研究者詳細 - 加勢田　馨

論文 - 加勢田　馨

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Initial single-institutional experience with salvage surgery for stage IV non-small cell lung cancer.

Hishida T, Oka N, Yano K, Omura S, Okubo Y, Masai K, Kaseda K, Ohgino K, Terai H, Yasuda H, Asakura K

Interdisciplinary cardiovascular and thoracic surgery 2025年02月

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Thoracic posture-related morphological changes in patients with pectus excavatum versus healthy controls

Suzuki T., Asakura K., Yamada Y., Masai K., Yamada M., Yokoyama Y., Okubo Y., Kaseda K., Hishida T., Jinzaki M.

European Journal of Cardio-thoracic Surgery 66 （ 5 ） 2024年11月

ISSN 10107940

OBJECTIVES. Cases of severe pectus excavatum presenting with worsening cardiopulmonary symptoms in the upright position have been reported. However, the underlying mechanism remains unclear. We evaluated posture-related morphological changes of the thorax in patients with pectus excavatum. METHODS. Chest morphology was evaluated preoperatively using upright and supine computed tomography in 21 patients with pectus excavatum and 35 healthy volunteers. The minimum anterior–posterior thoracic diameter, depression depth, and Haller index on horizontal sections, as well as the T6-12 plumb line distance on sagittal sections, were compared between the 2 positions. RESULTS. In patients with pectus excavatum (median age, 22 years; 18 males and 3 females), the minimum anterior–posterior diameter was smaller (4.5 vs 5.1 cm, P < 0.001) and the Haller index was greater (10.1 vs 6.4, P < 0.001) in the upright position than in the supine position. The T6-T12 plumb line distance was longer in the upright position (2.4 vs 0.8 cm, P < 0.001), while the depression depth showed no significant difference. Healthy volunteers exhibited similar changes. The degree of spinal curvature increased in the upright position due to the anterior shift of the lower thoracic vertebrae, resulting in a shorter anterior–posterior diameter, irrespective of chest wall deformity. One patient with dyspnoea only in the upright position exhibited compression of the right inferior pulmonary vein only on upright computed tomography. CONCLUSIONS. The minimum anterior–posterior diameter is shorter in the upright position. This may explain the worsening of cardiopulmonary symptoms in patients with severe pectus excavatum when in an upright position.

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Clinical impact of multiple pectus bars on surgical outcomes following pectus excavatum repair

Oka N., Masai K., Okubo Y., Kaseda K., Hishida T., Asakura K.

Interdisciplinary Cardiovascular and Thoracic Surgery 39 （ 4 ） 2024年10月

OBJECTIVES: The Nuss procedure, a minimally invasive surgery for pectus excavatum, has undergone various improvements. However, the impact of using multiple bars on thoracic shape changes and surgical outcomes remains unclear. METHODS: We retrospectively evaluated patients who underwent the Nuss procedure for pectus excavatum between August 2014 and September 2021. We divided the patients into 2 groups based on the number of bars placed and identified differences in surgical outcomes and morphological characteristics. RESULTS: A total of 225 patients were evaluated, of whom 132 were classified into the ≤2 bar group (using 1 or 2 bars) and 93 into the ≥3 bar group (using 3 or more bars). There was no difference in the preoperative Haller index [median (interquartile range), 4.59 (3.67–6.16) vs 4.67 (4.12–6.14), P ¼ 0.227], and asymmetric excavatum was more frequently observed in the ≥3 bar group (81% vs 51%, P < 0.001). The preoperative sternal torsion angle was larger in the ≥3 bar group, but no difference was found between the 2 groups postoperatively. The incidence of postoperative complications (≥grade 3) was comparable between groups (10% vs 17%, P ¼ 0.105); however, postoperative pleurisy was more frequently observed in the ≥3 bar group (12% vs 4%, P ¼ 0.021). In univariable and multivariable analyses, ≥3 bar placement was the only risk factor for postoperative pleurisy. CONCLUSIONS: The placement of multiple bars (≥3 bars) is useful for the correction of asymmetric pectus excavatum, but attention should be paid to the potential risk of postoperative pleurisy.

