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| 1.
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捶井, 達也 ; 小田, 誠 ; 田村, 昌也 ; 早稲田, 龍一 ; 松本, 勲 ; 渡邊, 剛 ; Tarui, Tatsuya ; Oda, Makoto ; Tamura, Masaya ; Waseda, Ryuichi ; Matsumoto, Isao ; Watanabe, Go
概要:
金沢大学医薬保健研究域医学系<br />症例は32歳，女性．乳房痛を自覚し，精査のため胸部造影CTを施行したところ後縦隔に均一な造影効果を伴う径3.1cmの腫瘤を認めた．右上肢からの静脈造影では造影剤が上大静脈から奇静脈弓へ逆行性に流入し，
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腫瘤が濃染した．これにより腫瘤を静脈瘤と診断した．血栓による肺血栓塞栓症や瘤の破裂の可能性を考え外科的切除の方針とした．手術は胸腔鏡下にて施行した．まず血栓の流出を防止するため奇静脈弓の上大静脈合流部を自動縫合器にて切離した．次に瘤に流入する肋間静脈と奇静脈本幹を結紮，切離し，血行を遮断したのち瘤を切除した．術後合併症はなく10日目に退院した．<br />The patient was a 32-year-old female with a chief complaint of mastodynia. A computed tomography (CT) scan incidentally presented a homogeneously enhanced tumor, 3.1 cm in diameter, in the posterior mediastinum. Venography by the right brachial vein showed retrograde flow from the superior vena cava to azygos vein in the early phase. In the delayed phase, pooling of contrast medium in the tumor was observed. Based on the above findings, the tumor was diagnosed as an azygos vein aneurysm. She underwent aneurysm resection under video-assisted thoracic surgery (VATS) due to the risk of pulmonary thrombosis and rupture of the aneurysm. Initially, the proximal end of the azygos vein was resected due to the risk of pulmonary embolism, and, then, three intercostal veins and the distal end of the azygos vein were resected. Finally, after complete blockage of the azygos vein, the aneurysm was resected. The patient followed an uneventful postoperative course, and was discharged on the 10th postoperative day without complication.
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| 2.
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西田, 沙貴 ; 小田, 誠 ; 松本, 勲 ; 田村, 昌也 ; 早稲田, 龍一 ; 渡邊, 剛 ; Nishida, Saki ; Oda, Makoto ; Matsumoto, Isao ; Tamura, Masaya ; Waseda, Ryuichi ; Watanabe, Go
概要:
金沢大学医薬保健研究域医学系<br />症例は59歳，女性．3年前に子宮体癌を疑われ準広汎子宮全摘術，S状結腸切除術を施行された．病理診断および精査の結果，原発性肺腺癌の腹腔内転移と診断された．その後の経過で，計6レジメンの化学療法と計10
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0Gyの放射線治療が施行された．転移巣の制御は良好であったが，原発巣の増大傾向を認めたため，手術目的に当科紹介となった．手術は，肺門部において，肺動脈および上葉気管支と周囲組織との強固な癒着を認めたため，これらを一括して鉗子にてクランプした後に切離し，断端を3-0vicryl糸にて縫合して閉鎖した．断端は有茎傍心膜脂肪織にて被覆した．術後の病理診断で，低分化肺腺癌と診断された．術後さらに補助化学療法を追加し，術後9ヵ月間再発転移は認めていない．高容量化学放射線療法による炎症にて肺門部の処理が困難な症例に対しては，肺門部一括処理および有茎傍心膜脂肪織による気管支・肺動脈切離断端の被覆が有用であると考える．<br />A 59-year-old female was referred to our hospital for stage IV (cT3N2M1b) adenocarcinoma of the right lung. At the age of 56, at another hospital, she had undergone extended hysterectomy and resection of the sigmoid colon for suspected endometrial carcinoma and had received a diagnosis of lung adenocarcinoma based on pathological findings, a CT scan, and other examinations. A total of six regimens of chemotherapy and radiotherapy with a total dose of 100 Gy had been performed over 3 years, but it was resistant. Therefore, she was referred to our hospital to consider surgical treatment. We performed a right upper lobectomy because the tumor was localized and no other metastatic lesion was found. We ablated the tumor from the chest wall because it grew to the apical chest wall. In the hilum of the lung, individual ligation and closure of the pulmonary vessels and bronchus was found to be impossible because they tightly adhered to the peripheral tissue. Therefore, the hilar vessels and bronchus were clamped and cut in one mass. Their stumps were oversewn with 3-0 vicryl and covered with a pedicled pericardial flap. The post operative course was favorable, and the patient underwent adjuvant chemotherapy at the hospital that had originally referred her to us. She was free of clinically evident recurrence 9 months after treatment. We suggest that the mass closure of the hilar vessels and bronchus and covering the stumps with a pedicled pericardial flap are useful for cases in which it is difficult to individually close the vessels and bronchus due to ligneous scarring caused by radiation.
