Morihito Okada and Akira Tangoku have equally contributed to this work.
Publisher's Note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
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, based on surgical category. Herein, we summarize the results of the association’s annual survey of thoracic surgery performed in 2017.
Adhering to the norm to date, thoracic surgery was classified into three categories: cardiovascular, general thoracic, and esophageal surgeries. Patient data were examined and analyzed for each group. Access to computerized data is available to all members of the 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
740
678
91.6
(C) Esophageal surgery
568
523
92.1
Table 2
Categories subclassified according to the number of operations performed
Category
Number of operations performed
General thoracic surgery
0
6
1–24
28
25–49
72
50–99
167
100–149
129
150–199
100
≥ 200
176
Total
678
Number of operations performed
Esophageal surgery
0
76
1–4
114
5–9
96
10–19
98
20–29
47
30–39
26
40–49
21
≥ 50
45
Total
523
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 progress for improving operative results by enabling them to compare their work with that of others. In this way, the association has been able to gain a better understanding of present problems and future prospects, which is reflected in its activities and the education of its members.
Thirty-day mortality (so-called operative mortality) is defined as death within 30 days of surgery, regardless of the patient’s geographic location, including after the patient is discharged from hospital. Hospital mortality is defined as death within any time interval following surgery if the patient has not been discharged from hospital.
Hospital-to-hospital transfer in the category of 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 because of complications from surgery. Contrastingly, hospital-to-hospital transfer 30 days following surgery in the categories of cardiovascular and general thoracic surgery is considered discharge, as data related to the National Clinical Database (NCD 2017) were employed in this category, and hospital-to-hospital transfer 30 days following surgery is considered discharge according to the NCD.
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. The reason for this was that NCD information regarding esophageal surgery does not include non-surgical cases (i.e., patients with adjuvant chemotherapy or radiation only).
Anzeige
Because of changes in data collection related to cardiovascular surgery (initially self-reported using questionnaire sheets in each participating institution up to 2014, then by downloading an automatic package from the Japanese Cardiovascular Surgery Database (JCVSD), a cardiovascular sub-section of the NCD), the response rate is not available and is, 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).
Final report: 2017
(A) Cardiovascular surgery
We are extremely pleased with the cooperation of our colleagues (members) in terms of completing the cardiovascular surgery survey, thereby undoubtedly improving the quality of this annual report. We are truly grateful for the significant efforts made by all within each participating institution in completing the JCVSD/NCD.
Figure 1 illustrates the development of cardiovascular surgery in Japan over the past 30 years. Aneurysm surgery includes only surgeries for thoracic and thoracoabdominal aortic aneurysms. Extra-anatomic bypass surgery for thoracic aneurysm and pacemaker implantation has been excluded from the survey since 2015. The number of assist device implantation surgeries is not included in the total number of surgical procedures but was nonetheless included in the survey.
A total of 70,078 cardiovascular surgeries including 56 heart transplants were performed in 2017, an increase of 3.3% compared with that in the 2016 survey results (n = 67,867). The number of cardiovascular surgeries is continuously increasing, despite an apparent decrease in 2015, likely due to major changes in data collection and aggregation approaches.
When compared with data for 2016 [1] and 2007 [2], the number of surgeries in 2017 for congenital heart disease increased by 7.1% (9368 vs. 8744) and 0.2%, respectively; procedures for valvular heart disease increased by 0.2% (23,312 vs. 23,254) and 53.2%, respectively; surgery for thoracic aortic aneurysm increased by 8.7% (20,746 vs. 19,078) and 114.6%, respectively; ischemic heart procedures decreased by 6.6% (13,898 vs. 14,874) and 23.6%, respectively. Data for individual categories are summarized in Tables 3, 4, 5, 6, 7, and 8.
Table 3
Congenital (total; 9368)
(1) CPB (+) (total; 7072)
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
4
0
0
0
0
0
0
0
14
0
0
0
19
0
0
0
Coarctation (simple)
7
0
0
0
11
0
0
0
13
0
0
0
4
0
0
0
35
0
0
0
+VSD
49
0
0
1 (2.0)
51
2 (3.9)
0
3 (5.9)
13
0
0
0
0
0
0
0
113
2 (1.8)
0
4 (3.5)
+DORV
2
0
0
0
1
0
0
0
0
0
0
0
0
0
0
0
3
0
0
0
+AVSD
2
0
0
1 (50.0)
3
0
0
0
1
0
0
0
0
0
0
0
6
0
0
1 (16.7)
+TGA
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
+SV
2
0
0
0
0
0
0
0
1
0
0
0
0
0
0
0
3
0
0
0
+Others
5
0
0
0
7
0
0
0
8
0
0
0
2
0
0
0
22
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
27
0
0
1 (3.7)
23
0
0
1 (4.3)
12
0
0
0
0
0
0
0
62
0
0
2 (3.2)
+DORV
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
+Truncus
4
0
0
0
2
0
0
0
5
0
0
0
0
0
0
0
11
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
1
0
0
0
2
0
0
0
2
0
0
0
0
0
0
0
5
0
0
0
Vascular ring
1
0
0
0
1
0
0
0
0
0
0
0
0
0
0
0
2
0
0
0
PS
5
0
0
0
25
0
0
0
77
1 (1.3)
0
1 (1.3)
26
0
0
0
133
1 (0.8)
0
1 (0.8)
PA・IVS or critical PS
15
1 (6.7)
0
1 (6.7)
66
0
0
2 (3.0)
48
0
0
1 (2.1)
2
0
0
0
131
1 (0.8)
0
4 (3.1)
TAPVR
112
6 (5.4)
0
9 (8.0)
59
1 (1.7)
0
3 (5.1)
17
0
0
1 (5.9)
1
0
0
0
189
7 (3.7)
0
13 (6.9)
PAPVR ± ASD
0
0
0
0
5
0
0
0
38
0
0
0
22
0
0
0
65
0
0
0
ASD
1
0
0
0
73
0
0
0
583
0
0
0
761
7 (0.9)
0
7 (0.9)
1418
7 (3.7)
0
7 (0.5)
Cor triatriatum
1
0
0
0
8
0
0
0
6
0
0
0
4
0
0
0
19
0
0
0
AVSD (partial)
1
0
0
0
7
0
0
1 (14.3)
42
0
0
0
6
0
0
0
56
0
0
1 (1.8)
AVSD (complete)
8
0
0
0
117
3 (2.6)
0
4 (3.4)
94
2 (2.1)
0
2 (2.1)
3
0
0
0
222
5 (2.3)
0
