The Japanese Association for Thoracic Surgery has conducted annual surveys of thoracic surgery throughout Japan since 1986 to establish the statistics for the number of procedures by operative category. The results from our annual survey of thoracic surgery performed in 2016 are summarized.
As has been done so far, 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 members’ continued professional support and contributions (Tables 1, 2).
Table 1
Number of institutions involved in the survey
Questionnaires
Sent out
Responded
Response rate (%)
(A) Cardiovascular surgery
–
–
–
(B) General thoracic Surgery
744
693
93.1
(C) Esophageal surgery
584
543
93.0
Table 2
Categories subclassified according to the number of operations performed
Number of operations performed
Category
General thoracic surgery
0
5
1–24
52
25–49
119
50–99
185
100–149
130
150–199
89
≥ 200
113
Total
693
Number of operations performed
Esophageal surgery
0
70
1–4
138
5–9
107
10–19
95
20–29
41
30–39
26
40–49
22
≥ 50
44
Total
543
Anzeige
The incidence of hospital mortality was added to the survey to clarify the situation nationwide, which has contributed to Japanese surgeons understanding the present status of thoracic surgery in Japan and to make progress to improve operative results by comparing their work with that of others. The Association was able to gain a better understanding of present problems, as well as future prospects, which has been reflected in its activities, 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 after the patient has been discharged from the hospital. Hospital mortality is defined as death within any time interval after an operation if the patient has not been discharged from the hospital.
Hospital-to-hospital transfer in the categories of esophageal surgery 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. On the other hand, hospital-to-hospital transfer 30 days after operation in the categories of cardiovascular surgery and general thoracic surgery is considered discharge because data of the national clinical database (NCD) 2016 were used in this category, and hospital-to-hospital transfer 30 days after operation is considered discharge in the NCD.
Abstract of the survey
All data regarding cardiovascular surgery and thoracic surgery were obtained from the NCD, whereas data regarding esophageal surgery were collected from a survey questionnaire by The Japanese Association for Thoracic Surgery forms because NCD of esophageal surgery does not include non-surgical cases (i.e. patients with adjuvant chemotherapy or radiation alone).
Anzeige
In association with the change in data collection of cardiovascular surgery from self-reports using questionnaire sheets in each participating institution until the report in 2014 to automatic package download from the JCVSD (Japanese Cardiovascular Surgery Database, a cardiovascular part of the NCD), the response rate is not available and is not indicated in the category of cardiovascular surgery (Table 1). Further, the number of institutions classified by operation number is also not calculated in the category of cardiovascular surgery (Table 2).
2016 Final report
(A) Cardiovascular surgery
First, we are very pleased with our colleagues’ (members’) cooperation with our survey of cardiovascular surgery, which definitely enhances the quality of this annual report. We are truly grateful again for the enormous effort put into completing the JCVSD/NCD at each participating institution.
Figure 1 shows the development of cardiovascular surgery in Japan over the last 30 years. Aneurysm surgery includes only operations for thoracic and thoracoabdominal aortic aneurysms. Extra-anatomic bypass surgery for thoracic aneurysms and pacemaker implantation were totally excluded from the survey since 2015. The number of assist device implantation operations is not included in the total number of surgical operations, while it remained in the survey.
A total of 67,867 cardiovascular operations, including 51 heart transplantations, were performed at 580 institutions in 2016, which increased by 6.8% from the survey in 2015 (n = 63,520). Considering the trend in 2016, the data of which were collected and aggregated in the same method as in 2015, the actual number of cardiovascular operations is still continuously increasing, although the apparent number decreased in 2015 probably due to a major change in data collection and aggregation.
When compared with the data of 2015 [1] and of 2006 [2], the number of operations in 2016 for congenital heart disease decreased by 3.4% (8744 vs. 9054) and 7.6%, respectively; that for valvular heart disease increased by 16.1% (23,012 vs. 19,820) and 52.5%, respectively; that for thoracic aortic aneurysm increased by 9.4% (19,078 vs. 17,444) and 104.6%, respectively; that for ischemic heart decreased by 1.5% (14,874 vs. 15,103) and 21.1%, respectively; that for other cardiovascular procedures decreased slightly by 1.1% (1874 vs. 1895) and increased by 64.1%, respectively. Data for individual categories are summarized in Tables 3, 4, 5, 6, 7, 8.
Table 3
Congenital (total; 8744)
(1) CPB (+) (total; 6462)
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
PDA
1
0
0
0
2
0
0
0
0
0
0
0
3
1 (33.3)
0
1 (33.3)
6
1 (16.7)
0
1 (16.7)
Coarctation (simple)
13
1 (7.7)
0
1 (7.7)
12
0
0
0
15
0
0
0
4
0
0
0
44
1 (2.3)
0
1 (2.3)
+ VSD
44
2 (4.5)
1 (2.3)
2 (4.5)
43
2 (4.7)
0
3 (7.0)
14
0
0
0
0
0
0
0
101
4 (4.0)
1 (1.0)
5 (5.0)
+ DORV
0
0
0
0
3
0
0
0
0
0
0
0
0
0
0
0
3
0
0
0
+ AVSD
0
0
0
0
1
0
0
0
0
0
0
0
0
0
0
0
1
0
0
0
+ TGA
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
+ SV
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
+ Others
10
0
0
0
9
0
0
1 (11.1)
3
0
0
0
1
0
0
0
23
0
0
1 (4.3)
Interrupt. of Ao (simple)
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
+ VSD
20
1 (5.0)
0
1 (5.0)
24
1 (4.2)
0
1 (4.2)
9
0
0
0
0
0
0
0
53
2 (3.8)
0
2 (3.8)
+ DORV
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
+ Truncus
6
1 (16.7)
0
1 (16.7)
5
0
0
0
0
0
0
0
0
0
0
0
11
1 (9.1)
0
1 (9.1)
+ TGA
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
+ Others
1
0
0
0
4
0
0
0
0
0
0
0
0
0
0
0
5
0
0
0
Vascular ring
0
0
0
0
1
0
0
0
0
0
0
0
0
0
0
0
1
0
0
0
PS
3
1 (33.3)
0
1 (33.3)
27
0
0
0
105
0
0
0
19
0
0
0
154
1 (0.6)
0
1 (0.6)
PA·IVS or critical PS
4
0
0
0
53
1 (1.9)
0
1 (1.9)
63
0
0
0
9
0
0
0
129
1 (0.8)
0
1 (0.8)
TAPVR
100
7 (7.0)
0
12 (12.0)
52
0
0
0
8
0
0
1 (12.5)
0
0
0
0
160
7 (4.4)
0
13 (8.1)
PAPVR ± ASD
0
0
0
0
5
0
0
0
50
0
0
0
13
0
0
0
68
0
0
0
ASD
1
0
0
0
51
0
0
0
608
0
0
0
372
0
2 (0.5)
1 (0.3)
1032
0
2 (0.2)
1 (0.1)
Cor triatriatum
1
0
0
0
6
0
0
0
8
0
0
0
0
0
0
0
15
0
0
0
AVSD (partial)
0
0
0
0
13
1 (7.7)
0
1 (7.7)
36
0
0
0
3
0
0
0
52
1 (1.9)
0
1 (1.9)
AVSD (complete)
4
1 (25.0)
0
1 (25.0)
107
2 (1.9)
0
3 (2.8)
94
1 (1.1)
0
1 (1.1)
2
0
0
0
207