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Validity of Simple Thymomectomy for Clinical Stage I Thymoma without Myasthenia Gravis: A Propensity Score-Matched Analysis

Hishida, T; Suzuki, T; Omura, S; Okubo, Y; Masai, K; Kaseda, K; Asakura, K

JOURNAL OF THORACIC ONCOLOGY 19 （ 10 ） S274 - S274 2024年10月

ISSN 1556-0864

Multiple Lung Resections for Metastases from Pheochromocytoma to Reduce Catecholamine Production.

Yano K, Okubo Y, Ishiguro Y, Masai K, Kaseda K, Emoto K, Miyashita K, Hisihida T, Asakura K

Annals of thoracic surgery short reports 2 （ 3 ） 488 - 491 2024年09月

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Surgically resected sarcomatoid carcinoma of the lung: a nationwide retrospective study in 2010

Kaseda K., Asakura K., Shintani Y., Okami J., Toyooka S., Sato Y., Watanabe S.I., Chida M., Suzuki H., Miyaoka E., Yoshino I., Date H.

BMC Cancer 24 （ 1 ） 938 2024年08月

研究論文（学術雑誌）, 共著, 筆頭著者, 査読有り, ISSN 1471-2407

Background: Sarcomatoid carcinoma of the lung is a rare histological type of non-small cell lung cancer with a poor prognosis. We aimed to investigate the clinicopathological characteristics and prognostic factors of surgically resected sarcomatoid carcinoma of the lung. Methods: We retrospectively reviewed 14999 patients who underwent surgical resection for non-small cell lung cancer accumulated by the Japanese Joint Committee of Lung Cancer Registry in 2010. Clinicopathological characteristics and survival were compared between the sarcomatoid carcinoma and other non-small cell cancer groups. The prognostic factors in the sarcomatoid carcinoma group were identified using a multivariate Cox proportional hazard model. Results: Patients with sarcomatoid carcinoma comprised 1.4% of all patients. The sarcomatoid carcinoma group demonstrated a more aggressive pathology with presentation at more advanced stages, requiring more frequent extensive surgical resections. The sarcomatoid carcinoma group had remarkably poorer overall and recurrence-free survival than the other non-small cell lung cancer group. Adjuvant chemotherapy was associated with improved survival for pathological stage II–III sarcomatoid carcinoma cases rather than for pathological stage I disease. In the multivariate analysis, larger tumor size, lymphatic permeation, and no adjuvant chemotherapy were associated with the sarcomatoid carcinoma group’s overall and recurrence-free survival. Conclusions: Surgically resected sarcomatoid carcinoma of the lung has a higher aggressive and metastatic potential and a worse prognosis than other non-small cell lung cancers. Adjuvant chemotherapy, which was associated with enhanced survival in patients with pathological stage II–III of the disease, could be considered for treating patients with pathological stage II–III sarcomatoid carcinoma of the lung.

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高度漏斗胸に対してCombined Ravitch and Nuss Procedureを施行後に側弯の進行を認めたLoeys-Dietz症候群の一例

