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Erschienen in: General Thoracic and Cardiovascular Surgery 1/2024

Open Access 28.11.2023 | Annual Report

Thoracic and cardiovascular surgeries in Japan during 2020

Annual report by the Japanese Association for Thoracic Surgery

verfasst von: Goro Matsumiya, Yukio Sato, Hiroya Takeuchi, Tomonobu Abe, Shunsuke Endo, Yasutaka Hirata, Michiko Ishida, Hisashi Iwata, Takashi Kamei, Nobuyoshi Kawaharada, Shunsuke Kawamoto, Kohji Kohno, Hiraku Kumamaru, Kenji Minatoya, Noboru Motomura, Rie Nakahara, Morihito Okada, Hisashi Saji, Aya Saito, Hideyuki Shimizu, Kenji Suzuki, Hirofumi Takemura, Tsuyoshi Taketani, Yasushi Toh, Wataru Tatsuishi, Hiroyuki Yamamoto, Takushi Yasuda, Masayuki Watanabe, Naoki Yoshimura, Masanori Tsuchida, Yoshiki Sawa, Committee for Scientific Affairs, The Japanese Association for Thoracic Surgery

Erschienen in: General Thoracic and Cardiovascular Surgery | Ausgabe 1/2024

Hinweise
Goro Matsumiya, Yukio Sato, Hiroya Takeuchi, and Naoki Yoshimura contributed equally to this work.
Annual report by the Japanese Association for Thoracic Surgery: Committee for Scientific Affairs.

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Since 1986, the Japanese Association for Thoracic Surgery has conducted annual thoracic surgery surveys throughout Japan to determine statistics on the number of procedures performed by surgical categories. Herein, we summarize the results of the association’s annual thoracic surgery surveys in 2020. We regret that, for various reasons, this report has been delayed to 2023.
Adhering to the norm thus far, thoracic surgery had been classified into three categories, including 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.
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 in surgical outcome improvements 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 prospects, which is reflected in its activities and member education.
The 30-day mortality (also 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.
Transfer to a nursing home or a rehabilitation unit is considered hospital discharge unless the patient subsequently dies of complications from surgery, while hospital-to-hospital transfer during esophageal surgery is not considered a form of discharge. In contrast, hospital-to-hospital transfer 30 days following cardiovascular and general thoracic surgeries are considered discharge given that National Clinical Database (NCD)-related data were used in these categories.
Severe Acute Respiratory Syndrpme Coronavirus-2 (SARS-CoV-2), the causative pathogen for the coronavirus disease 2019 (COVID-19), first emerged in Wuhan, China, in December 2019 and by March 2020, it was declared a pandemic [1]. The pandemic of SARS-CoV-2 resulted in a global healthcare and financial crisis. There was a significant estimated reduction in national case volume of cardiac surgeries and the cumulative backlog of patients in the United State [2]. We have to estimate the nationwide effect of SARS-CoV-2 pandemic on cardiovascular, general thoracic, and esophageal surgeries in Japan, with surgical volume, outcomes and patient data for each group.

Survey abstract

All data on cardiovascular, general thoracic, and esophageal surgeries were obtained from the NCD. In 2018, the data collection method for general thoracic and esophageal surgeries had been modified from self-reports using questionnaire sheets following each institution belonging to the Japanese Association for Thoracic Surgery to an automatic package downloaded from the NCD in Japan.
The data collection related to cardiovascular surgery (initially self-reported using questionnaire sheets in each participating institution up to 2014) changed to downloading an automatic package from the Japanese Cardiovascular Surgery Database (JCVSD), which is a cardiovascular subsection of the NCD in 2015.

Final report: 2020

(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 34 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 included in the survey.
A total of 64,075 cardiovascular surgeries, including 54 heart transplants, had been performed in 2020, with a 9.5% decrease compared to that in 2019 (n = 70,769). For the first time since the beginning of data collection, except for the year 2015 when there was a decrease due to a change in data collection and aggregation methods, a decline in the number of cases has been observed. Although the impact of the COVID-19 pandemic is suggested, this will be reported separately.
Compared to data for 2019 [3] and 2010 [4], data for 2020 showed 4.6% (8595 vs. 9006) and 10.1% fewer surgeries for congenital heart disease, 21.3% (18,366 vs. 23,340) fewer and 1.9% fewer surgeries for valvular heart disease, 8.6% (11,524 vs. 12,603) and 31.9% fewer surgeries for ischemic heart procedures, and 0.7% (22,540 vs. 22,708) fewer and 77.3% more surgeries for thoracic aortic aneurysm, respectively. Data for individual categories are summarized in Tables 1, 2, 3, 4, 5, 6.
Table 1
Congenital (total; 8595)
(1) CPB (+) (total; 6543)
 