4 (1.9)
0
5 (2.4)
+ TOF or DORV
1
0
0
0
7
1 (14.3)
0
2 (28.6)
12
0
0
1 (8.3)
0
0
0
0
20
1 (5.0)
0
3 (15.0)
+ Others
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
VSD (subarterial)
2
0
0
0
88
0
0
0
171
0
0
0
13
0
0
0
274
0
0
0
VSD (perimemb./muscular)
11
0
0
0
825
0
0
1 (0.1)
366
0
0
2 (0.5)
30
0
0
0
1232
0
0
3 (0.2)
VSD (type unknown)
0
0
0
0
0
0
0
0
0
0
0
0
48
0
0
1 (2.1)
48
0
0
1 (2.1)
VSD + PS
2
0
0
0
26
0
0
0
22
0
0
0
0
0
0
0
50
0
0
0
DCRV ± VSD
0
0
0
0
5
0
0
0
23
0
0
0
9
0
0
0
37
0
0
0
Aneurysm of sinus of Valsalva
0
0
0
0
0
0
0
0
0
0
0
0
5
0
0
0
5
0
0
0
TOF
14
0
0
0
162
1 (0.6)
0
2 (1.2)
174
2 (1.1)
0
3 (1.7)
25
0
0
1 (4.0)
375
3 (0.8)
0
6 (1.6)
PA + VSD
9
1 (11.1)
0
1 (11.1)
56
0
0
2 (3.6)
109
0
0
0
10
0
0
0
184
1 (0.5)
0
3 (1.6)
DORV
25
0
0
0
140
2 (1.4)
0
2 (1.4)
158
1 (0.6)
0
2 (1.3)
11
0
0
1 (9.1)
334
3 (0.9)
0
5 (1.5)
TGA (simple)
98
1 (1.0)
0
4 (4.1)
11
0
0
1 (9.1)
2
0
0
0
2
0
0
0
113
1 (0.9)
0
5 (4.4)
+ VSD
37
2 (5.4)
0
4 (10.8)
10
0
0
0
11
1 (9.1)
0
1 (9.1)
2
0
0
0
60
3 (5.0)
0
5 (8.3)
VSD + PS
0
0
0
0
1
0
0
0
1
0
0
0
0
0
0
0
2
0
0
0
Corrected TGA
2
0
0
0
8
0
0
0
24
0
0
1 (4.2)
7
0
0
0
41
0
0
1 (2.4)
Truncus arteriosus
6
0
0
0
24
0
0
1 (4.2)
16
0
0
1 (6.3)
1
0
0
0
47
0
0
2 (4.3)
SV
24
2 (8.3)
0
6 (25.0)
181
3 (1.7)
0
7 (3.9)
199
3 (1.5)
0
6 (3.0)
28
2 (7.1)
0
3 (10.7)
432
10 (2.3)
0
22 (5.1)
TA
8
0
0
0
48
2 (4.2)
0
3 (6.3)
48
0
0
1 (2.1)
10
0
0
0
114
2 (1.8)
0
4 (3.5)
HLHS
28
2 (7.1)
0
5 (17.9)
124
3 (2.4)
0
9 (7.3)
74
1 (1.4)
0
3 (4.1)
0
0
0
0
226
6 (2.7)
0
17 (7.5)
Aortic valve lesion
10
1 (10.0)
0
1 (10.0)
22
1 (4.5)
0
4 (18.2)
110
0
0
0
36
2 (5.6)
0
4 (11.1)
178
4 (2.2)
0
9 (5.1)
Mitral valve lesion
1
0
0
1 (100.0)
37
0
0
0
62
0
0
0
11
1 (9.1)
0
1 (9.1)
111
1 (0.9)
0
2 (1.8)
Ebstein
9
1 (11.1)
0
1 (11.1)
15
0
0
0
26
0
0
0
10
0
0
0
60
1 (1.7)
0
1 (1.7)
Coronary disease
4
2 (50.0)
0
2 (50.0)
7
1 (14.3)
0
2 (28.6)
18
1 (5.6)
0
1 (5.6)
2
0
0
0
31
4 (12.9)
0
5 (16.1)
Others
15
0
0
1 (6.7)
24
0
0
0
41
0
0
2 (4.9)
54
0
0
0
134
0
0
3 (2.2)
Conduit failure
0
0
0
0
5
0
0
1 (20.0)
37
0
0
0
12
0
0
0
54
0
0
1 (1.9)
Redo (excluding conduit failure)
5
0
0
0
63
2 (3.2)
0
4 (6.3)
104
1 (1.0)
0
4 (3.8)
63
1 (1.6)
0
1 (1.6)
235
4 (1.7)
0
9 (3.8)
Total
519
26 (5.0)
1 (0.2)
45 (8.7)
2307
23 (1.0)
0
51 (2.2)
2821
11 (0.4)
0
30 (1.1)
815
7 (0.9)
2 (0.2)
14 (1.7)
6462
67 (1.0)
3 (0.0)
140 (2.2)
(), % mortality
CPB cardiopulmonary bypass, PDA patent ductus arteriosus, VSD ventricular septal defect, DORV double outlet right ventricle, AVSD atrioventricular septal defect, TGA transposition of great arteries, SV single ventricle, Interrupt. of Ao. interruption of aorta, 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; 2282)
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
After discharge
Hospital
After discharge
Hospital
After discharge
Hospital
After discharge
Hospital
After discharge
Hospital mortality
PDA
344
5 (1.5)
0
12 (3.5)
197
1 (0.5)
0
4 (2.0)
25
0
0
0
3
0
0
0
569
6 (1.1)
0
16 (2.8)
Coarctation (simple)
18
0
0
0
7
0
0
0
3
0
0
0
0
0
0
0
28
0
0
0
+ VSD
38
0
0
0
11
1 (9.1)
0
1 (9.1)
2
0
0
0
0
0
0
0
51
1 (2.0)
0
1 (2.0)
+ DORV
3
0
0
0
0
0
0
0
1
0
0
0
0
0
0
0
4
0
0
0
+ AVSD
2
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
2
0
0
0
+ TGA
1
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
1
0
0
0
+ SV
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
+ Others
12
0
0
0
5
0
0
0
1
0
0
0
0
0
0
0
18
0
0
0
Interrupt. of Ao (simple)
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
+ VSD
26
1 (3.8)
0
1 (3.8)
3
0
0
0
0
0
0
0
0
0
0
0
29
1 (3.4)
0
1 (3.4)
+ DORV
1
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
1
0
0
0
+ Truncus
7
2 (28.6)
0
2 (28.6)
3
0
0
0
0
0
0
0
0
0
0
0
10
2 (20.0)
0
2 (20.0)
+ TGA
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
+ Others
1
0
0
0
2
0
0
0
0
0
0
0
0
0
0
0
3
0
0
0
Vascular ring
3
0
0
0
12
0
0
0
8
0
0
0
0
0
0
0
23
0
0
0
PS
5
0
0
0
9
0
0
0
1
0
0
0
1
0
0
0
16
0
0
0
PA·IVS or critical PS
27
1 (3.7)
0
1 (3.7)
34
1 (2.9)
0
1 (2.9)
6
0
0
0
1
0
0
0
68
2 (2.9)
0
2 (2.9)
TAPVR
13
1 (7.7)
0
1 (7.7)
2
0
0
0
0
0
0
0
0
0
0
0
15
1 (6.7)
0
1 (6.7)
PAPVR ± ASD
0
0
0
0
2
0
0
0
1
0
0
0
0
0
0
0
3
0
0
0
ASD
0
0
0
0
2
0
0
0
4
0
0
0
2
0
0
0
8
0
0
0
Cor triatriatum
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
AVSD (partial)
1
0
0
0
0
0
0
0
2
0
0
0
0
0
0
0
3
0
0
0
AVSD (complete)
50
0
0
1 (2.0)
82
0
1 (1.2)
1 (1.2)
7
0
0
0
0
0
0
0
139
0
1 (0.7)
2 (1.4)
+ TOF or DORV
0
0
0
0
5
0
0
0
2
0
0
0
0
0
0
0
7
0
0
0
+ Others
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
VSD (subarterial)
4
0
0
0
6
0
0
0
0
0
0
0
0
0
0
0
10
0
0
0
VSD (perimemb./muscular)
47
0
0
1 (2.1)
111
1 (0.9)
0
1 (0.9)
5
0
0
0
1
0
0
0
164
1 (0.6)
0
2 (1.2)
VSD + PS
0
0
0
0
2
0
0
0
0
0
0
0
0
0
0
0
2
0
0
0
DCRV ± VSD
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
Aneurysm of sinus of Valsalva
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
TOF
16
1 (6.3)
0
1 (6.3)
84
1 (1.2)
0
1 (1.2)
12
0
0
0
3
0
0
0
115
2 (1.7)
0
2 (1.7)
PA + VSD
20
0
0
0
54
0
0
1 (1.9)
25
1 (4.0)
0
3 (12.0)
1
0
0
0
100
1 (1.0)
0
4 (4.0)
DORV
50
0
0
0
83
0
0
0
16
0
0
0
0
0
0
0
149
0
0
0
TGA (simple)
5
0
0
0
3
0
0
0
0
0
0
0
2
0
0
0
10
0
0
0
+ VSD
9
0
0
0
4
0
0
0
1
0
0
0
1
0
0
0
15
0
0
0
VSD + PS
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
Corrected TGA
4
0
0
0
8
0
0
0
14
0
0
0
4
0
0
0
30
0
0
0
Truncus arteriosus
24
0
0
1 (4.2)
7
0
0
0
2
0
0
0
0
0
0
0
33
0
0
1 (3.0)
SV
68
3 (4.4)
1 (1.5)
6 (8.8)
51
1 (2.0)
0
3 (5.9)
19
0
0
0
2
0
0
0
140
4 (2.9)
1 (0.7)
9 (6.4)
TA
20
0
0
1 (5.0)
21
1 (4.8)
0
1 (4.8)
3
0
0
0
3
0
0
0
47
1 (2.1)
0
2 (4.3)
HLHS
77
2 (2.6)
0
4 (5.2)
25
0
0
0
15
0
0
0
0
0
0
0
117
2 (1.7)
0
4 (3.4)
Aortic valve lesion
6
0
1 (16.7)
2 (33.3)
2
0
0
0
1
0
0
0
0
0
0
0
9
0
1 (11.1)
2 (22.2)
Mitral valve lesion
1
1 (100.0)
0
1 (100.0)
2
0
0
0
4
0
0
0
1
0
0
0
8
1 (12.5)
0
1 (12.5)
Ebstein
6
1 (16.7)
0
1 (16.7)
3
0
0
0
1
0
0
0
0
0
0
0
10
1 (10.0)
0
1 (10.0)
Coronary disease
5
0
0
0
3
0
0
0
1
0
0
0
2
0
0
0
11
0
0
0
Others
10
0
0
0
16
0
0
2 (12.5)
13
3 (23.1)
0
3 (23.1)
5
0
0
0
44
3 (6.8)
0
5 (11.4)
Conduit failure
0
0
0
0
0
0
0
0
0
0
0
0
1
0
0
0
1
0
0
0
Redo (excluding conduit failure)
7
0
0
0
106
0
0
1 (0.9)
126
1 (0.8)
0
1 (0.8)
30
0
0
0
269
1 (0.4)
0
2 (0.7)
Total
931
18 (1.9)
2 (0.2)
36 (3.9)
967
7 (0.7)
1 (0.1)
17 (1.8)
321
5 (1.6)
0
7 (2.2)
63
0
0
0
2282
30 (1.3)
3 (0.13)
60 (2.6)
(), % mortality
CPB cardiopulmonary bypass, PDA patent ductus arteriosus, VSD ventricular septal defect, DORV double outlet right ventricle, AVSD atrioventricular septal defect, TGA transposition of the great arteries, SV single ventricle, Interrupt. of Ao. interruption of aorta, 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
162
4 (2.5)
1 (0.6)
7 (4.3)
431
5 (1.2)
0
8 (1.9)
49
0
0
1 (2.0)
0
0
0
0
642
9 (1.4)
1 (0.2)
16 (2.5)
2
PAB
270
5 (1.9)
1 (0.4)
11 (4.1)
284
2 (0.7)
1 (0.4)
5 (1.8)
16
0