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小田, 誠 ; 金森, 太郎 ; 丸川, 洋平 ; 伊藤, 祥隆 ; 石川, 暢己 ; 田村, 昌也 ; 呉, 哲彦 ; 渡辺, 俊一 ; 太田, 安彦 ; 渡辺, 剛 ; 渡辺, 洋宇 ; Oda, Makoto ; Kanamori, Taro ; Marukawa, Yohei ; Itoh, Y. ; Ishikawa, Y. ; Tamura, Masaya ; Go, Tetsuhiko ; Watanabe, Shun-ichi ; Ohta, Yasuhiko ; Watababe, Go ; Watanabe, Yoh
概要:
金沢大学医薬保健研究域医学系<br />The purpose of this study was to evaluate the results of new TNM staging system for lung cancer in 1
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997, especially T3N0M0, stage IIIA, stage IIIB, and pm. Five-year survival rates of the patients with stage IIIA and stage IIIB were 16% and 18% respectively (NS). Five-year survival rates of patients with T3N1M0, T1N2M0, T2N2M0, and T3N2M0 were 40%, 28%, 15%, and 3%, respectively. The prognosis of T3N2M0 was significantly worse than that of T3N1M0, T1N2M0, and T2N2M0. Five-year survival rates of the patients excluding pm 1 with T4N0M0, T4N1M0, T4N2M0, and T4N3M0 were 21%, 10%, 10%, and 0%, respectively. The prognosis of the patients with T4N0 was significantly better than that of T4N2 and T4N3. In the patients with pm, 5-year survival rates of the patients with pm 1 and pm 2 were 26% and 7%, respectively (p < 0.01). In the patients with pm 1, 5-year survival rates of the patients with N0 + N1 and N1 + N2 were 53% and 16%, respectively (p < 0.01). From our these results, we supported the new TNM system as putting T3N0M0 to stage IIB, putting pm 2 into stage IV. We proposed; 1) chest wall invasion with bone destruction stay in stage IIIA or is T4, 2) T3N1M0 is classified with stage IIB, 3) main stem bronchus invasion is classified with T2, 4) pm 1 is subdivide by N status. Furthermore, stage III seemed to be reasonably subdivided into T1-2N3M0, T4N0-1M0 as stage IIIA and T3-4N2, T1-4N3 as stage IIIB.
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小田, 誠 ; 金森, 太郎 ; 伊藤, 祥隆 ; 石川, 暢己 ; 田村, 昌也 ; 呉, 哲彦 ; 渡辺, 俊一 ; 太田, 安彦 ; 渡辺, 剛 ; 渡辺, 洋宇 ; Oda, Makoto ; Kanamori, Taro ; Itoh, Y. ; Ishikawa, Y. ; Tamura, Masaya ; Go, Tetsuhiko ; Watanabe, Shun-ichi ; Ohta, Yasuhiko ; Watababe, Go ; Watanabe, Yoh
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金沢大学医薬保健研究域医学系<br />The purpose of this study was to evaluate the results of carinal resection for bronchogenic carcinom
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a in our institute. From 1981 to 1999, 24 carinal resection were performed for squamous cell carcinoma (n = 19), adenoid cystic carcinoma (n = 2), small cell carcinoma (n = 1), adenocarcinoma (n = 1), and mucoepidermoid carcinoma (n = 1). Nineteen underwent sleeve pneumonectomy, 2 had carinal resection without lung resection, 2 had carinal resection with right middle and lower lobectomy, and 1 had wedge pneumonectomy. In the patients with sleeve or wedge pneumonectomy, there were 5 operative death and 3 patients had survived for more than 3 years. Two patients with low-grade malignant tumors underwent carinal resection without lung resection and survived more than 10 years. We believe that limited carinal resection for low-grade malignant tumors are safe and valuable procedure. Careful selection of patients with sleeve or wedge pneumonectomy is mandatory.
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| 5.
