The Japanese Association for Thoracic Surgery has conducted annual surveys of thoracic surgery throughout Japan since 1987 to determine the statistics regarding the number of procedures according to operative category. Here, we have summarized the results from our annual survey of thoracic surgery performed during 2012.
Table 1 Questionnaires sent out and received back by the end of December 2013
Sent out
Returned
Response rate (%)
(A) Cardiovascular surgery
601
583
97.0
(B) General thoracic surgery
802
777
96.9
(C) Esophageal surgery
582
555
95.4
Table 2 Categories subclassified according to the number of operations performed
The incidence of hospital mortality was added to the survey to determine the nationwide status, which has contributed to the Japanese surgeons to understand the present status of thoracic surgery in Japan and to make progress to improve operative results by comparing their work with those of others. The Association was able to gain a better understanding of the present problems as well as future prospects, which has been reflected to its activity including education of its members. Thirty-day mortality (so-called “operative mortality) is defined as death within 30 days of operation regardless of the patient’s geographic location and even though the patient had been discharged from the hospital.
Anzeige
Hospital mortality is defined as death within any time interval after an operation if the patient had not been discharged from the hospital. Hospital-to-hospital transfer is not considered discharge: transfer to a nursing home or a rehabilitation unit is considered hospital discharge unless the patient subsequently dies of complications of the operation. The definitions of the Ad Hoc Liaison Committee for Standardizing Definitions of Prosthetic Heart Valve Morbidity of the Society of Thoracic Surgeons and the American Association for Thoracic Surgery (Edmunds et al. Ann Thorac Surg 1996;62:932–5; J Thorac Cardiovasc Surg 1996;112:708–11).
Thoracic surgery was classified into three categories—cardiovascular, general thoracic, and esophageal surgery—and the patient data were examined and analyzed for each group. Access to the computerized data is offered to all members of this Association. We honor and value all member’s continued kind support and contributions (Tables 1, 2).
Table 1 Congenital (total; 9,558)
(1) CPB (+) (total; 7,171)
Neonate
Infant
1–17 years
≧18 years
Total
Cases
30-day mortality
Hospital mortality
Cases
30-day mortality
Hospital mortality
Cases
30-day mortality
Hospital mortality
Cases
30-day mortality
Hospital mortality
Cases
30-day mortality
Hospital mortality
Hospital
After discharge
Hospital
After discharge
Hospital
After discharge
Hospital
After discharge
Hospital
After discharge
1
PDA
15
0
0
0
2
0
0
0
4
0
0
0
24
1 (4.2)
0
1 (4.2)
45
1 (2.2)
0
1 (2.2)
2
Coarctation (simple)
7
0
0
0
13
0
0
0
17
0
0
0
7
0
0
0
44
0
0
0
3
+VSD
32
2 (6.3)
0
2 (6.3)
34
0
0
0
8
0
0
0
2
0
0
0
76
2 (2.6)
0
2 (2.6)
4
+DORV
2
0
0
1 (50.0)
3
0
0
0
2
0
0
0
0
0
0
0
7
0
0
1 (14.3)
5
+AVSD
5
0
0
0
4
0
0
0
1
0
0
0
0
0
0
0
10
0
0
0
6
+TGA
3
1 (33.3)
0
1 (33.3)
3
0
0
0
1
0
0
0
0
0
0
0
7
1 (14.3)
0
1 (14.3)
7
+SV
9
2 (22.2)
0
2 (22.2)
7
0
0
0
4
0
0
0
0
0
0
0
20
2 (10.0)
0
2 (10.0)
8
+Others
2
0
0
0
5
0
0
0
4
0
0
0
1
0
0
0
12
0
0
0
9
Interrupt. of Ao (simple)
1
0
0
0
2
1 (50.0)
0
1 (50.0)
2
0
0
0
1
0
0
0
6
1 (16.7)
0
1 (16.7)
10
+VSD
25
2 (8.0)
0
2 (8.0)
16
0
0
0
4
0
0
0
10
0
0
0
55
2 (3.6)
0
2 (3.6)
11
+DORV
3
1 (33)
0
1 (33.3)
4
0
0
0
2
0
0
0
0
0
0
0
9
1 (11.1)
0
1 (11.1)
12
+Truncus
2
1 (50.0)
0
1 (50.0)
2
0
0
0
0
0
0
0
0
0
0
0
4
1 (25.0)
0
1 (25.0)
13
+TGA
2
0
0
0
1
0
0
0
0
0
0
0
0
0
0
0
3
0
0
0
14
+Others
4
0
0
0
10
1 (10.0)
0
1 (10.0)
2
0
0
0
1
0
0
0
17
1 (5.9)
0
1 (5.9)
15
Vascular ring
0
0
0
0
4
0
0
0
3
0
0
0
0
0
0
0
7
0
0
0
16
PS
1
0
0
0
15
0
0
0
14
0
0
0
4
0
0
1 (25.0)
34
0
0
1 (2.9)
17
PAIVS or critical PS
12
0
0
0
50
1 (2.0)
0
1 (2.0)
55
0
0
0
2
0
0
1 (50.0)
119
1 (0.8)
0
2 (1.7)
18
TAPVR
126
9 (7.1)
0
15 (11.9)
49
1 (2)
2 (4.08)
2 (4.1)
8
0
0
0
0
0
0
0
183
10 (5)
2 (1.1)
17 (9)
19
PAPVR ± ASD
0
0
0
0
4
0
0
0
52
0
0
0
29
0
0
0
85
0
0
0
20
ASD
11
1 (9.1)
0
1 (9.1)
54
0
0
0
693
0
0
0
573
2 (0.3)
1 (0.2)
2 (0.3)
1,331
3 (0.2)
1 (0.08)
3 (0.2)
21
Cor triatriatum
1
0
0
0
13
2 (15.4)
0
2 (15.4)
3
0
0
0
4
0
0
0
21
2 (9.5)
0
2 (9.5)
22
AVSD (partial)
1
1 (100.0)
0
1 (100.0)
19
1 (5.3)
0
1 (5.3)
40
0
0
0
13
0
0
0
73
2 (2.7)
0
2 (2.7)
23
AVSD (complete)
4
0
0
1 (25.0)
108
5 (4.6)
0
5 (4.6)
69
0
0
0
4
0
0
0
185
5 (2.7)
0
6 (3.2)
24
+TOF or DORV
0
0
0
0
6
1 (16.7)
0
2 (33.3)
21
0
0
0
3
0
0
0
30
1 (3.3)
0
2 (6.7)
25
+Others
1
0
0
0
10
1 (10.0)
0
1 (10.0)
8
0
0
0
1
0
0
0
20
1 (5.0)
0
1 (5.0)
26
VSD (subarterial)
3
0
0
0
128
0
0
0
197
0
0
0
29
0
0
0
357
0
0
0
27
VSD (perimemb./muscular)
10
0
0
0
770
0
1 (0.13)
0
390
0
0
0
90
0
0
0
1,260
0
1 (0.1)
0
28
VSD + PS
0
0
0
0
39
0
0
0
33
0
0
0
7
0
0
0
79
0
0
0
29
DCRV ± VSD
2
0
0
0
16
0
0
0
39
0
0
0
19
0
0
0
76
0
0
0
30
Aneurysm of sinus valsalva
0
0
0
0
6
0
0
0
1
0
0
0
24
0
0
0
31
0
0
0
31
TOF
15
1 (6.7)
0
1 (6.7)
168
0
0
0
231
2 (0.9)
0
2 (0.9)
22
0
0
2 (9.1)
436
3 (0.7)
0
5 (1.1)
32
PA + VSD
4
0
0
0
78
1 (1.3)
0
1 (1.3)
125
3 (2.4)
0
5 (4.0)
9
0
0
0
216
4 (1.9)
0
6 (2.8)
33
DORV
17
1 (5.9)
0
1 (5.9)
91
1 (1.1)
0
3 (3.3)
112
2 (1.8)
0
2 (1.8)
3
1 (33.3)
0
1 (33.3)
223
5 (2.2)
0
7 (3.1)
34
TGA (simple)
101
2 (2.0)
0
3 (3.0)
12
0
0
0
0
0
0
0
4
0
0
0
117
2 (1.7)
0
3 (2.6)
35
+VSD
44
1 (2.3)
0
1 (2.3)
17
1 (5.9)
0
1 (5.9)
2
0
0
0
0
0
0
0
63
2 (3.2)
0
2 (3.2)
36
VSD + PS
4
0
0
0
8
0
0
0
26
0
0
0
2
0
0
0
40
0
0
0
37
Corrected TGA
2
0
0
0
11
0
0
0
42
1 (2.4)
0
1 (2.4)
13
0
0
0
68
1 (1.5)
0
1 (1.5)
38