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
2
0
0
0
4
0
0
0
2
0
0
1 (50.0)
16
0
0
0
24
0
0
1 (4.2)
Coarctation (simple)
10
0
0
0
13
0
0
0
9
0
0
0
15
0
0
0
47
0
0
0
 + VSD
57
1 (1.8)
0
3 (5.3)
45
1 (2.2)
0
2 (4.4)
19
0
0
0
2
0
0
0
123
2 (1.6)
0
5 (4.1)
 + DORV
4
0
0
0
3
0
0
0
2
0
0
0
0
0
0
0
9
0
0
0
 + AVSD
5
0
0
0
7
0
0
0
1
0
0
0
0
0
0
0
13
0
0
0
 + TGA
2
0
0
0
3
0
0
0
2
0
0
0
0
0
0
0
7
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
7
0
0
0
8
0
0
1 (12.5)
4
0
0
1 (25.0)
1
0
0
0
20
0
0
2 (10.0)
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
13
0
0
0
19
1 (5.3)
0
1 (5.3)
17
0
0
0
0
0
0
0
49
1 (2.0)
0
1 (2.0)
 + DORV
1
0
0
0
1
0
0
0
0
0
0
0
0
0
0
0
2
0
0
0
 + Truncus
1
0
0
0
5
1 (20.0)
0
1 (20.0)
3
1 (33.3)
0
1 (33.3)
0
0
0
0
9
2 (22.2)
0
2 (22.2)
 + TGA
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
 + Others
3
0
0
0
1
0
0
0
3
0
0
0
0
0
0
0
7
0
0
0
Vascular ring
0
0
0
0
1
0
0
0
1
0
0
0
0
0
0
0
2
0
0
0
PS
2
0
0
0
23
0
0
0
78
0
0
0
17
0
0
0
120
0
0
0
PA·IVS or critical PS
15
0
0
0
56
1 (1.8)
0
1 (1.8)
57
0
0
2 (3.5)
5
0
0
0
133
1 (0.8)
0
3 (2.3)
TAPVR
109
2 (1.8)
0
8 (7.3)
52
2 (3.8)
0
3 (5.8)
17
0
0
0
2
0
0
0
180
4 (2.2)
0
11 (6.1)
PAPVR ± ASD
0
0
0
0
3
0
0
0
43
0
0
0
9
0
0
0
55
0
0
0
ASD
1
0
0
0
40
0
0
0
398
0
0
0
749
8 (1.1)
0
8 (1.1)
1188
8 (0.7)
0
8 (0.7)
Cor triatriatum
2
0
0
0
6
0
0
0
5
0
0
0
0
0
0
0
13
0
0
0
AVSD (partial)
3
1 (33.3)
0
1 (33.3)
8
0
0
0
34
0
0
0
9
0
0
0
54
1 (1.9)
0
1 (1.9)
AVSD (complete)
6
0
0
1 (16.7)
101
1 (1.0)
0
1 (1.0)
115
1 (0.9)
0
3 (2.6)
4
0
0
0
226
2 (0.9)
0
5 (2.2)
 + TOF or DORV
0
0
0
0
6
0
0
0
10
0
0
0
0
0
0
0
16
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
98
0
0
0
144
0
0
0
9
0
0
0
253
0
0
0
VSD (perimemb./muscular)
13
0
0
0
675
1 (0.1)
0
2 (0.3)
329
0
0
0
26
1 (3.8)
0
1 (3.8)
1043
2 (0.2)
0
3 (0.3)
VSD (type unknown)
0
0
0
0
0
0
0
0
0
0
0
0
105
1 (1.0)
0
1 (1.0)
105
1 (1.0)
0
1 (1.0)
VSD + PS
0
0
0
0
33
0
0
0
16
0
0
0
2
1 (50.0)
0
1 (50.0)
51
1 (2.0)
0
1 (2.0)
DCRV ± VSD
0
0
0
0
8
0
0
0
27
0
0
0
8
0
0
0
43
0
0
0
Aneurysm of sinus of Valsalva
0
0
0
0
1
0
0
0
1
0
0
0
2
0
0
0
4
0
0
0
TOF
7
0
0
0
156
0
0
1 (0.6)
156
0
0
0
45
1 (2.2)
0
2 (4.4)
364
1 (0.3)
0
3 (0.8)
PA + VSD
8
0
0
1 (12.5)
76
2 (2.6)
0
3 (3.9)
108
0
0
0
11
0
0
0
203
2 (1.0)
0
4 (2.0)
DORV
14
0
0
0
111
1 (0.9)
0
3 (2.7)
160
2 (1.3)
0
2 (1.3)
7
0
0
0
292
3 (1.0)
0
5 (1.7)
TGA (simple)
89
0
1 (1.1)
0
5
0
0
0
5
0
0
0
3
0
0
0
102
0
1 (1.0)
0
 + VSD
32
0
0
0
12
0
0
0
6
0
0
0
1
0
0
0
51
0
0
0
 VSD + PS
0
0
0
0
33
0
0
0
16
0
0
0
2
1 (50.0)
0
1 (50.0)
51
1 (2.0)
0
1 (2.0)
Corrected TGA
3
0
0
0
13
0
0
0
26
0
0
0
11
0
0
0
53
0
0
0
Truncus arteriosus
11
1 (9.1)
0
1 (9.1)
18
0
0
0
23
0
0
0
4
0
0
0
56
1 (1.8)
0
1 (1.8)
SV
30
4 (13.3)
0
10 (33.3)
167
7 (4.2)
0
12 (7.2)
176
1 (0.6)
0
1 (0.6)
20
0
0
0
393
12 (3.1)
0
23 (5.9)
TA
3
0
0
0
30
1 (3.3)
0
1 (3.3)
49
0
0
0
2
0
0
0
84
1 (1.2)
0
1 (1.2)
HLHS
38
4 (10.5)
0
13 (34.2)
119
5 (4.2)
0
7 (5.9)
78
2 (2.6)
0
2 (2.6)
1
0
0
0
236
11 (4.7)
0
22 (9.3)
Aortic valve lesion
3
0
0
0
13
0
0
0
102
0
0
1 (1.0)
29
0
0
0
147
0
0
1 (0.7)
Mitral valve lesion
1
0
0
0
37
1 (2.7)
0
1 (2.7)
64
0
0
1 (1.6)
24
0
0
2 (8.3)
126
1 (0.8)
0
4 (3.2)
Ebstein
8
1 (12.5)
0
2 (25.0)
13
0
0
0
30
0
0
1 (3.3)
7
0
0
0
58
1 (1.7)
0
3 (5.2)
Coronary disease
0
0
0
0
6
0
0
0
19
0
0
0
7
0
0
0
32
0
0
0
Others
7
1 (14.3)
0
1 (14.3)
14
0
0
0
37
0
0
1 (2.7)
211
2 (0.9)
0
2 (0.9)
269
3 (1.1)
0
4 (1.5)
Conduit failure
1
0
0
0
0
0
0
0
12
0
0
0
6
0
0
0
19
0
0
0
Redo (excluding conduit failure)
2
1 (50.0)
0
1 (50.0)
50
3 (6.0)
0
4 (8.0)
71
2 (2.8)
0
3 (4.2)
88
3 (3.4)
0
4 (4.5)
211
9 (4.3)
0
12 (5.7)
Total
515
16 (3.1)
1 (0.2)
42 (8.2)
2093
28 (1.3)
0
44 (2.1)
2475
9 (0.4)
0
20 (0.8)
1460
18 (1.2)
0
22 (1.5)
6543
71 (1.1)
1 (0.0)
128 (2.0)
(), % 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; 2052)
 
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
291
7 (2.4)
0
14 (4.8)
115
0
0
1 (0.9)
14
0
0
0
0
0
0
0
420
7 (1.7)
0
15 (3.6)
Coarctation (simple)
11
0
0
0
10
0
0
0
5
0
0
0
1
0
0
0
27
0
0
0
 + VSD
44
0
0
3 (6.8)
19
1 (5.3)
0
2 (10.5)
0
0
0
0
0
0
0
0
63
1 (1.6)
0
5 (7.9)
 + DORV
4
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
4
0
0
0
 + AVSD
2
0
0
0
3
0
0
1 (33.3)
0
0
0
0
0
0
0
0
5
0
0
1 (20.0)
 + TGA
3
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
3
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
7
1 (14.3)
0
1 (14.3)
4
0
0
0
3
0
0
0
0
0
0
0
14
1 (7.1)
0
1 (7.1)
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
17
0
0
0
11
1 (9.1)
0
1 (9.1)
1
0
0
0
0
0
0
0
29
1 (3.4)
0
1 (3.4)
 + DORV
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
 + Truncus
5
0
0
0
1
1 (100.0)
0
1 (100.0)
0
0
0
0
0
0
0
0
6
1 (16.7)
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
 + Others
3
0
0
0
2
0
0
0
0
0
0
0
0
0
0
0
5
0
0
0
Vascular ring
4
0
0
0
11
0
0
0
5
0
0
0
0
0
0
0
20
0
0
0
PS
2
0
0
0
5
0
0
1 (20.0)
1
0
0
0
0
0
0
0
8
0
0
1 (12.5)
PA·IVS or critical PS
12
2 (16.7)
0
2 (16.7)
23
1 (4.3)
0
1 (4.3)
6
1 (16.7)
0
1 (16.7)
1
0
0
0
42
4 (9.5)
0
4 (9.5)
TAPVR
24
2 (8.3)
0
3 (12.5)
13
1 (7.7)
0
2 (15.4)
0
0
0
0
0
0
0
0
37
3 (8.1)
0
5 (13.5)
PAPVR ± ASD
0
0
0
0
1
0
0
0
0
0
0
0
0
0
0
0
1
0
0
0
ASD
2
0
0
0
1
0
0
0
2
0
0
0
1
1 (100.0)
0
1 (100.0)
6
1 (16.7)
0
1 (16.7)
Cor triatriatum
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
AVSD (partial)
3
1 (33.3)
0
1 (33.3)
1
0
0
0
0
0
0
0
0
0
0
0
4
1 (25.0)
0
1 (25.0)
AVSD (complete)
51
1 (2.0)
0
2 (3.9)
75
2 (2.7)
0
2 (2.7)
9
1 (11.1)
0
1 (11.1)
0
0
0
0
135
4 (3.0)
0
5 (3.7)
 + TOF or DORV
0
0
0
0
1
0
0
0
1
0
0
0
1
0
0
0
3
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)
3
0
0
1 (33.3)
8
0
0
0
1
0
0
0
0
0
0
0
12
0
0
1 (8.3)
VSD (perimemb./muscular)
55
1 (1.8)
0
1 (1.8)
148
2 (1.4)
0
2 (1.4)
2
0
0
0
3
1 (33.3)
0
1 (33.3)
208
4 (1.9)
0
4 (1.9)
VSD (type unknown)
0
0
0
0
0
 