6 (2.7)
+TOF or DORV
2
1 (50.0)
0
1 (50.0)
9
0
0
0
14
1 (7.1)
0
1 z(7.1)
0
0
0
0
25
2 (8.0)
0
2 (8.0)
+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
106
0
0
0
142
0
0
0
14
0
0
0
265
0
0
0
VSD (perimemb./muscular)
17
0
0
0
729
1 (0.1)
0
1 (0.1)
325
0
0
1 (0.3)
21
0
0
0
1092
1 (0.1)
0
2 (0.2)
VSD (type unknown)
0
0
0
0
5
3
0
123
2 (1.6)
0
2 (1.6)
131
2 (1.5)
0
2 (1.5)
VSD + PS
0
0
0
0
32
0
1 (3.1)
0
21
0
0
0
1
0
0
0
54
0
1 (1.9)
0
DCRV ± VSD
1
0
0
0
5
0
0
0
20
0
0
0
11
0
0
0
37
0
0
0
Aneurysm of sinus of Valsalva
0
0
0
0
0
0
0
0
2
0
0
0
3
0
0
0
5
0
0
0
TOF
13
0
0
0
174
2 (1.1)
0
3 (1.7)
212
1 (0.5)
0
1 (0.5)
37
0
0
0
436
3 (0.7)
0
4 (0.9)
PA + VSD
9
1 (11.1)
0
1 (11.1)
76
0
0
2 (2.6)
108
1 (0.9)
0
3 (2.8)
15
0
0
0
208
2 (1.0)
0
6 (2.9)
DORV
24
1 (4.2)
0
2 (8.3)
142
0
0
3 (2.1)
160
0
0
0
11
0
0
0
337
1 (0.3)
0
5 (1.5)
TGA (simple)
97
1 (1.0)
0
4 (4.1)
9
1 (11.1)
0
1 (11.1)
3
0
0
0
2
0
0
0
111
2 (1.8)
0
5 (4.5)
+VSD
40
1 (2.5)
0
1 (2.5)
16
0
0
0
9
0
0
0
2
0
0
0
67
1 (1.5)
0
1 (1.5)
VSD + PS
0
0
0
0
0
0
0
0
2
0
0
0
1
0
0
0
3
0
0
0
Corrected TGA
2
0
0
0
17
0
0
0
33
1 (3.0)
0
1 (3.0)
16
0
0
0
68
1 (1.5)
0
1 (1.5)
Truncus arteriosus
13
0
0
1 (7.7)
17
1 (5.9)
0
1 (5.9)
16
0
0
0
0
0
0
0
46
1 (2.2)
0
2 (4.3)
SV
27
0
0
2 (7.4)
151
2 (1.3)
1 (0.7)
7 (4.6)
213
0
0
0
12
0
0
0
403
2 (0.5)
1 (0.2)
9 (2.2)
TA
5
0
0
0
39
0
0
1 (2.6)
47
0
0
1 (2.1)
6
1 (16.7)
0
1 (16.7)
97
1 (1.0)
0
3 (3.1)
HLHS
33
6 (18.2)
0
11 (33.3)
80
0
0
3 (3.8)
104
3 (2.9)
0
5 (4.8)
0
0
0
0
217
9 (4.1)
0
19 (8.8)
Aortic valve lesion
11
1 (9.1)
0
2 (18.2)
18
1 (5.6)
0
2 (11.1)
104
0
0
1 (1.0)
30
2 (6.7)
0
2 (6.7)
163
4 (2.5)
0
7 (4.3)
Mitral valve lesion
0
0
0
0
43
0
0
1 (2.3)
70
0
0
1 (1.4)
19
2 (10.5)
0
2 (10.5)
132
2 (1.5)
0
4 (3.0)
Ebstein
12
4 (33.3)
0
4 (33.3)
9
0
0
0
23
0
0
0
7
0
0
0
51
4 (7.8)
0
4 (7.8)
Coronary disease
2
0
0
0
10
0
0
0
18
0
0
0
1
0
0
0
31
0
0
0
Others
13
2 (15.4)
0
2 (15.4)
27
1 (3.7)
0
3 (11.1)
49
0
0
1 (2.0)
232
1 (0.4)
0
1 (0.4)
321
4 (1.2)
0
7 (2.2)
Conduit failure
0
0
0
0
2
0
0
0
19
1 (5.3)
0
1 (5.3)
7
0
0
0
28
1 (3.6)
0
1 (3.6)
Redo (excluding conduit failure)
0
0
0
0
41
0
0
2 (4.9)
106
2 (1.9)
0
5 (4.7)
83
2 (2.4)
0
3 (3.6)
230
4 (1.7)
0
10 (4.3)
Total
568
25 (4.4)
0
44 (7.7)
2222
15 (0.7)
2 (0.09)
44 (2.0)
2783
13 (0.5)
0
27 (1.0)
1499
17 (1.1)
0
18 (1.2)
7072
70 (1.0)
2 (0.0)
133 (1.9)
( ), % mortality
CPB cardiopulmonary bypass, PDA patent ductus arteriosus, VSD ventricular septal defect, DORV double-outlet right ventricle, AVSD atrioventricular septal defect, TGA transposition of 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; 2296)
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
325
11 (3.4)
0
14 (4.3)
164
0
0
4 (2.4)
24
0
0
0
1
0
0
0
514
11 (2.1)
0
18 (3.5)
Coarctation (simple)
23
0
0
0
15
0
0
0
9
0
0
0
0
0
0
0
47
0
0
0
+ VSD
39
2 (5.1)
0
3 (7.7)
18
1 (5.6)
0
2 (11.1)
1
0
0
0
0
0
0
0
58
3 (5.2)
0
5 (8.6)
+ DORV
2
0
0
0
1
0
0
0
0
0
0
0
0
0
0
0
3
0
0
0
+ AVSD
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
+ SV
0
0
0
0
1
0
0
0
0
0
0
0
0
0
0
0
1
0
0
0
+ Others
8
0
0
0
9
0
0
1 (11.1)
2
0
0
0
0
0
0
0
19
0
0
1 (5.3)
Interrupt. of Ao (simple)
2
0
0
1 (50.0)
0
0
0
0
0
0
0
0
0
0
0
0
2
0
0
1 (50.0)
+ VSD
31
1 (3.2)
0
2 (6.5)
11
0
0
0
2
0
0
0
0
0
0
0
44
1 (2.3)
0
2 (4.5)
+ DORV
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
+ Truncus
2
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
2
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
1
0
0
0
1
0
0
0
4
0
0
0
Vascular ring
1
0
0
0
10
0
0
0
6
0
0
0
1
0
0
0
18
0
0
0
PS
3
0
0
0
9
0
0
0
4
0
0
0
0
0
0
0
16
0
0
0
PA・IVS or critical PS
33
1 (3.0)
0
1 (3.0)
26
0
0
0
3
0
0
0
3
0
0
0
65
1 (1.5)
0
1 (1.5)
TAPVR
22
2 (9.1)
0
4 (18.2)
12
0
0
1 (8.3)
1
0
0
0
0
0
0
0
35
2 (5.7)
0
5 (14.3)
PAPVR ± ASD
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
ASD
0
0
0
0
2
0
0
0
1
0
0
0
1
0
0
0
4
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)
0
0
0
0
0
0
0
0
1
0
0
0
1
0
0
0
2
0
0
0
AVSD (complete)
51
0
0
2 (3.9)
84
3 (3.6)
0
4 (4.8)
16
0
0
0
1
0
0
0
152
3 (2.0)
0
6 (3.9)
+ TOF or DORV
1
0
0
0
9
0
0
0
0
0
0
0
0
0
0
0
10
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)
2
0
0
0
6
0
0
0
1
0
0
0
0
0
0
0
9
0
0
0
VSD (perimemb./muscular)
67
2 (3.0)
0
2 (3.0)
129
2 (1.6)
0
3 (2.3)
7
0
0
0
1
0
0
0
204
4 (2.0)
0
5 (2.5)
VSD (Type Unknown)
0
0
0
0
0
0
0
0
0
1
0
0
1
0
0
0
VSD + PS
1
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
1
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
79
1 (1.3)
0
2 (2.5)
9
1 (11.1)
0
1 (11.1)
1
0
0
0
108
2 (1.9)
0
3 (2.8)
PA + VSD
20
2 (10.0)
0
3 (15.0)
52
0
0
1 (1.9)
23
0
0
1 (4.3)
0
0
0
0
95
2 (2.1)
0
5 (5.3)
DORV
46
0
0
3 (6.5)
85
1 (1.2)
0
1 (1.2)
19
1 (5.3)
0
1 (5.3)
1
0
0
0
151
2 (1.3)
0
5 (3.3)
TGA (simple)
6
0
0
0
4
0
0
0
1
0
0
0
0
0
0
0
11
0
0
0
+ VSD
12
0
0
0
8
0
0
0
1
0
0
0
1
0
0
0
22
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
7
0
0
0
10
0
0
0
15
1 (6.7)
0
1 (6.7)
3
1 (33.3)
0
1 (33.3)
35
2 (5.7)
0
2 (5.7)
Truncus arteriosus
18
1 (5.6)
0
2 (11.1)
9
0
0
0
1
0
0
0
0
0
0
0
28
1 (3.6)
0
2 (7.1)
SV
50
2 (4.0)
0
4 (8.0)
53
3 (5.7)
0
3 (5.7)
20
0
0
0
5
0
0
1 (20.0)
128
5 (3.9)
0
8 (6.3)
TA
23
0
0
2 (8.7)
15
0
0
0
3
0
0
0
3
0
0
0
44
0
0
2 (4.5)
HLHS
66
4 (6.1)
0
17 (25.8)
22
0
0
0
21
1 (4.8)
0
4 (19.0)
0
0
0
0
109
5 (4.6)
0
21 (19.3)
Aortic valve lesion
8
1 (12.5)
0
2 (25.0)
1
0
0
0
0
0
0
0
0
0
0
0
9
1 (11.1)
0
2 (22.2)
Mitral valve lesion
3
1 (33.3)
0
1 (33.3)
1
0
0
0
2
0
0
0
7
0
0
0
13
1 (7.7)
0
1 (7.7)
Ebstein
8
0
0
4 (50.0)
2
0
0
0
4
0
0
0
0
0
0
0
14
0
0
4 (28.6)
Coronary disease
1
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
1
0
0
0
Others
13
1 (7.7)
0
1 (7.7)
14
0
0
3 (21.4)
15
2 (13.3)
0
3 (20.0)
10
0
0
0
52
3 (5.8)
0
7 (13.5)
Conduit failure
0
0
0
0
3
0
0
0
0
0
0
0
0
0
0
0
3
0
0
0
Redo (excluding conduit failure)
16
1 (6.3)
0
2 (12.5)
91
2 (2.2)
0
6 (6.6)
117
1 (0.9)
0
2 (1.7)
35
1 (2.9)
0
2 (5.7)
259
5 (1.9)
0
12 (4.6)
Total
932
32 (3.4)
0
70 (7.5)
957
13 (1.4)
0
31 (3.2)
330
7 (2.1)
0
13 (3.9)
77
2 (2.6)
0
4 (5.2)
2296
54 (2.4)
0
118 (5.1)
( ), % mortality
CPB cardiopulmonary bypass, PDA patent ductus arteriosus, VSD ventricular septal defect, DORV double-outlet right ventricle, AVSD atrioventricular septal defect, TGA transposition of 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