0
0
0
0
0
0
570
7 (1.2)
2 (0.4)
16 (2.8)
3
Bidirectional Glenn or hemi-Fontan ± α
0
0
0
0
285
2 (0.7)
0
5 (1.8)
114
0
0
1 (0.9)
6
0
0
0
405
2 (0.5)
0
6 (1.5)
4
Damus–Kaye–Stansel operation
3
0
0
0
31
3 (9.7)
0
5 (16.1)
13
0
0
1 (7.7)
1
0
0
0
48
3 (6.3)
0
6 (12.5)
5
PA reconstruction/repair (including redo)
16
0
0
0
138
3 (2.2)
0
4 (2.9)
200
1 (0.5)
0
2 (1.0)
14
0
0
0
368
4 (1.1)
0
6 (1.6)
6
RVOT reconstruction/repair
6
0
0
0
186
0
0
2 (1.1)
303
2 (0.7)
0
3 (1.0)
44
0
0
2 (4.5)
539
2 (0.4)
0
7 (1.3)
7
Rastelli procedure
1
0
0
0
27
0
0
1 (3.7)
106
0
0
0
9
0
0
0
143
0
0
1 (0.7)
8
Arterial switch procedure
138
3 (2.2)
0
7`(5.1)
26
2 (7.7)
0
2 (7.7)
6
1 (16.7)
0
1 (16.7)
1
0
0
0
171
6 (3.5)
0
10 (5.8)
9
Atrial switch procedure
1
0
0
0
2
0
0
1 (50.0)
7
0
0
1 (14.3)
1
0
0
0
11
0
0
2 (18.2)
10
Double switch procedure
0
0
0
0
0
0
0
0
7
0
0
0
0
0
0
0
7
0
0
0
11
Repair of anomalous origin of CA
3
1 (33.3)
0
1 (33.3)
4
0
0
1 (25.0)
2
0
0
0
1
0
0
0
10
1 (10.0)
0
2 (20.0)
12
Closure of coronary AV fistula
1
0
0
0
4
0
0
0
5
0
0
0
0
0
0
0
10
0
0
0
13
Fontan/TCPC
1
0
0
0
3
0
0
0
364
2 (0.5)
0
7 (1.9)
42
2 (4.8)
0
2 (4.8)
410
4 (1.0)
0
9 (2.2)
14
Norwood procedure
0
0
0
0
18
1 (5.6)
0
3 (16.7)
2
0
0
0
0
0
0
0
20
1 (5.0)
0
3 (15.0)
15
Ventricular septation
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
16
Left side AV valve repair (including Redo)
2
0
0
0
43
0
0
0
67
0
0
1 (1.5)
13
0
0
0
125
0
0
1 (0.8)
17
Left side AV valve replace (including Redo)
0
0
0
0
15
0
0
0
37
0
0
1 (2.7)
11
1 (9.1)
0
1 (9.1)
63
1 (1.6)
0
2 (3.2)
18
Right side AV valve repair (including Redo)
15
2 (13.3)
0
2 (13.3)
71
0
0
0
85
1 (1.2)
0
3 (3.5)
57
0
0
0
228
3 (1.3)
0
5 (2.2)
19
Right side AV valve replace (including Redo)
0
0
0
0
1
0
0
0
9
0
0
0
25
1 (4.0)
0
1 (4.0)
35
1 (2.9)
0
1 (2.9)
20
Common AV valve repair (including Redo)
8
3 (37.5)
0
6 (75.0)
19
1 (5.3)
0
3 (15.8)
10
1 (10.0)
0
1 (10.0)
1
0
0
0
38
5 (13.2)
0
10 (26.3)
21
Common AV valve replace (including Redo)
1
0
0
1 (100.0)
4
0
0
0
6
0
0
0
3
0
0
1 (33.3)
14
0
0
2 (14.3)
22
Repair of supra-aortic stenosis
2
1 (50.0)
0
1 (50.0)
2
0
0
0
8
0
0
0
1
0
0
0
13
1 (7.7)
0
1 (7.7)
23
Repair of subaortic stenosis (including Redo)
1
0
0
0
11
0
0
0
33
0
0
0
7
0
0
0
52
0
0
0
24
Aortic valve plasty ± VSD Closure
8
1 (12.5)
0
1 (12.5)
10
0
0
2 (20.0)
28
0
0
0
5
0
0
0
51
1 (2.0)
0
3 (5.9)
25
Aortic valve replacement
0
0
0
0
2
0
0
0
35
0
0
0
29
2 (6.9)
0
4 (13.8)
66
2 (3.0)
0
4 (6.1)
26
AVR with annular enlargement
0
0
0
0
0
0
0
0
10
0
0
0
0
0
0
0
10
0
0
0
27
Aortic root replace (except Ross)
0
0
0
0
0
0
0
0
7
0
0
0
10
0
0
0
17
0
0
0
28
Ross procedure
1
0
0
0
4
0
0
0
13
0
0
0
18
0
0
0
29
Bilateral pulmonary artery banding
156
4 (2.6)
1 (0.6)
8 (5.1)
19
1 (5.3)
0
2 (10.5)
0
0
0
0
0
0
0
0
175
5 (2.9)
1 (0.6)
10 (5.7)
Total
796
24 (3.0)
3 (0.4)
45 (5.7)
1640
20 (1.2)
1 (0.1)
44 (2.7)
1542
8 (0.5)
0
23 (1.5)
281
6 (2.1)
0
11 (3.9)
4259
58 (1.4)
4 (0.09)
123 (2.9)
(), % mortality
SP systemic-pulmonary, PAB pulmonary artery banding, PA pulmonary artery, RVOT right ventricular outflow tract, CA coronary artery, AV fistula arteriovenous fistula, TCPC total cavopulmonary connection, AV valve atrioventricular valve, VSD ventricular septal defect, AVR aortic valve replacement
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, LMT includes LMT alone or LMT with other branch diseases
(a-2) On-pump beating CABG (total; 2077)
Primary, elective
Primary, emergency
Redo, elective
Redo, emergency
Arterial graft only
Artery graft + SVG
SVG only
Others
Unclear
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
30
0
0
0
10
1 (10.0)
0
1 (10.0)
2
0
0
0
0
0
0
0
9
24
9
0
0
2VD
164
2 (1.2)
0
3 (1.8)
44
2 (4.5)
0
3 (6.8)
2
0
0
0
1
0
0
0
46
146
18
0
1
3VD
672
10 (1.5)
1 (0.1)
18 (2.7)
180
13 (7.2)
0
27 (15.0)
15
0
0
0
1
0
0
0
109
711
39
4
5
LMT
597
10 (1.7)
0
18 (3.0)
332
22 (6.6)
0
29 (8.7)
23
2 (8.7)
0
2 (8.7)
4
2 (50.0)
0
2 (50.0)
139
756
54
1
6
Total
1463
22 (1.5)
1 (0.1)
39 (2.7)
566
38 (6.7)
0
60 (10.6)
42
2 (4.8)
0
2 (4.8)
6
2 (33.3)
0
2 (33.3)
303
1637
120
5
12
Kawasaki
1
0
0
0
1
0
0
0
0
0
0
0
0
0
0
0
0
2
0
0
0
Hemodialysis
211
8 (3.8)
0
17 (8.1)
77
8 (10.4)
0
12 (15.6)
8
0
0
0
1
0
0
0
30
243
21
1
2
(), % mortality
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, LMT LMT alone or LMT with other branch diseases
(b) Off-pump CABG (total; 8554)
(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
Unclear
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
439
2 (0.5)
0
2 (0.5)
50
0
0
0
9
1 (11.1)
0
1 (11.1)
6
3 (50.0)
0
4 (66.7)
360
103
36
3
2
2VD
1222
9 (0.7)
0
16 (1.3)
136
4 (2.9)
0
6 (4.4)
17
0
0
0
3
1 (33.3)
0
1 (33.3)
510
808
40
5
15
3VD
2721
15 (0.6)
0
34 (1.2)
360
10 (2.8)
0
15 (4.2)
28
0
0
0
5
1 (20.0)
0
1 (20.0)
662
2359
56
15
22
LMT
2804
17 (0.6)
0
35 (1.2)
715
25 (3.5)
0
42 (5.9)
31
2 (6.5)
0
2 (6.5)
8
0
0
0
977
2438
95
15
33
Total
7186
43 (0.6)
0
87 (1.2)
1261
39 (3.1)
0
63 (5.0)
85
3 (3.5)
0
3 (3.5)
22
5 (22.7)
0
6 (27.3)
2509
5708
227
38
72
Kawasaki
14
0
0
0
3
1 (33.3)
0
1 (33.3)
0
0
0
0
0
0
0
0
12
4
0
1
0
Hemodialysis
818
20 (2.4)
0
38 (4.6)
139
4 (2.9)
0
10 (7.2)
11
0
0
0
3
1 (33.3)
0
1 (33.3)
229
688
46
2
6
(), % mortality
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, LMT includes LMT alone or LMT with other branch diseases
(c) Conversion from off-pump CABG to on-pump CABG or on- pump beating-heart CABG during surgery (total; 233)
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
After discharge
Hospital
After discharge
Hospital
After discharge
Hospital
After discharge
Hospital mortality
Conversion to on-pump CABG arrest heart
28
1 (3.6)
0
1 (3.6)
9
0
0
0
1
1 (100.0)
0
1 (100.0)
2
1 (50.0)
0
1 (50.0)
Conversion to on-pump beating-heart CABG
148
6 (4.1)
0
12 (8.1)
41
4 (9.8)
0
6 (14.6)
3
1 (33.3)
0
1 (33.3)
1
1 (100.0)
0
1 (100.0)
Total
176
7 (4.0)
0
13 (7.4)
50
4 (8.0)
0
6 (12.0)
4
2 (50.0)
0
2 (50.0)
3
2 (66.7)
0
2 (66.7)
Hemodialysis
35
3 (8.6)
0
6 (17.1)
6
0
0
0
0
0
0
0
1
1 (100.0)
0
1 (100.0)
(), % mortality
CABG coronary artery bypass grafting
(B) Operation for complications of MI (total; 1220)
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
145
4 (2.8)
0
11 (7.6)
16
5 (31.3)
0
5 (31.3)
90
43
17
VSP closure
45
5 (11.1)
0
5 (11.1)
222
71 (32.0)
1 (0.5)
89 (40.1)
81
0
2
Cardiac rupture
35
6 (17.1)
1 (2.9)
8 (22.9)
212
79 (37.3)
0
88 (41.5)
43
0
4
Mitral regurgitation
(1) Papillary muscle rupture
16
2 (12.5)
0
3 (18.8)
33
7 (21.2)
0
9 (27.3)
19
6
43
(2) Ischemic
309
19 (6.1)
0
32 (10.4)
37
7 (18.9)
0
11 (29.7)
254
229
117
Others
73
5 (6.8)
0
6 (8.2)
77
26 (33.8)
0
34 (44.2)
59
9
7
Total
623
41 (6.6)
1 (0.2)
65 (10.4)
597
195 (32.7)
1 (0.2)
236 (39.5)
546
287
190
(), % mortality
Acute within 2 weeks from the onset of myocardial infarction, MI myocardial infarction, CABG coronary artery bypass grafting, MVP mitral valve repair; MVR, mitral valve replacement; VSP, ventricular septal perforation
