Morihito Okada and Akira Tangoku have contributed equally to this work.
Annual report by the Japanese Association for Thoracic Surgery: Committee for Scientific Affairs.
Publisher's Note
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The Japanese Association for Thoracic Surgery has conducted annual surveys of thoracic surgery throughout Japan since 1986 to determine statistics pertaining to the number of procedures performed according to surgical categories. We herein summarize the results of the association’s annual survey of thoracic surgeries performed in 2018.
Adhering to the norm thus far, thoracic surgery had been classified into three categories, cardiovascular, general thoracic, and esophageal surgeries, with patient data for each group being examined and analyzed. We honor and value all members’ continued professional support and contributions.
Anzeige
Incidence of hospital mortality was included in the survey to determine nationwide status, which has contributed to Japanese surgeons’ understanding of the present status of thoracic surgery in Japan while helping to effect improvements in surgical outcomes by enabling comparisons between their work and that of others. This approach has enabled the association to gain a better understanding of present problems and future prospects, which is reflected in its activities and member education.
Thirty-day mortality (otherwise known as operative mortality) is defined as death within 30 days of surgery, regardless of the patient's geographic location, including post-discharge from the hospital. Hospital mortality is defined as death within any time interval following surgery among patients yet to be discharged from the hospital.
While hospital-to-hospital transfer during esophageal surgery is not considered a form of discharge, transfer to a nursing home or a rehabilitation unit is considered hospital discharge, unless the patient subsequently dies of complications from surgery. In contrast, hospital-to-hospital transfer 30 days following cardiovascular and general thoracic surgeries is considered discharge given that data related to the National Clinical Database (NCD) were employed in these categories.
Survey abstract
All data pertaining to cardiovascular and thoracic surgeries were obtained from the NCD, whereas data regarding esophageal surgery were collected from a survey questionnaire derived from the Japanese Association for Thoracic Surgery documentation. This is because NCD information regarding esophageal surgery does not include non-surgical cases (i.e., patients with adjuvant chemotherapy or radiation only).
Anzeige
Given the changes in data collection related to cardiovascular surgery [initially self-reported using questionnaire sheets in each participating institution up to 2014, followed by downloading of an automatic package from the Japanese Cardiovascular Surgery Database (JCVSD), a cardiovascular subsection of the NCD], response rates were unavailable and were therefore not indicated in the cardiovascular surgery category (Table 1). Additionally, the number of institutions (based on surgery count) was not calculated in the cardiovascular surgery category (Table 2).
Table 1
Number of institutions involved in the survey
Questionnaires
Sent out
Responded
Response rate
(A) Cardiovascular surgery
(B) General Thoracic Surgery
749
676
90.3%
(C) Esophageal surgery
552
Table 2
Categories subclassified according to the number of operations performed
Number of operations performed
Category
General thoracic surgery
0
5
1–24
38
25–49
94
50–99
193
100–149
121
150–199
107
≥ 200
118
Total
676
Final report: 2018
(A) Cardiovascular surgery
We are extremely pleased with the cooperation of our colleagues (members) in completing the cardiovascular surgery survey, which has undoubtedly improved the quality of this annual report. We are truly grateful for the significant efforts made by all participants within each participating institution in completing the JCVSD/NCD.
Figure 1 illustrates the development of cardiovascular surgery in Japan over the past 32 years. Aneurysm surgery includes only surgeries for thoracic and thoracoabdominal aortic aneurysms. Extra-anatomic bypass surgery for thoracic aneurysm and pacemaker implantation have been excluded from the survey since 2015. Assist device implantations were not included in the total number of surgical procedures but were nonetheless included in the survey.
A total of 69,063 cardiovascular surgeries, including 51 heart transplants, had been performed in 2018, a decrease of 0.7% compared to that in 2017 (n = 70,078).
Compared to data for 2017 [1] and 2008 [2], data for 2018 showed 1.2% (9253 vs. 9368) and 3.6% fewer surgeries for congenital heart disease, 0.5% (23,205 vs. 23,312) fewer and 38.6% more surgeries for valvular heart disease, 12.7% (12,135 vs. 13,898) and 36.9% fewer surgeries for ischemic heart procedures, and 4.2% (21,624 vs. 20,746) and 96.6% more surgeries for thoracic aortic aneurysm, respectively. Data for individual categories are summarized in Tables 3, 4, 5, 6, 7, 8.
Table 3
Congenital (total; 9368)
(1) CPB ( +) (total; 7130)
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
8
0
0
1 (12.5)
6
0
0
0
19
1 (5.3)
0
1 (5.3)
34
1 (2.9)
0
2 (5.9)
Coarctation (simple)
4
0
0
0
14
0
0
0
10
0
0
0
7
0
0
0
35
0
0
0
+ VSD
43
1 (2.3)
0
1 (2.3)
41
1 (2.4)
0
1 (2.4)
12
0
0
0
1
0
0
0
97
2 (2.1)
0
2(2.1)
+ DORV
3
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
3
0
0
0
+ AVSD
4
0
0
0
1
0
0
0
0
0
0
0
0
0
0
0
5
0
0
0
+ TGA
0
0
0
0
1
0
0
0
0
0
0
0
0
0
0
0
1
0
0
0
+ SV
2
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
2
0
0
0
+ Others
5
0
0
0
6
0
0
0
12
0
0
1 (8.3)
0
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
21
1 (4.8)
0
1 (4.8)
35
1 (2.9)
0
1 (2.9)
19
0
0
0
0
0
0
0
75
2 (2.7)
0
2 (2.7)
+ DORV
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
+ Truncus
3
0
0
0
6
0
0
0
2
0
0
0
0
0
0
0
11
0
0
0
+ TGA
1
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
1
0
0
0
+ Others
2
0
0
0
1
0
0
0
1
0
0
0
0
0
0
0
4
0
0
0
Vascular ring
1
0
0
0
3
0
0
0
0
0
0
0
0
0
0
0
4
0
0
0
PS
2
0
0
0
26
0
0
0
57
0
0
0
24
0
0
0
109
0
0
0
PA∙IVS or Critical PS
14
0
0
0
60
1 (1.7)
0
1 (1.7)
59
0
0
0
7
0
0
0
140
1 (0.7)
0
1 (0.7)
TAPVR
117
6 (5.1)
0
14 (12.0)
75
3 (4.0)
0
4 (5.3)
18
0
0
1 (5.6)
1
0
0
0
211
9 (4.3)
0
19 (9.0)
PAPVR ± ASD
0
0
0
0
6
0
0
0
39
0
0
0
11
0
0
0
56
0
0
0
ASD
1
0
0
0
51
0
0
0
528
0
0
0
822
13 (1.6)
0
13 (1.6)
1402
13 (0.9)
0
13 (0.9)
Cor triatriatum
0
0
0
0
12
0
0
1 (8.3)
5
0
0
0
0
0
0
0
17
0
0
1 (5.9)
AVSD (partial)
1
0
0
0
7
0
0
0
37
0
0
0
9
0
0
0
54
0
0
0
AVSD (complete)
6
0
0
1 (16.7)
106
0
0
1 (0.9)
86
1 (1.2)
0
3 (3.5)
5
0
0
0
203
1 (0.5)
0
5 (2.5)
+ TOF or DORV
0
0
0
0
8
0
0
1 (12.5)
7
0
0
0
2
0
0
0
17
0
0
1 (5.9)
+ Others
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
VSD (subarterial)
3
0
0
0
94
1 (1.1)
0
1 (1.1)
169
0
0
0
5
0
0
0
271
1 (0.4)
0
1 (0.4)
VSD (perimemb./muscular)
15
0
0
0
706
0
0
0
365
0
0
1 (0.3)
28
0
0
0
1,114
0
0
1 (0.1)
VSD (type unknown)
0
0
0
0
0
0
0
0
1
0
0
0
142
4 (2.8)
0
4 (2.8)
143
4 (2.8)
0
4 (2.8)
VSD + PS
1
0
0
0
37
0
0
0
32
0
0
0
2
0
0
0
72
0
0
0
DCRV ± VSD
0
0
0
0
6
0
0
0
28
0
0
0
4
0
0