Truncus arteriosus
4
0
0
0
26
2 (7.7)
0
3 (11.5)
12
0
0
0
1
0
0
0
43
2 (4.7)
0
3 (7.0)
39
SV
27
5 (18.5)
0
8 (29.6)
219
7 (3.2)
0
11 (5.0)
282
4 (1.4)
0
9 (3.2)
21
2 (9.5)
0
2 (9.5)
549
18 (3.3)
0
30 (5.5)
40
TA
2
0
0
0
30
0
0
0
53
0
0
0
5
0
0
0
90
0
0
0
41
HLHS
45
10 (22.2)
0
10 (22.2)
130
11 (8.5)
1 (0.77)
15 (11.5)
71
0
0
0
0
0
0
0
246
21 (8.5)
1 (11.7)
25 (10.2)
42
Aortic valve lesion
7
3 (42.9)
0
3 (42.9)
16
0
0
0
75
3 (4.0)
0
3 (4.0)
19
1 (5.3)
0
1 (5.3)
117
7 (6.0)
0
7 (6.0)
43
Mitral valve lesion
2
1 (50.0)
0
1 (50.0)
56
0
0
2 (3.6)
75
1 (1.3)
0
1 (1.3)
14
0
0
0
147
2 (1.4)
0
4 (2.7)
44
Ebstein
10
1 (10.0)
0
1 (10.0)
17
1 (5.9)
0
1 (5.9)
31
0
0
0
12
0
0
0
70
2 (2.9)
0
2 (2.9)
45
Coronary disease
0
0
0
0
11
0
0
0
16
0
0
0
13
0
0
0
40
0
0
0
46
Others
11
0
0
1 (9.1)
27
3 (11.1)
0
3 (11.1)
34
2 (5.9)
0
2 (5.9)
14
0
0
0
86
5 (5.8)
0
6 (7.0)
47
Redo VSD
0
0
0
0
6
0
0
0
10
0
0
0
7
0
0
0
23
0
0
0
48
PS release
0
0
0
0
8
0
0
0
42
0
0
0
23
0
0
0
73
0
0
0
49
RV-PA conduit replace
0
0
0
0
3
0
0
0
68
1 (1.5)
0
1(1.5)
17
0
0
1 (5.9)
88
1 (1.1)
0
2 (2.3)
50
Others
1
0
0
0
62
6 (9.7)
0
7 (11.3)
121
2 (1.7)
0
4 (3.3)
46
1 (2.2)
0
1 (2.2)
230
9 (3.9)
0
12 (5.2)
Total
580
45 (7.8)
0
58 (10.0)
2,393
47 (2.0)
4 (0.17)
63 (2.6)
3,105
21 (0.7)
0
30 (1.0)
1,093
8 (0.7)
1 (0.1)
13 (1.2)
7,171
121 (1.7)
5 (0.1)
164 (2.3)
Values in parenthesis represent mortality %
CPB cardiopulmonary bypass, PDA patient ductus arteriosus, VSD ventricular septal defect, DORV double outlet right ventricle, AVSD atrioventricular septal defect, TGA transposition of great arteries, SV single ventricle, Interupt. of Ao., interrupted aortic arch, PS pulmonary stenosis, PA-IVS pulmonary atresia with intact ventricular septum, TAPVR total anomalous pulmonary venous return, PAPVR partial anomalous pulmonary venous return, ASD atrial septal defect, TOF tetralogy of Fallot, DCRV double-chambered right ventricle, TA tricuspid atresia, HLHS hypoplastic left heart syndrome, RV-PA right ventricle–pulmonary artery
(2) CPB (−) (total; 2,387)
Neonate
Infant
1–17 years
≧18 years
Total
Cases
30-day mortality
Hospital mortality
Cases
30-day mortality
Hospital mortality
Cases
30-day mortality
Hospital mortality
Cases
30-day mortality
Hospital mortality
Cases
30-day mortality
Hospital mortality
Hospital
After discharge
Hospital
After discharge
Hospital
After discharge
Hospital
After discharge
Hospital
After discharge
1
PDA
358
2 (0.6)
0
3 (0.8)
225
0
0
2 (0.9)
46
0
0
0
1
0
0
0
630
2 (0.3)
0
5 (0.8)
2
Coarctation (simple)
21
0
0
0
14
0
0
0
4
0
0
0
1
0
0
0
40
0
0
0
3
+VSD
38
1 (2.6)
1 (2.6)
1 (2.6)
26
1 (3.8)
0
1 (3.8)
0
0
0
0
0
0
0
0
64
2 (3.1)
1 (1.6)
2 (3.1)
4
+DORV
5
0
0
1 (20.0)
2
0
0
0
0
0
0
0
0
0
0
0
7
0
0
1 (14.3)
5
+AVSD
5
1 (20.0)
0
1 (20.0)
0
0
0
0
0
0
0
0
0
0
0
0
5
1 (20.0)
0
1
6
+TGA
7
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
7
0
0
0
7
+SV
5
0
0
0
2
0
0
0
0
0
0
0
0
0
0
0
7
0
0
0
8
+Others
4
0
0
0
2
0
0
0
0
0
0
0
0
0
0
0
6
0
0
0
9
Interrupt. of Ao (simple)
1
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
1
0
0
0
10
+VSD
21
0
0
1 (4.8)
5
0
0
0
2
0
0
0
0
0
0
0
28
0
0
1 (3.6)
11
+DORV
4
1 (25)
0
2 (50)
0
0
0
0
0
0
0
0
0
0
0
0
4
1 (25)
0
2 (50)
12
+Truncus
3
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
3
0
0
0
13
+TGA
2
0
0
0
1
0
0
0
0
0
0
0
0
0
0
0
3
0
0
0
14
+Others
7
0
0
1 (14.3)
0
0
0
0
0
0
0
0
0
0
0
0
7
0
0
1 (14.3)
15
Vascular ring
1
0
0
0
12
1 (8.3)
0
1 (8.3)
9
0
0
0
0
0
0
0
22
1 (4.5)
0
1 (4.5)
16
PS
0
0
0
0
1
0
0
0
0
0
0
0
0
0
0
0
1
0
0
0
17
PAIVS or critical PS
30
3 (10.0)
0
3 (10.0)
26
0
0
0
3
0
0
0
2
0
0
0
61
3 (4.9)
0
3 (4.9)
18
TAPVR
1
0
0
0
2
0
0
0
0
0
0
0
0
0
0
0
3
0
0
0
19
PAPVR ± ASD
0
0
0
0
0
0
0
0
0
0
0
0
1
0
0
0
1
0
0
0
20
ASD
0
0
0
0
0
0
0
0
12
0
0
0
15
0
0
0
27
0
0
0
21
Cor triatriatum
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
22
AVSD (partial)
2
0
0
0
4
0
0
0
1
0
0
0
0
0
0
0
7
0
0
0
23
AVSD (complete)
32
0
0
0
68
0
0
1 (1.5)
4
0
0
0
0
0
0
0
104
0
0
1 (1.0)
24
+TOF or DORV
3
0
0
0
13
1 (7.7)
0
1 (7.7)
6
0
0
0
0
0
0
0
22
1 (4.5)
0
1 (4.5)
25
+Others
3
1 (33.3)
0
1 (33.3)
4
0
0
0
2
0
0
0
0
0
0
0
9
1 (11.1)
0
1 (11.1)
26
VSD (subarterial)
2
0
0
0
11
0
0
0
2
0
0
0
2
0
0
0
17
0
0
0
27
VSD (perimemb./muscular)
38
0
0
0
117
1 (0.9)
0
3 (2.6)
5
0
0
0
1
0
0
0
161
1 (0.6)
0
3 (1.9)
28
VSD + PS
0
0
0
0
1
0
0
0
0
0
0
0
0
0
0
0
1
0
0
0
29
DCRV ± VSD
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
30
Aneurysm of sinus valsalva
1
0
0
0
0
0
0
0
0
0
0
0
1
0
0
0
2
0
0
0
31
TOF
24
0
0
0
100
2 (2.0)
0
2 (2.0)
13
0
0
0
4
0
0
0
141
2 (1.4)
0
2 (1.4)
32
PA + VSD
26
0
0
0
83
0
0
0
15
0
0
0
1
0
0
0
125
0
0
0
33
DORV
27
0
0
0
55
1 (1.8)
0
2 (3.6)
14
0
0
0
2
0
0
0
98
1 (1.0)
0
2 (2.0)
34
TGA (simple)
7
0
0
0
1
0
0
0
1
0
0
0
1
0
0
0
10
0
0
0
35
+VSD
7
0
0
0
3
0
0
0
0
0
0
0
0
0
0
0
10
0
0
0
36
VSD + PS
9
1 (11.1)
0
1 (11.1)
5
0
0
0
2
0
0
0
0
0
0
0
16
1 (6.3)
0
1 (6.3)
37
Corrected TGA
8
0
0
0
18
1 (5.6)
0
1 (5.6)
4
0
0
0
0
0
0
0
30
1 (3.3)
0
1 (3.3)
38
Truncus arteriosus
20
0
0
1 (5.0)
1
0
0
0
5
0
0
0
0
0
0
0
26
0
0
1 (3.8)
39
SV
72
2 (2.8)
0
3 (4.2)
57
1 (1.8)
0
3 (5.3)
21
1 (4.8)
0
1
3
1 (33.3)
0
1 (33.3)
153
5 (3.3)
0
8 (5.2)
40
TA
18
0
0
0
20
0
0
0
12
0
0
0
1
0
0
0
51
0
0
0
41
HLHS
81
2 (2.5)
0
3 (3.7)
19
0
0
0
3
0
0
0
0
0
0
0
103
2 (1.9)
0
3 (2.9)
42
Aortic valve lesion
4
0
0
0
2
0
0
0
4
0
0
0
2
0
0
0
12
0
0
0
43
Mitral valve lesion
0
0
0
0
0
0
0
0
1
0
0
0
0
0
0
0
1
0
0
0
44
Ebstein
6
1 (16.7)
0
2 (33.3)
4
0
0
0
1
0
0
0
3
0
0
0
14
1 (7.1)
0
2 (14.3)
45
Coronary disease
1
1 (100.0)
0
1 (100.0)
0
0
0
0
2
0
0
0
1
0
0
0
4
1 (25.0)
0
1 (25.0)
46
Others
24
1 (4.2)
0
1 (4.2)
65
1 (1.5)
0
1 (1.5)
75
1 (1.3)
0
1
23
0
0
0
187
3 (1.6)
0
3 (1.6)
47
Redo VSD
0
0