169
5 (3.0)
0
12 (7.1)
356
1 (0.3)
0
6 (1.7)
55
0
0
1 (1.8)
1
0
0
0
581
6 (1.0)
0
19 (3.3)
2
PAB
308
3 (1.0)
0
14 (4.5)
311
4 (1.3)
0
9 (2.9)
15
1 (6.7)
0
1 (6.7)
1
0
0
0
635
8 (1.3)
0
24 (3.8)
3
Bidirectional Glenn or hemi-Fontan ±α
1
0
0
0
240
0
0
3 (1.3)
103
1 (1.0)
0
1 (1.0)
6
0
0
0
350
1 (0.3)
0
4 (1.1)
4
Damus–Kaye–Stansel operation
3
1 (33.3)
0
1 (33.3)
21
1 (4.8)
0
1 (4.8)
4
0
0
0
0
0
0
0
28
2 (7.1)
0
2 (7.1)
5
PA reconstruction/repair (including redo)
19
1 (5.3)
0
2 (10.5)
190
4 (2.1)
0
7 (3.7)
180
1 (0.6)
0
3 (1.7)
17
0
0
0
406
6 (1.5)
0
12 (3.0)
6
RVOT reconstruction/repair
6
0
0
0
200
1 (0.5)
1 (0.5)
2 (1.0)
338
1 (0.3)
0
1 (0.3)
39
0
0
0
583
2 (0.3)
1 (0.2)
3 (0.5)
7
Rastelli procedure
3
0
0
0
31
0
0
0
96
1 (1.0)
0
2 (2.1)
5
0
0
0
135
1 (0.7)
0
2 (1.5)
8
Arterial switch procedure
143
3 (2.1)
0
7 (4.9)
22
0
0
0
5
0
0
0
0
0
0
0
170
3 (1.8)
0
7 (4.1)
9
Atrial switch procedure
0
0
0
0
1
0
0
0
7
1 (14.3)
0
1 (14.3)
0
0
0
0
8
1 (12.5)
0
1 (12.5)
10
Double-switch procedure
0
0
0
0
1
0
0
0
12
0
0
0
0
0
0
0
13
0
0
0
11
Repair of anomalous origin of CA
0
0
0
0
4
0
0
0
3
0
0
0
0
0
0
0
7
0
0
0
12
Closure of coronary AV fistula
3
0
0
0
1
0
0
0
6
0
0
0
2
0
0
0
12
0
0
0
13
Fontan/TCPC
0
0
0
0
1
0
0
0
401
2 (0.5)
0
4 (1.0)
27
2 (7.4)
0
2 (7.4)
429
4 (0.9)
0
6 (1.4)
14
Norwood procedure
34
5 (14.7)
0
8 (23.5)
70
1 (1.4)
0
5 (7.1)
4
0
0
0
0
0
0
0
108
6 (5.6)
0
13 (12.0)
15
Ventricular septation
0
0
0
0
1
0
0
0
0
0
0
0
0
0
0
0
1
0
0
0
16
Left-side AV valve repair (including redo)
0
0
0
0
46
0
0
1 (2.2)
77
1 (1.3)
0
2 (2.6)
15
0
0
0
138
1 (0.7)
0
3 (2.2)
17
Left-side AV valve replace (including redo)
0
0
0
0
8
0
0
1 (12.5)
33
1 (3.0)
0
1 (3.0)
13
1 (7.7)
0
1 (7.7)
54
2 (3.7)
0
3 (5.6)
18
Right-side AV valve repair (including redo)
19
6 (31.6)
0
6 (31.6)
82
1 (1.2)
0
2 (2.4)
85
1 (1.2)
0
2 (2.4)
72
0
0
0
258
8 (3.1)
0
10 (3.9)
19
Right-side AV valve replace (including redo)
0
0
0
0
2
0
0
0
12
0
0
0
36
1 (2.8)
0
1 (2.8)
50
1 (2.0)
0
1 (2.0)
20
Common AV valve repair (including redo)
4
1 (25.0)
0
1 (25.0)
20
2 (10.0)
1 (5.0)
3 (15.0)
5
0
0
0
3
0
0
0
32
3 (9.4)
1 (3.1)
4 (12.5)
21
Common AV valve replace (including redo)
0
0
0
0
4
0
0
0
8
0
0
1 (12.5)
1
0
0
0
13
0
0
1 (7.7)
22
Repair of supra-aortic stenosis
0
0
0
0
10
0
0
1 (10.0)
19
0
0
1 (5.3)
2
0
0
0
31
0
0
2 (6.5)
23
Repair of subaortic stenosis (including redo)
1
0
0
0
6
0
0
0
32
0
0
0
1
0
0
0
40
0
0
0
24
Aortic valve plasty ± VSD closure
5
0
0
0
10
0
0
0
37
1 (2.7)
0
1 (2.7)
2
0
0
0
54
1 (1.9)
0
1 (1.9)
25
Aortic valve replacement
1
0
0
0
0
0
0
0
27
1 (3.7)
0
2 (7.4)
30
0
0
0
58
1 (1.7)
0
2 (3.4)
26
AVR with annular enlargement
0
0
0
0
0
0
0
0
9
0
0
0
0
0
0
0
9
0
0
0
27
Aortic root replace (except Ross)
0
0
0
0
0
0
0
0
9
0
0
0
7
1 (14.3)
0
1 (14.3)
16
1 (6.3)
0
1 (6.3)
28
Ross procedure
1
0
0
0
2
0
0
0
17
0
0
0
20
0
0
0
29
Bilateral pulmonary artery banding
143
9 (6.3)
0
28 (19.6)
9
0
0
1 (11.1)
0
0
0
0
0
152
9 (5.9)
0
29 (19.1)
Total
863
34 (3.9)
0
79 (9.2)
1,649
15 (0.9)
2 (0.1)
42 (2.5)
1,599
13 (0.8)
0
24 (1.5)
280
5 (1.8)
0
5 (1.8)
4,391
67 (1.5)
2 (0.05)
150 (3.4)
( ), % 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
34
0
0
0
6
0
0
0 (0.0)
0
0
0
0
0
0
0
0
Converted to beating
131
5 (3.8)
0
9 (6.9)
45
6 (13.3)
0
6 (13.3)
1
0
0
0
1
0
0
0
Total
165
5 (3.0)
0
9 (5.5)
51
6 (11.8)
0
6 (11.8)
1
0
0
0
1
0
0
0
On dialysis
31
1 (3.2)
0
3 (9.7)
9
4 (44.4)
0
4 (44.4)
0
0
0
0
0
0
0
0
( ), % mortality
CABG coronary artery bypass grafting
(B) Operation for complications of MI (total; 1269)
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
122
7 (5.7)
0
8 (6.6)
24
5 (20.8)
0
7 (29.2)
87
22
10
VSP closure
66
10 (15.2)
0
13 (19.7)
242
60 (24.8)
0
81 (33.5)
86
2
3
Cardiac rupture
28
7 (25.0)
1 (3.6)
10 (35.7)
221
64 (29.0)
0
86 (38.9)
35
2
5
Mitral regurgitation
1) Papillary muscle rupture
21
1 (4.8)
0
1 (4.8)
47
14 (29.8)
0
17 (36.2)
28
15
53
2) Ischemic
295
15 (5.1)
0
29 (9.8)
36
10 (27.8)
1 (2.8)
14 (38.9)
235
193
138
Others
80
3 (3.8)
0
4 (5.0)
87
20 (23.0)
0
30 (34.5)
58
10
6
Total
612
43 (7.0)
1 (0.2)
65 (10.6)
657
173 (26.3)
1 (0.2)
235 (35.8)
529
244
215
( ), % mortality
Acute, within 2 weeks from the onset of myocardial infarction
Except for 153 isolated cases, all remaining 4913 cases are doubly allocated, one for this subgroup and the other for the subgroup corresponding to the concomitant operations
In 2017, among 9368 procedures for congenital heart disease, 7072 open-heart surgeries were performed with an overall hospital mortality of 1.9%. Compared with data for 2007, the number of surgeries for neonates and infants has not changed significantly; however, hospital mortality decreased significantly from 13.7 to 7.7% for neonates and from 3.9 to 2.0% for infants. In 2017, atrial septal defect was once again the most common disease (1418 cases) for the first time in 3 years. This was primarily due to a doubling in the number of surgeries for patients above the age of 18 years (from 372 to 761 cases). Ventricular septal defect (perimemb/muscular) was the second most common health issue (1092 cases) and had previously been the most common disease in 2015 and 2016. In the past 10 years, hospital mortality for complex congenital heart disease was as follows (2007 [2], 2012 [3], and 2017): complete atrioventricular septal defect (4.3%, 3.2%, and 2.7%, respectively), tetralogy of Fallot (1.4%, 1.1%, and 0.9%, respectively), transposition of the great arteries with intact septum (2.7%, 2.6%, and 4.5%, respectively) and with ventricular septal defect (5.6%, 3.2%, and 1.5%, respectively), and single ventricle (5.4%, 5.5%, and 2.2%, respectively) and hypoplastic left heart syndrome (20.1%, 10.2%, and 8.8%, respectively). Right heart bypass surgery is now commonly performed (350 bidirectional Glenn procedures excluding 28 Damus–Kaye–Stansel procedures and 429 Fontan type procedures including total cavopulmonary connection) at an acceptable hospital mortality rate (1.1% and 1.4%). The Norwood type I procedure was performed in 108 cases, with a relatively low hospital mortality rate of 12.0% (Table 9).