0
38
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
9
0
0
0
189
3 (1.6)
0
4 (2.1)
227
1 (0.4)
0
1 (0.4)
38
0
0
0
463
4 (0.9)
0
5 (1.1)
PA + VSD
7
0
1 (14.3)
0
80
4 (5.0)
0
5 (6.3)
136
0
0
0
11
0
0
0
234
4 (1.7)
1 (0.4)
5 (2.1)
DORV
26
2 (7.7)
0
3 (11.5)
148
2 (1.4)
0
4 (2.7)
154
0
0
1 (0.6)
11
0
0
0
339
4 (1.2)
0
8 (2.4)
TGA (simple)
86
2 (2.3)
0
2 (2.3)
4
0
0
0
2
0
0
0
2
0
0
0
94
2 (2.1)
0
2 (2.1)
+ VSD
42
1 (2.4)
0
3 (7.1)
18
0
0
2 (11.1)
10
0
0
0
2
0
0
0
72
1 (1.4)
0
5 (6.9)
VSD + PS
0
0
0
0
1
0
0
0
0
0
0
0
1
0
0
0
2
0
0
0
Corrected TGA
0
0
0
0
8
0
0
0
25
0
0
0
10
0
0
1 (10.0)
43
0
0
1 (2.3)
Truncus arteriosus
7
0
0
0
25
0
0
1 (4.0)
22
0
0
0
1
0
0
0
55
0
0
1 (1.8)
SV
17
2 (11.8)
0
4 (23.5)
138
2 (1.4)
0
7 (5.1)
179
3 (1.7)
1 (0.6)
6 (3.4)
22
1 (4.5)
0
1 (4.5)
356
8 (2.2)
1 (0.3)
18 (5.1)
TA
3
0
0
0
47
1 (2.1)
0
3 (6.4)
52
0
0
1 (1.9)
10
0
0
0
112
1 (0.9)
0
4 (3.6)
HLHS
35
4 (11.4)
0
11 (31.4)
113
2 (1.8)
0
6 (5.3)
78
3 (3.8)
0
3 (3.8)
0
0
0
0
226
9 (4.0)
0
20 (8.8)
Aortic valve lesion
3
0
0
0
27
0
0
1 (3.7)
115
0
0
1 (0.9)
42
1 (2.4)
0
1 (2.4)
187
1 (0.5)
0
3 (1.6)
Mitral valve lesion
1
0
0
0
31
1 (3.2)
0
3 (9.7)
83
0
0
0
20
0
0
1 (5.0)
135
1 (0.7)
0
4 (3.0)
Ebstein
10
1 (10.0)
0
1 (10.0)
17
0
0
0
30
0
0
0
14
0
0
1 (7.1)
71
1 (1.4)
0
2 (2.8)
Coronary disease
1
0
0
0
17
0
0
2 (11.8)
25
0
0
0
4
0
0
0
47
0
0
2 (4.3)
Others
9
1 (11.1)
0
1 (11.1)
32
1 (3.1)
0
2 (6.3)
43
1 (2.3)
0
3 (7.0)
237
3 (1.3)
0
3 (1.3)
321
6 (1.9)
0
9 (2.8)
Conduit failure
1
0
0
0
0
0
0
0
20
0
0
0
6
0
0
0
27
0
0
0
Redo (excluding conduit failure)
1
0
0
0
52
1 (1.9)
0
2 (3.8)
78
0
0
1 (1.3)
68
1 (1.5)
0
3 (4.4)
199
2 (1.0)
0
6 (3.0)
Total
508
21 (4.1)
1 (0.2)
42 (8.3)
2257
24 (1.1)
0
54 (2.4)
2772
9 (0.3)
1 (0.0)
23 (0.8)
1593
24 (1.5)
0
29 (1.8)
7130
78 (1.1)
2 (0.0)
148 (2.1)
( ), % 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; 2123)
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
305
5 (1.6)
0
12 (3.9)
151
2 (1.3)
0
5 (3.3)
25
0
0
0
2
0
0
0
483
7 (1.4)
0
17 (3.5)
Coarctation (simple)
22
0
0
0
15
0
0
0
1
0
0
0
1
0
0
0
39
0
0
0
+ VSD
47
0
0
0
14
0
0
1 (7.1)
1
0
0
0
0
0
0
0
62
0
0
1 (1.6)
+ DORV
3
0
0
0
0
0
0
0
1
0
0
0
0
0
0
0
4
0
0
0
+ AVSD
4
0
0
2 (50.0)
0
0
0
0
0
0
0
0
0
0
0
0
4
0
0
2 (50.0)
+ TGA
0
0
0
0
1
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
8
0
0
0
5
0
0
0
1
0
0
0
0
0
0
0
14
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
29
1 (3.4)
0
2 (6.9)
8
0
0
0
2
0
0
0
0
0
0
0
39
1 (2.6)
0
2 (5.1)
+ DORV
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
+ Truncus
1
0
0
0
0
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
+ Others
2
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
2
0
0
0
Vascular ring
5
0
0
0
15
0
0
1 (6.7)
6
0
0
0
0
0
0
0
26
0
0
1 (3.8)
PS
4
0
0
0
7
0
0
0
1
0
0
0
0
0
0
0
12
0
0
0
PA∙IVS or Critical PS
15
0
0
0
20
0
0
0
3
0
0
1 (33.3)
0
0
0
0
38
0
0
1 (2.6)
TAPVR
16
1 (6.3)
0
1 (6.3)
12
0
0
0
3
0
0
0
0
0
0
0
31
1 (3.2)
0
1 (3.2)
PAPVR ± ASD
0
0
0
0
0
0
0
0
1
0
0
0
1
0
0
0
2
0
0
0
ASD
2
0
0
0
2
0
0
0
1
0
0
0
3
0
0
0
8
0
0
0
Cor triatriatum
0
0
0
0
1
0
0
0
0
0
0
0
0
0
0
0
1
0
0
0
AVSD (partial)
1
0
0
0
2
0
0
0
0
0
0
0
0
0
0
0
3
0
0
0
AVSD (complete)
50
0
0
2 (4.0)
70
0
0
1 (1.4)
13
0
0
0
1
0
0
0
134
0
0
3 (2.2)
+ TOF or DORV
3
0
0
0
6
0
0
0
2
0
0
0
1
0
0
0
12
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)
1
0
0
0
6
0
0
0
0
0
0
0
0
0
0
0
7
0
0
0
VSD (perimemb./muscular)
46
2 (4.3)
0
4 (8.7)
119
0
0
1 (0.8)
6
0
0
0
1
0
0
0
172
2 (1.2)
0
5 (2.9)
VSD (Type Unknown)
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
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
1
0
0
0
0
0
0
0
0
0
0
0
1
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
19
0
0
0
82
0
0
0
11
0
0
0
2
0
0
0
114
0
0
0
PA + VSD
15
1 (6.7)
0
1 (6.7)
38
0
0
0
20
0
1 (5.0)
0
1
0
0
0
74
1 (1.4)
1 (1.4)
1 (1.4)
DORV
45
0
0
1 (2.2)
74
1 (1.4)
1 (1.4)
2 (2.7)
12
0
0
0
1
0
0
0
132
1 (0.8)
1 (0.8)
3 (2.3)
TGA (simple)
4
0
0
0
2
0
0
0
0
0
0
0
0
0
0
0
6
0
0
0
+ VSD
13
0
0
0
6
0
0
0
0
0
0
0
1
0
0
0
20
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
6
0
0
0
8
0
0
0
9
0
0
0
0
0
0
0
23
0
0
0
Truncus arteriosus
18
0
0
1 (5.6)
5
0
0
0
1
0
0
0
0
0
0
0
24
0
0
1 (4.2)
SV
48
2 (4.2)
0
3 (6.3)
40
1 (2.5)
0
1 (2.5)
20
0
0
1 (5.0)
2
0
0
0
110
3 (2.7)
0
5 (4.5)
TA
14
0
0
0
19
0
0
0
3
0
0
0
4
0
0
0
40
0
0
0
HLHS
80
1 (1.3)
0
3 (3.8)
28
0
0
2 (7.1)
7
0
0
0
0
0
0
0
115
1 (0.9)
0
5 (4.3)
Aortic valve lesion
5
0
0
0
2
0
0
0
2
0
0
0
1
0
0
0
10
0
0
0
Mitral valve lesion
3
0
0
0
5
0
0
0
4
0
0
0
0
0
0
0
12
0
0
0
Ebstein
6
1 (16.7)
0
1 (16.7)
4
0
0
0
3
0
0
0
0
0
0
0
13
1 (7.7)
0
1 (7.7)
Coronary disease
0
0
0
0
8
0
0
0
0
0
0
0
1
0
0
0
9
0
0
0
Others
9
0
0
2 (22.2)
13
2 (15.4)
0
3 (23.1)
18
3 (16.7)
0
3 (16.7)
4
0
0
0
44
5 (11.4)
0
8 (18.2)
Conduit failure
0
0
0
0
1
0
0
0
1
0
0
0
1
0
0
0
3
0
0
0
Redo (excluding conduit failure)
26
0
0
0
113
2 (1.8)
0
5 (4.4)
110
0
0
0
27
0
0
0
276
2 (0.7)
0
5 (1.8)
Total
875
14 (1.6)
0
35 (4.0)
905
8 (0.9)
1 (0.1)
22 (2.4)
288
3 (1.0)
1 (0.3)
5 (1.7)
55
0
0
0
2,123
25 (1.2)
2 (0.09)
62 (2.9)
( ), % 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
After discharge
Hospital
After discharge
Hospital
After discharge
Hospital
After discharge
Hospital
After discharge
1
SP Shunt
102
2 (2.0)
0
3 (2.9)
360
6 1.7)
1 (0.3)
10 (2.8)
50
0
0
4 (8.0)
1
0
0
0
513
8 (1.6)
1 (0.2)
17 (3.3)
2
PAB
275
2 (0.7)
0
9 (3.3)
304
0
0
5 (1.6)
20
0
0
0
2
0
0
0
601
2 (0.3)
0
14 (2.3)
3
Bidirectional Glenn or hemi-Fontan ± α
1
0
0
0
257
1 (0.4)
0
5 (1.9)
98
2 (2.0)
0
3 (3.1)
3
0
0
0
359
3 (0.8)
0
8 (2.2)
4
Damus-Kaye-Stansel operation
0
0
0
0
27
0
0
2 (7.4)
8
0
0
0
1
0
0
0
36
0
0
2 (5.6)
5
PA reconstruction/repair (including redo)
16
0
0
1 (6.3)
180
2 (1.1)
0
4 (2.2)
195
0
0
3 (1.5)
16
0
0
0
407
2 (0.5)
0
8 (2.0)
6
RVOT reconstruction/repair
5
0
1 (20.0)
0
208
2 (1.0)
0
3 (1.4)
309
1 (0.3)
0
1 (0.3)
43
0
0
0
565
3 (0.5)
1 (0.2)
4 (0.7)
7
Rastelli procedure
2
0
0
0
49
1 (2.0)
0
1 (2.0)
114
0
0
1 (0.9)
2
0
0
0
167
1 (0.6)
0
2 (1.2)
8
Arterial switch procedure
140
6 (4.3)
0
9 (6.4)
23
1 (4.3)
0
2 (8.7)
2
0
0
0
0
0
0
0
165
7 (4.2)
0
11 (6.7)
9
Atrial switch procedure
0
0
0
0
0
0
0
0
4
0
0
0
2
0
0
0
6
0
0
0
10
Double switch procedure
0
0
0
0
1
0
0
0
6
0
0
0
0
0
0
0
7
0
0
0
11
Repair of anomalous origin of CA
0
0
0
0
9
0
0
2 (22.2)
4
0
0
0
0
0
0
0
13
0
0
2 (15.4)
12
Closure of coronary AV fistula
1
0
0
0
4
0
0
0
6
0
0
0
2
0
0
0
13
0
0
0
13
Fontan/TCPC
0
0
0
0
1
0
0
0
353
1 (0.3)
0
4 (1.1)
41
2 (4.9)
0
2 (4.9)
395
3 (0.8)
0
6 (1.5)
14
Norwood procedure
31
3 (9.7)
0
5 (16.1)
95
7 (7.4)
0
14 (14.7)
4
1 (25.0)
0
1 (25.0)
0
0
0
0
130
11(8.5)
0
20 (15.4)
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)
0
0
0
0
23
0
0
0
88
0
0
0
17
0
0
0
128
0
0
0
17
Left side AV valve replace (including Redo)
1
0
0
0
10
0
0
1 (10.0)
46
0
0
1 (2.2)
18
0
0
2 (11.1)
75
0
0
4 (5.3)
18
Right side AV valve repair (including Redo)
12
2 (16.7)
0
2 (16.7)
71
0
0
0
81
0
0
0
67
0
0
1 (1.5)
231
2 (0.9)
0
3 (1.3)
19
Right side AV valve replace (including Redo)
0
0
0
0
1
0
0
0
9
1 (11.1)
0
1 (11.1)
26
0
0
0
36
1 (2.8)
0
1 (2.8)
20
Common AV valve repair (including Redo)
3
0
0
2 (66.7)
17
0
0
1 (5.9)
11
0
0
0
2
0
0
0
33
0
0
3(9.1)
21
Common AV valve replace (including Redo)
0
0
0
0
4
1 (25.0)
0