(3) Operation for arrhythmia (total; 7168)
Cases
30-Day mortality
Hospital mortality
Concomitant operation
Isolated
Congenital
Valve
IHD
Others
Multiple combination
Hospital
After discharge
2 categories
3 categories
Maze
3974
82 (2.1)
0
138 (3.5)
136
168
3459
665
288
712
42
For WPW
1
0
0
0
0
0
0
1
0
0
0
For ventricular tachyarrhythmia
34
1 (2.9)
0
1 (2.9)
4
1
17
18
4
10
1
Others
3159
59 (1.9)
1 (0.03)
104 (3.3)
199
116
2478
671
306
572
48
Total
7168
142 (2.0)
1 (0.01)
243 (3.4)
339
285
5954
1355
598
1294
91
(), % mortality
Except for 339 isolated cases, all remaining 6829 cases are doubly allocated, one for this subgroup and the other for the subgroup corresponding to the concomitant operations
In 2016, of 8744 operations for congenital heart disease, 6462 open-heart surgeries were performed with overall hospital mortality of 2.2%. The number of operations decreased gradually throughout these 10 years (maximum 7386 cases in 2006), and overall hospital mortality showed a plateau at around 3.0%. In detail, the most common disease was ventricular septal defect (VSD) (perimembranous/muscular) (1232 cases), as in 2015 when VSD became the most common disease for the first time since the inauguration of this survey. Atrial septal defect (ASD) was the “second” most common one (1032 cases) in 2016. It was mainly due to the development and increasing use of commercially available catheter devices for ASD closure. In the last 10 years, hospital mortality for complex congenital heart disease was as follows (2006 [2], 2011 [3], and 2016), complete atrio-septal defect (4.5%, 4.7%, and 3.5%), tetralogy of Fallot (1.9%, 0.7%, and 1.6%), transposition of the great arteries with intact septum (4.4%, 2.5%, and 4.4%) and with ventricular septal defect (9.1%, 3.6%, and 8.3%), single ventricle (6.7%, 4.4%, and 5.1%), and hypoplastic left heart syndrome (16.6%, 14.3%, and 7.5%). Right heart bypass surgery is now commonly performed (405 bidirectional Glenn procedures excluding 48 Damus–Kaye–Stansel procedures and 410 Fontan-type procedures including total cavo-pulmonary connection) with acceptable hospital mortality (1.5% and 2.2%, respectively). The Norwood type I procedure was performed in 20 cases, with a relatively low hospital mortality rate of 15%.
The total number of operations for valvular heart disease is increasing, although the apparent number dropped in the survey in 2015, probably because of a major change in the process of data collection. The number of isolated aortic valve replacements/repairs with/without CABG (n = 9472) increased by 9.5% from the previous year (8651) and by 10.3% from 5 years ago (n = 8589), although trans-catheter aortic valve replacement (TAVR or TAVI) was introduced in 2013 and is rapidly spreading.
The hospital mortality of single valve placement was 3.1% and 6.3% for the aortic and mitral positions, while that for mitral valve repair was only 1.5%. The hospital mortality for redo valve surgery was 7.1% in the aortic and 8.2% in the mitral positions, respectively. Finally, overall hospital mortality did not show a dramatic improvement over the last 10 years (4.0% in 2006 [2], 3.4% in 2011 [3], and 3.5% in 2016), which might be partially due to the recent increasing age of the patients. Repair of the valve became a common procedure (367 cases of aortic, 6711 cases of mitral, and 5400 cases tricuspid), and mitral valve repair constituted 29.2% of all valvular operations and 64.4% of all mitral valve procedures, which are similar to those of the last 5 years. Aortic and mitral valve replacements with bioprostheses were performed in 9693 cases and 2499 cases, respectively. The ratio of bioprostheses was 81.9% in the aortic and 65.2% in the mitral positions. This ratio of using bioprostheses increased dramatically from 30 to 40% in the early 2000s [4, 5]. CABG was performed as a concomitant procedure in 18.5% of all valvular operations (15.1% in 2006 [2] and 17.5% in 2011 [3]).
Anzeige
Isolated CABG was performed in 13,654 cases, only 76.1% of that 10 years ago (n = 17,941) [2]. Among these, off-pump CABG was intended in 8554 cases (62.6%), with a success rate of 97.3%, so that the final success rate of off-pump CABG was 60.9%. The percentage of intended off-pump CABG reached 60.3% in 2004 [4], and it was then kept at over 60% until now. In 13,654 isolated CABG patients, 13,029 patients (95.4%) received at least one arterial graft, while all-arterial-graft CABG was performed in only 3103 patients or 22.7% of them. The operative and hospital mortality rates associated with primary elective CABG procedures in 11,154 cases were 0.9% and 1.6%, respectively. A similar data analysis of CABG including primary/redo and elective/emergency data was begun in 2003 [5], and the operative and hospital mortality rates associated with primary elective CABG procedures in 2003 were 1.0% and 1.5%, respectively, so that the operative results of primary CABG have been stable. Hospital mortality of primary emergency CABG in 2318 cases was still high, at 6.9%. The conversion from off-pump CABG rate was 2.7%, with hospital mortality of 9.9%. A total of 1220 patients underwent surgery for complications of myocardial infarction, including 675 operations for left ventricular aneurysm, ventricular septal perforation, or cardiac rupture and 395 operations for ischemic mitral regurgitation. In this report, the number of concomitant coronary artery bypass grafting (CABG) procedures with other major procedures is not included in the category of ischemic heart disease but in other categories such as valvular heart disease and thoracic aneurysm; then, the overall number of CABG procedure including concomitant CABG with other major procedures still remained at over 20,000 cases per year (20,589 cases) in 2016.
Operations for arrhythmia were performed mainly as a concomitant procedure in 7168 cases, with a 24.3% increase compared with that of 2015. Implantations of pacemakers and ICDs are not included in this category. The hospital mortality of arrhythmia surgery including 3974 MAZE procedures was 3.4%. The MAZE procedure has become a quite common procedure (2944 cases in 2006 [2], and 3771 cases in 2011 [3]).
In 2016, 19,078 operations were performed for diseases of the thoracic and thoracoabdominal aortae: 9441 for aortic dissection and 9637 for non-dissection. The number of operations for aortic dissection increased by 10.5% this year compared with the previous year (n = 8547). The hospital mortality of operations for 5461 Stanford type A acute aortic dissections remained as high as 11.3%. The number of operations for non-dissected aneurysm increased by 8.3%, with overall hospital mortality of 5.7% (4.3% and 21.2% for unruptured and ruptured aneurysms, respectively).