杉野功祐, 政井恭兵, 大久保祐, 加勢田馨, 菱田智之, 朝倉啓介

日本呼吸器外科学会雑誌（一般社団法人日本呼吸器外科学会） 38 （ 5 ） 470 - 475 2024年07月

ISSN 09190945

<p>Loeys-Diez症候群（LDS）はMarfan症候群類縁の先天性結合織疾患で，骨格系の異常として漏斗胸を併存することが知られている．我々は漏斗胸手術後に側弯の進行を認めたLDSの一例を経験した．患者は9歳，男児．5歳時に遺伝子検査でLDSと診断された．Haller index 9.81の高度漏斗胸とCobb角8.5度の軽度側弯があり，漏斗胸に対してRavitch法とNuss法を組み合わせた術式（Combined Ravitch and Nuss Procedure：CRN法）を施行した．左右の肋軟骨を一部分節切除した後に2本のチタンバーを挿入し胸骨挙上術を施行した．術後のHaller indexは3.57となり，漏斗胸の改善が得られたが，側弯はCobb角34.2度に増悪した．術後早期に側弯の進行を認めたため，側弯症に対して装具治療を行った．術後4ヵ月で側弯の改善がみられ，現在経過観察中である．側弯症を合併する漏斗胸の場合，漏斗胸治療により側弯の進行を認める可能性がある．本症例では結合組織の脆弱性が背景にあり，漏斗胸の矯正が過度の側弯変形を招いた可能性が示唆された．</p>

Clinicopathological predictors of postoperative long-term myasthenic status in resected thymoma with myasthenia gravis

Suzuki T., Hishida T., Suzuki S., Okubo Y., Masai K., Kaseda K., Asakura K., Emoto K., Asamura H.

Surgery Today （Surgery Today） 54 （ 7 ） 787 - 794 2024年07月

ISSN 09411291

Purpose: Surgical patients with thymoma and myasthenia gravis (MG) must have their MG status and oncological outcomes critically monitored. We aimed to identify clinicopathological predictors of the postoperative MG status. Methods: We conducted a retrospective review of 40 consecutive surgical patients with MG-related thymomas between 2002 and 2020. The quantitative myasthenia gravis score (QMGS) and Myasthenia Gravis Foundation of America post-intervention status (MGFA-PIS) were used to evaluate postoperative MG status. Results: All patients underwent extended total thymectomy. The most common WHO type was type B2 (32%), while 65% of patients had type B1–B3 and 35% had type A–AB thymomas. Eleven patients (28%) achieved controlled MG status in MGFA-PIS 6 months after surgery. This controlled status was observed more frequently in type A–AB than in B1–B3 (57% vs. 12%, p = 0.007). In a multivariate analysis, WHO type (A–AB or B1–B3) was an independent predictor of worsening episodes of MG based on the QMGS (Type B1–B3, hazard ratio: 3.23, 95% confidence interval: 1.12–9.25). At the last follow-up, 23 patients (58%) achieved controlled MG status. The 5-year overall survival rate of all patients was 93.7%. Conclusion: The WHO type of thymoma is an informative predictor of postoperative MG status in patients with MG-related thymoma.

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Glomus Tumor of Intrathoracic Chest Wall: a Case Report

Ishiguro Y., Masai K., Sugino K., Yano K., Nomura R., Okubo Y., Kaseda K., Hishida T., Asakura K., Kurebayashi Y., Minami Y.

Japanese Journal of Lung Cancer （Japanese Journal of Lung Cancer） 64 （ 3 ） 208 - 209 2024年06月

ISSN 03869628

<p>40歳女性．左肺尖部に5.9 cm大の腫瘤影を認め，経皮的生検を行った所，カルチノイド腫瘍が疑われ，画像上は肺尖部胸壁浸潤癌を考え，手術の方針とした．胸腔内を観察すると腫瘍は胸壁から発生しており，胸壁腫瘍を切除した．病理では類円形核と好酸性の胞体を有する異型の弱い腫瘍細胞が増生し，形態像と免疫染色所見から胸壁発生のグロムス腫瘍と診断した．胸壁発生のグロムス腫瘍の報告は極めて少なく，文献的考察を加えて報告する．</p>

Quality of life, psychological states, and personality traits in patients with pectus excavatum

Matsuda K., Fujisawa D., Masai K., Miyazaki N., Suzuki S., Okubo Y., Kaseda K., Asakura K., Hishida T., Asamura H.

