Department of Thoracic Surgery
Yukihiro Yoshida
2023/7/1
Introduction
The Department of Thoracic Surgery deals with various kinds of neoplasms and allied diseases in the thorax, except the esophagus. These include both primary and metastatic lung tumors, mediastinal tumors, pleural tumors (mesotheliomas) and chest wall tumors. The main clinical activity of our department and the subject of most of its research activities has been the surgical management of lung cancer patients.
The Team and What We Do
Our department has 4 attending surgeons and resident surgeons perform all the inpatient care, surgeries, examinations, and outpatient care. In 2022, we performed a total of 736 operations: for lung cancer in 649 patients, metastatic tumors in 8, mediastinal tumors in 50 and other tumors in 29.
The treatment strategy for patients with lung cancer is based on tumor histology (non-small cell vs. small cell), the extent of the disease (clinical stage) and the physical status of the patient. In lung cancer patients, surgical resection is usually indicated for clinical stages I, II and some IIIA with non-small cell lung cancer [NSCLC] and clinical stage I with small cell lung cancer [SCLC]. However, to improve the poor prognosis of patients with clinically and histologically proven mediastinal lymph node metastasis or with invasion of vital neighboring structures, optimal treatment modalities are sought in a clinical trial setting. In addition, adjuvant therapy has often been given to patients with advanced lung cancer, even after complete resection.
Lymph node dissection for lung cancer has been a major issue in lung cancer treatment and has been extensively studied in our department. We continue to improve our surgical dissection technique, taking oncological and surgical aspects into consideration: a more effective and less invasive lymph node dissection called “selective mediastinal/hilar dissection”, according to the location of the primary tumor by the lobe.
Minimally invasive open surgery (MIOS), using a thoracoscope for thoracic malignancies, is also an important challenge in our department. Indications and surgical techniques of VATS for early lung cancer are of special interest given the increased incidence of such minute tumors due to improvements in CT devices and CT screening.
Recently, the role of segmentectomy has become more important because the rate of detection for early-stage lung cancer is increasing. We have actively performed segmentectomy for early-stage lung cancer in recent years. In 2022, we performed the largest number of segmentectomies as well as lung cancer surgeries in Japan.