0
0
0
0
0
0
1
0
0
0
1
0
0
0
VSD + PS
0
0
0
0
1
0
0
0
0
0
0
0
0
0
0
0
1
0
0
0
DCRV ± VSD
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
Aneurysm of sinus of Valsalva
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
TOF
13
0
0
0
49
0
0
0
5
0
0
0
1
0
0
0
68
0
0
0
PA + VSD
7
0
0
0
44
1 (2.3)
0
1 (2.3)
17
0
0
0
0
0
0
0
68
1 (1.5)
0
1 (1.5)
DORV
54
2 (3.7)
0
5 (9.3)
56
1 (1.8)
0
2 (3.6)
11
0
0
0
1
1 (100.0)
0
1 (100.0)
122
4 (3.3)
0
8 (6.6)
TGA (simple)
11
0
0
0
2
0
0
0
0
0
0
0
1
0
0
0
14
0
0
0
 + VSD
9
1 (11.1)
0
1 (11.1)
4
0
0
0
1
0
0
0
0
0
0
0
14
1 (7.1)
0
1 (7.1)
 VSD + PS
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
Corrected TGA
17
0
0
0
9
0
0
0
13
0
0
0
1
0
0
0
40
0
0
0
Truncus arteriosus
19
1 (5.3)
0
1 (5.3)
12
0
0
0
2
0
0
0
1
0
0
0
34
1 (2.9)
0
1 (2.9)
SV
47
1 (2.1)
0
5 (10.6)
57
3 (5.3)
0
4 (7.0)
16
0
0
0
4
0
0
1 (25.0)
124
4 (3.2)
0
10 (8.1)
TA
17
0
0
2 (11.8)
16
0
0
1 (6.3)
2
0
0
0
1
0
0
0
36
0
0
3 (8.3)
HLHS
76
2 (2.6)
0
12 (15.8)
26
2 (7.7)
0
2 (7.7)
12
1 (8.3)
0
1 (8.3)
0
0
0
0
114
5 (4.4)
0
15 (13.2)
Aortic valve lesion
6
1 (16.7)
0
1 (16.7)
2
0
0
0
4
0
0
0
1
0
0
0
13
1 (7.7)
0
1 (7.7)
Mitral valve lesion
1
0
0
0
5
1 (20.0)
0
1 (20.0)
0
0
0
0
0
0
0
0
6
1 (16.7)
0
1 (16.7)
Ebstein
5
1 (20.0)
0
1 (20.0)
1
0
0
0
1
0
0
0
0
0
0
0
7
1 (14.3)
0
1 (14.3)
Coronary disease
0
0
0
0
0
0
0
0
3
0
0
0
0
0
0
0
3
0
0
0
Others
6
0
0
1 (16.7)
13
2 (15.4)
0
2 (15.4)
10
0
0
0
4
0
0
0
33
2 (6.1)
0
3 (9.1)
Conduit failure
0
0
0
0
1
0
0
0
1
0
0
0
0
0
0
0
2
0
0
0
Redo (excluding conduit failure)
36
1 (2.8)
0
5 (13.9)
118
9 (7.6)
0
19 (16.1)
120
2 (1.7)
0
4 (3.3)
26
4 (15.4)
0
5 (19.2)
300
16 (5.3)
0
33 (11.0)
Total
867
25 (2.9)
0
62 (7.2)
868
28 (3.2)
0
46 (5.3)
268
5 (1.9)
0
7 (2.6)
49
7 (14.3)
0
9 (18.4)
2052
65 (3.2)
0
124 (6.0)
(), % 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
118
3 (2.5)
0
7 (5.9)
310
3 (1.0)
0
7 (2.3)
32
0
0
0
2
0
0
0
462
6 (1.3)
0
14 (3.0)
2
PAB
266
8 (3.0)
0
17 (6.4)
304
6 (2.0)
0
8 (2.6)
9
0
0
0
0
0
0
0
579
14 (2.4)
0
25 (4.3)
3
Bidirectional Glenn or hemi-Fontan ± α
0
0
0
0
230
2 (0.9)
0
3 (1.3)
105
1 (1.0)
0
1 (1.0)
0
0
0
0
335
3 (0.9)
0
4 (1.2)
4
Damus-Kaye-Stansel operation
1
0
0
0
25
0
0
0
8
0
0
0
1
0
0
0
35
0
0
0
5
PA reconstruction/repair (including redo)
16
2 (12.5)
0
2 (12.5)
161
5 (3.1)
0
6 (3.7)
196
0
0
0
11
0
0
0
384
7 (1.8)
0
8 (2.1)
6
RVOT reconstruction/repair
4
0
0
0
207
1 (0.5)
0
2 (1.0)
267
0
0
0
42
0
0
0
520
1 (0.2)
0
2 (0.4)
7
Rastelli procedure
2
0
0
0
41
0
0
0
101
0
0
0
2
0
0
0
146
0
0
0
8
Arterial switch procedure
129
0
1 (0.8)
0
24
0
0
0
2
0
0
0
1
0
0
1 (100.0)
156
0
1 (0.6)
1 (0.6)
9
Atrial switch procedure
0
0
0
0
1
0
0
0
3
0
0
0
1
0
0
0
5
0
0
0
10
Double switch procedure
0
0
0
0
0
0
0
0
7
0
0
0
0
0
0
0
7
0
0
0
11
Repair of anomalous origin of CA
0
0
0
0
6
0
0
0
3
0
0
0
1
0
0
0
10
0
0
0
12
Closure of coronary AV fistula
0
0
0
0
0
0
0
0
4
0
0
0
1
0
0
0
5
0
0
0
13
Fontan/TCPC
0
0
0
0
0
0
0
0
353
1 (0.3)
0
3 (0.8)
25
0
0
0
378
1 (0.3)
0
3 (0.8)
14
Norwood procedure
28
1 (3.6)
0
9 (32.1)
84
7 (8.3)
0
10 (11.9)
5
0
0
0
0
0
0
0
117
8 (6.8)
0
19 (16.2)
15
Ventricular septation
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
16
Left side AV valve repair (including Redo)
2
1 (50.0)
0
1 (50.0)
40
1 (2.5)
0
2 (5.0)
56
0
0
0
26
1 (3.8)
0
1 (3.8)
124
3 (2.4)
0
4 (3.2)
17
Left side AV valve replace (including Redo)
0
0
0
0
9
1 (11.1)
0
1 (11.1)
36
0
0
2 (5.6)
23
0
0
2 (8.7)
68
1 (1.5)
0
5 (7.4)
18
Right side AV valve repair (including Redo)
14
2 (14.3)
0
3 (21.4)
91
1 (1.1)
0
1 (1.1)
83
2 (2.4)
0
2 (2.4)
58
0
0
1 (1.7)
246
5 (2.0)
0
7 (2.8)
19
Right side AV valve replace (including Redo)
0
0
0
0
6
1 (16.7)
0
1 (16.7)
10
0
0
2 (20.0)
35
0
0
1 (2.9)
51
1 (2.0)
0
4 (7.8)
20
Common AV valve repair (including Redo)
8
0
0
2 (25.0)
26
2 (7.7)
0
3 (11.5)
16
0
0
0
0
0
0
0
50
2 (4.0)
0
5 (10.0)
21
Common AV valve replace (including Redo)
2
0
0
0
6
1 (16.7)
0
2 (33.3)
4
1 (25.0)
0
1 (25.0)
2
0
0
0
14
2 (14.3)
0
3 (21.4)
22
Repair of supra-aortic stenosis
0
0
0
0
9
0
0
0
19
0
0
0
0
0
0
0
28
0
0
0
23
Repair of subaortic stenosis (including Redo)
3
0
0
0
3
0
0
0
32
0
0
0
3
1 (33.3)
0
1 (33.3)
41
1 (2.4)
0
1 (2.4)
24
Aortic valve plasty ± VSD Closure
0
0
0
0
10
0
0
0
44
1 (2.3)
0
1 (2.3)
2
0
0
0
56
1 (1.8)
0
1 (1.8)
25
Aortic valve replacement
0
0
0
0
2
0
0
0
27
0
0
0
31
0
0
0
60
0
0
0
26
AVR with annular enlargement
0
0
0
0
0
0
0
0
16
0
0
1 (6.3)
4
0
0
0
20
0
0
1 (5.0)
27
Aortic root Replace (except Ross)
0
0
0
0
0
0
0
0
7
0
0
0
16
1 (6.3)
0
2 (12.5)
23
1 (4.3)
0
2 (8.7)
28
Ross procedure
0
0
0
0
3
0
0
0
13
0
0
0
    