The number of stent graft procedures has recently increased remarkably. Most importantly, the number of open stent grafts with total arch replacement strikingly increased 5 times (228–1155) and 3.4 times (308–1048) in dissecting and non-dissecting aortic aneurysms, respectively. This must be associated with the commercial availability of special designed device for open stent grafting since 2014.
Anzeige
A total of 3287 patients with aortic dissection underwent stent graft placement: 2052 thoracic endovascular aortic repair (TEVAR) and 1235 open stent grafting. The number of TEVAR procedures for type B chronic aortic dissections increased by 41.4% from 1065 cases in 2015 to 1506 cases in 2016. The hospital mortality rates associated with TEVAR for type B aortic dissection were 9.6% and 2.1% in acute and chronic cases, respectively.
A total of 4257 patients with non-dissected aortic aneurysms underwent stent graft placement, consisting of 3063 TEVAR [5.2% increase compared with 2015 (n = 2912)] and 1194 open stent grafts [27.4% increase compared with 2015 (n = 937)]. The hospital mortality rates for TEVAR and open stenting were as follows: TEVAR, 3.7% for unruptured and 21.4% for ruptured aneurysms; open stent grafting, 6.1% for unruptured and 17.9% for ruptured aneurysms.
(B) General thoracic surgery
The 2016 survey of general thoracic surgery comprised 693 surgical units, and most data were submitted through the web-based collection system of the national clinical database (NCD) [6]. In total, 82,193 operations were reported by general thoracic surgery departments in 2016, 1.9 times the number of operations in 2001 and 2418 more operations than in 2015, while the number of surgical units submitting reports to this survey decreased by 43 due to conversion of the data collection system since 2014 (Fig. 2).
Fig. 2
General thoracic surgery
×
In 2016, 42,107 operations for primary lung cancer were performed (Table 9), and the number has increased every year. The 2016 value is 2.2 times that of 2001. Operations for lung cancer accounted for 51.2% of all procedures in general thoracic surgery.
Table 9
Total cases of general thoracic surgery during 2016
Cases
%
Benign pulmonary tumor
2124
2.6
Primary lung cancer
42,107
51.2
Other primary malignant pulmonary tumor
375
0.5
Metastatic pulmonary tumor
8497
10.3
Tracheal tumor
122
0.1
Mesothelioma
634
0.8
Chest wall tumor
664
0.8
Mediastinal tumor
5026
6.1
Thymectomy for MG without thymoma
145
0.2
Inflammatory pulmonary disease
2142
2.6
Empyema
2833
3.4
Bullous disease excluding pneumothorax
436
0.5
Pneumothorax
14,867
18.1
Chest wall deformity
189
0.2
Diaphragmatic hernia including traumatic
37
0.0
Chest trauma excluding diaphragmatic hernia
426
0.5
Lung transplantation
75
0.1
Others
1494
1.8
Total
82,193
100.0
Anzeige
The number of video-assisted thoracic surgery (VATS) operations, defined as a surgical procedure using a skin incision longer than 8 cm and/or a minithoracotomy (hybrid) approach, has been described since the Annual Report 2015. The number of VATS operations for benign pulmonary tumor, primary lung cancer, and the total number of VATS operations in 2016 are shown in Tables 10, 11, 13, 16, 17, 18, 19, 20, 21, 22, 23, 25, 26, 27, and 29, respectively.
Table 10
Benign pulmonary tumor
Cases
30-Day mortality
Hospital mortality
by VATS
Hospital
after discharge
Benign pulmonary tumor
Hamartoma
442
0
0
1 (0.2)
423
Sclerosing hemangioma
96
0
0
0
94
Papilloma
17
0
0
0
16
Mucous gland adenoma bronchial
6
0
0
0
5
Fibroma
118
0
1 (0.8)
0
110
Lipoma
10
0
0
0
7
Neurogenic tumor
15
0
0
0
13
Clear cell tumor
5
0
0
0
5
Leiomyoma
15
0
0
0
14
Chondroma
7
0
0
0
6
Inflammatory myofibroblastic tumor
2
0
0
0
2
Pseudolymphoma
39
0
0
0
37
Histiocytosis
9
0
0
0
8
Teratoma
6
0
0
0
5
Others
1337
0
0
1 (0.1)
1270
Total
2124
0
1 (0.05)
2 (0.1)
2015
(), Mortality %
Table 11
Primary malignant pulmonary tumor
Cases
30-Day mortality
Hospital mortality
VATS
Hospital
After discharge
Primary malignant pulmonary tumor
42,482
118 (0.3)
52 (0.1)
242 (0.6)
28,568
Lung cancer
42,107
115 (0.3)
52 (0.1)
237 (0.6)
28,568
Adenocarcinoma
29,607
53 (0.2)
24 (0.1)
96 (0.3)
Squamous cell carcinoma
7877
40 (0.5)
17 (0.2)
102 (1.3)
Large cell carcinoma
791
1 (0.1)
4 (0.5)
5 (0.6)
(LCNEC)
480
0
2 (0.4)
2 (0.4)
Small cell carcinoma
755
6 (0.8)
2 (0.3)
10 (1.3)
Adenosquamous carcinoma
574
6 (1.0)
1 (0.2)
8 (1.4)
Carcinoma with pleomorphic, sarcomatoid or sarcomatous elements
468
4 (0.9)
1 (0.2)
7 (1.5)
Carcinoid
251
0
1 (0.4)
0
Carcinomas of salivary-gland type
33
0
0
0
Unclassified
59
0
0
0
Multiple lung cancer
1327
3 (0.2)
1 (0.1)
7 (0.5)
Others
365
2 (0.5)
1 (0.3)
2 (0.5)
Wedge resection
6275
8 (0.1)
9 (0.1)
19 (0.3)
5395
Segmental excision
4391
8 (0.18)
1 (0.0)
13 (0.3)
3265
(Sleeve segmental excision)
16
0
0
0
5
Lobectomy
30,597
86 (0.3)
37 (0.1)
176 (0.6)
19,697
(Sleeve lobectomy)
481
3 (0.6)
1 (0.2)
7 (1.5)
92
Pneumonectomy
477
8 (1.7)
3 (0.6)
22 (4.6)
39
(Sleeve pneumonectomy)
15
1 (6.7)
0
5 (33.3)
2
Other bronchoplasty
48
1 (2.1)
0
1 (2.1)
0
Pleuropneumonectomy
3
1 (33.3)
0
1 (33.3)
0
Others
316
3 (0.9)
2 (0.6)
5 (1.6)
172
Unknown
0
0
0
0
Sarcoma
49
1 (2.0)
0
2 (4.1)
AAH
131
0
0
0
Others
195
2 (1.0)
0
3 (1.5)
(), Mortality %
There were 2124 operations for benign pulmonary tumors in 2016, similar to the number in 2015 (Table 10). Hamartoma was the most frequent diagnosis in operations for benign pulmonary tumors. VATS was performed in 2015 patients (94.7%).
Additional information on primary malignant pulmonary tumors is shown in Tables 11 and 12. With regard to lung cancer subtype, adenocarcinoma was by far the most frequent diagnosis (70.3% of all lung cancer operations), followed by squamous cell carcinoma (18.7%). Sublobar resection was performed in 10,666 lung cancer cases (25.1% of all cases), and lobectomy was performed in 30,597 cases (72.0% of all cases). Sleeve lobectomy was performed in 481 cases, and pneumonectomy was required in 477 cases (1.1% of all cases). VATS lobectomy for lung cancer was performed in 19,697 cases (64.3% of all lobectomy cases). The number of VATS procedures for primary lung cancer was slightly higher than in 2015. The number of patients aged 80 years or older who underwent lung cancer surgery was 5279 (12.5%). In total, 115 patients died before hospital discharge within 30 days after surgery, and 52 patients died after discharge within 30 days after surgery. Therefore, 167 patients died within 30 days after surgery (30-day mortality rate, 0.4%). In total, 237 patients died before discharge (hospital mortality rate, 0.6%), and the 30-day mortality rate, by procedure, was 0.3% for segmentectomy, 0.6% for lobectomy, and 4.6% for pneumonectomy. Interstitial pneumonia was the leading cause of death after lung cancer surgery, followed by pneumonia, cardiovascular events, and respiratory failure. The risk calculators for mortality and morbidity, such as broncho-pleural fistula and respiratory failure, after lung cancer surgery based on the NCD are now available [7, 8].
Table 12
Details of lung cancer operations
TNM
c-Stage
Cases
Ia
25,963
Ib
7947
IIa
3149
IIb
1796
IIIa
2459
IIIb
175
IV
441
NA
177
Total
42,107
Sex
Cases
Male
25,716
Female
16,391
NA
0
Total
42,107
Cause of death
Cases
Cardiovascular
32
Pneumonia
42
Pyothorax
3
Bronchopleural fistula
18
Respiratory failure
29
Pulmonary embolism
2
Interstitial pneumonia
84
Brain infarction or bleeding
6
Others
62
Unknown
11
Total
289
p-Stage
Cases
0 (pCR)
634
Ia
22,249
Ib
8334
IIa
3354
IIb
2131
IIIa
4029
IIIb
180
IV
1013
NA
183
Total
42,107
Age (years)
Cases
< 20
32
20–29
45
30–39
233
40–49
1154
50–59
3710
60–69
14,181
70–79
17,491
80–89
5187
≥ 90
74
NA
0
Total
42,107
Operations for metastatic pulmonary tumors are shown in Table 13; 8497 operations were performed in 2016. Colorectal cancer was the most frequent diagnosis (47.7% of all cases).