JTCVS Open （JTCVS Open） 19 355 - 369 2024年06月

Objective: The quality of life (QOL) and psychological states of patients with pectus excavatum (PE) have yet to be well understood. This study aimed to evaluate the health-related QOL (HRQOL), psychological states, and personality traits of patients with PE, alongside the associations of these factors with the severity of PE. Methods: A cross-sectional evaluation was prospectively performed in patients scheduled to undergo PE repair surgery between July 2019 and April 2021. The primary outcome was the patients’ HRQOL, and the secondary outcomes were depression, social anxiety, self-efficacy, and personality traits. Results: In total, 129 patients were subjected to analyses. Patients' HRQOL had a lower role component summary score (mean ± standard deviation: 41.8 ± 12.8, P < .001) than the general population controls. Patients' HRQOL had a significantly better physical component summary (54.0 ± 10.4, P < .001) and mental component summary (53.3 ± 8.8, P < .001) than that of the general population. Fourteen patients' (10.9%) and 56 patients' (43.4%) scores indicated the presence of depression and social anxiety disorder, respectively. Patients’ self-efficacy (46.1 ± 11.4, P, .001) and level of extraversion (46.5 ± 11.8, P < .001) were lower than those of the general population. No significant correlation was found between the severity of PE and these scores. Conclusions: Our study revealed that patients with PE had decreased social-role QOL, depressive tendencies, increased social anxiety, lower self-efficacy, and introversion. No correlation between the severity of PE and the patients’ psychological outcomes leads us to conclude that surgical implications of PE should not be decided solely by a physical index.

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胸壁に発生したグロムス腫瘍の1切除例

石黒勇輝, 政井恭兵, 杉野功祐, 矢野海斗, 野村塁, 大久保祐, 加勢田馨, 菱田智之, 朝倉啓介, 紅林泰, 南優子

肺癌（(NPO)日本肺癌学会） 64 （ 3 ） 208 - 209 2024年06月

ISSN 0386-9628

Nuss procedure for the treatment of pectus excavatum with dyspnea following oropharyngeal cancer surgery: a case report

Masai K., Nakai T., Okubo Y., Kaseda K., Hishida T., Asakura K.

Journal of Surgical Case Reports （Journal of Surgical Case Reports） 2024 （ 1 ） rjad714 2024年01月

ISSN 2042-8812

Pectus excavatum (PE) causes cardiopulmonary dysfunction depending on the degree and form of the depression. The patient was a 74-year-old woman with a history of PE. Fourteen years ago, a total glossolaryngectomy was performed for oropharyngeal cancer. Two years later, the patient gradually experienced difficulty in breathing. Computed tomography (CT) revealed severe PE and right main bronchial stenosis. We performed a Nuss procedure for PE repair to surgically release the stenosis of the right main bronchus. Postoperative chest CT showed improvement in the sternal depression and right main bronchial stenosis. Furthermore, shortness of breath was relieved postoperatively. Oropharyngeal cancer surgery may cause tracheal support disruption, leading to leftward shift and severe stenosis of the right main bronchus due to sternum depression. This is an important report regarding respiratory distress caused by a combination of PE and post-oropharyngeal cancer surgery.

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Survival impact of pathologic features after salvage lung resection following definitive chemoradiotherapy or systemic therapy for initially unresectable lung cancer

Oka N., Hishida T., Kaseda K., Suzuki Y., Okubo Y., Masai K., Asakura K., Emoto K., Asamura H.

General Thoracic and Cardiovascular Surgery 2024年

ISSN 18636705

Purpose: Salvage surgery for primary lung cancer is expected to become increasingly common. This study aimed to clarify the survival impact of pathologic characteristics after salvage surgery. Methods: Consecutive patients who underwent salvage surgery following definitive chemoradiotherapy or systemic therapy for initially unresectable lung cancer from 2010 to 2020 were enrolled in this study. The tumor slides were reviewed to determine the size of the tumor bed and the proportions of viable tumor, necrosis, and stroma. Results: A total of 23 patients were evaluated, and 18 had clinical stage IIIB–IV disease. Six received chemoradiotherapy and 17 received systemic therapy alone. A major pathologic response (MPR, ≤ 10% of viable tumor) was observed in 6 patients, and 4 patients achieved a pathological complete response. The 3-year overall and recurrence-free survival rates (OS and RFS) were 78.6% and 59.2%, respectively. There was no significant difference in OS between patients with and without MPR, and even non-MPR patients achieved a favorable 3-year OS of 70.2%. Meanwhile, patients with high (≥ 30%) stroma showed significantly better OS than those with low (< 30%) stroma (3-year OS: 100% vs. 23.3%, p < 0.001). Conclusions: This study showed that the proportion of stroma can be useful for predicting long-term survival after salvage surgery. Further large-scale studies are warranted to confirm the current findings.