16
0
0
0
29
Bilateral pulmonary artery banding
166
6 (3.6)
0
24 (14.5)
15
0
0
2 (13.3)
1
0
0
0
0
0
0
0
182
6 (3.3)
0
26 (14.3)
Total
759
23 (3.0)
1 (0.1)
65 (8.6)
1613
31 (1.9)
0
48 (3.0)
1459
6 (0.4)
0
13 (0.9)
287
3 (1.0)
0
9 (3.1)
4118
63 (1.5)
1 (0.02)
135 (3.3)
(), % 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
Table 2
Acquired (total, (1) + (2) + (4) + (5) + (6) + (7) + isolated operations for arrhythmia in (3); 32,509
(1) Valvelar heart disease (total; 18,366)
 
Valve
Cases
Operation
30-Day mortality
Hospital mortality
Redo
Mechanical
Bioprosthesis
Repair
Unknown
with CABG
Hospital
After discharge
Cases
30-Day mortality
Hospital mortality
Replace
Repair
Replace
Repair
Replace
Repair
Hosipital
After discharge
Isolated
A
8592
949
7465
125
53
2115
146 (1.7)
2 (1.6)
2 (0.02)
0
268 (3.2)
3 (2.4)
629
30 (4.8)
0
46 (7.3)
 
M
4471
414
849
3177
31
607
50 (4.0)
17 (0.5)
1 (0.08)
1 (0.03)
97 (7.7)
36 (1.1)
622
15 (2.4)
0
39 (6.3)
 
T
226
5
63
157
1
30
3 (4.4)
5 (3.2)
0
0
5 (7.4)
8 (5.1)
64
1 (1.6)
0
4 (6.3)
 
P
11
0
11
0
0
1
0
2 (40)
0
0
0
0
10
0
0
0
A + M
 
1064
    
189
45 (4.2)
 
1 (0.09)
 
80 (7.5)
 
158
9 (5.7)
0
17 (10.8)
 
A
 
202
827
31
4
           
 
M
 
140
381
538
5
           
A + T
 
381
    
68
16 (4.2)
 
1 (0.3)
 
25 (6.6)
 
58
2 (3.4)
0
3 (5.2)
 
A
 
48
331
2
0
           
 
T
 
0
0
371
10
           
M + T
 
2818
    
292
48 (1.7)
 
1 (0.04)
 
92 (3.3)
 
358
9 (2.5)
1 (0.3)
19 (5.3)
 
M
 
260
811
1734
13
           
 
T
 
8
24
2762
24
           
A + M + T
 
756
    
104
25 (3.3)
 
0
 
50 (6.6)
 
104
4 (3.8)
1 (1.0)
9 (8.7)
 
A
 
84
655
15
2
           
 
M
 
57
335
354
10
           
 
T
 
0
10
743
3
           
Others
 
47
    
4
1 (2.1)
 
0
 
1 (2.1)
 
19
1 (5.3)
0
1 (5.3)
Total
 
18,366
    
3410
358 (1.9)
 
7 (0.04)
 
665 (3.6)
 
2022
71 (3.5)
2 (0.1)
138 (6.8)
 
Cases
30-Day mortality
TAVR
9774
99
(1.0)
(2) Ischemic heart disease (total, (A) + (B); 11,524)
(A) Isolated CABG (total; (a) + (b); 10,311)
(a-1) On-pump arrest CABG (total; 2263)
 
Primary, elective
Primary, emergent
Redo, elective
Redo, emergent
Artery only
Artery + svg
svg only
Others
Unclear
Cases
30 day mortality
Hospital mortality
Cases
30 day mortality
Hospital mortality
Cases
30 day mortality
Hospital mortality
Cases
30 day mortality
Hospital mortality
Hospital
After discharge
Hospital
After discharge
Hospital
After discharge
Hospital
After discharge
1VD
36
1 (2.8)
0
1 (2.8)
12
2 (16.7)
0
2 (16.7)
1
0
0
0
0
0
0
0
20
14
15
0
0
2VD
257
4 (1.6)
0
7 (2.7)
39
3 (7.7)
0
6 (15.4)
3
0
0
0
1
1 (100.0)
0
1 (100.0)
34
235
30
1
0
3VD
847
8 (0.9)
0
14 (1.7)
80
2 (2.5)
0
6 (7.5)
3
1 (33.3)
0
1 (33.3)
1
0
0
0
30
869
28
4
0
LMT
792
15 (1.9)
0
21 (2.7)
152
11 (7.2)
0
17 (11.2)
3
0
0
0
2
0
0
0
83
822
38
6
0
No info
24
0
0
1 (4.2)
8
1 (12.5)
0
1 (12.5)
1
1 (100.0)
0
1 (100.0)
1
1 (100.0)
0
1 (100.0)
3
23
7
0
1
Total
1956
28 (1.4)
0
44 (2.2)
291
19 (6.5)
0
32 (11.0)
11
2 (18.2)
0
2 (18.2)
5
2 (40.0)
0
2 (40.0)
170
1963
118
11
1
Kawasaki
4
1 (25.0)
0
1 (25.0)
0
0
0
0
0
0
0
0
0
0
0
0
4
0
0
0
0
on dialysis
249
12 (4.8)
0
15 (6.0)
37
0
0
4 (10.8)
3
0
0
0
0
0
0
0
19
252
18
0
0
(), % mortality
CABG coronary artery bypass grafting, 1VD one-vessel disease, 2VD two-vessel disease, 3VD three-vessel disease, LMT left main trunk, SVG saphenous vein graft
LMT includes LMT alone or LMT with other branch diseases
(a-2) On-pump beating CABG (total; 2034)
 
Primary, elective
Primary, emergent
Redo, elective
Redo, emergent
Artery only
Artery + svg
svg only
Others
Unclear
Cases
30 day mortality
Hospital mortality
Cases
30 day mortality
Hospital mortality
Cases
30 day mortality
Hospital mortality
Cases
30 day mortality
Hospital mortality
Hospital
After discharge
Hospital
After discharge
Hospital
After discharge
Hospital
After discharge
1VD
30
1 (3.3)
0
0
1 (3.3)
9
1 (11.1)
0
2 (22.2)
2
0
0
0
1
0
0
0
18
14
10
0
0
2VD
211
3 (1.4)
0
0
5 (2.4)
36
4 (11.1)
0
6 (16.7)
2
0
0
0
0
0
0
0
56
172
18
3
0
3VD
679
13 (1.9)
0
0
20 (2.9)
133
14 (10.5)
0
21 (15.8)
9
0
0
1 (11.1)
1
0
0
0
93
697
26
6
0
LMT
664
14 (2.1)
1
0.150602
21 (3.2)
212
15 (7.1)
0
23 (10.8)
11
1 (9.1)
0
2 (18.2)
4
2 (50.0)
0
3 (75.0)
154
701
34
2
0
No info
21
0 (0.0)
0
0
0 (0.0)
6
3 (50.0)
0
3 (50.0)
0
0
0
0
3
0
0
1 (33.3)
9
11
8
2
0
Total
1605
31 (1.9)
1
0.062305
47 (2.9)
396
37 (9.3)
0 (0.0)
55 (13.9)
24
1 (4.2)
0
3 (12.5)
9
2 (22.2)
0
4 (44.4)
330
1595
96
13
0
Kawasaki
6
0
0
 