Table 13
Metastatic pulmonary tumor
Cases
30-Day mortality
Hospital mortality
VATS
Hospital
After discharge
Metastatic pulmonary tumor
8497
11 (0.1)
9 (0.1)
20 (0.2)
7909
Colorectal
4052
4 (0.1)
3 (0.1)
8 (0.2)
3766
Hepatobiliary/pancreatic
400
1 (0.3)
0
1 (0.3)
381
Uterine
431
1 (0.2)
0
1 (0.2)
410
Mammary
472
0
1 (0.2)
0
444
Ovarian
69
0
0
0
64
Testicular
61
0
0
0
57
Renal
724
0
0
1 (0.1)
688
Skeletal
140
0
0
0
130
Soft tissue
213
0
0
0
192
Otorhinolaryngological
459
2 (0.4)
1 (0.2)
2 (0.4)
430
Pulmonary
549
1 (0.2)
2 (0.4)
3 (0.5)
471
Others
927
2 (0.2)
2 (0.2)
4 (0.4)
876
(), Mortality %
There were 122 operations for malignant tracheal tumor in 2016, but only 29 patients were treated with curative intent (Table 14).
Table 14
Tracheal tumor
Cases
30-Day mortality
Hospital
After discharge
Hospital mortality
Tracheal tumor
122
4 (3.3)
0
5 (4.1)
A. Primary malignant tumor
Histological classification
Squamous cell carcinoma
15
0
0
1 (6.7)
Adenoid cystic carcinoma
20
1 (5.0)
0
1 (5.0)
Mucoepidermoid carcinoma
0
0
0
0
Others
11
0
0
0
Total
46
1 (2.2)
0
2 (4.3)
B. Metastatic/invasive malignant tumor
e.g. invasion of thyroid cancer
36
3 (8.3)
0
3 (8.3)
C. Benign tracheal tumor
Histological classification
Papilloma
6
0
0
0
Adenoma
2
0
0
0
Neurofibroma
0
0
0
0
Chondroma
0
0
0
0
Leiomyoma
4
0
0
0
Others
28
0
0
0
Histology unknown
0
0
0
0
Total
40
0
0
0
Operation
Sleeve resection with reconstruction
27
0
0
0
Wedge with simple closure
0
0
0
0
Wedge with patch closure
1
0
0
0
Total laryngectomy with tracheostomy
1
0
0
0
Others
4
1 (25.0)
0
1 (25.0)
Unknown
0
0
0
0
Total
33
1 (3.0)
0
1 (3.0)
(), Mortality %
There were 634 pleural tumors in 2016 (Table 15). Diffuse malignant pleural mesothelioma was the most frequent histologic diagnosis. Total pleurectomy was performed in 73 cases, and extrapleural pneumonectomy was performed in 64 cases. The hospital mortality rate was 0% after total pleurectomy and 1.6% after extrapleural pneumonectomy, which were better than the previous outcomes.
Table 15
Tumor of pleural origin
Histological classification
Cases
30-Day mortality
Hospital mortality
Hospital
After discharge
Tumor of pleural origin
Solitary fibrous tumor
122
0
0
0
Diffuse malignant pleural mesothelioma
247
1 (0.4)
0
2 (0.8)
Localized malignant pleural mesothelioma
42
0
0
0
Others
223
4 (1.8)
1 (0.4)
8 (3.6)
Total
634
5 (0.8)
1 (0.2)
10 (1.6)
Operative procedure
Cases
30-Day mortality
Hospital mortality
Hospital
After discharge
Extrapleural pneumonectomy
64
0
0
1 (1.6)
Total pleurectomy
73
0
0
0
Others
110
1 (0.9)
0
1 (0.9)
Total
247
1 (0.4)
0
2 (0.8)
(), Mortality %
In total, 664 chest wall tumors were resected in 2016 (Table 16), of which 346 (52.1%) were benign. Among the 318 malignant chest wall tumors, 207 (65.1%) were metastatic tumors.
Table 16
Chest wall tumor
Cases
30-Day mortality
Hospital mortality
VATS
Hospital
After discharge
Chest wall tumor
Primary malignant tumor
111
0
0
0
54
Metastatic malignant tumor
207
1 (0.5)
0
2 (1.0)
93
Benign tumor
346
0
0
0
267
Total
664
1 (0.2)
0
2 (0.3)
414
(), Mortality %
Mediastinal tumors were resected in 5026 patients, a slight increase from the previous year (Table 17). Thymic epithelial tumor, including 1986 thymomas, 314 thymic carcinomas, and 40 thymic carcinoids, was the most frequent mediastinal tumor type in 2016.
Table 17
Mediastinal tumor
Cases
30-Day mortality
Hospital mortality
By VATS
Hospital
After discharge
Mediastinal tumor
5026
6 (0.1)
3 (0.06)
9 (0.2)
3636
Thymoma
1986
2 (0.1)
2 (0.1)
2 (0.1)
1218
Thymic cancer
314
2 (0.6)
1 (0.3)
2 (0.6)
164
Thymus carcinoid
40
0
0
0
20
Germ cell tumor
84
0
0
0
47
Benign
56
0
0
0
34
Malignant
28
0
0
0
13
Neurogenic tumor
447
0
0
0
419
Congenital cyst
1111
0
0
0
993
Goiter
81
0
0
1 (1.2)
31
Lymphatic tumor
182
2 (1.1)
0
2 (1.1)
136
Excision of pleural recurrence of thymoma
31
0
0
0
27
Thymolipoma
22
0
0
0
17
Others
728
0
0
2 (0.3)
564
(), Mortality %
Thymectomy for myasthenia gravis was performed in 478 patients (Table 18); 333 operations were associated with thymoma, and the remaining were not associated with thymoma.
Table 18
Thymectomy for myasthenia gravis
Cases
30-Day mortality
Hospital mortality
by VATS
Hospital
After discharge
Thymectomy for myasthenia gravis
478
2 (0.4)
1 (0.2)
2 (0.4)
276
With thymoma
333
2 (0.6)
1 (0.3)
2 (0.6)
189
(), Mortality %
Operations for non-neoplastic disease were performed in 22,424 patients. There were 2142 cases of lung resection for inflammatory lung diseases (Table 19); 21.7% of the cases were associated with atypical mycobacterium infections, and 15.2% were fungal infections. An operation for inflammatory nodules was performed because lung cancer was suspected before surgery in 913 cases (42.6%)
Table 19
Operations for non-neoplastic diseases
Cases
30-Day mortality
Hospital mortality
Hospital
After discharge
Operations for non-neoplastic diseases
22,424
195 (0.9)
20 (0.1)
466 (2.1)
Cases
30-Day mortality
Hospital mortality
VATS
Hospital
After discharge
A. Inflammatory pulmonary disease
2142
6 (0.3)
1 (0.0)
16 (0.7)
1948
Tuberculous infection
41
0
0
0
38
Mycobacterial infection
464
0
0
3 (0.6)
423
Fungal infection
326
1 (0.3)
1 (0.3)
4 (1.2)
255
Bronchiectasis
58
0
0
0
47
Tuberculous nodule
88
0
0
0
83
Inflammatory pseudotumor
774
3 (0.4)
0
4 (0.5)
751
Interpulmonary lymph node
51
0
0
0
50
Others
340
2 (0.6)
0
5 (1.5)
301
(), Mortality %
The 2833 operations for empyema (Table 20) included 2085 cases (73.6%) of acute empyema and 748 cases of chronic empyema. A bronchopleural fistula was reported in 470 patients with acute empyema and 359 patients with chronic empyema. The hospital mortality rate was 18.3% in patients with acute empyema with fistula.
Table 20
B. Empyema
Cases
30-Day mortality
Hospital mortality
by VATS
Hospital
After discharge
Acute empyema
2085
50 (2.4)
5 (0.2)
150 (7.2)
1758
With fistula
470
24 (5.1)
1 (0.2)
86 (18.3)
272
Without fistula
1596
26 (1.6)
4 (0.3)
63 (3.9)
1469
Unknown
19
0
0
1 (5.3)
17
Chronic empyema
748
19 (2.5)
2 (0.3)
45 (6.0)
442
With fistula
359
15 (4.2)
2 (0.6)
26 (7.2)
160
Without fistula
355
4 (1.1)
0
16 (4.5)
257
Unknown
34
0
0
3 (8.8)
25
Total
2833
69 (2.4)
7 (0.2)
195 (6.9)
2200
(), Mortality %
There were 100 operations for descending necrotizing mediastinitis (Table 21). The hospital mortality rate was 14.0%.
Table 21
C. Descending necrotizing mediastinitis
Cases
30-Day mortality
Hospital mortality
VATS
Hospital
After discharge
C. Descending necrotizing mediastinitis
100
7 (7.0)
0
14 (14.0)
71
(), Mortality %
There were 436 operations for bullous diseases (Table 22). Lung volume reduction surgery was performed in only 18 patients.