2 (50.0)
7
0
1 (14.3)
0
2
0
0
0
13
1 (7.7)
1 (7.7)
2 (15.4)
22
Repair of supra-aortic stenosis
0
0
0
0
5
0
0
1 (20.0)
16
0
0
0
1
0
0
0
22
0
0
1 (4.5)
23
Repair of subaortic stenosis (including Redo)
0
0
0
0
8
0
0
0
42
0
0
0
5
0
0
0
55
0
0
0
24
Aortic valve plasty ± VSD Closure
4
0
0
0
15
0
0
1 (6.7)
29
0
0
0
5
0
0
0
53
0
0
1 (1.9)
25
Aortic valve replacement
0
0
0
0
2
0
0
0
32
0
0
0
30
1 (3.3)
0
1 (3.3)
64
1 (1.6)
0
1 (1.6)
26
AVR with annular enlargement
0
0
0
0
3
0
0
0
9
0
0
1 (11.1)
2
0
0
0
14
0
0
1 (7.1)
27
Aortic root Replace (except Ross)
0
0
0
0
0
0
0
0
8
0
0
0
19
0
0
0
27
0
0
0
28
Ross procedure
0
0
0
0
3
0
0
0
13
0
0
0
16
0
0
0
29
Bilateral pulmonary artery banding
175
5 (2.9)
0
14 (8.0)
8
0
0
1 (12.5)
0
0
0
0
0
0
0
0
183
5 (2.7)
0
15 (8.2)
Total
768
20 (2.6)
1 (0.1)
45 (5.9)
1688
21 (1.2)
1 (0.1)
55 (3.3)
1564
6 (0.4)
1 (0.1)
20 (1.3)
307
3 (1.0)
0
6 (2.0)
4327
50 (1.2)
3 (0.07)
126 (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
(c) Cases of conversion, during surgery, from off-pump CABG to on-pump CABG or on- pump beating-heart CABG [these cases are also included in category (b)]
Primary, elective
Primary, emergent
Redo, elective
Redo, emergent
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
Converted to arrest
30
0
0
2 (6.7)
4
0
0
0
1
0
0
0
0
0
0
0
Converted to beating
120
2 (1.7)
0
3 (2.5)
33
5 (15.2)
0
6 (18.2)
1
0
0
0
0
0
0
0
Total
150
2 (1.3)
0
5 (3.3)
37
5 (13.5)
0
6 (16.2)
2
0
0
0
0
0
0
0
On dialysis
24
2 (8.3)
0
5 (20.8)
9
3 (33.3)
0
4 (44.4)
1
0
0
0
0
0
0
0
( ), % mortality
CABG coronary artery bypass grafting
(B) Operation for complications of MI (total; 1310)
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
108
6 (5.6)
0
7 (6.5)
26
5 (19.2)
0
8 (30.8)
77
24
13
VSP closure
78
12 (15.4)
0
20 (25.6)
284
68 (23.9)
0
112 (39.4)
95
3
3
Cardiac rupture
25
5 (20.0)
0
5 (20.0)
227
72 (31.7)
0
87 (38.3)
32
4
2
Mitral regurgitation
(1) Papillary muscle rupture
8
1 (12.5)
0
1 (12.5)
58
22 (37.9)
0
23 (39.7)
29
11
55
(2) Ischemic
250
10 (4.0)
0
18 (7.2)
50
9 (18.0)
0
10 (20.0)
221
169
131
Others
89
4 (4.5)
0
7 (7.9)
107
23 (21.5)
0
36 (33.6)
68
13
6
Total
558
38 (6.8)
0
58 (10.4)
752
199 (26.5)
0
276 (36.7)
522
224
210
( ), % mortality
Acute, within 2 weeks from the onset of myocardial infarction
Except for 170 isolated cases, all remaining 5,164 cases are doubly allocated, one for this subgroup and the other for the subgroup corresponding to the concomitant operations.
Among the 9253 procedures for congenital heart disease conducted in 2018, 7130 were open-heart surgeries, with an overall hospital mortality rate of 2.1%. The number of surgeries for neonates and infants in 2018 did not differ significantly compared to that in 2008; however, hospital mortality improved from 10.8 to 8.3% for neonates and from 3.8 to 2.4% for infants. In 2018, atrial septal defect was the most common disease (1402 cases), with patients aged 18 or older accounting for 58.6% of atrial septal defect surgery. Ventricular septal defect (perimembranous/muscular), which had been the most common disease in 2015 and 2016, was the second most common disease (1114 cases).
Within the past 10 years, hospital mortality for complex congenital heart disease was as follows (2008 [2], 2013 [3], and 2018): complete atrio-ventricular septal defect (3.5%, 0.6%, and 2.5%, respectively); tetralogy of Fallot (1.8%, 1.4%, and 1.1%, respectively); transposition of the great arteries with intact septum (3.8%, 3.6%, and 2.1%, respectively), ventricular septal defect (5.5%, 5.2%, and 6.9%, respectively), and single ventricle (5.5%, 5.7%, and 5.1%, respectively); and hypoplastic left heart syndrome (12.9%, 9.1%, and 8.8%, respectively). Currently, right heart bypass surgery has been commonly performed (359 bidirectional Glenn procedures excluding 36 Damus–Kaye–Stansel procedures and 395 Fontan-type procedures including total cavopulmonary connection) with acceptable hospital mortality rates (2.2% and 1.5%). The Norwood type I procedure was performed in 130 cases, with a relatively low hospital mortality rate (15.4%).
The total number of valvular heart disease procedures, excluding transcatheter procedures, was slightly lower than that in the previous year. Moreover, the number of isolated aortic valve replacement/repair with/without coronary artery bypass grafting (CABG) (n = 10,584) was 1.0% lower than that in the previous year (n = 10,690) but 2.0% higher than that 5 years ago (n = 10,379), despite the rapid utilization of transcatheter aortic valve replacement (n = 6610 in 2018). The number of isolated mitral valve replacement/repair with/without CABG (n = 4898) was 4.5% higher than that in the previous year (n = 4687) and 2.2% higher than that 5 years ago (n = 4793). A total of 10,744 and 2757 cases underwent aortic and mitral valve replacement with bioprosthesis, respectively. The rate at which bioprosthesis was utilized had increased dramatically from 30% in the early 2000s [4, 5] to 83.9% and 70.0% in 2018 for aortic and mitral positions, respectively. Additionally, CABG was performed as a concomitant procedure in 17.3% of all valvular procedures (16.7% in 2008 [2] and 17.8% in 2013 [3]). Valve repair had been popular for mitral and tricuspid valve positions (7147 and 6032 cases, respectively), but had been less frequently observed for aortic valve positions (348 patients, only 2.6% of all aortic valve procedures). Mitral valve repair constituted 63.3% of all mitral valve procedures. Hospital mortality rates for single valve replacement were 3.0% and 7.1% for aortic and mitral positions, respectively, but only 1.5% for mitral valve repair. Moreover, hospital mortality rates for redo valve surgery were 7.7% and 5.9% for the aortic and mitral positions, respectively. Finally, overall hospital mortality rates did not improve over the past 10 years (3.3% in 2008 [2], 3.1% in 2013 [3], and 3.5% in 2018).
Anzeige
Isolated CABG had been performed in 12,135 cases, accounting for only 68.3% of the number performed 10 years ago (n = 17,764) [2]. Among the aforementioned cases, 7197 (58.8%) underwent off-pump CABG, with a success rate of 97.4%. The percentage of intended off-pump CABG in 2018 was similar to that in 2017 when it fell below 60% for the first time since 2004 [4]. Hospital mortality associated with primary elective CABG procedures among 7707 cases was 1.3%, which did not differ from that in 2008 (1.5%) [2]. Nonetheless, hospital mortality for primary emergency CABG among 1667 cases still remained high (7.3%). The percentage of conversion from off-pump to on-pump CABG or on-pump beating-heart CABG was 2.6%, with a hospital mortality rate of 5.8%. Patients with end-stage renal failure on dialysis had higher hospital mortality rates than overall mortality, regardless of surgical procedure (on-pump arrest, on-pump beating, and off-pump). In this report, concomitant CABGs alongside other major procedures were not included under the ischemic heart disease category but rather under other categories, such as valvular heart disease and thoracic aortic aneurysm. Accordingly, the overall number of CABGs in 2018, including concomitant CABG with other major procedures, was 17,678.
