 80-120 mg/body per day. Twenty-four patients with completely resected NSCLC were enrolled in this study from November 2007 through December 2010. The primary endpoint was the rate of completion of the scheduled adjuvant chemotherapy. The secondary endpoints were safety, overall survival, and relapse-free survival. Results : Five patients were censored because of disease recurrence. The planned 9 courses of S-1 were administered to completion in 8 patients. Twelve patients completed more than 70% of the planned courses. Grade 3 adverse reactions, such as elevated total bilirubin (4.2%) and pneumonitis (4.2%), were observed, but there were no Grade 4 adverse reactions. Patients who completed more than 70% of the 9 courses demonstrated better overall survival than those who completed less than 70%. Conclusion : Postoperative administration of S-1 may be possible with few severe adverse events as adjuvant chemotherapy for patients with curatively resected pathological stage II-IIIA NSCLC

大腸癌肺転移切除例の検討

The objective of this study was to evaluate prognostic factors after pulmonary resection for metastasis of colorectal cancer. We retrospectively analyzed the clinicopathological factors and the prognosis of 36patients who received pulmonary resection for metastasis of colorectal cancer. The 5-year overall survival after pulmonary resection was 75.4％, and the 3-year disease free survival after pulmonary resection was 53.5％. There was no significant prognostic factor regarding overall survival after pulmonary resection by multivariate analysis. However, regarding disease-free survival after pulmonary resection, T4 stage colorectal cancer showed significant poorer prognosis by multivariate analysis（p＝0.014）. Patients who received reoperation for pulmonary recurrence showed better prognosis than patients who did not receive reoperation (p＝ 0.04). Prognosis after pulmonary resection for metastasis of colorectal cancer is favorable owing to progresses of chemotherapies. Metastasectomy may not be the primary therapy for patients with pulmonary metastasis from T4 stage colorectal cancer because of their short disease-free survival after metastasectomy. Reoperation for resectable recurrence of pulmonary metastasis may improve overall survival