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滝沢, 昌也 ; 小田, 誠 ; 太田, 安彦 ; 川上, 和之 ; 常塚, 宣男 ; 松本, 勲 ; 田村, 昌也 ; 谷内, 毅 ; 渡辺, 剛 ; 高仲, 強 ; 西嶋, 博司 ; 松井, 修 ; Takizawa, Masaya ; Oda, Makoto ; Ohta, Yasuhiko ; Kawakami, Kazuyuki ; Tsunezuka, Yoshio ; Matsumoto, Isao ; Tamura, Masaya ; Yachi, Tsuyoshi ; Watanabe, Go ; Takanaka, Tsuyoshi ; Nishijima, Hiroshi ; Matsui, Osamu
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金沢大学医薬保健研究域医学系<br />We evaluated the efficacy of perioperative targeting brachytherapy for lung cancer invading the ches
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t wall. Between 1998 and 2003, 7 patients underwent perioperative targeting brachytherapy for lung cancer invading the chest wall. There were 5 male and 2 female patients. The mean age was 63.3 years, with a range of 45 to 77 years. All patients underwent complete resection including the chest wall combined resection. During the operation, plastic afterloading catheters fixed on the Vicryl mesh at interval of 1 cm were placed on the site of chest wall resection. From the third to sixth day after the operation, 15 to 32 Gy of radiation was delivered over 3 or 4 days using a high dose rate remote afterloading system. The area targeted for brachytherapy was determined by a computed tomography (CT) scanner translator with a computer program for radiation planning. The median postoperative hospital stay was 35 days. Local recurrences were observed in 2 patients, but there was no evidence of recurrence in the margin of the resected chest wall. We believe that this short period of treatment and the low side effects enhances the quality of the patients. Prevention of local recurrence was achieved in short term follow-up.
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| 6.
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太田, 安彦 ; 清水, 洋介 ; 加藤, 陽介 ; 松本, 勲 ; 田村, 昌也 ; 小田, 誠 ; 湊, 宏 ; 渡辺, 剛 ; Ohta, Yasuhiko ; Shimizu, Yosuke ; Kato, Yosuke ; Matsumoto, Isao ; Tamura, Masaya ; Oda, Makoto ; Minato, Hiroshi ; Watanabe, Go
概要:
金沢大学医薬保健研究域医学系<br />This retrospective analysis was undertaken to review our results of treatment of lung cancers with i
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nvasion of non-apical and non-vertebral chest wall structures. In summary of our experience, although relatively good prognosis can be expected in N0M0 patients with the histological type of adenocarcinoma by initial operation, distant relapse remains a major problem of the disease. Furthermore, our results are in agreement with the idea that postoperative adjuvant therapy is of little value in patients with complete resection. To ameliorate surgical outcomes, induction treatment should be considered and preoperative staging assessment needs to be strictly done for proper selection of patients with this locally advanced disease. The indication of initial operation needs to be cautiously determined for patients with this disease.
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| 7.
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田村, 昌也 ; 小田, 誠 ; 滝沢, 昌也 ; 谷内, 毅 ; 松本, 勲 ; 常塚, 宣男 ; 川上, 和之 ; 渡辺, 剛 ; Tamura, Masaya ; Oda, Makoto ; Takizawa, Masaya ; Yachi, Tsuyoshi ; Matsumoto, Isao ; Tsunezuka, Yoshio ; Kawakami, Kazuyuki ; Watanabe, Go
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金沢大学医薬保健研究域医学系<br />We report a case of completion pneumonectomy after 4 times of metastasectomy for metastatic lung tum
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ors from rectal carcinoma. A 63-year-old man underwent Miles' operation for advanced rectal carcinoma. Forty-seven months after the operation, bilateral metastasis was appeared, and bilateral metastasectomy was performed. After the resection, 3 times of metastasectomy were performed during 40 months. Follow-up X-ray and computed tomography (CT) showed abnormal shadow in his left hilum of lung. Completion pneumonectomy with mediastinal lymph node sampling was performed. He is still alive without recurrence 4 years after first thoracotomy. Repeated pulmonary resection can lead to good outcome for selective patients with metastatic colorectal carcinoma, and repeated surgery can be useful for pulmonary recurrences after thoracotomy.
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| 8.