Measures for arrhythmia were performed primarily as concomitant procedures in 5334 cases, with a hospital mortality rate of 3.2%. Pacemaker and implantable cardioverter–defibrillator implantation was not included in this category.
In 2018, 21,624 procedures for thoracic and thoracoabdominal aortae diseases were performed, among which 10,453 and 11,171 were for aortic dissection and non-dissection, respectively. The number of surgeries for aortic dissection this year was 3.6% higher than that in the preceding year (n = 10,086). Hospital mortality rates for the 6157 Stanford type A acute aortic dissections remained high (10.5%). The number of procedures for non-dissected aneurysm increased by 4.8%, with a hospital mortality rate of 5.2% for all aneurysms and 3.7% and 22.5% for unruptured and ruptured aneurysms, respectively. The rate at which thoracic endovascular aortic repair (TEVAR) has been performed for aortic diseases has been increasing. A total of 3974 patients with aortic dissection underwent stent graft placement: 2151 TEVARs and 1823 open stent graftings, respectively. Moreover, 1373 and 294 cases underwent TEVAR and open stent grafting for type B chronic aortic dissection, accounting for 58.6% and 12.5% of the total number of cases, respectively. Hospital mortality rates associated with simple TEVAR for type B aortic dissection were 7.0% and 2.0% for acute and chronic cases, respectively. A total of 5087 patients with non-dissected aortic aneurysm underwent stent graft placement, among which 3641 were TEVARs (a 10.6% increase compared to that in 2017, n = 3292) and 1446 were open stent graftings (a 6.0% increase compared to that in 2017, n = 1364). Hospital mortality rates for TEVARs were 2.7% and 20.4% for unruptured and ruptured aneurysms, respectively, whereas those for open stenting were 5.0% and 30.1% for unruptured and ruptured aneurysms, respectively.
(B) General thoracic surgery
The 2018 survey of general thoracic surgeries comprised 749 surgical units, with the bulk of the data submitted via a web-based collection system established by the NCD [1]. In total, 86,589 procedures had been reported by general thoracic surgery departments in 2018, twice the number of surgeries compared to 2000 and approximately 11,200 more procedures than that in 2013 (Fig. 2).
Fig. 2
General thoracic surgery
×
Anzeige
In 2018, 44,859 procedures for primary lung cancer had been performed, a number that has continued to increase annually. Accordingly, the number of procedures in 2018 was 2.4 times higher than that in 2000, with lung cancer procedures accounting for 52% of all general thoracic surgeries (Table 9).
Table 9
Total cases of general thoracic surgery during 2018
Cases
%
Benign pulmonary tumor
2342
2.7
Primary lung cancer
44,859
51.8
Other primary malignant pulmonary tumor
384
0.4
Metastatic pulmonary tumor
8978
10.4
Tracheal tumor
127
0.1
Mesothelioma
664
0.8
Chest wall tumor
656
0.8
Mediastinal tumor
5361
6.2
Thymectomy for MG without thymoma
151
0.2
Inflammatory pulmonary disease
2400
2.8
Empyema
3103
3.6
Bullous disease excluding pneumothorax
376
0.4
Pneumothorax
14,731
17.0
Chest wall deformity
176
0.2
Diaphragmatic hernia including traumatic
30
0.0
Chest trauma excluding diaphragmatic hernia
431
0.5
Lung transplantation
71
0.1
Others
1749
2.0
Total
86,589
100.0
Information regarding the number of video-assisted thoracoscopic surgery (VATS), defined as surgical procedures utilizing a skin incision over 8 cm and/or a minithoracotomy (hybrid) approach, has been available since the 2015 annual report. The number of VATS procedures for benign pulmonary tumors and primary lung cancer and the total number of VATS procedures in 2016 are presented in Tables 10, 11, 13, 16, 17, 18, 19, 20, 21, 22, 23, 25, 26, 27, respectively.
Table 10
Benign pulmonary tumor
Cases
30-Day mortality
Hospital mortality
By VATS
Hospital
After discharge
Benign pulmonary tumor
Hamartoma
527
0
0
0
503
Sclerosing hemangioma
109
0
0
0
104
Papilloma
23
0
0
0
22
Mucous gland adenoma bronchial
4
0
0
0
4
Fibroma
136
0
0
0
123
Lipoma
8
0
0
0
7
Neurogenic tumor
18
0
0
0
15
Clear cell tumor
2
0
0
0
2
Leiomyoma
12
0
0
0
12
Chondroma
4
0
0
0
4
Inflammatory myofibroblastic tumor
0
0
0
0
0
Pseudolymphoma
26
0
0
0
25
Histiocytosis
12
0
0
0
12
Teratoma
7
0
0
0
6
Others
1454
1 (0.1)
1 (0.1)
1 (0.1)
1383
Total
2342
1 (0.04)
1 (0.04)
1 (0.04)
2222
(), mortality %
Table 11
Primary malignant pulmonary tumor
Cases
30-Day mortality
Hospital mortality
VATS
Hospital
After discharge
Primary malignant pulmonary tumor
45,243
107 (0.2)
28 (0.1)
244 (0.5)
34,249
Lung cancer
44,859
107 (0.2)
28 (0.1)
242 (0.5)
34,249
Adenocarcinoma
31,720
52 (0.2)
11 (0.03)
92 (0.3)
Squamous cell carcinoma
8265
40 (0.5)
13 (0.2)
106 (1.3)
Large cell carcinoma
280
0
0
1 (0.4)
LCNEC
543
2 (0.4)
0
4 (0.7)
Small cell carcinoma
785
3 (0.4)
2 (0.3)
10 (1.3)
Adenosquamous carcinoma
560
2 (0.4)
0
4
(0.7)
Carcinoma with pleomorphic, sarcomatoid or sarcomatous elements
511
4 (0.8)
0
10 (2.0)
Carcinoid
252
0
0
0
Carcinomas of salivary-gland type
40
0
0
1 (2.5)
Unclassified
46
0
0
0
Multiple lung cancer
1554
2 (0.1)
2 (0.1)
9 (0.6)
Others
302
2 (0.7)
0
5
(1.7)
Wedge resection
7683
11 (0.1)
13 (0.2)
21 (0.3)
6900
Segmental excision
5136
5 (0.1)
1 (0.02)
17 (0.3)
4219
(Sleeve segmental excision)
12
0
0
0
6
Lobectomy
31,365
83 (0.3)
14 (0.04)
188 (0.6)
22,880
(Sleeve lobectomy)
474
1 (0.2)
0
3 (0.6)
75
Pneumonectomy
324
5 (1.5)
0
10 (3.1)
42
(Sleeve pneumonectomy)
9
0
0
0
0
Other bronchoplasty
34
1 (2.9)
0
1 (2.9)
7
Pleuropneumonectomy
2
0
0
0
0
Others
315
2 (0.6)
0
5 (1.6)
201
Unknown
0
0
0
0
Sarcoma
51
0
0
1 (2.0)
AAH
103
0
0
0
Others
230
0
0
1 (0.4)
(), mortality %
Table 12
Details of lung cancer operations
TNM
c-Stage
Cases
IA1
7,832
IA2
12,773
IA3
8,048
IB
4,977
IIA
1,577
IIB
3,862
IIIA
2,683
IIIB
499
IIIC
26
IVA
388
IVB
81
NA
2,113
Total
44,859
Sex
Cases
Male
27,385
Female
17,474
NA
0
Total
44,859
Cause of death
Cases
Cardiovascular
24
Pneumonia
41
Pyothorax
2
Bronchopleural fistula
13
Respiratory failure
22
Pulmonary embolism
5
Interstitial pneumonia
79
Brain infarction or bleeding
13
Others
65
Unknown
6
Total
270
p-Stage
Cases
0 (pCR)
3,234
IA1
9,035
IA2
9,839
IA3
4,890
IB
6,107
IIA
1,190
IIB
4,561
IIIA
3,808
IIIB
820
IIIC
16
IVA
1,010
IVB
73
NA
276
Total
44,859
Age (years)
Cases
< 20
25
20–29
31
30–39
277
40–49
1,195
50–59
3,736
60–69
13,290
70–79
20,190
80–89
6,003
≥ 90
112
NA
0
Total
44,859
Table 13
Metastatic pulmonary tumor
Cases
30-Day mortality
Hospital mortality
VATS
Hospital
After discharge
Metastatic pulmonary tumor
8978
6 (0.1)
4 (0.04)
13 (0.1)
8342
Colorectal
4396
2 (0.05)
1 (0.02)
5 (0.1)
4088
Hepatobiliary/Pancreatic
433
0
0
0
414
Uterine
504
0
1 (0.2)
0
469
Mammary
543
2 (0.4)
0
3 (0.6)
522
Ovarian
82
0
0
0
76
Testicular
60
0
0
0
56
Renal
690
0
0
0
646
Skeletal
110
0
0
0
96
Soft tissue
261
0
0
0
238
Otorhinolaryngological
471
0
1 (0.2)
0
442
Pulmonary
470
1 (0.2)
0
2 (0.4)
405
Others
958
1 (0.1)
1 (0.1)
3 (0.3)
890