Table 9
Total cases of general thoracic surgery during 2017
Cases
%
Benign pulmonary tumor
2197
2.6
Primary lung cancer
44,140
51.7
Other primary malignant pulmonary tumor
423
0.5
Metastatic pulmonary tumor
8950
10.5
Tracheal tumor
120
0.1
Mesothelioma
698
0.8
Chest wall tumor
691
0.8
Mediastinal tumor
5197
6.1
Thymectomy for MG without thymoma
189
0.2
Inflammatory pulmonary disease
2423
2.8
Empyema
2962
3.5
Bullous disease excluding pneumothorax
400
0.5
Pneumothorax
14,499
17.0
Chest wall deformity
193
0.2
Diaphragmatic hernia including traumatic
28
0.0
Chest trauma excluding diaphragmatic hernia
443
0.5
Lung transplantation
68
0.1
Others
1686
2.0
Total
85,307
100.0
The total number of procedures for valvular heart disease is increasing. The number of isolated aortic valve replacement/repair with/without coronary artery bypass grafting (CABG) (n = 10,690) increased by 12.9% from the previous year (n = 9472) and by 10.3% from 5 years ago (n = 9688), despite the rapid spread of transcatheter aortic valve replacement (n = 4632 in 2017). On the other hand, the number of isolated mitral valve replacement/repair with/without CABG (n = 4687) remained stable, with a 2.4% increase from the previous year (n = 4576) and a 1.5% increase from 5 years ago (n = 4617). Aortic and mitral valve replacements with bioprosthesis procedures were performed in 10,871 cases and 2747 cases, respectively. The ratio for employing bioprosthesis increased dramatically from the 30% level in the early 2000s [4, 5] and was 83.9% and 68.7% in the aortic and mitral positions, respectively, in 2017. Additionally, CABG was performed as a concomitant procedure in 17.8% for all valvular procedures (15.7% in 2007 [2] and 18.2% in 2012 [3]). Repair of the valve was a popular procedure in mitral and tricuspid valve positions (6976 cases in the mitral and 6061 cases in the tricuspid) but is less frequently observed in aortic valve positions (405 patients, only 2.7% of all aortic valve procedures). Mitral valve repair constituted 29.9% of all valvular operations and 62.2% of all mitral valve procedures. Hospital mortality for single valve replacement was 3.1% and 5.3% for the aortic and mitral positions, respectively, whereas for mitral valve repair, this was only 1.2%. The hospital mortality for redo valve surgery was 3.4% and 5.7% in the aortic and mitral positions, respectively. Finally, overall hospital mortality did not show dramatic improvement during the past 10 years (3.8% in 2007 [2], 3.2% in 2012 [3], and 3.6% in 2017).
Isolated CABG was performed in 12,629 cases, representing only 73.0% of the number performed 10 years ago (n = 17,295) [2]. Among these, off-pump CABG was intended in 7431 cases (58.8%) at a success rate of 97.1%. The percentage of intended off-pump CABG in 2017 was less than 60% for the first time in 13 years, since 2004 [4]. Hospital mortality associated with primary elective CABG procedures in 10,283 cases was 1.6%, unchanged from 2003 (1.5%) [5]. Hospital mortality for primary emergency CABG in 2211 cases was still as high as 7.1%. The result of conversion from off-pump CABG was 2.9%, and hospital mortality in this context was 6.9%. Hospital mortality was higher in patients with end-stage renal failure on dialysis, regardless of surgical procedures (on-pump arrest, on-pump beating, and off-pump). In this report, the number of concomitant CABGs alongside other major procedures was not included in the category of ischemic heart disease but in other categories such as valvular heart disease and thoracic aortic aneurysm. Accordingly, the overall number of CABGs, including concomitant CABG with other major procedures, remained more than 18,000 cases per year (18,327 cases) in 2017.
Anzeige
Measures for arrhythmia were performed primarily as concomitant procedures in 5066 cases, with hospital mortality of 2.8%. Implantation of pacemaker and implantable cardioverter–defibrillator was not included in this category.
In 2017, 20,746 procedures were performed for thoracic and thoracoabdominal aortic diseases; 10,086 and 10,660 were for aortic dissection and non-dissection, respectively. The number of surgeries for aortic dissection increased by 6.9% this year, compared with that in the preceding year (n = 9441). The hospital mortality of procedures for 5995 Stanford type A acute aortic dissections remained as high as 11.2%. The number of procedures for non-dissected aneurysm increased by 10.6%, with overall hospital mortality of 5.5%, and 4.3% and 22.5% for unruptured and ruptured aneurysms, respectively. The rate of thoracic endovascular aortic repair (TEVAR) among all operative procedures for aortic diseases is increasing. A total of 3563 patients with aortic dissection underwent stent graft placement: 1969 TEVARs and 1594 open stent graftings, respectively. The number of TEVARs for type B chronic aortic dissections was 1505 cases and accounted for 68.3% of total cases. The hospital mortality rates associated with TEVAR for type B aortic dissection were 11.0% and 3.1% in acute and chronic cases, respectively. A total of 4656 patients with non-dissected aortic aneurysm underwent stent graft placement, comprising 3269 TEVARs (a 6.7% increase compared with that in 2016, n = 3063) and 1387 open stent graftings (a 16.2% increase compared with that in 2016, n = 1194). The hospital mortality rates for TEVARs and open stenting were as follows: TEVAR, 2.8% and 21.7% for unruptured and ruptured aneurysms, respectively, and open stent grafting, 5.1% and 28.7% for unruptured and ruptured aneurysms, respectively.
(B) General thoracic surgery
The 2017 survey of general thoracic surgery comprised 678 surgical units, with the bulk of data submitted via a web-based collection system of the NCD [1]. In total, 85,307 procedures were reported by general thoracic surgery departments in 2017, twice the number of operations in 2000 and 12,560 more than in 2012 (Fig. 2).
Fig. 2
General thoracic surgery
×
In 2017, 44,140 procedures for primary lung cancer were performed, a number that has increased annually. The 2017 value was 2.4 times that of 2000. Procedures for lung cancer represented 52% of all general thoracic surgery instances.