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Prognostic factors affecting survival in patients with non-small cell lung cancer treated with salvage surgery after drug therapy: a multi-institutional retrospective study

Suzuki S., Asakura K., Okui M., Izawa N., Sawafuji M., Sakamaki H., Shigenobu T., Tajima A., Oka N., Masai K., Kaseda K., Hishida T., Yasuda H., Fukunaga K., Asamura H.

World Journal of Surgical Oncology （World Journal of Surgical Oncology） 21 （ 1 ） 290 2023年12月

Background: The prevalence of salvage surgeries after drug therapy for non-small cell lung cancer (NSCLC) has risen, mainly due to recent progress in molecular-targeted drugs and immune checkpoint inhibitors for NSCLC. While the safety and effectiveness of salvage surgery after drug therapy for NSCLC have been studied, its indications remain unclear. We aimed to identify the prognostic factors affecting survival in patients with advanced-stage (stages III–IV) NSCLC treated with salvage surgery after drug therapy. Methods: A retrospective investigation was conducted on patients who received salvage surgery after drug therapy at four hospitals between 2007 and 2020. Salvage surgery was defined as surgery after drug therapy for local progression, tumor conversion to resectable status, and discontinuation of prior drug therapy owing to serious complications. Results: Thirty-two patients received cytotoxic agents alone (n = 12 [38%]), tyrosine kinase inhibitors (TKIs; n = 16 [50%]), or immune checkpoint inhibitors (n = 4 [13%]) as prior drug therapy. In 11 (34%) and 21 (66%) patients, the clinical stage before treatment was III or IV, respectively. The median initial and preoperative serum carcinoembryonic antigen (CEA) levels were 10.2 (range, 0.5–1024) ng/mL and 4.2 (range, 0.6–92.5) ng/mL, respectively. Among the patients, 28 (88%) underwent lobectomy, 2 (6%) underwent segmentectomy, and 2 (6%) underwent wedge resection. Complete resection of the primary lesion was accomplished in 28 (88%) patients. Postoperative complications were documented in six (19%) patients. Mortality rates were 0% at 30 days and 3% at 90 days post-operation. The 5-year overall survival rate stood at 66%, while the 5-year progression-free survival rate was 21%. Multivariate analyses showed that prior TKI therapy and preoperative serum CEA level < 5 ng/mL were prognostic factors influencing overall survival (hazard ratio [95% confidence interval]: 0.06 [0.006–0.68] and 0.03 [0.002–0.41], respectively). The 5-year overall survival in the 11 patients with both favorable prognosticators was 100%. Conclusions: In this study, prior TKI therapy and preoperative serum CEA level < 5 ng/mL were favorable prognostic factors for overall survival in patients with NSCLC treated with salvage surgery. Patients with these prognostic factors are considered good candidates for salvage surgery after drug therapy.

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Combined Ravitch and Nuss procedure for pectus excavatum with dyspnea following scoliosis repair

Oka N., Masai K., Okubo Y., Kaseda K., Hishida T., Asakura K.

Journal of Surgical Case Reports （Journal of Surgical Case Reports） 2023 （ 11 ） rjad618 2023年11月

ISSN 2042-8812

Pectus excavatum (PE) is often associated with scoliosis and can elicit cardiovascular disturbances under rare conditions. Here we report a patient who was treated with a combined Ravitch and Nuss procedure for PE with dyspnea following scoliosis repair to improve her symptoms. The patient was a 49-year-old woman with a history of PE and scoliosis. Right inferior pulmonary vein stenosis was caused by posterior spinal fusion for scoliosis prior to the PE repair. We could safely correct the chest wall deformity and treat dyspnea by performing a modified Ravitch repair in combination with the Nuss procedure.