0
0
0
0
0
1
0
0
0
0
0
0
0
2
5
0
0
0
on dialysis
246
18 (7.3)
0
 
25 (10.2)
54
14 (25.9)
0 (0.0)
21 (38.9)
5
0 (0.0)
0
2 (40.0)
4
2 (50.0)
0
3 (75.0)
33
249
24
3
0
(), % mortality
CABG coronary artery bypass grafting, 1VD one-vessel disease, 2VD two-vessel disease, 3VD three-vessel disease, LMT left main trunk, SVG saphenous vein graft
LMT includes LMT alone or LMT with other branch diseases
(b) Off-pump CABG (total; 6014)
(Including cases of planned off-pump CABG in which, during surgery, the change is made to an on-pump CABG or on-pump beating-heart procedure)
 
Primary, elective
Primary, emergent
Redo, elective
Redo, emergent
Artery only
Artery + svg
svg only
Others
Unclear
Cases
30 day mortality
Hospital mortality
Cases
30 day mortality
Hospital mortality
Cases
30 day mortality
Hospital mortality
Cases
30 day mortality
Hospital mortality
Hospital
After discharge
Hospital
After discharge
Hospital
After discharge
Hospital
After discharge
1VD
340
0 (0.0)
0
1 (0.3)
28
3 (10.7)
0
 
3 (10.7)
5
0
0
0
1
0
0
0
256
76
41
0
1
2VD
836
2 (0.2)
0
9 (1.1)
63
1 (1.6)
0
 
3 (4.8)
6
0
0
0
0
0
0
0
301
579
21
3
1
3VD
2151
18 (0.8)
3 (0.1)
29 (1.3)
182
5 (2.7)
0
 
7 (3.8)
8
0
0
0 (0.0)
7
1 (14.3)
0
1 (14.3)
438
1857
32
21
0
LMT
1966
13 (0.7)
2 (0.1)
24 (1.2)
328
11 (3.4)
1
0.304878
18 (5.5)
15
0
0
0
3
0 (0.0)
0
0 (0.0)
615
1641
43
11
2
No info
50
0 (0.0)
0 (0.0)
1 (2.0)
19
0
0
 
3 (15.8)
4
0
0
0
2
2 (100.0)
0
2 (100.0)
26
41
8
0
0
Total
5343
33 (0.6)
5 (0.1)
64 (1.2)
620
20 (3.2)
1
0.16129
34 (5.5)
38
0
0
0 (0.0)
13
3 (23.1)
0
3 (23.1)
1636
4194
145
35
4
Kawasaki
11
0
0
0
1
0
0
 
0
0
0
0
0
0
0
0
0
5
7
0
0
0
on dialysis
584
4 (0.7)
1 (0.2)
12 (2.1)
56
2 (3.6)
0
 
4 (7.1)
6
0
0
0 (0.0)
2
0 (0.0)
0
0 (0.0)
139
482
25
2
0
(), % mortality
CABG coronary artery bypass grafting, 1VD one-vessel disease, 2VD two-vessel disease, 3VD three-vessel disease, LMT left main trunk, SVG saphenous vein graft
LMT includes LMT alone or LMT with other branch diseases
(c) 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
24
2 (8.3)
0
3 (12.5)
5
2 (40.0)
0
2 (40.0)
0
0
0
0
0
0
0
0
Converted to beating
97
6 (6.2)
0
10 (10.3)
30
4 (13.3)
0
5 (16.7)
0
0
0
0
0
0
0
0
Total
121
8 (6.6)
0
13 (10.7)
35
6 (17.1)
0
7 (20.0)
0
0
0
0
0
0
0
0
On dialysis
36
4 (11.1)
0
7 (19.4)
5
1 (20.0)
0
2 (40.0)
0
0
0
0
0
0
0
0
(), % mortality
CABG coronary artery bypass grafting
(B) Operation for complications of MI (total; 1213)
 
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
119
8 (6.7)
0
10 (8.4)
26
4 (15.4)
0
7 (26.9)
80
31
2
VSP closure
85
9 (10.6)
0
13 (15.3)
250
67 (26.8)
0
87 (34.8)
92
0
8
Cardiac rupture
37
12 (32.4)
0
12 (32.4)
247
63 (25.5)
0
80 (32.4)
46
3
9
Mitral regurgitation
 (1) Papillary muscle rupture
9
0
0
0
51
10 (19.6)
0
16 (31.4)
26
4
56
 (2) Ischemic
204
12 (5.9)
0
24 (11.8)
39
8 (20.5)
0
12 (30.8)
191
138
105
Others
69
1 (1.4)
0
4 (5.8)
77
25 (32.5)
0
27 (35.1)
51
8
5
Total
523
42 (8.0)
0
63 (12.0)
690
177 (25.7)
0
229 (33.2)
486
184
185
(), % mortality
MI myocardial infarction; CABG, coronary artery bypass grafting; MVP, mitral valve repair; MVR, mitral valve replacement; VSP, ventricular septal perforation
Acute, within 2 weeks from the onset of myocardial infarction
(3) Operation for arrhythmia (total; 6831)
 
Cases
30-Day mortality
Hospital mortality
Concomitant operation
Isolated
Congenital
Valve
IHD
Others
Multiple combination
Hospital
After discharge
2 categories
3 categories
Maze
3680
55 (1.5)
1 (0.03)
104 (2.8)
204
158
3126
631
344
728
45
For WPW
0
0
0
0
0
0
0
0
0
0
0
For ventricular tachyarrhythmia
23
1 (4.3)
0
1 (4.3)
5
0
10
10
1
0
0
Others
3128
60 (1.9)
1 (0.03)
117 (3.7)
68
139
2625
575
378
626
42
Total
6831
116 (1.7)
2 (0.03)
222 (3.2)
277
297
5761
1216
723
1354
87
(), % mortality
WPW Wolff–Parkinson–White syndrome, IHD ischemic heart disease
Except for 170 isolated cases, all remaining 5164 cases are doubly allocated, one for this subgroup and the other for the subgroup corresponding to the concomitant operations
(4) Operation for constrictive pericarditis (total; 210)
 
CPB (+)
CPB (−)
Cases
30-Day mortality
Hospital mortality
Cases
30-Day mortality
Hospital mortality
Hospital
After discharge
Hospital
After discharge
Total
119
7 (5.9)
0
18 (15.1)
91
3 (3.3)
1 (1.1)
7 (7.7)
(), % mortality
CPB cardiopulmonary bypass
(5) Cardiac tumor (total; 628)
 
Cases
30-Day mortality
Hospital mortality
Concomitant operation
Hospital
After discharge
AVR
MVR
CABG
Others
Benign tumor
537
4 (0.7)
0
4 (0.7)
30
23
60
116
(Cardiac myxoma)
353
0
0
0
9
7
33
67
Malignant tumor
91
6 (6.6)
1 (1.1)
9 (9.9)
3
3
1
9
(Primary)
48
3 (6.3)
0
4 (8.3)
1
3
1
5
(), % mortality
AVR aortic valve replacement, MVR mitral valve replacement, CABG coronary artery bypass grafting
(6) HOCM and DCM (total; 264)
 