Table 22
D. Bullous diseases
Cases
30-Day mortality
Hospital mortality
VATS
Hospital
After discharge
D. Bullous diseases
436
2 (0.5)
0
3 (0.7)
405
Emphysematous bulla
354
0
0
1 (0.3)
331
Bronchogenic cyst
15
0
0
0
14
Emphysema with LVRS
18
0
0
0
17
Others
49
2 (4.1)
0
2 (4.1)
43
(), Mortality %
LVRS lung volume reduction surgery
A total of 14,867 operations were performed for spontaneous pneumothorax (Table 23). The 11,835 operations for primary pneumothorax included 3028 patients (25.6%) who underwent bullectomy only and 7966 patients (67.3%) who underwent an additional procedure. There were 3032 operations for secondary pneumothorax. COPD was by far the most prevalent associated disease (70.7%). The hospital mortality rate for secondary pneumothorax associated with COPD was 2.8%.
Table 23
E. Pneumothorax
Cases
30-Day mortality
Hospital mortality
Hospital
After discharge
14,867
57 (0.4)
11 (0.1)
129 (0.9)
Spontaneous pneumothorax
Operative procedure
Cases
30-Day mortality
Hospital mortality
VATS
Hospital
After discharge
Bullectomy
3028
2 (0.1)
1 (0.0)
8 (0.3)
2986
Bullectomy with additional procedure
7966
9 (0.11)
0
12 (0.2)
7860
Coverage with artificial material
7564
7 (0.09)
0
9 (0.1)
7461
Parietal pleurectomy
53
1 (1.9)
0
1 (1.9)
52
Coverage and parietal pleurectomy
73
1 (1.4)
0
1 (1.4)
73
Others
276
0
0
1 (0.4)
274
Others
836
6 (0.7)
1 (0.1)
11 (1.3)
771
Unknown
5
0
0
0
5
Total
11,835
17 (0.1)
2 (0.02)
31 (0.3)
11,622
Secondary pneumothorax
Associated disease
Cases
30-Day mortality
Hospital mortality
VATS
Hospital
After discharge
COPD
2145
20 (0.9)
5 (0.2)
59 (2.8)
2068
Tumorous disease
124
8 (6.5)
2 (1.6)
15 (12.1)
114
Catamenial
166
0
0
0
166
LAM
38
0
0
0
38
Others (excluding pneumothorax by trauma)
559
12 (2.1)
2 (0.4)
24 (4.3)
520
Unknown
0
0
0
0
0
Operative procedure
Cases
30 Day mortality
Hospital mortality
VATS
Hospital
After discharge
Bullectomy
433
4 (0.9)
1 (0.2)
8 (1.8)
417
Bullectomy with additional procedure
1828
17 (0.9)
4 (0.2)
42 (2.3)
1779
Coverage with artificial material
1736
16 (0.9)
4 (0.2)
38 (2.2)
1689
Parietal pleurectomy
6
0
0
0
5
Coverage and parietal pleurectomy
23
0
0
2 (8.7)
23
Others
63
1 (1.6)
0
2 (3.2)
62
Others
768
19 (2.5)
4 (0.5)
48 (6.3)
707
Unknown
3
0
0
0
3
Total
3032
40 (1.3)
9 (0.3)
98 (3.2)
2906
(), Mortality %
The 2016 survey reported 181 operations for chest wall deformity (Table 24). However, this might be an underestimate, because the Nuss procedure for pectus excavatum was more likely to have been performed in pediatric surgery centers not associated with JATS.
Table 24
F. Chest wall deformity
Cases
30-Day mortality
Hospital mortality
Hospital
After discharge
F. Chest wall deformity
181
0
0
0
Funnel chest
8
0
0
0
Others
7
0
0
0
(), Mortality %
Diaphragmatic hernia was treated surgically in 37 patients (Table 25). This figure might be an underestimate, since some procedures might have been classified as gastrointestinal surgery.
Table 25
G. Diaphragmatic hernia
Cases
30-Day mortality
Hospital mortality
VATS
Hospital
After discharge
G. Diaphragmatic hernia
37
0
0
0
19
Congenital
9
0
0
0
8
Traumatic
13
0
0
0
6
Others
15
0
0
0
5
(), Mortality %
The survey reported 426 procedures for chest trauma excluding iatrogenic injuries (Table 26). The hospital mortality rate was 7.3%.
Table 26
H. Chest trauma
Cases
30-Day mortality
Hospital mortality
VATS
Hospital
After discharge
H. Chest trauma
426
26 (6.1)
0
31 (7.3)
277
(), Mortality %
Table 27 shows operations for other diseases, including 81 cases of arteriovenous malformation and 113 cases of pulmonary sequestration.
Table 27
I. Other respiratory surgery
Cases
30-Day mortality
Hospital mortality
VATS
Hospital
After discharge
I. Other respiratory surgery
1394
28 (2.0)
1 (0.1)
78 (5.6)
1008
Arteriovenous malformation
81
0
0
1 (1.2)
78
Pulmonary sequestration
113
0
0
0
95
Postoperative bleeding · air leakage
428
15 (3.5)
1 (0.2)
40 (9.3)
292
Chylothorax
67
1 (1.5)
0
2 (3.0)
55
Others
705
12 (1.7)
0
35 (5.0)
488
(), Mortality %
A total of 75 lung transplantations were performed in 2016 (Table 28): 58 patients received lung transplants from brain-dead donors and 17 received transplants from living-related donors. The number of lung transplantation procedures has increased slightly.
Table 28
Lung transplantation
Cases
30-Day mortality
Hospital mortality
Hospital
After discharge
Single lung transplantation from brain-dead donor
29
0
0
1 (3.4)
Bilateral lung transplantation from brain-dead donor
29
0
0
2 (6.9)
Lung transplantation from living donor
17
1 (5.9)
0
2 (11.8)
Total lung transplantation
75
1 (1.3)
0
5 (6.7)
Donor of living donor lung transplantation
33
0
0
0
(), Mortality %
The number of VATS procedures has increased annually, reaching 64,036 (77.9% of all general thoracic surgeries) in 2016 (Table 29).
Table 29
Video-assisted thoracic surgery
Cases
30-Day mortality
Hospital mortality
Hospital
After discharge
Video-assisted thoracic surgery
64,036
191 (0.3)
58 (0.09)
424 (0.7)
(), Mortality %
(including thoracic sympathectomy 160)
The details of tracheobronchoplasty, pediatric surgery, and combined resection of neighboring organs are shown in Tables 30, 31, and 32, 33.
Table 30
Tracheobronchoplasty
Cases
30-Day mortality
Hospital mortality
Hospital
After discharge
Tracheobronchoplasty
790
11 (1.4)
1 (0.1)
26 (3.3)
Trachea
41
1 (2.4)
0
1 (2.4)
Sleeve resection with reconstruction
32
0
0
0
Wedge with simple closure
2
0
0
0
Wedge with patch closure
1
0
0
0
Total laryngectomy with tracheostomy
1
0
0
0
Others
5
1 (20.0)
0
1 (20.0)
Carinal reconstruction
22
1 (4.5)
0
1 (4.5)
Sleeve pneumonectomy
17
1 (5.9)
0
5 (29.4)
Sleeve lobectomy
483
2 (0.4)
1 (0.2)
7 (1.4)
Sleeve segmental excision
17
0
0
0
Bronchoplasty without lung resection
26
1 (3.8)
0
3 (11.5)
Others
184
5 (2.7)
0
9 (4.9)
(), Mortality %
Table 31
Pediatric surgery
Cases
30-Day mortality
Hospital mortality
Hospital
After discharge
Pediatric surgery
353
2 (0.6)
0
3 (0.8)
(), Mortality %
Table 32
Combined resection of neighboring organ(s)
Cases
30-Day mortality
Hospital mortality
Hospital
After discharge
Combined resection of neighboring organ(s)
1396
5 (0.4)
6 (0.4)
20 (1.4)
Organ resected
Cases
30-Day mortality
Hospital mortality
Hospital
After discharge
A. Primary lung cancer
Aorta
12
0
0
0
Superior vena cava
29
1 (3.4)
0
2 (6.9)
Brachiocephalic vein
7
0
0
0
Pericardium
102
2 (2.0)
1 (1.0)
3 (2.9)
Pulmonary artery
103
0
0
3 (2.9)
Left atrium
17
0
0
2 (11.8)
Diaphragm
62
1 (1.6)
1 (1.6)
4 (6.5)
Chest wall (including ribs)
347
1 (0.3)
2 (0.6)
4 (1.2)
Vertebra
16
0
0
1 (6.3)
Esophagus
4
0
0
0
Total
699
5 (0.7)
4 (0.6)
19 (2.7)
B. Mediastinal tumor
Aorta
6
0
0
0
Superior vena cava
68
0
0
0
Brachiocephalic vein
122
1 (0.8)
1 (0.8)
1 (0.8)
Pericardium
358
1 (0.3)
1 (0.3)
2 (0.6)
Pulmonary artery
5
0
0
0
Left atrium
0
0
0
0
Diaphragm
47
0
1 (2.1)
0
Chest wall (including ribs)
8
0
0
0
Vertebra
4
0
0
0
Esophagus
8
0
0
0
Lung
524
1 (0.2)
2 (0.4)
2 (0.4)
Total
1150
3 (0.3)
5 (0.4)
5 (0.4)
(), Mortality %
Table 33
Operation of lung cancer invading the chest wall of the apex
Cases
30-Day mortality
Hospital mortality
Hospital
After discharge
Operation of lung cancer invading the chest wall of the apex
754
3 (0.4)
2 (0.3)
7 (0.9)
(), 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 2016 alone, a total of 12,753 patients with esophageal diseases were registered from 543 institutions (response rate: 93.0%) affiliated to the Japanese Association for Thoracic Surgery and/or to the Japan Esophageal Society. Among these institutions, those where 20 or more patients underwent esophageal surgeries within 2016 were 133 institutions (24.5%), which shows no definite shift of esophageal operations to high-volume institutions when compared to the data of 2015 (23.8%) (Table 34). Of 2418 patients with a benign esophageal disease, 1525 (63.1%) patients underwent surgery, and 73 (3.0%) patients underwent endoscopic resection, while 820 (33.9%) patients did not undergo any surgical treatment (Table 35). Of 10,830 patients with a malignant esophageal tumor, 8296 (76.6%) patients underwent resection, with esophagectomy for 6158 (56.9%) and endoscopic mucosal resection (EMR) or endoscopic submucosal dissection (ESD) for 2138 (19.7%), while 2534 (23.4%) patients did not undergo any resection (Tables 36, 37). The annual trend of registered in-patients with esophageal diseases has not changed in the last decades (Fig. 3).