(), mortality %
Table 14
Tracheal tumor
Cases
30-Day mortality
Hospital mortality
Hospital
After discharge
Tracheal tumor
127
5 (3.9)
1 (0.8)
6 (4.7)
A. Primary malignant tumor
Histological classification
Squamous cell carcinoma
17
1 (5.9)
0
1 (5.9)
Adenoid cystic carcinoma
17
0
0
0
Mucoepidermoid carcinoma
6
0
0
0
Others
19
0
0
1 (5.3)
Total
59
1 (1.7)
0
2 (3.4)
B. Metastatic/invasive malignant tumor, e.g. invasion of thyroid cancer
33
1 (3.0)
1 (3.0)
1 (3.0)
C. Benign tracheal tumor
Histological classification
Papilloma
1
0
0
0
Adenoma
2
0
0
0
Neurofibroma
1
0
0
0
Chondroma
0
0
0
0
Leiomyoma
3
0
0
0
Others
28
3 (10.7)
0
3 (10.7)
Histology unknown
0
0
0
0
Total
35
3 (8.6)
0
3 (8.6)
Operation
Sleeve resection with reconstruction
30
0
0
0
Wedge with simple closure
1
0
0
0
Wedge with patch closure
1
0
0
0
Total laryngectomy with tracheostomy
0
0
0
0
Others
3
0
0
0
Unknown
0
0
0
0
Total
35
0
0
0
(), mortality %
Table 15
Tumor of pleural origin
Histological classification
Cases
30-Day mortality
Hospital mortality
Hospital
After discharge
Solitary fibrous tumor
146
0
0
0
Diffuse malignant pleural mesothelioma
264
4 (1.5)
1 (0.4)
13 (4.9)
Localized malignant pleural mesothelioma
32
0
0
1 (3.1)
Others
222
1 (0.5)
0
4 (1.8)
Total
664
5 (0.8)
1 (0.2)
18 (2.7)
Operative procedure
Cases
30-Day mortality
Hospital mortality
Hospital
After discharge
Extrapleural pneumonectomy
64
2 (3.1)
0
6 (9.4)
Total pleurectomy
100
1 (1.0)
0
2 (2.0)
Others
100
1 (1.0)
1 (1.0)
5 (5.0)
Total
264
4 (1.5)
1 (0.4)
13 (4.9)
(), mortality %
Table 16
Chest wall tumor
Cases
30-Day mortality
Hospital mortality
VATS
Hospital
After discharge
Primary malignant tumor
132
0
0
0
71
Metastatic malignant tumor
179
1 (0.6)
0
1 (0.6)
84
Benign tumor
345
0
0
0
265
Total
656
1 (0.2)
0
1 (0.2)
420
(), mortality %
Table 17
Mediastinal tumor
Cases
30-Day mortality
Hospital mortality
By VATS
Hospital
After discharge
Mediastinal tumor
5361
2 (0.04)
1 (0.02)
6 (0.1)
4009
Thymoma*
2098
0
0
2 (0.1)
1379
Thymic cancer
325
1 (0.3)
0
1 (0.3)
171
Thymus carcinoid
43
0
0
0
22
Germ cell tumor
81
0
0
0
44
Benign
58
0
0
0
35
Malignant
23
0
0
0
9
Neurogenic tumor
492
1 (0.2)
0
1 (0.2)
461
Congenital cyst
1224
0
0
0
1129
Goiter
98
0
0
1 (1.0)
40
Lymphatic tumor
172
0
0
1 (0.6)
122
Excision of pleural recurrence of thymoma
20
0
0
0
15
Thymolipoma
20
0
0
0
17
Others
788
0
1 (0.1)
0
609
(), mortality %
Table 18
Thymectomy for myasthenia gravis
Cases
30-Day mortality
Hospital mortality
By VATS
Hospital
After discharge
Thymectomy for myasthenia gravis
499
0
0
0
319
With thymoma
348
0
0
0
209
(), mortality %
Table 19
Operations for non-neoplastic diseases
Cases
30-Day mortality
Hospital mortality
Hospital
After discharge
Operations for non-neoplastic diseases
22,996
229
(1.0)
30
(0.1)
465
(2.0)
Cases
30-Day mortality
Hospital mortality
VATS
Hospital
After discharge
A. Inflammatory pulmonary disease
2400
8 (0.3)
4 (0.2)
18 (0.8)
2102
Tuberculous infection
54
1 (1.9)
0
1 (1.9)
46
Mycobacterial infection
526
2 (0.4)
0
3 (0.6)
465
Fungal infection
325
1 (0.3)
2 (0.6)
6 (1.8)
241
Bronchiectasis
64
0
0
0
48
Tuberculous nodule
70
0
0
0
65
Inflammatory pseudotumor
902
0
0
3 (0.3)
838
Interpulmonary lymph node
59
0
0
0
58
Others
400
4 (1.0)
2 (0.5)
5 (1.3)
341
(), mortality %
Table 20
B. Empyema
Cases
30-day mortality
Hospital mortality
by VATS
hospital
After discharge
Acute empyema
2402
57 (2.4)
4 (0.2)
124 (5.2)
2013
With fistula
509
34 (6.7)
1 (0.2)
66 (13.0)
270
Without fistula
1876
22 (1.2)
3 (0.2)
54 (2.9)
1729
Unknown
17
1 (5.9)
0
4 (23.5)
14
Chronic empyema
701
23 (3.3)
1 (0.1)
63 (9.0)
407
With fistula
325
14 (4.3)
0
36 (11.1)
125
Without fistula
324
8 (2.5)
1 (0.3)
25 (7.7)
241
Unknown
52
1 (1.9)
0
2 (3.8)
41
Total
3103
80 (2.6)
5 (0.2)
187 (6.0)
2420
(), mortality %
Table 21
C. Descending necrotizing mediastinitis
Cases
30-day mortality
Hospital mortality
VATS
Hospital
After discharge
C. Descending necrotizing mediastinitis
106
4 (3.8)
1 (0.9)
6 (5.7)
81
(), mortality %
Table 22
D. Bullous diseases
Cases
30-Day mortality
Hospital mortality
VATS
Hospital
After discharge
D. Bullous diseases
376
0
0
0
349
Emphysematous bulla
270
0
0
0
258
Bronchogenic cyst
21
0
0
0
18
Emphysema with LVRS
23
0
0
0
19
Others
62
0
0
0
54
(), mortality %
LVRS lung volume reduction surgery
Table 23
E. Pneumothorax
Cases
30-day mortality
Hospital mortality
VATS
Hospital
After discharge
14,731
81 (0.5)
19 (0.1)
146 (1.0)
14,379
Spontaneous pneumothorax
Operative procedure
Cases
30-Day mortality
Hospital mortality
VATS
Hospital
After discharge
Bullectomy
2825
7 (0.2)
4 (0.1)
11 (0.4)
2,770
Bullectomy with additional procedure
7632
5 (0.1)
1 (0.01)
10 (0.1)
7,535
Coverage with artificial material
7383
5 (0.1)
1 (0.01)
10 (0.1)
7,291
Parietal pleurectomy
27
0
0
0
27
Coverage and parietal pleurectomy
57
0
0
0
54
Others
165
0
0
0
163
Others
657
3 (0.5)
2 (0.3)
5 (0.8)
610
Unknown
10
0
0
0
9
Total
11,124
15 (0.1)
7 (0.1)
26 (0.2)
10,924
Secondary pneumothorax
Associated disease
Cases
30-Day mortality
Hospital mortality
VATS
Hospital
After discharge
COPD
2,437
33 (1.4)
8 (0.3)
65 (2.7)
2,359
Tumorous disease
128
9 (7.0)
1 (0.8)
14 (10.9)
123
Catamenial
199
0
0
1 (0.5)
194
LAM
39
0
0
0
38
Others (excluding pneumothorax by trauma)
804
24 (3.0)
3 (0.4)
40 (5.0)
741
Unknown
0
0
0
0
0
Operative procedure
Cases
30 Day mortality
Hospital mortality
VATS
Hospital
After discharge
Bullectomy
607
5 (0.8)
1 (0.2)
8 (1.3)
587
Bullectomy with additional procedure
2,079
33 (1.6)
5 (0.2)
50 (2.4)
2,030
Coverage with artificial material
1,969
32 (1.6)
5 (0.3)
49 (2.5)
1,924
Parietal pleurectomy
4
0
0
0
4
Coverage and parietal pleurectomy
37
0
0
0
35
Others
69
1 (1.4)
0
1 (1.4)
67
Others
917
28 (3.1)
6 (0.7)
62 (6.8)
836
Unknown
4
0
0
0
2
Total
3607
66 (1.8)
12 (0.3)
120 (3.3)
3,455
(), mortality %
Table 24
F. Chest wall deformity
Cases
30-Day mortality
Hospital mortality
Hospital
After discharge
F. Chest wall deformity
176
0
0
1 (0.6)
Funnel chest
165
0
0
1 (0.6)
Others
11
0
0
0
(), mortality %
Table 25
G. Diaphragmatic hernia
Cases
30-Day mortality
Hospital mortality
VATS
Hospital
After discharge
G. Diaphragmatic hernia
30
1 (3.3)
0
3 (10.0)
21
Congenital
5
0
0
2 (40.0)
4
Traumatic
4
0
0
0
3
Others
21
1 (4.8)
0
1(4.8)
14
(), mortality %
Table 26
H. Chest trauma
Cases
30-Day mortality
Hospital mortality
VATS
Hospital
After discharge
H. Chest trauma
431
21 (4.9)
0
33 (7.7)
280
(), mortality %
Table 27
I. Other respiratory surgery
Cases
30-Day mortality
Hospital mortality
VATS
Hospital
After discharge
I. Other respiratory surgery
1643
34 (2.1)
1 (0.1)
71 (4.3)
1258
Arteriovenous malformation*
84
0
0
0
79
Pulmonary sequestration
103
0
0
0
92
Postoperative bleeding · air leakage
481
17 (3.5)
0
36 (7.5)
329
Chylothorax
73
0
0
3 (4.1)
61
Others
902
17 (1.9)
1 (0.1)
32 (3.5)
697
(), mortality %
In 2018, a total of 2342 procedures for benign pulmonary tumors had been conducted (Table 10). Hamartomas were the most frequent benign pulmonary tumors diagnosed, with 2222 patients (95%) undergoing VATS.
