On December 16, 2015, the Supreme Court of Japan ruled that Article 750 of the Civil Code enforcing married couples to use the same surname does not violate the Constitution of Japan. It stated, “A husband and wife shall...On December 16, 2015, the Supreme Court of Japan ruled that Article 750 of the Civil Code enforcing married couples to use the same surname does not violate the Constitution of Japan. It stated, “A husband and wife shall adopt the surname of the husband or wife in accordance with that which is decided at the time of marriage.” While the law does not stipulate which name married couples should adopt, invariably, in fact in 96.3％ of the cases, women adopt their husband’s surname, a reflection of Japan’s male-dominated society and the discrimination against women. With an increasing number of women in the workforce in recent times, those who adopt their husband’s surname face professional inconveniences. Women surgeons, in particular, find that changing their surname after marriage interferes with their career growth; their professional reputation and identity would have to be rebuilt, for example, while making presentations at academic events or publishing papers. In the modern era of individuality and diversity, men and women should have equal rights to pursue a career whether they are married or have children. Women surgeons, in particular, deserve the right to use their original surname to pursue their careers as surgeons and/or medical researchers.
On April 25th, 2015, a massive 7.8-Mw earthquake occurred 77 km northwest of Kathmandu, the capital of Nepal. Disaster relief medical teams from the Japan International Cooperation Agency (JICA) were sent to Nepal on Apr...On April 25th, 2015, a massive 7.8-Mw earthquake occurred 77 km northwest of Kathmandu, the capital of Nepal. Disaster relief medical teams from the Japan International Cooperation Agency (JICA) were sent to Nepal on April 28th. The primary medical team consisted of 46 people, including two trauma surgeons. A meeting was held in Kathmandu by the Nepal Government Ministry of Health and Population and the World Health Organization for the foreign medical teams. The JICA team was asked to provide hub hospital services in Barhabise in the District of Sindhupalchok where some of the greatest damage had occurred. It was not until May 4th that medical supplies for our large medical tents and surgeries arrived in Kathmandu; the supplies were then sent on to Barhabise by road that same day. Our field hospital for both surgery and patient beds was finally operational on May 5th. This was the first time that a Japanese team performed surgery using general anesthesia in a Japanese field hospital. The surgery was for a left Lisfranc joint dislocation with open fracture in a 37-year-old woman. We had patients stay in the field hospital overnight after their surgeries. As the quantity of supplies increases, response times are affected because we have no transportation means such as the armed forces. These problems need to be considered in the future.
Malignant pleural mesothelioma (MPM) is a very aggressive tumor with poor prognosis. Unlike other solid malignancies, the aim of surgery for MPM is cytoreductive rather than radical. Surgery is performed as multimodality...Malignant pleural mesothelioma (MPM) is a very aggressive tumor with poor prognosis. Unlike other solid malignancies, the aim of surgery for MPM is cytoreductive rather than radical. Surgery is performed as multimodality therapy in MPM, combining extrapleural pneumonectomy (EPP) and pleurectomy/decortication (P/D). An en-bloc resection of the pleura, lung, diaphragm, and pericardium is performed in EPP. P/D is a lung-sparing procedure that removes the pleura alone without the lung parenchyma. P/D is less invasive and preserves greater cardiopulmonary function compared with EPP, which leads to good postoperative quality of life (QOL). Tumor recurrence is more frequent after P/D, but it is possible to perform additional treatment because cardiopulmonary function is preserved and QOL is maintained. P/D is a feasible curative surgical treatment for MPM, and it will be performed more frequently in Japan.
Phrenic nerve injury often causes diaphragmatic dysfunction. Damage to the phrenic nerve may be caused by iatrogenic injury such as transection or crush during thoracic or neck surgery to treat bronchogenic, mediastinal,...Phrenic nerve injury often causes diaphragmatic dysfunction. Damage to the phrenic nerve may be caused by iatrogenic injury such as transection or crush during thoracic or neck surgery to treat bronchogenic, mediastinal, or neck tumors. Plication of the diaphragm is a procedure in which the flaccid hemidiaphragm is tautened by oversuturing it. Although it has been offered to patients with unilateral diaphragmatic paralysis who have severe dyspnea and other symptoms, the essential treatment should be restoration of the function to the paralyzed diaphragm. Established reconstructive techniques for peripheral nerves are indicated to treat some phrenic nerve injury cases. Muscle contraction and diaphragmatic function following nerve reconduction is recovered in many clinical cases, and favorable experimental results were seen in animal models. Reconstructive nerve procedures such as repair, graft, or transfer may be indicated in more cases of phrenic nerve injury to improve prognostic outcomes of surgery to treat locally advanced malignancies.
Surgical resection remains the only reliable curative method for lung cancer, and combined resection of the primary tumor and involved neighboring structures is performed when possible in patients with locally advanced d...Surgical resection remains the only reliable curative method for lung cancer, and combined resection of the primary tumor and involved neighboring structures is performed when possible in patients with locally advanced disease. Lung cancers involving the chest wall and diaphragm are now classified as T3 lesions, and the surgical treatment for those tumors is generally accepted. However, the outcomes are frequently unsatisfactory, and the 5-year survival rates of patients with chest wall and diaphragmatic invasion were reported to be 30-40％ and 20-40％, respectively, with mortality rates of 1.8-7.8％ for chest wall resection and 0-2.0％ for diaphragm resection. In combined resection, a good surgical indication is N0-1 disease, and complete resection is essential. The indication for reconstruction of the chest wall is a large lesion in the caudal area which is not covered by the scapula. If the lesion area in the diaphragmatic muscle is smaller than fist size, it is possible to perform direct suturing with nonabsorbable bladed sutures. In cases of large lesions, diaphragmatic reconstruction using nonabsorbable material is necessary to prevent the herniation of abdominal organs. In the near future, it is hoped that multidisciplinary treatments including surgery will improve the outcomes of patients with those locally advanced lung cancer.