Anzeige
The number of video-assisted thoracoscopic surgery (VATS) instances, defined by a surgical procedure utilizing a skin incision longer than 8 cm and/or a minithoracotomy (hybrid) approach, has been noted 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 shown in Tables 10, 11, 13, 16, 17, 18, 19, 20, 21, 22, 23, 25, 26, and 27, respectively.
Table 10
Benign pulmonary tumor
Cases
30-Day mortality
Hospital mortality
By VATS
Hospital
After discharge
Benign pulmonary tumor
Hamartoma
518
0
0
0
498
Sclerosing hemangioma
76
0
0
0
73
Papilloma
23
0
0
0
21
Mucous gland adenoma bronchial
2
0
0
0
2
Fibroma
132
0
0
0
129
Lipoma
4
0
0
0
4
Neurogenic tumor
21
0
0
0
17
Clear cell tumor
3
0
0
0
3
Leiomyoma
18
0
0
0
17
Chondroma
7
0
0
0
7
Inflammatory myofibroblastic tumor
5
0
0
0
5
Pseudolymphoma
19
0
0
0
17
Histiocytosis
13
0
0
0
12
Teratoma
6
0
0
0
2
Others
1350
2 (0.1)
2 (0.1)
5 (0.4)
1264
Total
2197
2 (0.1)
2 (0.09)
5 (0.2)
2071
(), mortality %
Table 11
Primary malignant pulmonary tumor
Cases
30-Day mortality
Hospital mortality
VATS
Hospital
After discharge
Primary malignant pulmonary tumor
44,563
122 (0.3)
32 (0.1)
247 (0.6)
32,206
Lung cancer
44,140
121 (0.3)
31 (0.1)
244 (0.6)
32,206
Adenocarcinoma
31,119
52 (0.2)
13 (0.0)
91 (0.3)
Squamous cell carcinoma
8132
56 (0.7)
14 (0.2)
121 (1.5)
Large cell carcinoma
301
1 (0.3)
1 (0.3)
4 (1.3)
LCNEC
601
3 (0.5)
0
4 (0.7)
Small cell carcinoma
823
2 (0.2)
0
4 (0.5)
Adenosquamous carcinoma
571
1 (0.2)
2 (0.4)
2 (0.4)
Carcinoma with pleomorphic, sarcomatoid or sarcomatous elements
493
2 (0.4)
0
9 (1.8)
Carcinoid
233
0
0
0
Carcinomas of salivary-gland type
38
0
0
1 (2.6)
Unclassified
43
0
0
0
Multiple lung cancer
1464
3 (0.2)
1 (0.1)
6 (0.4)
Others
322
1 (0.3)
0
2 (0.6)
Wedge resection
7099
14 (0.2)
8 (0.1)
28 (0.4)
6299
Segmental excision
4685
9 (0.19)
2 (0.0)
16 (0.3)
3698
(Sleeve segmental excision)
14
0
0
0
3
Lobectomy
31,584
85 (0.3)
18 (0.1)
179 (0.6)
21,992
(Sleeve lobectomy)
496
1 (0.2)
2 (0.4)
2 (0.4)
71
Pneumonectomy
403
8 (2.0)
1 (0.2)
15 (3.7)
33
(Sleeve pneumonectomy)
10
2 (20.0)
0
2 (20.0)
2
Other bronchoplasty
33
0
0
0
4
Pleuropneumonectomy
1
0
0
0
0
Others
335
5 (1.5)
2 (0.6)
6 (1.8)
180
Unknown
0
0
0
0
Sarcoma
56
1 (1.8)
1 (1.8)
1 (1.8)
AAH
117
0
0
0
Others
250
0
0
2 (0.8)
(), mortality %
Table 12
Details of lung cancer operations
TNM
c-Stage
Cases
IA1
7464
IA2
12,312
IA3
7771
IB
5228
IIA
1661
IIB
3846
IIIA
2802
IIIB
524
IIIC
25
IVA
449
IVB
70
NA
1988
Total
44,140
Sex
Cases
Male
27,089
Female
14,051
NA
0
Total
41,140
Cause of death
Case
Cardiovascular
23
Pneumonia
43
Pyothorax
2
Bronchopleural fistula
11
Respiratory failure
25
Pulmonary embolism
5
Interstitial pneumonia
78
Brain infarction or bleeding
11
Others
62
Unknown
15
Total
275
p-Stage
Cases
0(pCR)
2940
IA1
8908
IA2
9422
IA3
4873
IB
5999
IIA
1242
IIB
4579
IIIA
4026
IIIB
818
IIIC
17
IVA
982
IVB
69
NA
265
Total
44,140
Age (years)
Cases
< 20
20
20–29
38
30–39
209
40–49
1226
50–59
3768
60–69
14,080
70–79
19,020
80–89
5681
≥ 90
98
NA
0
Total
44,140
Table 13
Metastatic pulmonary tumor
Cases
30-Day mortality
Hospital mortality
VATS
Hospital
After discharge
Metastatic pulmonary tumor
8950
12 (0.1)
4 (0.0)
18 (0.2)
8298
Colorectal
4240
5 (0.1)
0
7 (0.2)
3965
Hepatobiliary/pancreatic
422
0
0
1 (0.2)
400
Uterine
448
0
0
0
425
Mammary
545
0
1 (0.2)
0
517
Ovarian
71
0
0
0
65
Testicular
72
1 (1.4)
1 (1.4)
1 (1.4)
66
Renal
746
0
0
0
706
Skeletal
144
0
0
1 (0.7)
124
Soft tissue
274
0
1 (0.4)
0
248
Otorhinolaryngological
435
0
0
0
397
Pulmonary
573
3 (0.5)
0
4 (0.7)
483
Others
980
3 (0.3)
1 (0.1)
4 (0.4)
902
(), mortality %
Table 14
Tracheal tumor
Cases
30-Day mortality
Hospital mortality
Hospital
After discharge
Tracheal tumor
120
2 (1.7)
2 (1.7)
4 (3.3)
A. Primary malignant tumor
Histological classification
Squamous cell carcinoma
10
0
0
0
Adenoid cystic carcinoma
20
0
0
0
Mucoepidermoid carcinoma
4
0
0
0
Others
12
0
1 (8.3)
0
Total
46
0
1 (2.2)
0
B. Metastatic/invasive malignant tumor
(e.g., invasion of thyroid cancer)
36
0
1 (2.8)
2 (5.6)
C. Benign tracheal tumor
Histological classification
Papilloma
5
0
0
0
Adenoma
1
0
0
0
Neurofibroma
0
0
0
0
Chondroma
0
0
0
0
Leiomyoma
2
0
0
0
Others
30
2 (6.7)
0
2 (6.7)
Histology unknown
0
0
0
0
Total
38
2 (5.3)
0
2 (5.3)
Operation
Sleeve resection with reconstruction
21
0
0
0
Wedge with simple closure
2
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
27
0
0
0
(), mortality %
Table 15
Tumor of pleural origin
Histological classification
Cases
30-Day mortality
Hospital mortality
Hospital
After discharge
Tumor of pleural origin
Solitary fibrous tumor
131
0
0
0
Diffuse malignant pleural mesothelioma
264
2 (0.8)
0
8 (3.0)
Localized malignant pleural mesothelioma
35
1 (2.9)
0
1 (2.9)
Others
268
1 (0.4)
1 (0.4)
5 (1.9)
Total
698
4 (0.6)
1 (0.1)
14 (2.0)
Operative procedure
Cases
30-Day mortality
Hospital mortality
Hospital
After discharge
Extrapleural pneumonectomy
65
1 (1.5)
0
1 (1.5)
Total pleurectomy
104
0
0
3 (2.9)
Others
95
1 (1.1)
0
4 (4.2)
Total
264
2 (0.8)
0
8 (3.0)
(), mortality %
Table 16
Chest wall tumor
Cases
30-Day mortality
Hospital mortality
VATS
Hospital
After discharge
Chest wall tumor
Primary malignant tumor
140
1 (0.7)
1 (0.7)
6 (4.3)
65
Metastatic malignant tumor
189
0
1 (0.5)
0
77
Benign tumor
362
1 (0.3)
0
1 (0.3)
281
Total
691
2 (0.3)
2 (0.3)
7 (1.0)