Additional information on primary malignant pulmonary tumors is shown in Tables 11, 12. Accordingly, adenocarcinoma had been the most frequently diagnosed lung cancer subtype (71% of all lung cancers), followed by squamous cell carcinoma (18%). Sublobar resection was performed in 12,819 lung cancer cases (29% of all cases) and lobectomy in 31,365 cases (70% of all cases). Sleeve lobectomy was performed in 474 cases, while pneumonectomy was required in 324 cases (0.7% of all cases). VATS lobectomy for lung cancer was performed in 22,880 cases (73% of all lobectomy cases). The number of patients aged 80 years or older who underwent lung cancer surgery was 6115 (14%). Among those who died within 30 days following surgery, 107 died prior to hospital discharge, while 28 died after discharge. Overall, 135 patients died within 30 days after surgery (30-day mortality rate, 0.3%), while 242 died prior to discharge (hospital mortality rate, 0.5%). Moreover, 30-day mortality rates according to procedure were 0.1%, 0.2%, and 1.5% for segmentectomy, lobectomy, and pneumonectomy, respectively. Interstitial pneumonia had been the leading cause of death following lung cancer surgery, followed by pneumonia, cardiovascular events, and respiratory failure.
Anzeige
The procedures for metastatic pulmonary tumors, 8978 of which were performed in 2018, are shown in Table 13. Among such procedures, colorectal cancer had been the most frequent diagnosis (49% of all cases).
A total of 59 procedures for malignant tracheal tumor were performed in 2018; however, 30 patients underwent sleeve resection and reconstruction (Table 14).
Overall, 664 pleural tumors had been diagnosed in 2018 (Table 15), with diffuse malignant pleural mesothelioma being the most frequent histologic diagnosis. Total pleurectomy was performed in 100 cases and extrapleural pneumonectomy in 64 cases. The 30-day mortality rate was 1% and 3% following total pleurectomy and extrapleural pneumonectomy, respectively, both of which had better outcomes than previously reported.
Overall, 656 chest wall tumor resections had been performed in 2018 (Table 16), among which 345 (53%) were benign. Among the 311 malignant chest wall tumors, 179 (58%) were metastatic.
A total of 5361 mediastinal tumors were resected in 2018, a slight increase compared to that in the previous year (Table 17). Thymic epithelial tumors—including 2098 thymomas, 325 thymic carcinomas, and 43 thymic carcinoids—were the most frequently diagnosed mediastinal tumor subtype in 2018.
In total, 499 patients underwent thymectomy for myasthenia gravis (Table 18), among which 348 procedures were associated with thymoma.
Overall, 22,996 patients underwent procedures for non-neoplastic disease. Accordingly, 2400 patients underwent lung resection for inflammatory lung diseases (Table 19), among which 22% and 14% were associated with mycobacterial infections and fungal infections, respectively. Procedures for inflammatory nodules were performed in cases where lung cancer was suspected prior to surgery (902 cases, 38%).
A total of 3103 procedures were performed for empyema (Table 20), among which 2402 (77%) were acute and 701 were chronic. Moreover, 509 patients with acute empyema and 325 patients with chronic empyema had developed bronchopleural fistulas. The hospital mortality rate was 13% among patients with acute empyema with fistula.
In 2018, 106 operations were performed for descending necrotizing mediastinitis (Table 21), with a hospital mortality rate of 6%. Furthermore, 376 procedures were conducted for bullous diseases (Table 22), while only 23 patients underwent lung volume reduction surgery.
A total of 14,731 procedures were performed for spontaneous pneumothorax (Table 23). Among the 11,124 procedures for primary pneumothorax, 2825 (25%) were bullectomies alone, while 7632 (69%) required additional procedures. A total of 3607 procedures for secondary pneumothorax were conducted, with COPD being the most prevalent associated disease (2437 cases, 68%). The hospital mortality rate for secondary pneumothorax associated with COPD was 2.7%.
The 2018 survey reported 176 procedures for chest wall deformity (Table 24). However, this may have been underestimated given that the Nuss procedure for pectus excavatum was more likely to have been performed in pediatric surgery centers not associated with the Japanese Association for Thoracic Surgery.
Overall, 30 patients underwent surgical treatment for diaphragmatic hernia (Table 25). This figure may have also been underestimated considering that procedures may have been classified as gastrointestinal surgery.
The survey reported 431 procedures for chest trauma, excluding iatrogenic injuries (Table 26), with a hospital mortality rate of 8%.
Table 27 summarizes the procedures for other diseases, including 84 and 103 cases of arteriovenous malformation and pulmonary sequestration, respectively.
A total of 71 lung transplantations were performed in 2018 (Table 28), among which 57 and 14 were from brain-dead and living related donors, respectively.
Table 28
Lung transplantation
Cases
30-Day mortality
Hospital mortality
Hospital
After discharge
Single lung transplantation from brain-dead donor
30
0
0
0
Bilateral lung transplantation from brain-dead donor
27
0
0
0
Lung transplantation from living donor
14
0
0
1 (7.1)
Total lung transplantation
71
0
0
1 (1.4)
Donor of living donor lung transplantation
23
0
0
0
(), mortality %
The number of VATS procedures has continued to increase annually, ultimately reaching 71,171 (82% of all general thoracic surgeries) in 2018 (Table 29).
Details regarding tracheobronchoplasty, pediatric surgery, and combined resection of neighboring organs are presented in Tables 30, 31, 32, 33.
Table 30
Tracheobronchoplasty
Cases
30-Day mortality
Hospital mortality
Hospital
After discharge
Tracheobronchoplasty
747
8 (1.1)
1 (0.1)
11 (1.5)
Trachea
46
1 (2.2)
0
1 (2.2)
Sleeve resection with reconstruction
32
0
0
0
Wedge with simple closure
4
0
0
0
Wedge with patch closure
1
0
0
0
Total laryngectomy with tracheostomy
0
0
0
0
Others
9
1 (11.1)
0
1 (11.1)
Carinal reconstruction
35
0
0
1 (2.9)
Sleeve pneumonectomy
10
0
0
0
Sleeve lobectomy
464
1 (0.2)
0
2 (0.4)
Sleeve segmental excision
15
0
0
0
Bronchoplasty without lung resection
23
1 (4.3)
1 (4.3)
1 (4.3)
Others
154
5 (3.2)
0
6 (3.9)
(), mortality %
Table 31
Pediatric surgery
Cases
30-Day mortality
Hospital mortality
Hospital
After discharge
Pediatric surgery
287
7 (2.4)
1 (0.3)
11 (3.8)
(), mortality %
Table 32
Combined resection of neighboring organ(s)
Cases
30-Day mortality
Hospital mortality
Hospital
After discharge
Combined resection of neighboring organ(s)
1401
10
(0.7)
1
(0.1)
21
(1.5)
Organ resected
Cases
30-Day mortality
Hospital mortality
Hospital
After discharge
A. Primary lung cancer
Aorta
10
1 (10.0)
0
1 (10.0)
Superior vena cava
21
0
0
1 (4.8)
Brachiocephalic vein
8
0
0
1 (12.5)
Pericardium
122
1 (0.8)
0
4 (3.3)
Pulmonary artery
146
1 (0.7)
0
2 (1.4)
Left atrium
18
0
0
0
Diaphragm
74
1 (1.4)
0
1 (1.4)
Chest wall (including ribs)
330
5 (1.5)
0
9 (2.7)
Vertebra
8
0
0
0
Esophagus
4
0
0
0
Total
741
9 (1.2)
0
19 (2.6)
B. Mediastinal tumor
Aorta
6
1 (16.7)
0
1 (16.7)
Superior vena cava
53
0
0
1 (1.9)
Brachiocephalic vein
112
0
0
1 (0.9)
Pericardium
336
0
1 (0.3)
1 (0.3)
Pulmonary artery
4
1 (25.0)
0
1 (25.0)
Left atrium
2
0
0
0
Diaphragm
30
0
0
0
Chest wall (including ribs)
4
0
0
0
Vertebra
5
0
0
0
Esophagus
4
0
0
0
Lung
487
1 (0.2)
1 (0.2)
2 (0.4)
Total
1,043
3 (0.3)
2 (0.2)
7 (0.7)
(), mortality %
Table 33
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
772
6 (0.8)
0
9 (1.2)
(), mortality %
Includes tumors invading the anterior apical chest wall and posterior apical chest wall (superior sulcus tumor, so called Pancoast type)
(C) Esophageal surgery
In 2018, the data collection method for esophageal surgery had been modified from self-reports using questionnaire sheets according to each institution belonging to the Japanese Association for Thoracic Surgery to an automatic package downloaded from the NCD in Japan. Consequently, data for non-surgical cases with esophageal diseases had been excluded from the registry. Furthermore, data regarding the histological classification of malignant tumors, multiple primary cancers, and mortality rates for cases with combined resection of other organs could not be registered given that they were not included in the NCD. Instead, detailed data regarding postoperative surgical and non-surgical complications were collected from the NCD. Moreover, data regarding surgeries for corrosive esophageal strictures and salvage surgeries for esophageal cancer had been exceptionally registered by participating institutions.
Throughout 2018, a total of 7324 patients underwent surgery for esophageal diseases (1068 and 6256 for benign and malignant esophageal diseases, respectively) from 552 institutions across Japan. Among them, 329 (63.0%) and 441 (79.9%) institutions performed surgeries for benign and malignant esophageal diseases, respectively. Among institutions performing surgeries for malignant esophageal diseases, 82 (18.6%) had 20 or more patients who underwent esophageal surgeries within 2018, while 271 (61.5%) had less than 10 patients (i.e., 1–9 patients) who underwent the same procedure within the same year. This distribution was quite different from that in 2017 [125 (29.2%) and 215 (50.2%), respectively], suggesting the differences between the two data collection methods, as mentioned previously (Table 34). Annual trends among registered in-patients with esophageal diseases have remained unchanged for the past 5 years (Fig. 3).