0
0
3
0
0
0
36
0
0
0
1
0
0
0
40
0
0
0
48
PS release
0
0
0
0
0
0
0
0
1
0
0
0
0
0
0
0
1
0
0
0
49
RV-PA conduit replace
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
50
Others
18
0
0
1 (5.6)
36
0
0
0
45
0
0
0
16
1 (6.3)
0
1 (6.3)
115
1 (0.9)
0
2 (1.7)
Total
946
17 (1.8)
1 (0.1)
27 (2.9)
1,008
10 (1.0)
0
18 (1.8)
351
2 (0.6)
0
2
82
2 (2.4)
0
2 (2.4)
2,387
31 (1.3)
1 (0.04)
49 (2.1)
Values in parenthesis represent mortality %
CPB cardiopulmonary bypass, PDA patient ductus arteriosus, VSD ventricular septal defect, DORV double outlet right ventricle, AVSD atrioventricular septal defect, TGA transposition of great arteries, SV single ventricle, Interupt. of Ao. interrupted aortic arch, PS pulmonary stenosis, PA-IVS pulmonary atresia with intact ventricular septum, TAPVR total anomalous pulmonary venous return, PAPVR partial anomalous pulmonary venous return, ASD atrial septal defect, TOF tetralogy of Fallot, DCRV double-chambered right ventricle, TA tricuspid atresia, HLHS hypoplastic left heart syndrome, RV-PA right ventricle–pulmonary artery
(3) Main procedure
Neonate
Infant
1–17 years
≧18 years
Total
Cases
30-day mortality
Hospital mortality
Cases
30-day mortality
Hospital mortality
Cases
30-day mortality
Hospital mortality
Cases
30-day mortality
Hospital mortality
Cases
30-day mortality
Hospital mortality
Hospital
After discharge
Hospital
After discharge
Hospital
After discharge
Hospital
After discharge
Hospital
After discharge
1
SP shunt
170
5 (2.9)
0
9 (5.3)
425
9 (2.1)
0
12 (2.8)
58
1 (1.7)
0
1 (1.7)
1
0
0
0
654
15 (2.3)
0
22 (3.4)
2
PAB
359
6 (1.7)
0
10 (2.8)
250
3 (1.2)
0
5 (2.0)
15
0
0
0
2
0
0
0
626
9 (1.4)
0
15 (2.4)
3
Bidirectional Glenn or hemi-Fontan ± α
0
0
0
0
265
6 (2.3)
0
6 (2.3)
106
0
0
2 (1.9)
4
0
0
0
375
6 (1.6)
0
8 (2.1)
4
Damus–Kaye–Stansel operation
4
1 (25.0)
0
2
45
2
0
2
21
0
0
0
0
0
0
0
70
3 (4.3)
0
4 (5.7)
5
PA reconstruction/repair (including redo)
9
0
0
0
99
1 (1.0)
0
2 (2.0)
108
0
0
1 (0.9)
18
0
0
1 (5.6)
234
1 (0.4)
0
4 (1.7)
6
RVOT reconstruction/repair
16
2 (12.5)
0
2 (12.5)
107
0
0
1 (0.9)
231
2 (0.9)
0
2 (0.9)
17
0
0
0
371
4 (1.1)
0
5 (1.3)
7
Rastelli procedure
3
1 (33.3)
0
1 (33.3)
44
2 (4.5)
0
2 (4.5)
108
2 (1.9)
0
3 (2.8)
10
0
0
0
165
5 (3.0)
0
6 (3.6)
8
Arterial switch procedure
154
5 (3.2)
0
8 (5.2)
23
1 (4.3)
0
1 (4.3)
6
0
0
0
0
0
0
0
183
6 (3.3)
0
9 (4.9)
9
Atrial switch procedure
4
0
0
0
0
0
0
0
2
0
0
0
1
0
0
0
7
0
0
0
10
Double switch procedure
0
0
0
0
0
0
0
0
11
0
0
0
0
0
0
0
11
0
0
0
11
Repair of anomalous origin of CA
1
0
0
0
6
0
0
0
14
0
0
0
7
0
0
0
28
0
0
0
12
Closure of coronary AV fistula
0
0
0
0
1
0
0
0
5
0
0
1 (20.0)
24
0
0
0
30
0
0
1 (3.3)
13
Fontan/TCPC
1
0
0
0
3
0
0
0
408
4 (1.0)
0
6 (1.5)
26
2 (7.7)
0
3 (11.5)
438
6 (1.4)
0
9 (2.1)
14
Norwood procedure
42
8 (19.0)
1 (2.4)
7 (16.7)
78
7 (9.0)
0
11 (14.1)
10
1 (10.0)
0
2 (20.0)
0
0
0
0
130
16 (12.3)
1 (8.1)
20 (15.4)
15
Ventricular septation
0
0
0
0
7
2 (28.6)
0
2 (28.6)
4
0
0
0
1
0
0
0
12
2 (16.7)
0
2 (16.7)
16
Left side AV valve repair (including redo)
0
0
0
0
66
1 (1.5)
0
1 (1.5)
63
1 (1.6)
0
1 (1.6)
11
1 (9.1)
0
1 (9.1)
140
3 (2.1)
0
3 (2.1)
17
Left side AV valve replace (including redo)
1
1 (100)
0
1 (100)
15
1 (6.7)
0
1 (6.7)
41
2 (4.9)
0
2 (4.9)
20
0
0
0
77
4 (5.2)
0
4 (5.2)
18
Right side AV valve repair (including redo)
2
0
0
0
13
0
0
0
34
0
0
0
30
0
0
0
79
0
0
0
19
Right side AV valve replace (including redo)
0
0
0
0
1
0
0
0
6
0
0
0
8
0
0
0
15
0
0
0
20
Common AV valve repair (including redo)
2
1 (50.0)
0
1 (50.0)
34
5 (14.7)
0
5 (14.7)
19
1 (5.3)
0
1 (5.3)
1
0
0
0
56
7 (12.5)
0
7 (12.5)
21
Common AV valve replace (including redo)
2
1 (50.0)
0
1 (50.0)
6
1 (16.7)
0
1 (16.7)
8
0
0
1 (12.5)
3
0
0
0
19
2 (10.5)
0
3 (15.8)
22
Repair of supra-aortic stenosis
1
0
0
0
6
1 (16.7)
0
1 (16.7)
9
1 (11.1)
0
1 (11.1)
0
0
0
0
16
2 (12.5)
0
2 (12.5)
23
Repair of subaortic stenosis (including redo)
1
1 (100.0)
0
1 (100.0)
7
0
0
1 (14)
36
0
0
0
4
0
0
0
48
1 (2.1)
0
2 (4.2)
24
Aortic valve plasty ± VSD closure
3
0
0
0
12
0
0
1 (8.3)
24
0
0
0
4
0
0
0
43
0
0
1 (2.3)
25
Aortic valve replacement
0
0
0
0
2
0
0
0
22
0
0
0
23
0
0
0
47
0
0
0
26
AVR with annular enlargement
1
0
0
0
3
0
0
0
13
0
0
0
6
1 (16.7)
0
1 (16.7)
23
1 (4.3)
0
1 (4.3)
27
Aortic root replace (except Ross)
0
0
0
0
0
0
0
0
6
0
0
0
5
0
0
0
11
0
0
0
28
Ross procedure
0
0
0
0
3
0
0
0
10
0
0
0
1
0
0
0
14
0
0
0
Total
776
32 (4.1)
1 (0.1)
43 (5.5)
1,521
42 (2.8)
0
55 (3.6)
1,398
15 (1.1)
0
24 (1.7)
227
4 (1.8)
0
6 (2.6)
3,922
93 (2.4)
1 (0.03)
128 (3.3)
Values in parenthesis represent mortality %
SP systemic pulmonary, PAB pulmonary artery banding, PA pulmonary artery, RVOT right ventricular outflow tract, CA coronary artery, AVfustula arteriovenous fistula, TCPC total cavopulmonary connection, AV valve atrioventricular valve, VSD ventricular septal defect, AVR aortic valve replacement
Abstract of the survey
We sent out survey questionnaire forms to the departments of each category in all 1,986 institutions (601 cardiovascular, 802 general thoracic and 582 esophageal) nationwide in early April 2013. The response rates in each category by the end of December 2013 were 97.0, 96.8, and 95.2 %, respectively. This high response rate has been keep throughout recent survey, and more than 95 % response rate in all fields in 2012 survey has to be congratulated.
2012 Final report
(A) Cardiovascular surgery
First, we are very pleased with the high response rate to our survey of cardiovascular surgery (97.0 %), which definitely enhances the quality of this annual report. We very much appreciate the enormous effort put into completing the survey at each participating institution.
Anzeige