Cases
30-Day mortality
Hospital mortality
Concomitant operation
Hospital
After discharge
AVR
MVR
MVP
CABG
Myectomy
118
3 (2.5)
0
5 (4.2)
41
17
24
10
Myotomy
5
0
0
1 (20.0)
1
1
1
0
No-resection
133
7 (5.3)
0
10 (7.5)
27
60
73
14
Volume reduction surgery of the left ventricle
8
0
0
0
0
1
2
2
Total
264
10 (3.8)
0
16 (6.1)
69
79
100
26
(), % mortality
HOCM hypertrophic obstructive cardiomyopathy, DCM dilated cardiomyopathy, AVR aortic valve replacement, MVR mitral valve replacement, MVP mitral valve repair, CABG coronary artery bypass grafting
(7) Other open-heart operation (total; 1240)
 
Cases
30-Day mortality
Hospital mortality
Hospital
After discharge
Open-heart operation
511
56 (11.0)
0
83 (16.2)
Non-open-heart operation
729
81 (11.1)
0
114 (15.6)
Total
1240
137 (11.0)
0
197 (15.9)
(), % mortality
Table 3
Thoracic aortic aneurysm (total; 22,540)
(1) Dissection (total; 10,855)
Stanford type
Acute
Chronic
Concomitant operation
A
B
A
B
Replaced site
Cases
30-Day mortality
Hospital mortality
Cases
30-Day mortality
Hospital mortality
Cases
30-Day mortality
Hospital mortality
Cases
30-Day mortality
Hospital mortality
AVP
AVR
MVP
MVR
CABG
Others
Hospital
After discharge
Hospital
After discharge
Hospital
After discharge
Hospital
After discharge
Ascending Ao
2071
146 (7.0)
1 (0.05)
189 (9.1)
1
0
0
0
187
6 (3.2)
0
8 (4.3)
1
0
0
0
61
137
22
8
110
32
Aortic Root
191
35 (18.3)
0
36 (18.8)
0
0
0
0
80
4 (5.0)
0
5 (6.3)
3
0
0
0
32
194
6
2
65
7
Arch
1954
135 (6.9)
1 (0.05)
174 (8.9)
31
0
0
0
355
9 (2.5)
0
13 (3.7)
172
5 (2.9)
0
6 (3.5)
54
113
10
5
118
25
Aortic root + asc. Ao. + Arch
167
23 (13.8)
0
26 (15.6)
0
0
0
0
47
1 (2.1)
0
3 (6.4)
6
0
0
0
23
143
2
0
35
2
Descending Ao
35
4 (11.4)
0
4 (11.4)
28
2 (7.1)
0
2 (7.1)
56
1 (1.8)
0
1 (1.8)
220
9 (4.1)
0
10 (4.5)
2
4
0
0
4
0
Thoracoabdominal
1
1 (100.0)
0
1 (100.0)
11
1 (9.1)
0
1 (9.1)
46
5 (10.9)
0
5 (10.9)
182
11 (6.0)
1 (0.5)
13 (7.1)
0
0
0
0
1
0
Simple TEVAR
101
9 (8.9)
0
11 (10.9)
442
30 (6.8)
0
34 (7.7)
264
2 (0.8)
0
3 (1.1)
1171
7 (0.6)
0
8 (0.7)
1
2
0
0
2
2
Open SG with BR
1213
101 (8.3)
2 (0.16)
133 (11.0)
62
3 (4.8)
0
3 (4.8)
207
8 (3.9)
0
11 (5.3)
237
4 (1.7)
0
7 (3.0)
61
115
10
2
104
16
Open SG without BR
435
32 (7.4)
0
45 (10.3)
28
2 (7.1)
0
3 (10.7)
52
2 (3.8)
0
4 (7.7)
82
3 (3.7)
0
3 (3.7)
20
45
1
0
30
2
Arch TEVAR with BR
14
1 (7.1)
0
1 (7.1)
123
6 (4.9)
0
10 (8.1)
73
2 (2.7)
0
2 (2.7)
364
7 (1.9)
0
8 (2.2)
1
0
0
0
0
0
Thoracoabdominal TEVAR with BR
0
0
0
0
11
0
0
0
6
0
0
1 (16.7)
33
2 (6.1)
0
4 (12.1)
0
0
0
0
0
0
Other
18
6 (33.3)
0
6 (33.3)
13
3 (23.1)
0
3 (23.1)
10
0
0
0
51
2 (3.9)
0
2 (3.9)
0
2
0
0
1
1
Total
6200
353 (5.7)
4 (0.06)
626 (10.1)
750
47 (6.3)
0
56 (7.5)
1383
40
(2.9)
0
56 (4.0)
2522
50 (2.0)
1 (0.0)
61 (2.4)
255
755
51
17
470
87
(), % mortality
Ao aorta, AVP aortic valve repair, AVR aortic valve replacement, MVP mitral valve repair, MVR mitral valve replacement, CABG coronary artery bypass grafting, TEVAR thoracic endovascular aortic (aneurysm) repair
Acute, within 2 weeks from the onset
(2) Non-dissection (total; 11,685)
Replaced site
Unruptured
Ruptured
Concomitant operation
Cases
30-Day mortality
Hospital mortality
Cases
30-Day mortality
Hospital mortality
AVP
AVR
MVP
MVR
CABG
Others
Hospital
After discharge
Hospital
After discharge
Ascending Ao
1423
33 (2.3)
0
51 (3.6)
56
7 (12.5)
0
11 (19.6)
43
1055
65
68
181
115
Aortic Root
1056
22 (2.1)
0
35 (3.3)
59
10 (16.9)
0
11 (18.6)
243
783
73
27
144
77
Arch
2035
38 (1.9)
0
67 (3.3)
113
10 (8.8)
0
14 (12.4)
33
569
37
23
304
76
Aortic root + asc. Ao. + Arch
306
10 (3.3)
0
14 (4.6)
10
0
0
2 (20.0)
53
225
12
0
39
10
Descending Ao
305
5 (1.6)
2 (0.66)
14 (4.6)
32
5 (15.6)
0
5 (15.6)
1
8
0
0
16
3
Thoracoabdominal
377
14 (3.7)
0
27 (7.2)
45
5 (11.1)
0
8 (17.8)
0
0
0
0
0
0
Simple TEVAR
2457
32 (1.3)
5 (0.20)
55 (2.2)
373
56 (15.0)
1 (0.27)
74 (19.8)
0
2
0
0
1
5
Open SG with BR
1115
40 (3.6)
0
68 (6.1)
66
7 (10.6)
0
13 (19.7)
7
121
13
2
166
12
Open SG without BR
398
8 (2.0)
0
24 (6.0)
33
3 (9.1)
0
7 (21.2)
6
67
7
2
55
8
Arch TEVAR with BR
1080
21 (1.9)
3
33 (3.1)
58
8 (13.8)
0
9 (15.5)
0
0
1
0
3
2
Thoracoabdominal TEVAR with BR
107
9 (8.4)
1 (0.93)
11 (10.3)
15
1 (6.7)
0
2 (13.3)
0
0
0
0
0
0
Other
137
2 (1.5)
0
6 (4.4)
29
7 (24.1)
0
8 (27.6)
0
14
2
0
8
4
Total
10,796
234 (2.2)
11 (0.10)
405 (3.8)
889
119 (13.4)
1 (0.11)
164 (18.4)
386
2844
210
122
917
312
(), % mortality
Ao aorta, AVP aortic valve repair, AVR aortic valve replacement, MVP mitral valve repair, MVR mitral valve replacement, CABG coronary artery bypass grafting, TEVAR thoracic endovascular aortic (aneurysm) repair
Table 4
Pulmonary thromboembolism (total; 190)
 
Cases
30-Day mortality
Hospital mortality
Hospital
After discharge
Acute
131
25 (19.1)
 