Table 34
Distribution of number of esophageal operations in 2016 in each institution
Annual trend of in-patients with esophageal diseases. EMR endoscopic mucosal resection (including endoscopic submucosal)
×
Among benign esophageal diseases (Table 35), hiatal hernia, achalasia, esophageal varices, and esophagitis (including reflux esophagitis) were the most common conditions in Japan. On the other hand, benign esophageal tumors, spontaneous rupture of the esophagus, and congenital esophageal atresia were common diseases that were surgically treated, as well as the above-mentioned diseases. Open surgery was performed in 1030 (67.5%) patients with a benign esophageal disease, with 30-day mortality in 6 (0.6%), while thoracoscopic and/or laparoscopic surgery was performed for 495 (32.5%) patients, with no 30-day mortality. The difference in these death rates between open and endoscopic surgery seems to be related the conditions requiring open surgery.
The majority of malignant diseases were carcinomas (Table 36). Among esophageal carcinomas, the incidence of squamous cell carcinoma was 89.6%, while that of adenocarcinomas including Barrett’s cancer was 7.8%. The resection rate for patients with a squamous cell carcinoma was 75.3%, while that for patients with an adenocarcinoma was 89.7%.
According to location, cancer in the thoracic esophagus was the most common (Table 37). Of the 4305 patients (40.0% of all esophageal malignancies) having superficial esophageal cancers within mucosal and submucosal layers, 6158 (56.9%) patients underwent esophagectomy, while 2138 (19.7%) patients underwent EMR or ESD. The 30-day mortality rate and hospital mortality rate after esophagectomy for patients with a superficial cancer were 0.4% and 0.8%, respectively.
Multiple primary cancers were observed in 2068 (19.1%) of the 10,830 patients with esophageal cancer. Synchronous cancer was found in 1008 (9.3%) patients, while metachronous cancer was observed in 1060 (9.8%) patients. The stomach, and head and neck region are the common sites for both synchronous and metachronous malignancies (Table 37).
Among esophagectomy procedures, transthoracic esophagectomy through right thoracotomy was the most commonly performed for patients with a superficial cancer, as well as for those with an advanced cancer (Table 38). Transhiatal esophagectomy, commonly performed in western countries, was performed in only 5.8% of patients having a superficial cancer and advanced cancer who underwent esophagectomy in Japan. Thoracoscopic and/or laparoscopic esophagectomy was performed for 1296 patients (67.7%) with a superficial cancer and for 2060 patients (48.6%) with an advanced cancer. The number of cases of thoracoscopic and/or laparoscopic surgery for superficial or advanced cancer has been increasing for several years (Fig. 4).
(2) Transthoracic (rt.) esophagectomy and reconstruction
1645
5 (0.3)
4 (0.2)
11 (0.7)
1229
3 (0.2)
4 (0.3)
8 (0.7)
(3) Transthoracic (lt.) esophagectomy and reconstruction
24
0
1 (4.2)
1 (4.2)
0
0
0
0
(4) Cervical esophageal resection and reconstruction
47
0
0
0
31
0
0
0
(5) Others
15
0
0
0
5
0
0
0
(6) Esophagectomy without reconstruction
59
0
0
0
17
0
0
0
(7) not specified
13
0
0
0
0
0
0
0
Advanced cancer (T2–T4)
Esophagectomy
4240
32 (0.8)
36 (0.8)
86 (2.0)
2060
15 (0.7)
19 (0.9)
38 (1.8)
11
(1) Transhiatal esophagectomy
244
3 (1.2)
2 (0.8)
5 (2.0)
33
1 (3.0)
0
1 (3.0)
(2) Transthoracic (rt.) esophagectomy and reconstruction
3638
26 (0.7)
30 (0.8)
68 (1.9)
1986
13 (0.7)
18 (0.9)
35 (1.8)
(3) Transthoracic (lt.) esophagectomy and reconstruction
110
1 (0.9)
0
1 (0.9)
3
0
0
0
(4) Cervical esophageal resection and reconstruction
133
0
0
2 (1.5)
11
0
0
0
(5) Others
38
1 (2.6)
1 (2.6)
3 (7.9)
7
0
0
0
(6) Esophagectomy without reconstruction
77
1 (1.3)
2 (2.6)
6 (7.8)
20
1 (5.0)
1 (5.0)
2 (10.0)
(7) not specified
0
0
1
1
0
0
0
0
(Depth not specified)
5
0
0
0
0
0
0
0
0
Combined resection of other organs
226
1 (0.4)
4 (1.8)
8 (3.5)
(1) Aorta
3
0
0
0
(2) Trachea, Bronchus
12
0
0
1 (8.3)
(3) Lung
56
0
2 (3.6)
2 (3.6)
(4) Others
155
1 (0.6)
2 (1.3)
5 (3.2)
Unknown
0
0
0
0
Salvage surgery
250
4 (1.6)
8 (3.2)
15 (6.0)
69
2 (2.9)
3 (4.3)
5 (7.2)
26
Fig. 4
Annual trend of video-assisted esophagectomy for esophageal malignancy
×
Combined resection of the neighboring organs during resection of an esophageal cancer was performed in 226 patients (Tables 38, 39). Resection of the aorta together with esophagectomy was performed in 3 cases. Tracheal and/or bronchial resection combined with esophagectomy was performed in 12 patients, with both 30-day mortality and hospital mortality of 0%. Lung resection combined with esophagectomy was performed in 56 patients, with 30-day mortality of 0% and hospital mortality of 3.6%.
Table 39
Mortality after combined resection of the neighbouring organs
Year
Esophagectomy
Combined resection
a
b
c (%)
Aorta
Tracheobronchus
Lung
Others
a
b
c (%)
a
b
c (%)
a
b
c (%)
a
b
c (%)
1996
4194
120
2.86
7
3
42.86
24
0
0.00
50
2
4.00
78
4
5.13
1997
4441
127
2.86
1
0
0.00
34
5
14.71
56
1
1.79
94
3
3.19
1998
4878
136
2.79
4
0
0.00
29
0
0.00
74
1
1.35
128
2
1.56
1999
5015
116
2.31
5
0
0.00
23
2
8.70
68
0
0.00
122
1
0.82
2000
5350
81
1.51
2
0
0.00
23
2
8.70
69
0
0.00
96
1
1.04
2001
5521
110
1.99
1
0
0.00
26
1
3.85
83
3
3.61
99
2
2.02
2002
4904
66
1.35
3
1
33.33
20
2
10.00
63
0
0.00
63
1
1.59
2003
4639
45
0.97
0
0
0.00
24
2
8.33
58
0
0.00
88
1
1.14
2004
4739
64
1.35
2
0
0.00
17
0
0.00
59
5
8.47
119
2
1.68
2005
5163
52
1.01
1
0
0.00
11
1
9.09
67
1
1.49
73
1
1.37
2006
5236
63
1.20
0
0
0.00
17
0
0.00
62
2
3.23
122
3
2.46
2007
4990
60
1.20
0
0
0.00
25
1
4.00
44
1
2.27
138
2
1.45
2008
5124
63
1.23
0
0
0.00
17
1
5.88
48
1
2.08
185
0
0.00
2009
5260
63
1.20
0
0
0.00
19
2
10.53
58
2
3.45
211
3
1.42
2010
5180
45
0.87
2
0
0.00
33
0
0.00
58
0
0.00
245
5
2.04
2011
5430
38
0.70
4
0
0.00
26
0
0.00
41
0
0.00
179
5
2.79
2012
6055
47
0.78
2
0
0.00
23
1
4.35
69
0
0.00
240
1
0.42
2013
5824
41
0.70
2
0
0.00
44
0
0.00
77
1
1.30
156
3
1.92
2014
6244
47
0.75
2
0
0.00
24
0
0.00
77
3
3.90
227
3
1.32
2015
6151
39
0.63
3
0
0.00
15
0
0.00
67
3
4.48
266
4
1.50
2016
6158
40
0.65
3
0
0.00
12
0
0.00
56
0
0.00
155
1
0.65
Total
1,10,496
1463
1.32
44
4
9.09
486
20
4.12
1304
26
1.99
3084
48
1.56
aNumber of patients who underwent the operation
bNumber of patients who died within 30 days after operation
c% ratio of b/a, i.e., direct operative mortality
Salvage surgery after definitive (chemo-) radiotherapy was performed in 250 patients, with 30-day mortality of 1.6% and hospital mortality of 6.0% (Table 38).
Lastly, we should continue our efforts for complete surveys through more active collaboration with the Japan Esophageal Society and other related societies.
Acknowledgements
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 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made.
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