Figure 1 shows the development of cardiovascular surgery in Japan over the last 26 years. Aneurysm surgery includes only operations for thoracic and thoracoabdominal aortic aneurysm. Pacemaker implantation includes only transthoracic implantation and transvenous implantation is excluded. The number of pacemaker and assist device implantation operations is not included in the total number of surgical operations. A total of 63,800 cardiovascular operations were performed at 583 institutions during 2012 alone and included 28 heart transplantations, which were restarted in 1999.
Fig. 1
Annual trend of in-patients with esophageal diseases, EMR endoscopic mucosal resection (including endoscopic submucosal)
×
The number of operations for congenital heart disease (9,558 cases) decreased slightly (3.1 %) compared with that of 2011 (9,859 cases), while there was 3.9 % increase when compared with the data of 10 years ago (9,202 cases in 2002). The number of operations for adult cardiac disease (20,913 cases in valvular heart disease, 16,752 cases in ischemic heart disease, 14,944 cases in thoracic aortic aneurysm and 1,663 cases for other procedures) increased compared with those of 2011 in all categories (9.1, 7.5, 5.8 and 5.1 %, respectively). During the last 10 years, the numbers of operations for adult heart disease increased constantly except for that of ischemic heart disease (81.0 % increase in valvular heart disease, 26.6 % decrease in ischemic heart disease, 112.4 % increase in thoracic aortic aneurysm, and 40.7 % increase in other procedures compared those of 2002). The concomitant coronary artery bypass grafting procedure (CABG) is not included in ischemic heart disease but included in other categories such as valvular heart disease in our study, then, the number of CABG still remained over 20,000 cases per year (21,569 cases) in 2012, which is 89.4 % of that in 2002 (24,135 cases).
Data for individual categories are summarized in tables through 1 to 7.
In 2012, 7,171 open-heart operations for congenital heart disease were performed with overall hospital mortality of 2.3 %. The number of operations for congenital heart disease was quite steady throughout these 10 years (maximum 7,386 cases in 2006), while overall hospital mortality decreased gradually from that of 3.6 % in 2002. In detail, the most common disease was atrial septal defect (1,331 cases), however, its number deceased to 71.7 % of that in 2002, which might be due to the recent development of catheter closure of atrial septal defect in Japan. Hospital mortality for complex congenital heart disease improved dramatically in the last 10 years such as interrupted aortic arch with ventricular septal defect (13.9 % in 2002 to 3.6 % in 2012), complete atrio-septal defect (4.2 to 3.2 %), Tetralogy of Fallot (3.8 to 1.1 %), transposition of the great arteries with and without ventricular septal defect (14.0 to 3.2 % and 7.4 to 2.6 %, respectively), single ventricle and tricuspid atresia (9.2 to 5.5 % and 3.9 to 0 %, respectively), and hypoplastic left heart syndrome (37.9 to 10.2 %). Right heart bypass surgery is now commonly performed (375 bidirectional Glenn procedures and 438 Fontan type procedures including total cavopulmonary connection) with acceptable hospital mortality (2.1 % in each procedure). Norwood type I procedure was performed in 130 cases with relatively low hospital mortality rate of 15.4 %.
As previously mentioned, the number of operations for valvular heart disease increased by 81 % in the last 10 years, and the hospital mortality associated with primary single valve replacement was 3.0 and 4.5 % for the aortic and the mitral position, while that for primary mitral valve repair was 1.3 %. However, hospital mortality rate for redo valve surgery was still high and was 9.3 and 6.7 % for aortic and mitral procedure, respectively. Finally, overall hospital mortality did not show any improvement during the last 10 years (3.1 % in 2002 and 3.2 % in 2012), which might be partially due to the recent progression of age of the patients. Repair of the valve became popular procedure (484 cases in the aortic, 6,002 cases in the mitral, and 4,947 case in the tricuspid), and mitral valve repair constituted 28.7 % of all valvular heart disease operation and 57.6 % of all mitral valve procedure (10,425 procedures), which are similar to those of the last 4 years and increased compared with those of 2002 (19.5 and 34.9 %, respectively). Aortic and mitral valve replacement with bioprosthesis were performed in 8,926 cases and 3,002 cases, respectively, with the number consistently increasing. The ratio of prostheses changed dramatically during the last 10 years, and the usage of bioprosthesis is 74.3 % at the aortic position (37.3 % in 2002) and 61.0 % at the mitral position (24.2 % in 2002). CABG as a concomitant procedure increased gradually to 23.9 % of operations for all valvular heart disease (12.1 % in 2002).
Isolated CABG was performed in 15,462 cases which were only 71.5 % of that of 10 years ago (2002), however, there was an increase of 8.5 % compared with that in 2011. Among these 15,462 cases, off-pump CABG was intended in 9,499 cases (61.4 %) with a success rate of 97.9 %, so final success rate of off-pump CABG was 60.2 %. The percentage of intended off-pump CABG was 55.2 % in 2003, and was increased to 60.3 % in 2004, then was kept over 60 % until now. Conversion rate from off-pump CABG to on-pump CABG of 2.1 % was just same as that in 2011. In 15,462 isolated CABG patients, 96.5 % of them received at least one arterial graft, while, all arterial graft CABG was performed in only 23.5 % of them.