423
(), mortality %
Table 17
Mediastinal tumor
Cases
30-Day mortality
Hospital mortality
By VATS
Hospital
After discharge
Mediastinal tumor
5197
3 (0.1)
3 (0.06)
9 (0.2)
3808
Thymoma*
1939
1 (0.1)
2 (0.1)
3 (0.2)
1222
Thymic cancer
368
0
1 (0.3)
1 (0.3)
189
Thymus carcinoid
39
0
0
0
19
Germ cell tumor
85
0
0
0
59
Benign
66
0
0
0
51
Malignant
19
0
0
0
8
Neurogenic tumor
489
0
0
0
447
Congenital cyst
1185
1 (0.1)
0
1 (0.1)
1071
Goiter
68
0
0
0
29
Lymphatic tumor
185
0
0
1 (0.5)
134
Excision of pleural recurrence of thymoma
27
0
0
0
20
Thymolipoma
19
0
0
0
14
Others
793
1 (0.1)
0
3 (0.4)
604
(), mortality %
Table 18
Thymectomy for myasthenia gravis with thymoma
Cases
30-Day mortality
Hospital mortality
By VATS
Hospital
After discharge
Thymectomy for myasthenia gravis with thymoma
508
0
0
1 (0.2)
298
319
0
0
1 (0.3)
175
(), mortality %
Table 19
Operations for non-neoplastic diseases
Cases
30-Day mortality
Hospital mortality
Hospital
After discharge
Operations for non-neoplastic diseases
22,634
214 (0.9)
31 (0.1)
467 (2.1)
Cases
30-Day mortality
Hospital mortality
VATS
Hospital
After discharge
A. Inflammatory pulmonary disease
2423
3 (0.1)
2 (0.1)
9 (0.4)
2165
Tuberculous infection
46
0
0
0
41
Mycobacterial infection
496
0
1 (0.2)
1 (0.2)
447
Fungal infection
361
1 (0.3)
0
3 (0.8)
284
Bronchiectasis
58
0
0
0
43
Tuberculous nodule
79
0
0
0
70
Inflammatory pseudotumor
918
0
1 (0.1)
0
858
Interpulmonary lymph node
76
0
0
0
74
Others
389
2 (0.5)
0
5 (1.3)
348
(), mortality %
Table 20
B. Empyema
Cases
30-Day mortality
Hospital mortality
By VATS
Hospital
After discharge
Acute empyema
2226
54 (2.4)
5 (0.2)
128 (5.8)
1858
With fistula
453
26 (5.7)
1 (0.2)
69 (15.2)
251
Without fistula
1756
27 (1.5)
4 (0.2)
57 (3.2)
1592
Unknown
17
1 (5.9)
0
2 (11.8)
15
Chronic empyema
736
20 (2.7)
3 (0.4)
58 (7.9)
406
With fistula
355
9 (2.5)
2 (0.6)
23 (6.5)
148
Without fistula
357
11 (3.1)
1 (0.3)
33 (9.2)
236
Unknown
24
0
0
2 (8.3)
22
Total
2962
74 (2.5)
8 (0.3)
186 (6.3)
2264
(), mortality %
Table 21
C. Descending necrotizing mediastinitis
Cases
30-Day mortality
Hospital mortality
VATS
Hospital
After discharge
C. Descending necrotizing mediastinitis
101
5 (5.0)
0
7 (6.9)
75
(), mortality %
Table 22
D. Bullous diseases
Cases
30-Day mortality
Hospital mortality
VATS
Hospital
After discharge
D. Bullous diseases
400
2 (0.5)
0
5 (1.3)
371
Emphysematous bulla
308
2 (0.6)
0
5 (1.6)
289
Bronchogenic cyst
13
0
0
0
12
Emphysema with LVRS
28
0
0
0
28
Others
51
0
0
0
42
(), mortality %
LVRS lung volume reduction surgery
Table 23
E. Pneumothorax
Cases
30-Day mortality
Hospital mortality
VATS
Hospital
After discharge
14,499
70 (0.5)
16 (0.1)
156 (1.1)
14,783
Spontaneous pneumothorax
Operative procedure
Cases
30-Day mortality
Hospital mortality
VATS
Hospital
After discharge
Bullectomy
2838
2 (0.1)
1 (0.04)
8 (0.3)
2791
Bullectomy with additional procedure
7488
7 (0.1)
1 (0.01)
17 (0.2)
7382
Coverage with artificial material
7233
7 (0.1)
1 (0.01)
17 (0.2)
7130
Parietal pleurectomy
28
0
0
0
28
Coverage and parietal pleurectomy
79
0
0
0
78
Others
148
0
0
0
146
Others
783
6 (0.8)
3 (0.4)
12 (1.5)
745
Unknown
4
0
0
0
4
Total
11,113
15 (0.1)
5 (0.04)
37 (0.3)
10,922
Secondary pneumothorax
Associated disease
Cases
30-Day mortality
Hospital mortality
VATS
Hospital
After discharge
COPD
2350
28 (1.2)
6 (0.3)
62 (2.6)
2289
Tumorous disease
130
5 (3.8)
2 (1.5)
14 (10.8)
124
Catamenial
157
0
0
0
154
LAM
41
0
0
0
39
Others (excluding pneumothorax by trauma)
708
22 (3.1)
3 (0.4)
43 (6.1)
655
Unknown
0
0
0
0
0
Operative procedure
Cases
30-Day mortality
Hospital mortality
VATS
Hospital
After discharge
Bullectomy
571
6 (1.1)
3 (0.5)
18 (3.2)
551
Bullectomy with additional procedure
2016
25 (1.2)
6 (0.3)
44 (2.2)
1979
Coverage with artificial material
1914
24 (1.3)
5 (0.3)
43 (2.2)
1881
Parietal pleurectomy
8
0
0
0
8
Coverage and parietal pleurectomy
29
1 (3.4)
0
1 (3.4)
29
Others
65
0
1 (1.5)
0
61
Others
793
24 (3.0)
2 (0.3)
57 (7.2)
726
Unknown
6
0
0
0
5
Total
3386
55 (1.6)
11 (0.3)
119 (3.5)
3261
(), mortality %
Table 24
F. Chest wall deformity
Cases
30-Day mortality
Hospital mortality
Hospital
After discharge
F. Chest wall deformity
193
1 (0.5)
0
1 (0.5)
Funnel chest
182
0
0
0
Others
11
1 (9.1)
0
1 (9.1)
(), mortality %
Table 25
G. Diaphragmatic hernia
Cases
30-Day mortality
Hospital mortality
VATS
Hospital
After discharge
G. Diaphragmatic hernia
28
1 (3.6)
0
1 (3.6)
19
Congenital
4
0
0
0
3
Traumatic
10
0
0
0
6
Others
14
1 (7.1)
0
1 (7.1)
10
(), mortality %
Table 26
H. Chest trauma
Cases
30-Day mortality
Hospital mortality
VATS
Hospital
After discharge
H. Chest trauma
443
20 (4.5)
0
23 (5.2)
289
(), mortality %
Table 27
I. Other respiratory surgery
Cases
30-Day mortality
Hospital mortality
VATS
Hospital
After discharge
I. Other respiratory surgery
1585
38 (2.4)
5 (0.3)
79 (5.0)
1161
Arteriovenous malformation*
89
0
0
0
84
Pulmonary sequestration
92
0
0
0
84
Postoperative bleeding ∙ air leakage
492
17 (3.5)
1 (0.2)
30 (6.1)
339
Chylothorax
62
2 (3.2)
0
4 (6.5)
52
Others
850
19 (2.2)
4 (0.5)
45 (5.3)
602
(), mortality %
In 2017, 2197 procedures were conducted for benign pulmonary tumors (Table 10), a similar number to that recorded in 2016. Hamartoma was the most frequent diagnosis in procedures for benign pulmonary tumors. VATS was performed for 2071 patients (94%).