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Feasibility and Survival Outcomes of "Salvage Surgery" for Initially Clinical Stage IV Non-small Cell Lung Cancer

Hishida, T; Oka, N; Okubo, Y; Masai, K; Kaseda, K; Asamura, H; Asakura, K

JOURNAL OF THORACIC ONCOLOGY 18 （ 11 ） S592 - S593 2023年11月

ISSN 1556-0864

Clinicopathological Analyses for Predicting Survival After Salvage Surgery for Initially Unresectable Lung Cancer

Oka, N; Hishida, T; Kaseda, K; Oshiro, Y; Sakurada, A; Sugino, K; Aoki, H; Ishiguro, Y; Imoto, T; Okubo, Y; Masai, K; Asakura, K; Emoto, K; Asamura, H

JOURNAL OF THORACIC ONCOLOGY 18 （ 11 ） S572 - S572 2023年11月

ISSN 1556-0864

Combined Ravitch and Nuss procedure for patients with severe pectus excavatum: technique and initial results

Masai K., Okubo Y., Kaseda K., Hishida T., Asakura K.

Journal of Surgical Case Reports （Journal of Surgical Case Reports） 2023 （ 10 ） rjad576 2023年10月

ISSN 2042-8812

The Nuss procedure for pectus excavatum (PE) is both less invasive and very simple compared to the Ravitch procedure. However, it may be difficult to perform the Nuss procedure in cases of severe PE. Therefore, we developed a Combined Ravitch and Nuss (CRN) procedure and examined its effectiveness in patients with severe PE. Nine patients with severe PE underwent the CRN procedure. Data on patient characteristics and perioperative results were collected retrospectively. The median Haller index (HI) was 15.4 (range, 6.3-29.3). No significant intraoperative adverse events were noted. Postoperatively, marked improvements in HI were seen in all cases (3.29, range, 2.72-4.96). Two surgical site infections on the shallow layer and one wound seroma occurred. No recurrences were observed during the observation period. Our novel CRN procedure is useful for achieving adequate and sustainable sternal elevation with less invasiveness for patients with severe PE.

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臨床経験肺原発MALTリンパ腫切除例の臨床病理学的特徴

岡直幸, 政井恭兵, 大久保祐, 加勢田馨, 菱田智之, 江本桂, 朝倉啓介

胸部外科（南江堂） 76 （ 8 ） 623 - 628 2023年08月

ISSN 00215252

肺原発MALTリンパ腫切除例の臨床病理学的特徴

岡直幸, 政井恭兵, 大久保祐, 加勢田馨, 菱田智之, 江本桂, 朝倉啓介

胸部外科（(株)南江堂） 76 （ 8 ） 623 - 628 2023年08月

ISSN 0021-5252

2012年1月～2022年12月に手術を施行した肺原発MALTリンパ腫7例(男性2例、女性5例、年齢中央値70歳)の臨床病理学的特徴および画像的特徴について検討した。術前胸部CT所見はすりガラス結節影4例、単発腫瘤影1例、充実性結節影1例、両肺に多発するすりガラス結節影1例であり、腫瘍辺縁の境界は不明瞭で、5例で腫瘍内部に気管支透亮像を確認した。FDG-PETでは1例を除き有意な集積を認めなかった。術前にMALTリンパ腫と診断されていた単発腫瘤影例は左肺上区域切除を施行し、多発結節影を認めた1例では診断目的に肺部分切除を施行し、原発性肺癌疑いの5例は開胸生検目的に肺部分切除を施行した。多発肺結節に対する生検例1例を除く6例で完全切除が施行され、7例全例で病理組織学的にMALTリンパ腫と診断した。術後在院日数の中央値は5日であり、2例に術後補助治療としてrituximabを投与した。術後生存期間の中央値は52ヵ月で、6例が生存中である。

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