The operative and hospital mortality rates associated with primary elective CABG procedures in 13,004 cases were 0.6 and 1.1 %, respectively. Similar data analysis of CABG including primary/redo and elective/emergency data was begun in 2003, and the operative and hospital mortality rates associated with primary elective CABG procedures in 2003 were 1.0 and 1.5 %, respectively, so operative results of primary CABG have been improved. However, hospital mortality of primary emergency CABG in 2,224 cases was 7.4 %, which was still high in spite of slight improvement compared with 9.7 % of hospital mortality rate in 2003. In comparison with data in 2003, the results of conversion improved both conversion rate (3.1 to 2.1 %) and hospital mortality (8.5 to 5.1 %).
A total of 1,274 patients underwent surgery for complications of myocardial infarction, including 413 operations for a left ventricular aneurysm or ventricular septal perforation or cardiac rupture and 296 operations for ischemic mitral regurgitation.
Anzeige
Operations for arrhythmia were performed mainly as a concomitant procedure in 3,992 cases with satisfactory mortality (1.8 % hospital mortality) including 3,771 MAZE procedures. MAZE procedure has become quite popular procedure when compared with that in 2002 (1,141 cases).
Operations for thoracic aortic dissection were performed in 6,266 cases. For 4,186 Stanford type A acute aortic dissections, hospital mortality was 10.6 %, which was similar to that in 2011 (11.1 %) and better than that in 2002 (15.5 %). Operations for a non-dissected thoracic aneurysm were carried out in 8,678 cases, with overall hospital mortality of 5.4 %, which was better than that in 2011 (6.7 %). The hospital mortality associated with unruptured aneurysm was 4.0 %, and that of ruptured aneurysm was 22.2 %, which remains markedly high.
The number of stent graft procedures remarkably increased recently. A total of 835 patients with aortic dissection underwent stent graft placement: thoracic endovascular aortic repair (TEVAR) in 723 cases, open stent grafting in 109 cases, and unspecified in 3 cases. The number of TEVAR for type B chronic aortic dissections increased from 359 cases in 2011 to 492 cases in 2012. The hospital mortality rates associated with TEVAR for type B aortic dissection were 7.3 % in acute cases and 2.6 % for chronic cases, respectively.
A total of 3,236 patients with non-dissected aortic aneurysm underwent stent graft placement with 18.8 % increase compared with that in 2011 (2,725 cases); TEVAR in 3,006 cases (23.6 % increase compared with that in 2011), open stent grafting in 226 cases (20.8 % decrease compared with that in 2011), and unspecified in 4 cases. The hospital mortality rates for TEVAR were 2.5 and 16.1 % for non-ruptured and ruptured aneurysm, respectively.
Anzeige
In summary, the total cardiovascular operations increased during 2012 by 3,516 cases, with steadily improving results in almost all categories compared with those in 2011.
LMT includes LMT alone or LMT with other branch diseases. CABG coronary artery bypass grafting, 1VD one-vessel disease, 2VD two-vessel disease, 3VD three-vessel disease, LMT left main trunk, SVG saphenous vein graft
(a-2) On-pump beating CABG (total; 2,214)
Primary, elective
Primary, emergency
Redo, elective
Redo, emergency
Arterial graft only
Artery graft+SVG
SVG only
Others
Cases
30-day mortality
Hospital mortality
Cases
30-day mortality
Hospital mortality
Cases
30-day mortality
Hospital mortality
Cases
30-day mortality
Hospital mortality
Hospital
After discharge
Hospital
After discharge
Hospital
After discharge
Hospital
After discharge
1VD
23
0
0
1 (4.3)
14
0
0
1 (7.1)
4
0
0
0
4
1 (25.0)
0
2 (50.0)
22
5
18
0
2VD
235
2 (0.9)
0
6 (2.6)
65
7 (10.8)
0
7 (10.8)
11
1 (9.1)
0
1 (9.1)
3
0
0
0
65
223
25
1
3VD
805
8 (1.0)
1 (0.1)
16 (2.0)
211
20 (9.5)
0
28 (13.3)
12
0
0
1 (8.3)
1
0
0
0
107
889
33
0
LMT
550
4 (0.7)
0
9 (1.6)
264
27 (10.2)
1 (0.4)
36 (13.6)
10
0
0
0
2
0
0
0
139
639
48
0
Total
1,613
14 (0.9)
32 (2.0)
554
54 (9.7)
72 (13.0)
37
1 (2.7)
2 (5.4)
10
1 (10.0)
2 (20.0)
333
1,756
124
1
Kawasaki
1
0
0
0
1
0
0
0
0
0
0
0
0
0
0
0
1
1
0
0
Hemodialysis
158
2 (1.3)
0
8 (5.1)
46
5 (10.9)
0
5 (10.9)
3
0
0
1 (33.3)
3
0
0
0
18
176
16
0
Values in parenthesis represent mortality %
LMT includes LMT alone or LMT with other branch diseases. CABG coronary artery bypass grafting, 1VD one-vessel disease, 2VD two-vessel disease, 3VD three-vessel disease, LMT left main trunk, SVG saphenous vein graft
(b) Off-pump CABG (total; 9,499)
(The present section also includes cases of planned off-pump CABG in which, during surgery, the change is made to an on-pump CABG or on-pump beating-heart procedure)
Primary, elective
Primary, emergency
Redo, elective
Redo, emergency
Arterial graft only
Artery graft+SVG
SVG only
Others
Cases
30-day mortality
Hospital mortality
Cases
30-day mortality
Hospital mortality
Cases
30-day mortality
Hospital mortality
Cases
30-day mortality
Hospital mortality
Hospital
After discharge
Hospital
After discharge
Hospital
After discharge
Hospital
After discharge
1VD
582
1 (0.2)
0
6 (1.0)
67
2 (3.0)
0
3 (4.5)
40
0
1
0
8
0
0
0
590
48
59
0
2VD
1,484
6 (0.4)
0
12 (0.8)
135
3 (2.2)
0
5 (3.7)
18
2 (11.1)
0
2 (11.1)
5
0
0
0
630
961
41
0
3VD
3,645
11 (0.3)
1 (0.03)
31 (0.9)
390
14 (3.6)
0
21 (5.4)
22
0
0
0
3
1 (33.3)
0
1 (33.3)
772
3,221
61
2
LMT
2,496
14 (0.6)
0
24 (1.0)
574
23 (4.0)
0
31 (5.4)
24
0
0
0
6
1 (16.7)
0
1 (16.7)
855
2,161
75
0
Total
8,207
32 (0.4)
1 (0.01)
73 (0.9)
1,166
42 (3.6)
60 (5.1)
104
2 (1.9)
2 (1.9)
22
2 (9.1)
2 (9.1)
2,847
6,391
236
2
Kawasaki
6
0
0
0
1
0
0
0
1
0
0
0
0
0
0
0
7
1
0
0
Hemodialysis
659
7 (1.1)
0
15 (2.3)
94
10 (10.6)
0
17 (18.1)
10
0
0
0
0
0
0
0
163
581
19
0
Values in parenthesis represent mortality %
LMT includes LMT alone or LMT with other branch diseases. CABG coronary artery bypass grafting, 1VD one-vessel disease, 2VD two-vessel disease, 3VD three-vessel disease, LMT left main trunk, SVG saphenous vein graft
(c) Includes cases of conversion, during surgery, from off-pump CABG to on-pump CABG or on-pump beating-heart CABG (total; 197)
Primary, elective
Primary, emergency
Redo, elective
Redo, emergency
Cases
30-day mortality
Hospital mortality
Cases
30-day mortality
Hospital mortality
Cases
30-day mortality
Hospital mortality
Cases
30-day mortality
Hospital mortality
Hospital
After discharge
Hospital
After discharge
Hospital
After discharge
Hospital
After discharge
A conversion to on-pump CABG arrest heart
33
1 (3.0)
0
1 (3.0)
5
0
0
0
0
0
0
0
0
0
0
A conversion to on-pump beating-heart CABG
117
5 (4.3)
0
6 (5.1)
41
3 (7.3)
0
3 (7.3)
1
0
0
0
0
0
0
Total
150
7 (4.7)
0
7 (4.7)
46
3 (6.5)
3 (6.5)
1
0
0
0
0
0
0
0
Hemodialysis
13
1 (7.7)
0
1 (7.7)
6
2 (33.3)
2 (33.3)
0
0
0
0
0
0
0
0
Values in parenthesis represent mortality %
CABG coronary artery bypass grafting
(B) Operation for complications of MI (total; 1,274)
Chronic
Acute
Concomitant operation
Cases
30-day mortality
Hospital mortality
Cases
30-day mortality
Hospital mortality
Hospital
After discharge
Hospital
After discharge
CABG
MVP
MVR
Infarctectomy or aneurysmectomy
350
18 (5.1)
0
29 (8.3)
26
2 (7.7)
0
3 (11.5)
263
107
15
VSP closure
49
4 (8.2)
0
7 (14.3)
240
53 (22.1)
1
64 (26.7)
89
7
10
Cardiac rupture
14
1 (7.1)
0
1 (7.1)
224
75 (33.5)
0
85 (37.9)
40
2
4
Mitral regurgitation
1) Papillary muscle rupture
11
0
0
0
35
9 (25.7)
0
11 (31.4)
18
10
23
2) Ischemic
285
18 (6.3)
0
30 (10.5)
28
4 (14.3)
0
4 (14.3)
262
225
48
Others
5
0
0
0
7
1 (14.3)
0
1 (14.3)
2
0
0
Total
714
41 (5.7)
0
67 (9.4)
560
144 (25.7)
1
168 (30.0)
674
351
100
Values in parenthesis represent mortality %
Acute, within 2 weeks from the onset of myocardial infarction
Values in parenthesis represent mortality %. Except for 20 isolated cases, all remaining 4,163 cases are doubly allocated, one for this subgroup and the other for the subgroup corresponding to the concomitant operations
The total number of operations reported in 2012 in general thoracic surgery has reached 72,899, which means an increase of 3,676 cases compared with the number of operations in 2011. This is largely owing to the steady increase in lung cancer surgery (31,301; 2009, 32,801; 2010, 33,878:2011, 35,667:2012).