30 (22.9)
Chronic
59
0
 
1 (1.7)
Total
190
25 (13.2)
0
31 (16.3)
(), % mortality
Table 5
Implantation of VAD (total; 187)
 
Cases
30-Day mortality
Hospital mortality
Hospital
After discharge
Implantation of VAD
187
2 (1.1)
0
14 (7.5)
(), % mortality
VAD ventricular assist devise
Table 6
Heart transplantation (total; 54)
 
Cases
Age
< 18 years
18 years ≤
Heart transplantation
54
5
49
Heart and lung transplantation
0
0
0
Total
54
5
49
(), % mortality
Among the 8595 procedures for congenital heart disease conducted in 2020, 6543 were open-heart surgeries, with an overall hospital mortality rate of 2.0%. The number of surgeries for neonates and infants in 2020 did not significantly differ compared to that in 2010; however, hospital mortality improved from 11.5 to 8.2% for neonates and from 3.0 to 2.1% for infants. In 2020, atrial septal defect was the most common disease (1188 cases) as previously reported, with patients aged ≥ 18 years accounting for 63% 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 (1043 cases).
Hospital mortality for complex congenital heart disease within the past 10 years was as follows (2010 [4], 2015 [5], and 2020): complete atrioventricular septal defect (4.2%, 5.4%, and 2.2%); tetralogy of Fallot (0.8%, 2.1%, and 0.8%); transposition of the great arteries with the intact septum (4.1%, 7.1%, and 0%), ventricular septal defect (7.4%, 7.1%, and 0%), and single ventricle (7.5%, 3.9%, and 5.9%); and hypoplastic left heart syndrome (13.1%, 8.0%, and 9.3%). Currently, right heart bypass surgery has been commonly performed (335 bidirectional Glenn procedures, excluding 35 Damus–Kaye–Stansel procedures, and 378 Fontan type procedures, including total cavopulmonary connection) with acceptable hospital mortality rates (1.2% and 0.8%). The Norwood type I procedure was performed in 117 cases, with a relatively low hospital mortality rate (16.2%).
Valvular heart disease procedures, excluding transcatheter procedures, were performed less than that in the previous year. Isolated aortic valve replacement/repair with/without coronary artery bypass grafting (CABG) (n = 8592) was 16.3%% fewer than that in the previous year (n = 10,268) and 0.7% fewer than that 5 years ago (n = 8651), as opposed to the rapid increase of transcatheter aortic valve replacement (n = 9774 in 2020). Isolated mitral valve replacement/repairs with/without CABG (n = 4471) was 14.7% fewer than that in the previous year (n = 5239) and 1.2% fewer than that 5 years ago (n = 4524). Aortic and mitral valve replacement with bioprosthesis were performed in 9278 and 2376 cases, respectively. The rate at which bioprosthesis was used had dramatically increased from 30% in the early 2000s [6, 7] to 87.9% and 72.6% in 2020 for aortic and mitral positions, respectively. Additionally, CABG was performed concurrently in 18.6% of all valvular procedures (17.8% in 2010 [4] and 19.8% in 2015 [5]). Valve repair was common in mitral and tricuspid valve positions (5803 and 4033 cases, respectively) but less common in aortic valve positions (173 patients, only 1.6% of all aortic valve procedures). Mitral valve repair accounted for 63.7% of all mitral valve procedures. Hospital mortality rates for single valve replacement for aortic and mitral positions were 3.2% and 7.7%, respectively, but only 1.1% for mitral valve repair. Moreover, hospital mortality rates for redo valve surgery for the aortic and mitral positions were 7.3% and 6.3%, respectively. Finally, overall hospital mortality rates did not significantly improve over the past 10 years (3.4% in 2010 [4], 4.0% in 2015 [5], and 3.6% in 2020).
Isolated CABG had been performed in 10,311 cases, accounting for only 66.4% of the procedures performed 10 years ago (n = 15,521) [4]. Of the aforementioned cases, 6014 (58.3%) underwent off-pump CABG, with a success rate of 98.0%. The percentage of planned off-pump CABG in 2020 was similar to that in 2019. Hospital mortality associated with primary elective CABG procedures among 8904 cases accounted for 1.7%, which is slightly higher than that in 2010 (1.1%) [4]. Hospital mortality for primary emergency CABG among 1307 cases remained high (9.2%). The percentage of conversion from off-pump to on-pump CABG or on-pump beating-heart CABG was 2.3% among the primary elective CABG cases, with a hospital mortality rate of 10.7%. 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). This study excluded concomitant CABGs alongside other major procedures 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 2020, including concomitant CABG with other major procedures, was 15,681.
Arrhythmia management was primarily performed as concomitant procedures in 6831 cases, with a hospital mortality rate of 3.2%. Pacemaker and implantable cardioverter-defibrillator implantation were not included in this category.
In 2020, 22,540 procedures for thoracic and thoracoabdominal aortae diseases were performed, among which aortic dissection and non-dissection accounted for 10,855 and 11,685, respectively. The number of surgeries for aortic dissection this year was 0.1% higher than that in the preceding year (n = 10,847). Hospital mortality rates for the 6200 Stanford type A acute aortic dissections remained high (10.1%). The number of procedures for non-dissected aneurysms decreased by 1.5%, with a hospital mortality rate of 4.9% for all aneurysms and 3.8% and 18.4% for unruptured and ruptured aneurysms, respectively. Thoracic endovascular aortic repair (TEVAR) has been performed for aortic diseases at an increasing rate. Stent graft placement was performed in 4918 patients with aortic dissection, including 2602 TEVARs and 2316 open stent graftings. Moreover, 1568 and 319 cases underwent TEVAR and open stent grafting for type B chronic aortic dissection, accounting for 62.2% and 12.6% of the total number of cases, respectively. Hospital mortality rates associated with simple TEVAR for type B aortic dissection were 7.7% and 0.7% for acute and chronic cases, respectively. Stent graft placement was performed in 5702 patients with non-dissected aortic aneurysms, among which 4090 were TEVARs (an 0.4% increase compared to that in 2019, n = 4072) and 1612 were open stent graftings (a 7.5% increase compared to that in 2019, n = 1499). Hospital mortality rates were 2.7% and 19.1% for TEVARs and 6.1% and 20.2% for open stenting in unruptured and ruptured aneurysms, respectively.

(B) General thoracic surgery

The 2020 survey of general thoracic surgeries comprised 708 surgical units, with bulk data submitted via a web-based collection system established by the NCD [3]. General thoracic surgery departments reported 86,813 procedures in 2020 (Table 7), which is 2.1 times more than that in 2000 and approximately 7038 more procedures than that in 2015 (Fig. 2). However it decreased by 5.3% compared to that of 2019 (91,626), mostly because of COVID-19 pandemic, despite the steadily increase up to 2019.
Table 7
Total cases of general thoracic surgery during 2020
 