Additional information on primary malignant pulmonary tumors is shown in Tables 11 and 12. With regard to lung cancer sub-type, adenocarcinoma was by far the most frequent diagnosis (71% of all lung cancer procedures), followed by squamous cell carcinoma (18%). Sub-lobar resection was performed in 11,784 lung cancer cases (27% of all cases) and lobectomy in 31,584 cases (72% of all cases). Sleeve lobectomy was performed in 496 cases, and pneumonectomy was required in 403 cases (0.9% of all cases). VATS lobectomy for lung cancer was performed in 21,992 cases (70% of all lobectomy cases). The number of VATS procedures for primary lung cancer was slightly higher in 2017 than that in 2016. The number of the patients aged 80 years or older who underwent lung cancer surgery was 5779 (13%). In total, 121 patients died prior to hospital discharge within 30 days following surgery, and 32 patients died following discharge within 30 days after surgery. Therefore, 153 patients died within 30 days after surgery (30-day mortality rate 0.3%). In total, 247 patients died prior to discharge (hospital mortality rate 0.6%), and the 30-day mortality rate, according to procedure, was 0.2% for segmentectomy, 0.3% for lobectomy, and 2% for pneumonectomy. Interstitial pneumonia was the leading cause of death following lung cancer surgery, followed by pneumonia, respiratory failure, and cardiovascular events.
Procedures for metastatic pulmonary tumors, 8950 of which were performed in 2017, are shown in Table 13. In this instance, colorectal cancer was the most frequent diagnosis (47% of all cases).
Anzeige
There were 46 procedures for malignant tracheal tumor in 2017; however, 21 patients were treated with sleeve resection and reconstruction (Table 14).
Pleural tumors numbered 698 in 2017 (Table 15). Diffuse malignant pleural mesothelioma was the most frequent histologic diagnosis. Total pleurectomy was performed in 104 cases and extrapleural pneumonectomy in 65 cases. The 30-day mortality rate was 0% following total pleurectomy and 2% after extrapleural pneumonectomy, both representing better outcomes than before.
In total, 691 chest wall tumors were resected in 2017 (Table 16), 362 (52%) of which were benign. Among the 329 malignant chest wall tumors, 189 (57%) were metastatic tumors.
Mediastinal tumors were resected in 5197 patients in 2017, a slight increase from the previous year (Table 17). Thymic epithelial tumor—including 1939 thymomas, 368 thymic carcinomas, and 39 thymic carcinoids—was the most frequent mediastinal tumor type in 2017.
Thymectomy for myasthenia gravis was performed in 508 patients (Table 18); 319 procedures were associated with thymoma, and the remaining was not associated with thymoma.
Procedures for non-neoplastic disease were performed for 22,634 patients. There were 2423 cases of lung resection for inflammatory lung diseases (Table 19), 20% of which were associated with atypical mycobacterium infections and 15% with fungal infections. Procedures for inflammatory nodules were performed in cases where lung cancer was suspected prior to surgery (in 918 cases, 38%).
The 2962 procedures for empyema (Table 20) comprised 2226 cases (75%) of acute empyema and 736 cases of chronic empyema. Bronchopleural fistula was reported in 453 patients with acute empyema and in 355 patients with chronic empyema. The hospital mortality rate was 15% among patients with acute empyema with fistula.
In 2017, 101 operations were performed for descending necrotizing mediastinitis (Table 21). The hospital mortality rate was 7%. Furthermore, 400 procedures were conducted for bullous diseases (Table 22); lung volume reduction surgery was performed in only 28 patients.
A total of 14,499 procedures were performed for spontaneous pneumothorax (Table 23). The 11,113 procedures for primary pneumothorax comprised 2838 patients (26%) who underwent bullectomy only and 7488 patients (67%) who underwent an additional procedure. There were 3386 procedures for secondary pneumothorax, where COPD was by far the most prevalent associated disease (69%). The hospital mortality rate for secondary pneumothorax associated with COPD was 2.6%.
The 2017 survey reported 193 procedures for chest wall deformity (Table 24). However, this may have been underestimated, because 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.
Diaphragmatic hernia was treated surgically in 28 patients (Table 25). This figure may also have been underestimated, as procedures may have been classified as gastrointestinal surgery.
The survey reported 443 procedures for chest trauma excluding iatrogenic injuries (Table 26). In this context, hospital mortality rate was 5%.
Table 27 shows procedures for other diseases, including 89 cases of arteriovenous malformation and 92 cases of pulmonary sequestration.
A total of 68 lung transplantations were performed in 2017 (Table 28): 57 patients received lung transplants from brain-dead donors, and 11 patients received transplants from living, related donors.
Table 28
Lung transplantation
Cases
30-Day mortality
Hospital mortality
Hospital
After discharge
Single-lung transplantation from brain-dead donor
29
0
0
3 (10.3)
Bilateral lung transplantation from brain-dead donor
28
0
0
0
Lung transplantation from living donor
11
0
0
0
Total lung transplantation
68
0
0
3 (4.4)
Donor of living donor lung transplantation
19
0
0
0
(), mortality %
The number of VATS procedures has increased annually to reach 68,458 (80% of all general thoracic surgeries) in 2017 (Table 29).
Table 29
Video-assisted thoracic surgery
Cases
30-Day mortality
Hospital mortality
Hospital
After discharge
Video-assisted thoracic surgery
68,458
218 (0.3)
51 (0.07)
470 (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, 32, and 33.
Table 30
Tracheobronchoplasty
Cases
30-Day mortality
Hospital mortality
Hospital
After discharge
Tracheobronchoplasty
774
7 (0.9)
4 (0.5)
16 (2.1)
Trachea
40
0
0
1 (2.5)
Sleeve resection with reconstruction
28
0
0
1 (3.6)
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
7
0
0
0
Carinal reconstruction
31
1 (3.2)
0
2 (6.5)
Sleeve pneumonectomy
12
2 (16.7)
0
2 (16.7)
Sleeve lobectomy
492
1 (0.2)
2 (0.4)
2 (0.4)
Sleeve segmental excision
14
0
0
0
Bronchoplasty without lung resection
29
1 (3.4)
0
1 (3.4)
Others
156
2 (1.3)
2 (1.3)
8 (5.1)
(), mortality %
Table 31
Pediatric surgery
Cases
30-Day mortality
Hospital mortality
Hospital
After discharge
Pediatric surgery
292
3 (1.0)
0
3 (1.0)
(), mortality %
Table 32
Combined resection of neighboring organ(s)
Cases
30-Day mortality
Hospital mortality
Hospital
After discharge
Combined resection of neighboring organ (s)
1371
7 (0.5)
0
21 (1.5)
Organ resected
Cases
30-Day mortality
Hospital mortality
Hospital
After discharge
A. Primary lung cancer
Aorta
11
0
0
0
Superior vena cava
14
1 (7.1)
0
1 (7.1)
Brachiocephalic vein
8
0
0
1 (12.5)
Pericardium
108
1 (0.9)
0
2 (1.9)
Pulmonary artery
127
1 (0.8)
0
1 (0.8)
Left atrium
19
1 (5.3)
0
2 (10.5)
Diaphragm
55
1 (1.8)
0
1 (1.8)
Chest wall (including ribs)
352
4 (1.1)
0
12 (3.4)
Vertebra
19
0
0
0
Esophagus
3
0
0
0
Total
716
9 (1.3)
0
20 (2.8)
B. Mediastinal tumor
Aorta
7
0
0
0
Superior vena cava
54
0
0
0
Brachiocephalic vein
107
0
0
2 (1.9)
Pericardium
351
0
0
3 (0.9)
Pulmonary artery
3
0
0
1 (33.3)
Left atrium
0
0
0
0
Diaphragm
21
0
0
0
Chest wall (including ribs)
10
0
0
0
Vertebra
5
0
0
0
Esophagus
3
0
0
0
Lung
476
0
0
2 (0.4)
Total
1037
0
0
8 (0.8)
(), 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
743
7 (0.9)
2 (0.3)
15 (2.0)
(), 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 2017, a total of 12,336 patients with esophageal diseases were registered from 523 institutions (response rate: 92.1%) affiliated with the Japanese Association for Thoracic Surgery and/or the Japan Esophageal Society. Among these institutions, there were 139 (26.6%) where 20 or more patients underwent esophageal surgeries within the year 2017, indicating no definite shift from esophageal procedures to high-volume institutions when compared with the data from 2016 (24.5%) (Table 34). Among 2427 patients with a benign esophageal disease, 1614 (66.5%) underwent surgery and 73 (3.0%) underwent endoscopic resection, whereas 740 (30.5%) patients did not undergo surgical treatment (Tables 35, 36). Among 10,554 patients with a malignant esophageal tumor, 8525 (80.8%) underwent resection, esophagectomy was performed for 6319 (74.1%), and endoscopic mucosal resection (EMR) or endoscopic submucosal dissection (ESD) was performed for 2170 (25.5%); 2025 (23.8%) patients did not undergo any resection (Tables 36 and 37). Annual trends among registered inpatients with esophageal diseases have not changed for the past last decades (Fig. 3).