Surgery for lung cancer consists more than 49 % of all the general thoracic surgery. Among lung cancer subtypes, adenocarcinoma comprises an overwhelming percentage of 69.4 % of the total lung cancer surgery, followed by squamous cell carcinoma of 19.0 %. Limited resection by wedge resection or segmentectomy was performed in 6,789 lung cancer patients, which is 19.0 % of the entire cases. Lobectomy was performed 26,079 patients, which is 73.1 % of the entire cases. Sleeve lobectomy was done in 429 patients. Pneumonectomy was done in 571 patients, which is only 1.6 % of the entire cases. VATS (video-assisted thoracic surgery) procedure is performed in 65.6 % among the total lung cancer surgeries in 2012. 123 patients died within 30 days after lung cancer surgery (30-day mortality rate 0.34 %), and 248 patients died without discharge (Hospital mortality rate 0.70 %). 30-day mortality rate in regard to procedures is 0.26 % in segmentectomy, 0.31 % in lobectomy, and 2.45 % in pneumonectomy.
Anzeige
Interstitial pneumonia was the leading cause of death after lung cancer surgery, followed by pneumonia, cardiovascular event, bronchopleural fistula, and respiratory failure.
7,403 patients with metastatic pulmonary tumor were operated in 2012 with steady increase similar to lung cancer surgery (6,248:2009, 6,748:2010, 7,210:2011). VATS was adopted in 5,828 cases, which comprises 78.7 % of the entire cases. Colorectal cancer was by far the leading primary malignancy indicated for resection of metastatic tumors.
73 tracheal tumors were operated in 2012. Adenoid cystic carcinoma and squamous cell carcinoma were frequent primary tracheal tumor.
409 tumors of pleural origin were operated in 2012. Diffuse malignant pleural mesothelioma was the most frequent histology. Extrapleural pneumonectomy was the most frequently chosen operative method (135 cases) with a hospital death of 6.7 %.
752 chest wall tumors were resected in 2012.
4,671 mediastinal tumors were operated in 2012. There were 2,151 thymic epithelial tumors (1,842 thymomas, 271 thymic carcinomas, and 38 thymic carcinoid), followed by 906 congenital cysts, 495 neurogenic tumors, and 231 germ cell tumors. 2,425 cases (51.9 %) were resected by VATS.
Thymectomy for myasthenia gravis was done in 446 patients, and 302 among them were associated with thymoma, indicating that thymectomy for non-thymomatous myasthenia gravis was done only in 144 patients. Advancement in medical control of myasthenia gravis by immunosuppressants might reduce indication of extended thymectomy for non-thymomatous myasthenia gravis. This possibility should be further examined.
2,250 operations for empyema were reported in 2012. There were 1,710 patients (76 %) with acute empyema and 540 patients with chronic empyema. Bronchopleural fistula was associated in 348 patients (20.4 %) with acute empyema and 274 patients (50.7 %) with chronic empyema. It should be noted that hospital mortality was as high as 12.1 % in patients of acute empyema with fistula.
14,410 operations for pneumothorax were reported in 2012. 13,555 operations (94.1 %) were performed by VATS, similarly to cases in 2011.
44 lung transplantations were reported in 2012. The number of the brain-dead donors is slightly increasing after revision of the law on organ transplantation.
The number of lung transplantation operation is still small compared to those in North America and European countries because of shortage of donors, but the number of brain-dead donors is increasing slowly in Japan after revision of the law of organ transplantation in 2010.
Table 1 Total entry cases of general thoracic surgery during 2012
Cases
%
Benign pulmonary tumor
863
1.2
Primary lung cancer
35,667
48.9
Other primary malignant pulmonary tumor
348
0.5
Metastatic pulmonary tumor
7,403
10.2
Tracheal tumor
73
0.1
Mesothelioma
409
0.6
Chest wall tumor
752
1.0
Mediastinal tumor
4,671
6.4
Thymectomy for MG without thymoma
302
0.4
Inflammatory pulmonary disease
3,405
4.7
Empyema
2,250
3.1
Bullous disease excluding pneumothorax
569
0.8
Pneumothorax
14,410
19.8
Chest wall deformity
415
0.6
Diaphragmatic hernia including traumatic
112
0.2
Chest trauma excluding diaphragmatic hernia
393
0.5
Lung transplantation
44
0.1
Others
813
1.1
Total
72,899
100.0
Table 2
1. Benign pulmonary tumor
Cases
30-day mortality
Hospital mortality
By VATS
Hospital
After discharge
Hamartoma
421
0
0
0
371
Sclerosing hemangioma
104
0
0
0
84
Papilloma
9
0
0
0
7
Mucous gland adenoma bronchial
5
0
0
0
5
Fibroma
34
0
0
0
26
Lipoma
5
0
0
0
4
Neurogenic tumor
13
0
0
0
10
Clear cell tumor
1
0
0
0
1
Leiomyoma
13
0
0
0
8
Chondroma
3
0
0
0
3
Inflammatory myofibroblastic tumor
3
0
0
0
2
Pseudolymphoma
23
0
0
0
17
Histiocytosis
11
0
0
0
8
Teratoma
4
0
0
0
2
Others
214
0
0
0
171
Total
863
0
0
0
719
Values in parenthesis represent mortality %
Table 3
2. Primary malignant pulmonary tumor
Cases
30-day mortality
Hospital mortality
By VATS
Hospital
After discharge
2. Primary malignant pulmonary tumor
36,015
103 (0.3)
15 (0.04)
243 (0.7)
Lung cancer
35,667
112 (0.3)
11 (0.03)
248 (0.7)
23,411
Adenocarcinoma
24,749
48 (0.2)
5 (0.02)
84 (0.3)
Squamous cell carcinoma
7,114
47 (0.7)
4 (0.06)
122 (1.7)
Large cell carcinoma
917
3 (0.3)
0
14 (1.5)
(LCNEC)
471
2 (0.4)
0
6 (1.3)
Small cell carcinoma
591
2 (0.3)
0
3 (0.5)
Adenosquamous carcinoma
612
6 (1.0)
1
11 (1.8)
Carcinoma with pleomorphic, sarcomatoid or sarcomatous elements
Bilateral lung transplantation from brain-dead donor
18
0
0
0
Lung transplantation from living donor
10
0
0
0
Total of lung transplantation
44
0
0
1 (2.3)
Donor of living donor lung transplantation
17
0
0
0
Values in parenthesis represent mortality %
Table 21
11. Video-assisted thoracic surgery
Cases
30-day mortality
Hospital mortality
Hospital
After discharge
11. Video-assisted thoracic surgery
54,616
83 (0.2)
5 (0.01)
141 (0.3)
Values in parenthesis represent mortality %
(Including thoracic sympathectomy 146)
Table 22
12. Tracheobronchoplasty
Cases
30-day mortality
Hospital mortality
Hospital
After discharge
12. Tracheobronchoplasty
554
3 (0.5)
1 (0.2)
9 (1.6)
Trachea
105
0
0
2 (1.9)
Sleeve resection with reconstruction
58
0
0
0
Wedge with simple closure
29
0
0
1
Wedge with patch closure
1
0
0
0
Total laryngectomy with tracheostomy
2
0
0
1
Others
15
0
0
0
Cardinal reconstruction
7
0
0
0
Sleeve pneumonectomy
16
0
0
1 (6.3)
Sleeve lobectomy
383
3 (0.8)
1 (0.3)
6 (1.6)
Sleeve segmental excision
12
0
0
0
Bronchoplasty without lung resection
12
0
0
0
Others
19
0
0
0
Values in parenthesis represent mortality %
Table 23
13. Pediatric surgery
Cases
30-day mortality
Hospital mortality
Hospital
After discharge
13. Pediatric surgery
417
1 (0.2)
0
1 (0.2)
Values in parenthesis represent mortality %
Table 24
14. Combined resection of neighboring organ(s)
Cases
30-day mortality
Hospital mortality
Hospital
After discharge
14. Combined resection of neighboring organ(s)
1,002
5 (0.5)
3 (0.3)
15 (1.5)
(A) Primary lung cancer (organ resected)