Table 34
Distribution of number of esophageal operations in 2018 in each institution
Esophageal surgery
Number of operations in 2018
Benign esophageal diseases
Malignant Esophageal disease
Benign + Malignant
0
224
111
63
1–4
271
179
193
5–9
43
92
101
10–19
10
88
95
20–29
0
36
38
30–39
1
10
21
40–49
2
13
14
≧ 50
1
23
27
Total
552
552
552
Fig. 3
Annual trend of in-patients with esophageal diseases
×
With regard to benign esophageal diseases (Table 35), thoracoscopic and/or laparoscopic surgeries were performed in 89.1% (115/129), 81.5% (387/475), 51.6% (33/64), and 49.5% (102/206) of patients with esophagitis (including esophageal ulcer), hiatal hernia, benign tumors, and achalasia, respectively. On the other hand, 89.1% (115/129) of patients with spontaneous rupture of the esophagus underwent open surgery. Hospital mortality rates after surgery for benign esophageal diseases had only been recorded for those with hiatal hernia and spontaneous rupture of the esophagus, with 8 (1.7%) and 2 (1.6%) patients succumbing to mortality within 30 days following surgery, respectively. Only 3 (0.4%) among the 673 patients who underwent thoracoscopic and/or laparoscopic surgery died within 30 postoperative days, all of whom had hiatal hernia.
Table 35
Benign esophageal diseases
Operation ( +)
T/L*3
Cases
Hospital mortality
Cases
Hospital mortality
~ 30 days
31–90 days
Total (including after 91 days mortality)
~ 30 days
31–90 days
Total (including after 91 days mortality)
1. Achalasia
206
0
0
0
102
0
0
0
2. Benign tumor
64
0
0
0
33
0
0
0
3. Diverticulum
41
0
0
0
13
0
0
0
4. Hiatal hernia
475
8 (1.7)
5 (1.1)
13 (2.7)
387
3 (0.8)
3 (0.8)
6 (1.6)
5. Spontaneous rupture of the esophagus
129
2 (1.6)
0
2 (1.6)
14
0
0
0
6. Esophago-tracheal fistula
2
0
0
0
1
0
0
0
7. Esophagitis, Esophageal ulcer
129
0
0
0
115
0
0
0
8. Corrosive stricture of the esophagus
22
0
0
0
8
0
0
0
Total
1068
10 (0.9)
5 (0.5)
15 (1.4)
673
3 (0.4)
3 (0.4)
6 (0.9)
(), mortality %
T/L Thoracoscopic and/or laparoscopic
The most common tumor location for malignant esophageal diseases was the thoracic esophagus (Table 36). Among 6256 cases with esophageal malignancies, 2538 (40.6%) and 3718 (59.4%) underwent esophagectomy for superficial and advanced cancers, respectively. The 30-day and hospital mortality rates following esophagectomy were 0.4% and 0.6% for patients with superficial cancer and 1.0% and 1.8% for those with advanced cancer, respectively.
Table 36
Malignant esophageal disease
Operation (+)
Thoracoscopic and/or laparscopic procedure
Cases
Hospital mortality
Cases
Conversion to thoracotomy
Hospital mortality
~ 30 days
31–90 days
Total (including after 91days mortality)
~ 30 days
31–90 days
Total (including after 91days mortality)
Location
(1) Cervical esophagus
172
2 (1.2)
2 (1.2)
3 (1.7)
67
0
1 (1.5)
1 (1.5)
2 (3.0)
(2) Thoracic esophagus
5244
41 (0.8)
27 (0.5)
69 (1.3)
3848
42 (1.1)
28 (0.7)
15 (0.4)
43 (1.1)
(3) Abdominal esophagus
499
1 (0.2)
2 (0.4)
3 (0.6)
272
2 (0.7)
1 (0.4)
0
1 (0.4)
Total
5915
44 (0.7)
31 (0.5)
75 (1.3)
4187
44 (1.1)
30 (0.7)
16 (0.4)
46 (1.1)
Tumor depth
(A) Superficial cancer (T1)
(1) Transhiatal esophagectomy
15
0
0
0
0
0
0
0
0
(2) Mediastinoscopic esophagectomy and reconstruction
90
0
0
0
90
0
0
0
0
(3) Transthoracic (rt.) esophagectomy and reconstruction
1908
8 (0.4)
6 (0.3)
14 (0.7)
1534
12 (0.8)
7 (0.5)
4 (0.3)
11 (0.7)
(4) Transthoracic (lt.) esophagectomy and reconstruction
43
0
1 (2.3)
1 (2.3)
19
0
0
0
0
(5) Cervical esophageal resection and reconstruction
19
0
0
0
0
0
0
0
0
(6) Robot-assisted esophagectomy and reconstruction
172
1 (0.6)
0
1 (0.6)
174
0
2 (1.1)
0
2 (1.1)
(7) Others
58
0
0
0
14
1 (7.1)
0
0
0
(8) Esophagectomy without reconstruction
233
0
0
0
1
0
0
0
0
Subtotal
2538
9 (0.4)
7 (0.3)
16 (0.6)
1832
13 (0.7)
9 (0.5)
4 (0.2)
13 (0.7)
(B) Advanced cancer (T2–T4)
(1) Transhiatal esophagectomy
32
1 (3.1)
0
1 (3.1)
0
0
0
0
0
(2) Mediastinoscopic esophagectomy and reconstruction
83
2 (2.4)
0
2 (2.4)
82
0
2 (2.4)
0
2 (2.4)
(3) Transthoracic (rt.) esophagectomy and reconstruction
3045
30 (1.0)
18 (0.6)
49 (1.6)
2017
29 (1.4)
19 (0.9)
10 (0.5)
29 (1.4)
(4) Transthoracic (lt.) esophagectomy and reconstruction
94
0
1 (1.1)
1 (1.1)
25
0
0
0
0
(5) Cervical esophageal resection and reconstruction
66
0
1 (1.5)
0
0
0
0
0
0
(6) Robot-assisted esophagectomy and reconstruction
156
0
0
0
156
1 (0.6)
0
0
0
(7) Others
92
1 (1.1)
1 (1.1)
2 (2.2)
23
0
0
0
0
(8) Esophagectomy without reconstruction
150
4 (2.7)
8 (5.3)
12 (8.0)
8
0
0
2 (25.0)
2 (25.0)
Subtotal
3718
38 (1.0)
29 (0.8)
67 (1.8)
2311
30 (1.3)
21 (0.9)
12 (0.5)
33 (1.4)
Total
6256
47 (0.8)
36 (0.6)
83 (1.3)
4143
43 (1.0)
30 (0.7)
16 (0.4)
46 (1.1)
Cases
Overall morbidity
Morbidity ≥ CD III
Surgical complications
Surgical site infection
Anastomotic leakage
Recurrent nerve palsy
Wound dehiscence
Superficial incision
Deep incision
Organ space
Location
(1) Cervical esophagus
172
105 (61.0)
49 (28.5)
13 (7.6)
5 (2.9)
11 (6.4)
17 (9.9)
14 (8.1)
3 (1.7)
(2) Thoracic esophagus
5244
3061 (58.4)
1188 (22.7)
360 (6.9)
206 (3.9)
463 (8.8)
738 (14.1)
785 (15.0)
66 (1.3)
(3) Abdominal esophagus
499
236 (47.3)
93 (18.6)
21 (4.2)
11 (2.2)
43 (8.6)
65 (13.0)
29 (5.8)
4 (0.8)
Total
5915
3402 (57.5)
1330 (22.5)
394 (6.7)
222 (3.8)
517 (8.7)
820 (13.9)
828 (14.0)
73 (1.2)
Tumor depth
(A) Superficial cancer (T1)
(1) Transhiatal esophagectomy
15
10
(66.7)
7 (46.7)
2 (13.3)
2 (13.3)
3 (20.0)
5 (33.3)
1 (6.7)
0
(2) Mediastinoscopic esophagectomy and reconstruction
90
54
(60.0)
20 (22.2)
7 (7.8)
2 (2.2)
8 (8.9)
18 (20.0)
22 (24.4)
0
(3) Transthoracic (rt.) esophagectomy and reconstruction
1908
1100
(57.7)
421 (22.1)
129 (6.8)
75 (3.9)
171 (9.0)
294 (15.4)
274 (14.4)
29 (1.5)
(4) Transthoracic (lt.) esophagectomy and reconstruction
43
19
(44.2)
9 (20.9)
2 (4.7)
1 (2.3)
4 (9.3)
5 (11.6)
1 (2.3)
0
(5) Cervical esophageal resection and reconstruction
19
15
(78.9)
3 (15.8)
1 (5.3)
0
1 (5.3)
2 (10.5)
3 (15.8)
0
(6) Robot-assisted esophagectomy and reconstruction
172
99 (57.6)
35 (20.3)
6 (3.5)
2 (1.2)
13 (7.6)
25 (14.5)
25 (14.5)
1 (0.6)
(7) Others
58
30 (51.7)
9 (15.5)
0
0
5 (8.6)
11 (19.0)
0
0
(8) Esophagectomy without reconstruction
233
32 (13.7)
10 (4.3)
0
0
0
0
0
0
Subtotal
2538
1359 (53.5)
514 (20.3)
147 (5.8)
82 (3.2)
205 (8.1)
360 (14.2)
326 (12.8)
30 (1.2)
(B) Advanced cancer (T2–T4)
(1) Transhiatal esophagectomy
32
18 (56.3)
9 (28.1)
0
4 (12.5)
4 (12.5)
6 (18.8)
2 (6.3)
0
(2) Mediastinoscopic esophagectomy and reconstruction
83
55 (66.3)
21 (25.3)
4 (4.8)
2 (2.4)
6 (7.2)
16 (19.3)
20 (24.1)
0
(3) Transthoracic (rt.) esophagectomy and reconstruction
3045
1749 (57.4)
696 (22.9)
221 (7.3)
121 (4.0)
266 (8.7)
386 (12.7)
422 (13.9)
38 (1.2)
(4) Transthoracic (lt.) esophagectomy and reconstruction
94
51 (54.3)
23 (24.5)
4 (4.3)
6 (6.4)
9 (9.6)
10 (10.6)
7 (7.4)
0
(5) Cervical esophageal resection and reconstruction
66
41 (62.1)
15 (22.7)
9 (13.6)
3 (4.5)