To avoid a pneumonectomy procedure in patients with locally advanced lung cancer, extended resection including bronchovasculoplasty is an option to preserve the lung parenchyma. A triple-plasty operation involving the br...To avoid a pneumonectomy procedure in patients with locally advanced lung cancer, extended resection including bronchovasculoplasty is an option to preserve the lung parenchyma. A triple-plasty operation involving the bronchus, pulmonary artery, and pulmonary vein is sometimes termed “auto-lung transplantation” and divided into two distinctive procedures. In one, “transposition” of the preserved lung is performed in an in vivo manner, while the other is a type of “bench surgery” performed in an ex vivo manner. To protect the lung graft from ischemic-reperfusion injury, the excised lung should be irrigated with lung preservation solution. Excision of the lung graft is easier with the bench surgery approach as compared with conventional surgery, and it was reported that there is no prolongation of operative time. This bench surgery method for lung cancer is a new, challenging surgical entity, and its utility is expected to be assessed in the near future.
Plastic procedures for intrathoracic vessels are required for the preservation of pulmonary parenchyma. “Pneumonectomy itself is a disease” is one of the most famous concepts in thoracic oncology, and the preservation of...Plastic procedures for intrathoracic vessels are required for the preservation of pulmonary parenchyma. “Pneumonectomy itself is a disease” is one of the most famous concepts in thoracic oncology, and the preservation of lung function is obviously important. However, recent cases of lung cancer seen are generally small-sized early lesions, and the opportunity for performing such complex procedures is rare for modern thoracic surgeons. Thus the aim of this paper is to explain the importance of the procedures in detail, especially pulmonary arterioplasty. Plastic procedures of the pulmonary artery are most commonly required for left upper lobectomy for the treatment of lung cancer, due to the anatomic relations between the bronchial structure and pulmonary artery. The pulmonary artery is much longer than the bronchus, resulting in easy resection and reconstruction of the vessels. The types of reconstruction are direct running sutures, pericardial patch, and end-to-end anastomosis. Additionally, the pericardial conduit or pulmonary vein conduit has recently been reported to be useful in plastic procedures of the pulmonary artery. The details are discussed.
Bronchoplasty for patients with lung cancer is basically designed to achieve radical cure with the preservation of lung function. Functional lung parenchyma can be preserved, and the reimplanted lobes contribute to posto...Bronchoplasty for patients with lung cancer is basically designed to achieve radical cure with the preservation of lung function. Functional lung parenchyma can be preserved, and the reimplanted lobes contribute to postoperative quality of life. Pneumonectomy is associated with a higher occurrence of postoperative complications, poor quality of life, and cardiopulmonary dysfunction as compared with lobectomy. In addition, long-term complications (i.e., late pulmonary hypertension, respiratory failure, or so-called postpneumonectomy syndrome) are sometimes seen after pneumonectomy but seldom after lobectomy. Thus pneumonectomy itself is considered a disease. Sleeve lobectomy, or lobectomy with bronchoplasty, which allows the preservation of functional lung parenchyma with the possible advantages of lower mortality and morbidity rates, is a valid alternative to pneumonectomy and has recently been accepted as a standard treatment in noncompromised patients with lung cancer. Atypical bronchoplasties such as double-sleeve and extended-sleeve lobectomy, and sleeve segmentectomy are also performed at present. This article describes the surgical techniques for bronchoplastic procedures and compares the surgical outcomes of sleeve lobectomy with those of pneumonectomy reported in the literature.
Lobectomy has been and remains the standard surgical treatment for peripheral cT1aN0M0 lung cancer because of the conclusion of the randomized controlled trial performed by the Lung Cancer Study Group in 1995, and limite...Lobectomy has been and remains the standard surgical treatment for peripheral cT1aN0M0 lung cancer because of the conclusion of the randomized controlled trial performed by the Lung Cancer Study Group in 1995, and limited resection (segmentectomy and wedge resection) is still not the standard treatment for patients who are candidates for lobectomy; limited resection compared with lobectomy was statistically associated with a significantly greater incidence of local recurrence, although no statistically significant difference was identified in overall survival. In 2002, a Japanese prospective single-arm study of peripheral cT1aN0M0 lung cancer revealed no significantly different outcomes between segmentectomy and lobectomy with aggressive lymph node examination using frozen sections and wide surgical margins; the 5-year survival rate was 81.8％ and local recurrence rate was 1.8％. Recently, two clinical trials conducted by the Japan Clinical Oncology Group (JCOG) have completed patient enrollment: JCOG0802, a phase III randomized trial of lobectomy versus segmentectomy for small peripheral non-small cell lung cancer; and JCOG0804, a nonrandomized confirmatory study of limited surgical resection for peripheral early lung cancer as defined based on thoracic thin-section computed tomography. The results will be published in the near future, and the standard treatment for peripheral cT1aN0M0 lung cancer may change.