Aorta
9
1 (11.1)
0
1 (11.1)
Superior vena cava
35
0
0
2 (5.7)
Brachycephalic vein
12
1 (8.3)
0
1 (8.3)
Pericardium
171
1 (0.6)
0
3 (1.8)
Pulmonary artery
184
0
0
2 (1.1)
Left atrium
33
1 (3.0)
0
1 (3.0)
Diaphragm
94
0
0
1 (1.1)
Chest wall (including ribs)
494
2 (0.4)
1 (0.2)
12 (2.4)
Vertebra
30
0
0
2 (6.7)
Esophagus
7
0
0
0
Total
1,069
6 (0.6)
1 (0.1)
25 (2.3)
(B) Mediastinal tumor (organ resected)
Aorta
2
0
0
0
Superior vena cava
55
1 (1.8)
0
1 (1.8)
Brachycephalic vein
85
0
0
1 (1.2)
Pericardium
238
1 (0.4)
0
1 (0.4)
Pulmonary artery
1
0
0
0
Left atrium
0
0
0
0
Diaphragm
24
0
0
0
Chest wall (including ribs)
16
0
0
0
Vertebra
6
0
0
0
Esophagus
3
0
0
0
Lung
290
0
0
0
Total
720
2 (0.3)
0
3 (0.4)
Values in parenthesis represent mortality %
Table 25
15. Operation of lung cancer invading the chest wall of the apex
Cases
30-day mortality
Hospital mortality
Hospital
After discharge
15. Operation of lung cancer invading the chest wall of the apex
128
0
0
1 (0.01)
Values in parenthesis represent mortality %
Includes tumors invading the anterior apical chest wall and posterior apical chest wall (superior sulcus tumor, so-called Pancoast type)
(C) Esophageal surgery
During 2012 alone, a total of 12,315 patients with esophageal diseases were registered from 555 institutions (response rate: 95.4 %), affiliated to the Japanese Association for Thoracic Surgery and/or to the Japan Esophageal Society. Among these institutions, 20 or more patients underwent esophageal surgeries within the year of 2012 in 184 institutions (33.2 %), which shows definite shift of esophageal operations to high volume institutions when compared to the data of 2011 (22.9 %) (Table 1) Of 2,281 patients with a benign esophageal disease, 1,141 (50.0 %) patients underwent surgery, and 30 (1.3 %) patients underwent endoscopic resection, while 1,110 (48.7 %) patients did not undergo any surgical treatment. (Table 2) Of 10,034 patients with a malignant esophageal tumor, 7,859 (78.3 %) patients underwent resection, esophagectomy for 6,055 (60.3 %) and endoscopic mucosal resection (EMR) or endoscopic submucosal dissection (ESD) for 1,804 (18.0 %), while 2,175 (21.6 %) patients did not undergo any resection. (Tables 3, 4) The decrease of registered patients with nonsurgically treated benign esophageal diseases is obvious during 2011 and 2012. The patients registered, particularly those undergoing nonsurgical therapy for a malignant esophageal disease, have been increasing since 1990 (Fig. 1).
Among benign esophageal diseases (Table 2), esophageal varices, hiatal hernia, achalasia and esophagitis (including reflux esophagitis) were the most common conditions in Japan. On the other hand, spontaneous rupture of the esophagus, benign esophageal tumors and congenital esophageal atresia were common diseases which were surgically treated. The thoracoscopic and/or laparoscopic procedures have been widely adopted for benign esophageal diseases, in particular achalasia, hiatal hernia and benign tumors. Open surgery was performed in 828 patients with a benign esophageal disease with 30-day mortality in 5 (0.6 %), while thoracoscopic and/or laparoscopic surgery was performed for 233 patients with 0 (0.0 %) of the 30-day mortality The difference in these death rates between open and scopic surgery seems to be related to the conditions requiring open surgery.
The majority of malignant diseases were carcinomas (Table 3). Among esophageal carcinomas, the incidence of squamous cell carcinoma was 91.8 %, while that of adenocarcinomas including Barrett cancer was 5.7 %. The resection rate for patients with a squamous cell carcinoma was 77.6 %, while that for patients with an adenocarcinoma was 91.5 %.
According to location, cancer in the thoracic esophagus was the most common (Table 4). Of the 3,793 patients (37.8 % of total esophageal malignancies) having superficial esophageal cancers within mucosal and submucosal layers, 1,759 (46.3 %) patients underwent esophagectomy, while 1,802 (47.5 %) patients underwent EMR or ESD. The 30-day mortality rate and hospital mortality rate after esophagectomy for patients with a superficial cancer were 0.6 and 1.5 %, respectively. There was no EMR or ESD-related death. Advanced esophageal cancer invading deeper than the submucosal layer was observed in 6,231 (62.1 %) patients. Of the 6,231 patients with advanced esophageal cancer, 4,288 (68.8 %) underwent esophagectomy, with 0.8 % of the 30-day mortality rate, and with 2.4 % of the hospital mortality rate.
Multiple primary cancers were observed in 1,644 (16.4 %) of all the 10,034 patients with esophageal cancer. Synchronous cancer was found in 868 (52.9 %) patients, while metachronous cancer (found before esophageal cancer) was observed in 772 (47.0 %) patients. The stomach is the commonest site for both synchronous and metachronous malignancy followed by head & neck cancer (Table 4).
Among esophagectomy procedures, transthoracic esophagectomy through right thoracotomy was the most commonly adopted for patients with a superficial cancer as well as for those with an advanced cancer (Table 5). Transhiatal esophagectomy commonly performed in Western countries was adopted in only 4.4 % of patients having a superficial cancer who underwent esophagectomy, and in 2.0 % of those having an advanced cancer in Japan. The thoracoscopic and/or laparoscopic esophagectomy were adopted for 855 patients (48.6 %) with a superficial cancer, and for 1,193 patients (27.8 %) with an advanced cancer. The number of cases of thoracoscopic and/or laparoscopic surgery for superficial or advanced cancer has been increasing for these several years (Fig. 2).
Fig. 2
Annual trend of video-assisted esophagectomy for esophageal malignancy
×
Combined resection of the neighboring organs during resection of an esophageal cancer was performed in 334 patients (Tables 5, 6). Resection of the aorta together with the esophagectomy was performed in 2 cases. Tracheal and/or bronchial resection combined with esophagectomy was performed in 23 patients, with the 30-day mortality rate at 4.3 % and the hospital mortality rate at 13.0 %. Lung resection combined with esophagectomy was performed in 69 patients, with the 30-day mortality rate at 0 % and the hospital mortality rate at 1.4 %.
Salvage surgery after definitive (chemo-)radiotherapy was performed in 256 patients, with the 30-day mortality rate at 2.7 % and with the hospital mortality rate at 6.3 %. (Table 5).
Lastly, in spite of the efforts of the Committee to cover wider patient populations to this annual survey, the majority of the institutions which responded to the questionnaire were the departments of thoracic or esophageal surgery. It should be noted that larger number of patients with esophageal diseases should have been treated medically and endoscopically. We should continue our effort for complete survey through more active collaboration with the Japan Esophageal Society and other related societies.