Table 34
Distribution of number of esophageal operations in 2017 in each institution
Annual trend of inpatients 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 in addition to the aforementioned diseases. Open surgery was performed in 1009 (57.7%) patients with a benign esophageal disease, with 30-day mortality in 3 (0.3%) patients, whereas thoracoscopic and/or laparoscopic surgery was performed for 605 (37.5%) patients, with no instances of 30-day mortality. The difference in these death rates between open and scopic surgery appears to be related to conditions requiring open surgery.
The majority of malignant diseases were carcinomas (Table 36). Among esophageal carcinomas, the incidence of squamous cell carcinoma was 88.8%, whereas that of adenocarcinomas, including Barrett’s cancer, was 4.3%. The resection rate for patients with a squamous cell carcinoma was 79.9%, whereas that for patients with adenocarcinoma was 93.8%.
On the basis of location, cancer in the thoracic esophagus was the most common (Table 37). Among 4303 patients (40.9% of total esophageal malignancies) with superficial esophageal cancers within mucosal and submucosal layers, 6319 (60.1%) patients underwent esophagectomy, whereas 2170 (20.6%) patients underwent EMR or ESD. The 30-day mortality rate and hospital mortality rate after esophagectomy for patients with a superficial cancer were 0.5% and 1.0%, respectively.
Multiple primary cancers were observed in 2077 (19.8%) of all 10,514 patients with esophageal cancer. Synchronous cancer was found in 1008 (9.3%) patients, whereas metachronous cancer was observed in 1063 (10.1%) patients. The stomach and head and neck were common sites for both synchronous and metachronous malignancies (Table 37).
Among esophagectomy procedures, transthoracic esophagectomy via right thoracotomy was most commonly adopted for patients with a superficial cancer, as well as for those with advanced cancer (Table 38). Transhiatal esophagectomy, which is commonly performed in Western countries, was adopted in only 9.1% of patients with a superficial cancer or advanced cancer who underwent esophagectomy in Japan. Thoracoscopic and/or laparoscopic esophagectomy was adopted for 1434 patients (74.0%) with a superficial cancer and for 2422 patients (55.3%) with an advanced cancer. The number of cases of thoracoscopic and/or laparoscopic surgery for superficial or advanced cancer has been increasing for a number of years (Fig. 4).
(2) Transthoracic (rt.) esophagectomy and reconstruction
3818
21 (0.6)
20 (0.5)
55 (1.4)
2255
10 (0.4)
9 (0.4)
25 (1.1)
(3) Transthoracic (lt.) esophagectomy and reconstruction
89
0
0
0
4
0
0
0
(4) Cervical esophageal resection and reconstruction
105
0
0
1 (1.0)
6
0
0
0
(5) Robot-assisted esophagectomy
19
0
0
0
19
0
0
0
(6) Others
57
1 (1.8)
1 (1.8)
2 (3.5)
22
1 (4.5)
0
1 (4.5)
(7) Esophagectomy without reconstruction
43
0
2 (4.7)
4 (9.3)
19
0
0
1 (5.3)
(8) Not specified
6
0
0
0
5
0
0
0
(Depth not specified)
4
0
0
0
3
0
0
0
3
Combined resection of other organs
296
3 (1.0)
3(1.0)
7 (2.4)
(1) Aorta
8
1 (12.5)
0
1 (12.5)
(2) Trachea, bronchus
20
0
0
1 (5.0)
(3) Lung
60
0
0
0
(4) Others
208
2 (1.0)
3 (1.4)
5 (2.4)
Unknown
0
0
0
0
Salvage surgery
230
4 (1.7)
1 (0.4)
6 (2.6)
70
1 (1.4)
0
1 (1.4)
25
Fig. 4
Annual trend of video-assisted esophagectomy for esophageal malignancy
×
Combined resection of the neighboring organs during the resection of an esophageal cancer was performed in 296 patients (Tables 38 and 39). Resection of the aorta, together with esophagectomy, was performed in eight cases. Tracheal and/or bronchial resection combined with esophagectomy was performed for 20 patients, with both 30-day mortality rate and hospital mortality rate at 0%. Lung resection combined with esophagectomy was performed for 60 patients, with both 30-day mortality rate and hospital mortality rate at 0%.
Table 39
Mortality after combined resection of the neighbouring organs
Year
Esophagectomy
Combined resection
Aorta
Tracheobronchus
Lung
Others
a
b
c
a
b
c
a
b
c
a
b
c
a
b
c
1996
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%
2017
6319
33
0.52%
8
1
12.50%
20
0
0.00%
60
0
0.00%
208
2
0.96%
Total
116,815
1496
1.28%
52
5
9.62%
506
20
3.95%
1364
26
1.91%
3292
50
1.52%
a: number of patients who underwent the operation
b: number of patients died within 30 days after operation
c: % ratio of b/a, i.e., direct operative mortality
Salvage surgery following definitive (chemo)radiotherapy was performed for 230 patients, with 30-day mortality rate at 1.7% and hospital mortality rate at 2.6% (Table 38).
We aim to continue our efforts to gather all-encompassing survey data via 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.
Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/.
Publisher's Note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Mit der Zeitschrift Die Chirurgie erhalten Sie zusätzlich Online-Zugriff auf weitere 43 chirurgische Fachzeitschriften, CME-Fortbildungen, Webinare, Vorbereitungskursen zur Facharztprüfung und die digitale Enzyklopädie e.Medpedia.
Bis 30. April 2024 bestellen und im ersten Jahr nur 199 € zahlen!
Nach der Katheterablation von Vorhofflimmern kommt es bei etwa einem Drittel der Patienten zu Rezidiven, meist binnen eines Jahres. Wie sich spätere Rückfälle auf die Erfolgschancen einer erneuten Ablation auswirken, haben Schweizer Kardiologen erforscht.
Schmerzen im Unterbauch, aber sonst nicht viel, was auf eine Appendizitis hindeutete: Ein junger Mann hatte Glück, dass trotzdem eine Laparoskopie mit Appendektomie durchgeführt und der Wurmfortsatz histologisch untersucht wurde.
Derzeit wird empfohlen, eine Therapie mit GLP-1-Rezeptoragonisten präoperativ zu unterbrechen. Eine neue Studie nährt jedoch Zweifel an der Notwendigkeit der Maßnahme.
Die Ureterstriktur ist eine relativ seltene Komplikation, trotzdem bedarf sie einer differenzierten Versorgung. In komplexen Fällen wird dies durch die roboterassistierte OP-Technik gewährleistet. Erste Resultate ermutigen.
Update Chirurgie
Bestellen Sie unseren Fach-Newsletterund bleiben Sie gut informiert.
Das Karpaltunnelsyndrom ist die häufigste Kompressionsneuropathie peripherer Nerven. Obwohl die Anamnese mit dem nächtlichen Einschlafen der Hand (Brachialgia parästhetica nocturna) sehr typisch ist, ist eine klinisch-neurologische Untersuchung und Elektroneurografie in manchen Fällen auch eine Neurosonografie erforderlich. Im Anfangsstadium sind konservative Maßnahmen (Handgelenksschiene, Ergotherapie) empfehlenswert. Bei nicht Ansprechen der konservativen Therapie oder Auftreten von neurologischen Ausfällen ist eine Dekompression des N. medianus am Karpaltunnel indiziert.
Das Webinar beschäftigt sich mit Fragen und Antworten zu Diagnostik und Klassifikation sowie Möglichkeiten des Ausschlusses von Zusatzverletzungen. Die Referenten erläutern, welche Frakturen konservativ behandelt werden können und wie. Das Webinar beantwortet die Frage nach aktuellen operativen Therapiekonzepten: Welcher Zugang, welches Osteosynthesematerial? Auf was muss bei der Nachbehandlung der distalen Radiusfraktur geachtet werden?
Inhalte des Webinars zur S1-Leitlinie „Empfehlungen zur Therapie der akuten Appendizitis bei Erwachsenen“ sind die Darstellung des Projektes und des Erstellungswegs zur S1-Leitlinie, die Erläuterung der klinischen Relevanz der Klassifikation EAES 2015, die wissenschaftliche Begründung der wichtigsten Empfehlungen und die Darstellung stadiengerechter Therapieoptionen.