1 (1.5)
4 (6.1)
7 (10.6)
0
(6) Robot-assisted esophagectomy and reconstruction
156
87 (55.8)
25 (16.0)
6 (3.8)
2 (1.3)
7 (4.5)
17 (10.9)
36 (23.1)
0
(7) Others
92
45 (48.9)
19 (20.7)
0
0
11 (12.0)
13 (14.1)
4 (4.3)
2 (2.2)
(8) Esophagectomy without reconstruction
150
77 (51.3)
38 (25.3)
1 (0.7)
0
2 (1.3)
0
0
1 (0.7)
Subtotal
3718
2123 (57.1)
846 (22.8)
245 (6.6)
138 (3.7)
306 (8.2)
452 (12.2)
498 (13.4)
41 (1.1)
Total
6256
3482 (55.7)
1360 (21.7)
392 (6.3)
220 (3.5)
511 (8.2)
812 (13.0)
824 (13.2)
71 (1.1)
Cases
Nonsurgical complications
Readmission within 30 days
Reoperation within 30 days
Pneumonia
Unplanned intubation
prolonged ventilation>48h
pulmonary embolism
atelectasis
Renal failure
CNS events
Cardiac events
Septic shock
Location
(1) Cervical esophagus
172
16 (9.3)
12 (7.0)
18 (10.5)
5 (2.9)
7 (4.1)
3 (1.7)
1 (0.6)
3 (1.7)
3 (1.7)
3 (1.7)
17 (9.9)
(2) Thoracic esophagus
5244
798 (15.2)
269 (5.1)
337 (6.4)
38 (0.7)
302 (5.8)
27 (0.5)
27 (0.5)
20 (0.4)
38 (0.7)
134 (2.6)
333 (6.4)
(3) Abdominal esophagus
499
56 (11.2)
17 (3.4)
22 (4.4)
2 (0.4)
33 (6.6)
3 (0.6)
2 (0.4)
1 (0.2)
6 (1.2)
16 (3.2)
29 (5.8)
Total
5915
870 (14.7)
298 (5.0)
377 (6.4)
45 (0.8)
342 (5.8)
33 (0.6)
30 (0.5)
24 (0.4)
47 (0.8)
153 (2.6)
379 (6.4)
Tumor depth
(A) Superficial cancer (T1)
(1) Transhiatal esophagectomy
15
5 (33.3)
0
0
0
2 (13.3)
0
0
0
1 (6.7)
1 (6.7)
3 (20.0)
(2) Mediastinoscopic esophagectomy and reconstruction
90
10 (11.1)
6 (6.7)
8 (8.9)
0
3 (3.3)
1 (1.1)
0
1 (1.1)
1 (1.1)
2 (2.2)
5 (5.6)
(3) Transthoracic (rt.) esophagectomy and reconstruction
1908
281 (14.7)
84 (4.4)
105 (5.5)
20 (1.0)
97 (5.1)
10 (0.5)
9 (0.5)
6 (0.3)
13 (0.7)
44 (2.3)
123 (6.4)
(4) Transthoracic (lt.) esophagectomy and reconstruction
43
4 (9.3)
2 (4.7)
3 (7.0)
0
3 (7.0)
0
0
0
0
1 (2.3)
2 (4.7)
(5) Cervical esophageal resection and reconstruction
19
3 (15.8)
1 (5.3)
1 (5.3)
0
2 (10.5)
0
1 (5.3)
0
0
0
1 (5.3)
(6) Robot-assisted esophagectomy and reconstruction
172
21 (12.2)
5 (2.9)
9 (5.2)
3 (1.7)
3 (1.7)
3 (1.7)
2 (1.2)
0
0
3 (1.7)
3 (1.7)
(7) Others
58
7 (12.1)
1 (1.7)
1 (1.7)
1 (1.7)
5 (8.6)
0
0
0
0
2 (3.4)
4 (6.9)
(8) Esophagectomy without reconstruction
233
0
0
0
0
0
0
0
0
0
4 (1.7)
0
Subtotal
2538
331 (13.0)
99 (3.9)
127 (5.0)
24 (0.9)
115 (4.5)
14 (0.6)
12 (0.5)
7 (0.3)
15 (0.6)
57 (2.2)
141 (5.6)
(B) Advanced cancer (T2–T4)
(1) Transhiatal esophagectomy
32
1 (3.1)
1 (3.1)
3 (9.4)
0
1 (3.1)
0
0
1 (3.1)
0
0
3 (9.4)
(2) Mediastinoscopic esophagectomy and reconstruction
83
7 (8.4)
3 (3.6)
6 (7.2)
1 (1.2)
2 (2.4)
1 (1.2)
0
1 (1.2)
1 (1.2)
1 (1.2)
5 (6.0)
(3) Transthoracic (rt.) esophagectomy and reconstruction
3045
474 (15.6)
177 (5.8)
213 (7.0)
15 (0.5)
200 (6.6)
15 (0.5)
14 (0.5)
13 (0.4)
26 (0.9)
89 (2.9)
202 (6.6)
(4) Transthoracic (lt.) esophagectomy and reconstruction
94
15 (16.0)
4 (4.3)
6 (6.4)
2 (2.1)
6 (6.4)
1 (1.1)
2 (2.1)
0
0
5 (5.3)
6 (6.4)
(5) Cervical esophageal resection and reconstruction
66
6 (9.1)
4 (6.1)
3 (4.5)
1 (1.5)
0
0
1 (1.5)
1 (1.5)
0
0
5 (7.6)
(6) Robot-assisted esophagectomy and reconstruction
156
19 (12.2)
5 (3.2)
7 (4.5)
2 (1.3)
7 (4.5)
0
0
1 (0.6)
0
3 (1.9)
6 (3.8)
(7) Others
92
8 (8.7)
3 (3.3)
6 (6.5)
0
9 (9.8)
0
0
0
1 (1.1)
3 (3.3)
6 (6.5)
(8) Esophagectomy without reconstruction
150
3 (2.0)
2 (1.3)
3 (2.0)
0
1 (0.7)
0
1 (0.7)
0
2 (1.3)
6 (4.0)
3 (2.0)
Subtotal
3718
533 (14.3)
199 (5.4)
247 (6.6)
21 (0.6)
226 (6.1)
17 (0.5)
18 (0.5)
17 (0.5)
30 (0.8)
107 (2.9)
236 (6.3)
Total
6256
864 (13.8)
298 (4.8)
374 (6.0)
45 (0.7)
341 (5.5)
31 (0.5)
30 (0.5)
24 (0.4)
45 (0.7)
164 (2.6)
377 (6.0)
Among esophagectomy procedures, transthoracic esophagectomy via right thoracotomy or right thoracoscopy was most commonly adopted for patients with a superficial cancer (1908/2538, 75.2%) and advanced cancer (3045/3718, 81.9%) (Table 36). Transhiatal esophagectomy, which is commonly performed in Western countries, was adopted in only 15 (0.6%) and 32 (0.9%) patients with superficial and advanced cancer who underwent esophagectomy in Japan, respectively. Thoracoscopic and/or laparoscopic esophagectomy was utilized in 1832 (72.2%) and 2311 (62.2%) patients with superficial and advanced cancer, respectively. The number of patients who underwent thoracoscopic and/or laparoscopic surgery for superficial or advanced cancer has been increasing, whereas that of open surgery, especially for advanced cancer, has been decreasing annually (Fig. 4). Mediastinoscopic and robot-assisted esophagectomy and reconstruction were performed for 173 and 328 patients in 2018, respectively. The 30-day and hospital mortality rates following thoracoscopic and/or laparoscopic esophagectomy were 0.5% and 0.7% for patients with superficial cancer and 0.9% and 1.4% or those with advanced cancer, respectively (Table 36).
Fig. 4
Annual trend of esophagectomy
×
Detailed data collection regarding postoperative surgical and non-surgical complications have been initiated this year (Table 36). Overall, 1360 (21.7%) of 6256 patients developed grade III or higher complications based on the Clavien–Dindo classification. Among surgical complications, anastomotic leakage and recurrent nerve palsy occurred in 13.0% and 13.2% of the patients and in approximately 20% and 24% of those who underwent mediastinoscopic esophagectomy, respectively. Among non-surgical postoperative complications, pneumonia occurred in 13.8% of the patients, 4.8% of whom underwent unplanned intubation. Mediastinoscopic esophagectomy seemed to be less likely to promote postoperative pneumonia compared to transthoracic (rt.) esophagectomy. Postoperative pulmonary embolism occurred in 0.7% of the patients.
Salvage surgery following definitive (chemo) radiotherapy was performed in 570 patients, with a 30-day and hospital mortality rate of 0.5% and 1.6%, respectively. Thoracoscopic and/or laparoscopic esophagectomy were performed in 272 (47.7%) patients, both of which had comparable mortality rates (Table 37).
Table 37
Salvage surgery
Operation (+)
Thoracoscopic and/or laparscopic procedure
EMR or ESD
Cases
Hospital mortality
Cases
Conversion to thoracotomy
Hospital mortality
~ 30 days
31–90 days
Total (including after 91days mortality)
~ 30 days
31–90days
Total (including after 91days mortality)
Salvage surgery
570
3 (0.5)
6 (1.1)
9 (1.6)
272
4 (1.5)
1 (0.4)
3 (1.1)
4 (1.5)
245
We aim to continue our efforts in collecting comprehensive survey data through more active collaboration with the Japan Esophageal Society and other related institutions.
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.
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Prof. Dr. med. Gregor Antoniadis 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.
Dr. med. Benjamin Meyknecht, PD Dr. med. Oliver Pieske Das Webinar S2e-Leitlinie „Distale Radiusfraktur“ 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?
Dr. med. Mihailo Andric 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.