Table 1 Distribution of number of esophageal operations in 2012 in each institution
(2) Transthoracic (rt.) esophagectomy and reconstruction
1,387
9 (0.6)
1 (0.1)
21 (1.5)
735
6 (0.8)
0
12 (1.6)
(3) Transthoracic (lt.) esophagectomy and reconstruction
54
0
0
1 (1.9)
4
0
0
0
(4) Cervical esophageal resection and reconstruction
18
0
0
0
3
0
0
0
(5) Two-stage operation
27
0
0
0
7
0
0
0
(6) Others
184
0
0
1 (0.5)
76
0
0
0
(7) Not specified
13
0
0
1
24
0
0
1 (4.2)
Advanced cancer
Esophagectomy
4,288
35 (0.8)
1 (0.0)
104 (2.4)
1,193
8 (0.7)
0
21 (1.8)
0
(1) Transhiatal esophagectomy
84
1 (1.2)
0
6 (7.1)
8
0
0
0
(2) Transthoracic (rt.) esophagectomy and reconstruction
3,479
22 (0.6)
0
79 (2.3)
1,004
5 (0.5)
0
18 (1.8)
(3) Transthoracic (lt.) esophagectomy and reconstruction
227
2 (0.9)
1 (0.4)
3 (1.3)
32
0
0
0
(4) Cervical esophageal resection and reconstruction
120
2 (1.7)
0
4 (3.3)
6
0
0
0
(5) Two-stage operation
96
2 (2.1)
0
5 (5.2)
18
1 (5.6)
0
1 (5.6)
(6) Others/not specified
268
5 (1.9)
0
6 (2.2)
116
2 (1.7)
0
2 (1.7)
(7) Not specified
14
1 (7.1)
0
1 (7.1)
9
0 (0.0)
0
0
(Depth not specified)
8
0
0
1 (12.5)
Combined resection of other organs
334
2 (0.6)
0
9 (2.7)
(1) Aorta
2
0
0
0
(2) Trachea, bronchus
23
1 (4.3)
0
3 (13.0)
(3) Lung
69
0
0
1 (1.4)
(4) Others
240
1 (0.4)
0
5 (2.1)
Salvage surgery
256
7 (2.7)
0
16 (6.3)
31
1 (3.2)
0
4 (12.9)
35
Values in parenthesis represent mortality %
Table 6 Mortality after combined resection of the neighboring organs
Year
Esophagectomy
Combined resection
Aorta
Tracheobronchus
Lung
Others
a
b
c (%)
a
b
c (%)
a
b
c (%)
a
b
c (%)
a
b
c (%)
1996
4,194
120
2.86
7
3
42.86
24
0
0.00
50
2
4.00
78
4
5.13
1997
4,441
127
2.86
1
0
0.00
34
5
14.71
56
1
1.79
94
3
3.19
1998
4,878
136
2.79
4
0
0.00
29
0
0.00
74
1
1.35
128
2
1.56
1999
5,015
116
2.31
5
0
0.00
23
2
8.70
68
0
0.00
122
1
0.82
2000
5,350
81
1.51
2
0
0.00
23
2
8.70
69
0
0.00
96
1
1.04
2001
5,521
110
1.99
1
0
0.00
26
1
3.85
83
3
3.61
99
2
2.02
2002
4,904
66
1.35
3
1
33.33
20
2
10.00
63
0
0.00
63
1
1.59
2003
4,639
45
0.97
0
0
0.00
24
2
8.33
58
0
0.00
88
1
1.14
2004
4,739
64
1.35
2
0
0.00
17
0
0.00
59
5
8.47
119
2
1.68
2005
5,163
52
1.01
1
0
0.00
11
1
9.09
67
1
1.49
73
1
1.37
2006
5,236
63
1.20
0
0
0.00
17
0
0.00
62
2
3.23
122
3
2.46
2007
4,990
60
1.20
0
0
0.00
25
1
4.00
44
1
2.27
138
2
1.45
2008
5,124
63
1.23
0
0
0.00
17
1
5.88
48
1
2.08
185
0
0.00
2009
5,260
63
1.20
0
0
0.00
19
2
10.53
58
2
3.45
211
3
1.42
2010
5,180
45
0.87
2
0
0.00
33
0
0.00
58
0
0.00
245
5
2.04
2011
5,430
38
0.70
4
0
0.00
26
0
0.00
41
0
0.00
179
5
2.79
2012
6,055
47
0.78
2
0
0.00
23
1
4.35
69
0
0.00
240
1
0.42
Total
86,119
1,040
1.21
26
4
15.38
273
16
5.86
753
16
2.12
1,220
23
1.89
a number of patients who underwent the operation, b number of patients died within 30 days after operation, c % ratio of b/a, i.e., direct operative mortality
Fig. 1
General thoracic surgery
×
Acknowledgments
On behalf of The Japanese Association for Thoracic Surgery, the authors thank the Heads of the Affiliate and Satellite Institutes of Thoracic Surgery for their cooperation, and the Councilors of the Japan Esophageal Society.
Open AccessThis article is distributed under the terms of the Creative Commons Attribution License which permits any use, distribution, and reproduction in any medium, provided the original author(s) and the source are credited.
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Thoracic and cardiovascular surgery in Japan during 2012 Annual report by The Japanese Association for Thoracic Surgery
verfasst von
Munetaka Masuda Hiroyuki Kuwano Meinoshin Okumura Jun Amano Hirokuni Arai Shunsuke Endo Yuichiro Doki Junjiro Kobayashi Noboru Motomura Hiroshi Nishida Yoshikatsu Saiki Fumihiro Tanaka Kazuo Tanemoto Yasushi Toh Hiroyasu Yokomise Committee for Scientific Affairs, The Japanese Association for Thoracic Surgery
Nach der Katheterablation von Vorhofflimmern kommt es bei etwa einem Drittel der Patienten zu Rezidiven, meist binnen eines Jahres. Wie sich spätere Rückfälle auf die Erfolgschancen einer erneuten Ablation auswirken, haben Schweizer Kardiologen erforscht.
Schmerzen im Unterbauch, aber sonst nicht viel, was auf eine Appendizitis hindeutete: Ein junger Mann hatte Glück, dass trotzdem eine Laparoskopie mit Appendektomie durchgeführt und der Wurmfortsatz histologisch untersucht wurde.
Derzeit wird empfohlen, eine Therapie mit GLP-1-Rezeptoragonisten präoperativ zu unterbrechen. Eine neue Studie nährt jedoch Zweifel an der Notwendigkeit der Maßnahme.
Die Ureterstriktur ist eine relativ seltene Komplikation, trotzdem bedarf sie einer differenzierten Versorgung. In komplexen Fällen wird dies durch die roboterassistierte OP-Technik gewährleistet. Erste Resultate ermutigen.
Update Chirurgie
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Das Karpaltunnelsyndrom ist die häufigste Kompressionsneuropathie peripherer Nerven. Obwohl die Anamnese mit dem nächtlichen Einschlafen der Hand (Brachialgia parästhetica nocturna) sehr typisch ist, ist eine klinisch-neurologische Untersuchung und Elektroneurografie in manchen Fällen auch eine Neurosonografie erforderlich. Im Anfangsstadium sind konservative Maßnahmen (Handgelenksschiene, Ergotherapie) empfehlenswert. Bei nicht Ansprechen der konservativen Therapie oder Auftreten von neurologischen Ausfällen ist eine Dekompression des N. medianus am Karpaltunnel indiziert.
Das Webinar beschäftigt sich mit Fragen und Antworten zu Diagnostik und Klassifikation sowie Möglichkeiten des Ausschlusses von Zusatzverletzungen. Die Referenten erläutern, welche Frakturen konservativ behandelt werden können und wie. Das Webinar beantwortet die Frage nach aktuellen operativen Therapiekonzepten: Welcher Zugang, welches Osteosynthesematerial? Auf was muss bei der Nachbehandlung der distalen Radiusfraktur geachtet werden?
Inhalte des Webinars zur S1-Leitlinie „Empfehlungen zur Therapie der akuten Appendizitis bei Erwachsenen“ sind die Darstellung des Projektes und des Erstellungswegs zur S1-Leitlinie, die Erläuterung der klinischen Relevanz der Klassifikation EAES 2015, die wissenschaftliche Begründung der wichtigsten Empfehlungen und die Darstellung stadiengerechter Therapieoptionen.