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8. Plasma VEGF concentration can predict the tumor angiogenic capacity in non-small cell lung cancer
Tamura, Masaya ; 田村, 昌也
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取得学位 : 博士（医学）, 学位授与番号 : 医博甲第1488号 , 学位授与年月日 : 平成13年5月31日, 学位授与大学 : 金沢大学
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小田, 誠 ; 谷内, 毅 ; 田村, 昌也 ; 渡邊, 剛
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医薬保健研究域医学系<br />Purpose. In the has 4 years, we performed chemotherapy using paclitaxel (TXL) for 20 cases of recurrent
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non-small cell lung cancer and two cases of residual lung cancer patients. In this report, we present two cases showing complete remission. Case 1. The patient was a 69-year-old man who underwent an operation for stage IA adenocarcinoma. Thirty-eight months after the operation, this patient showed intrathoracic recurrence. No response was available after three couses of treatment using CDDP+VDS. This case was diagnosed as metachronous double primary lung cancer after the re-operation. Multiple recurrent tumors appeared in his left lung. Complete response was obtained after four courses of CBDCA+TXL. The patient is alive with no recurrence after seven courses of weekly TXL. Case 2. A 50-year old women underwent a non-curative operation for the tumor in the right S10 with intrathoracic dissemination. The pathological diagnosis was pT4NOM1, stage IV. The weekly TXL therapy was started because the residual tumors revelaed no response to the three courses of CBDCA+TXL. Complete response was obtained 20 months after the weekly TXL, therapy was started. The patient is alive with no sign of recurrence after 25 courses of weekly TXL therapy. Conclusion. Chemotherapy using TXL may be a promising regimen for the treatment of recurrent or residual non-small cell lung cancer. 目的.最近4年間に,非小細胞肺癌術後再発20例および術後癌遺残2例の計22例に対してパクリタキセルを用いた化学療法を施行した.このうちComplete Response (CR)が得られた2例を呈示する.症例1.69歳,男性.右腺癌(IA期)に対し手術を施行した.胸腔内再発を来し,シスプラチン+ビンデシンを3コース施行するも不変(NC)であった.再手術にて,多発癌と診断された.その後左肺に多発転移巣を認めたため,カルボプラチン+パクリタキセルを4コース施行し,転移巣はほぼ消失した.パクリタキセル隔週投与を計7コース施行し,現在再発の徴候は認めていない.症例2.50歳,女性.胸膜播種を伴う右S10の腫瘍に対して,手術(非完全切除)を施行した.中分化型腺癌(pT4NOM1,IV期)と診断された.カルボプラチン+パクリタキセルを3コース施行したが術後遺残した肺転移巣はNCであったため,パクリタキセル隔週投与を開始した.20ヵ月後CRが得られ,計25コース終了時点で一旦化学療法を中止した.現在無再発生存中である.結論.非小細胞肺癌に対するパクリタキセルを用いた化学療法は,術後再発例や癌遺残例に対しても治療の一選択肢となり得ると考えられた.
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| 10.
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太田, 安彦 ; 田村, 昌也 ; 飯野, 賢治 ; 常塚, 宣男 ; 新田, 香苗
概要:
癌性胸膜炎に対する腔内化学療法においては,長時間にわたる胸腔内での薬剤活性の維持が求められる.Paclitaxelの24時間胸腔内投与を含めた集学的治療の悪性胸水に対する治療成績につき中間報告する.方法.2001年10月から2004年5月ま
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でに,癌性胸膜炎と確診された10例に対して本治療を行なった.原発病巣は肺癌9例,乳癌1例.Paclitaxel(120 mg/m^2)24時間腔内投与を含む集学的治療を行なった.6例に対しては選択的に外科治療が,また9例に対しては全身化学療法が併用された.術式は肺部分切除+壁側胸膜切除(PL)2例,肺葉切除+PL2例,PL1例,胸壁切除+PL1例であった.結果.手術例においては術後平均7.7(3〜16)日目に腔内治療が施行された.Paclitaxel腔内投与に伴う副作用は10例中5例に認め,胸痛と白血球減少が頻度的には多かったが,重篤な副作用はみられず,5例においては副作用の発現は認めなかった.中間観察期間19ヶ月(3〜33ヶ月)にて,悪性胸水は8例において良好にコントロールされており,中間生存期間は18ヶ月であった.結語.症例数および観察期間ともなお蓄積が必要だが,paclitaxelを用いた長時間胸腔内治療は癌性胸膜炎に対する局所療法として新たな治療選択肢のひとつとなる可能性がある. Background. For successful intrapleural chemotherapy, efforts should be made to maintain the intrapleural drug activity as long as possible. In this interim report, the effectiveness of paclitaxel administered by 24-hour intrathoracic infusion as an adjunct to selective surgical management and/or systemic chemotherapy for controlling malignant pleural effusions is described. Methods. Between October 2001 and May 2004,10 patients with carcinomatous pleuritis were enrolled in the study. The primary sites of the diseases were the lung in 9 patients and the breast in one patient. Paclitaxel (120 mg/m^2) was administered by 24-hour intrathoracic infusion. Six of the 10 patients selectively underwent surgical treatment and 9 patients received adjuvant systemic chemotherapy. The operative procedures used were partial resection of the primary site plus parietal pleurectomy (PL) in 2 cases, lobectomy plus PL in 2 cases, PL only in one case, and chest wall resection plus PL in one case. Results. In patients who underwent surgery, the mean time interval between the operation and intrapleural chemotherapy was 7.7 days (range 3-16'days). Mild toxicity was found in 5 cases, and chest pain and neutropenia were dominant. During a median follow-up period of 19 months (range, 3-33 months), malignant effusions were successfully controlled in 8 patients and the median survival period was 18 months. Conclusion. The use of paclitaxel in this manner merits further investigation for possible intervention for malignant pleural effusions originating in lung and breast neoplasms.
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