Cases
%
Benign pulmonary tumor
2232
2.6
Primary lung cancer
45,436
52.3
Other primary malignant pulmonary tumor
336
0.4
Metastatic pulmonary tumor
9654
11.1
Tracheal tumor
98
0.1
Pleural tumor including mesothelioma
584
0.7
Chest wall tumor
652
0.8
Mediastinal tumor
5573
6.4
Thymectomy for MG without thymoma
130
0.1
Inflammatory pulmonary disease
2397
2.8
Empyema
3138
3.6
Bullous disease excluding pneumothorax
317
0.4
Pneumothorax
13,514
15.6
Chest wall deformity
180
0.2
Diaphragmatic hernia including traumatic
41
0.0
Chest trauma excluding diaphragmatic hernia
458
0.5
Lung transplantation
75
0.1
Others
1998
2.3
Total
86,813
100.0
In 2020, 45,436 procedures for primary lung cancer had been performed which decreased by 5.4% compared to that of 2019 (48,052) similarly to the total number of surgeries in general thoracic surgery. The number of procedures in 2020 was 2.4 times higher than that in 2000, with lung cancer procedures accounting for 52% of all general thoracic surgeries.
Information about the number of video-assisted thoracoscopic surgery (VATS), which is defined as surgical procedures using a skin incision less than 8 cm including a mini-thoracotomy (hybrid) approach, have been available since the 2015 annual report. Tables 8, 9, 11, 14, 15, 16, 18, 19, 20, 21, 22, and 24, 25, 26 present the number of VATS procedures for benign pulmonary tumors, primary lung cancer, metastatic pulmonary tumor, chest wall tumor, mediastinal tumor, thymectomy for myasthenia gravis, inflammatory pulmonary disease, empyema, descending necrotizing mediastinitis, bullous diseases, pneumothorax, diaphragmatic hernia, chest trauma and other respiratory surgeries in 2020, respectively.
Table 8
Benign pulmonary tumor
 
Cases
30-Day mortality
Hospital mortality
by VATS
Hospital
After discharge
1. Benign pulmonary tumor
 Hamartoma
443
0
0
0
429
 Sclerosing hemangioma
95
0
1 (1.1)
0
88
 Papilloma
20
0
0
0
19
 Mucous gland adenoma bronchial
12
0
0
0
11
 Fibroma
133
0
0
1 (0.8)
123
 Lipoma
9
0
0
0
7
 Neurogenic tumor
14
0
0
0
14
 Clear cell tumor
3
0
0
0
3
 Leiomyoma
22
0
0
0
21
 Chondroma
8
0
0
0
8
 Inflammatory myofibroblastic tumor
0
0
0
0
0
 Pseudolymphoma
22
0
0
0
20
 Histiocytosis
16
0
0
0
14
 Teratoma
4
0
0
0
4
 Others
1431
0
0
1 (0.1)
1318
Total
2232
0
1 (0.04)
2 (0.09)
2079
(), Mortality %
Table 9
Primary malignant pulmonary tumor
 
Cases
30-Day mortality
Hospital mortality
VATS
Robotic surgery
Hospital
After discharge
2. Primary malignant pulmonary tumor
45,772
122 (0.3)
45 (0.1)
235 (0.5)
33,992
3078
Lung cancer
45,436
122 (0.3)
45 (0.1)
235 (0.5)
33,992
3078
 Adenocarcinoma
31,632
55 (0.2)
21 (0.07)
97 (0.3)
  
 Squamous cell carcinoma
8217
44 (0.5)
16 (0.2)
98 (1.2)
  
 Large cell carcinoma
288
2 (0.7)
0
2 (0.7)
  
 LCNEC
573
7 (1.2)
3 (0.5)
10 (1.7)
  
 Small cell carcinoma
888
4 (0.5)
2 (0.2)
9 (1.0)
  
 Adenosquamous carcinoma
565
1 (0.2)
0
3 (0.5)
  
 Carcinoma with pleomorphic, sarcomatoid or sarcomatous elements
553
2 (0.4)
0
6 (1.1)
  
 Carcinoid
249
0
0
0
  
 Carcinomas of salivary-gland type
18
0
0
0
  
 Unclassified
39
0
1 (2.6)
0
  
 Multiple lung cancer
2061
4 (0.2)
2 (0.1)
7 (0.3)
  
 Others
306
3 (1.0)
0
3 (1.0)
  
 Wedge resection
8511
10 (0.1)
8 (0.1)
24 (0.3)
7815
12
 Segmental excision
5794
10 (0.2)
2 (0.03)
15 (0.3)
4784
253
  (Sleeve segmental excision)
10
0
0
0
4
0
 Lobectomy
30,604
94 (0.3)
35 (0.11)
182 (0.6)
21,179
2810
  (Sleeve lobectomy)
396
2 (0.5)
0
9 (2.3)
51
1
 Pneumonectomy
251
5 (2.0)
0
9 (3.6)
35
2
  (Sleeve pneumonectomy)
8
1 (12.5)
0
1 (12.5)
0
0
 Other bronchoplasty
32
1 (3.1)
0
1 (3.1)
4
0
 Pleuropneumonectomy
1
0
0
0
0
0
 Others
198
2 (1.0)
0
4 (2.0)
135
1
 Multiple incision for Multiple lung cancer
45
0
0
0
40
0
Sarcoma
53
0
0
0
  
AAH
11
0
0
0
  
Others
272
0
0
0
  
(), Mortality %
A total of 2232 procedures for benign pulmonary tumors had been conducted in 2020 (Table 8). Hamartomas were the most frequent benign pulmonary tumors diagnosed, with 2079 patients (93%) undergoing VATS.
Tables 9 and 10 show additional information on primary malignant pulmonary tumors. Accordingly, the most frequently diagnosed lung cancer subtype was adenocarcinoma (70% of all lung cancers), followed by squamous cell carcinoma (18%). Sublobar resection was performed in 14,305 lung cancer cases (31% of all cases) and lobectomy in 30,604 cases (67% of all cases). Sleeve lobectomy was performed in 396 cases (0.9% of all cases), while pneumonectomy was required in 251 cases (0.6% of all cases). VATS lobectomy was performed in 21,179 cases of lung cancer (69% of all lobectomy cases). RATS lobectomy was performed in 2810 cases of lung cancer (9% of all lobectomy cases). Patients aged ≥ 80 years who underwent lung cancer surgery accounted for 6521 (14%). Among those who died within 30 days postoperatively, 122 and 45 died before and after hospital discharge, respectively. Overall, 167 patients died within 30 days postoperatively (30-day mortality rate, 0.4%), while 122 died before discharge (hospital mortality rate, 0.3%). Moreover, 30-day mortality rates according to the procedure were 0.2%, 0.4%, and 2% for segmentectomy, lobectomy, and pneumonectomy, respectively. Interstitial pneumonia had been the leading cause of death after lung cancer surgery, followed by pneumonia, respiratory failure, and cardiovascular events.
Table 10
Details of lung cancer operations
TNM
c-Stage
Cases
IA1
8499
IA2
13,478
IA3
7783
IB
4886
IIA
1487
IIB
3746
IIIA
2448
IIIB
444
IIIC
19
IVA
367
IVB
105
NA
2129
Total
45,391
Sex
Cases
Male
27,831
Female
17,560
NA
0
Total
45,391
Cause of death
Cases
Cardiovascular
38
Pneumonia
96
Pyothorax
4
Bronchopleural fistula
11
Respiratory failure
32
Pulmonary embolism
4
Interstitial pneumonia
101
Brain infarction or bleeding
21
Others
140
Unknown
25
Total
472
p-Stage
Cases
0 (pCR)
3124
IA1
9234
IA2
10,515
IA3
4957
IB
6300
IIA
1177
IIB
4475
IIIA
3594
IIIB
780
IIIC
11
IVA
866
IVB
99
NA
257
Total
45,389
Age (y)
Cases
< 20
19
20–29
39
30–39
232
40–49
1142
50–59
3595
60–69
11,483
70–79
22,360
80–89
6422
≥ 90
99
NA
0
Total
45,391
The procedures for metastatic pulmonary tumors performed in 2020 increased 3.4% to 9654 cases compared to that in 2019 (9329), which showed contrastive trend to primary lung cancer (Table 11). Among such procedures, the most frequent primary tumor was colorectal cancer (48% of all cases).
Table 11
Metastatic pulmonary tumor
 
Cases
30-Day mortality
Hospital mortality
VATS
Hospital
After discharge
3. Metastatic pulmonary tumor
9654
11 (0.1)
7 (0.07)
21 (0.2)
8784
 Colorectal
4633
3 (0.06)
1 (0.02)
4 (0.1)
4232
 Hepatobiliary/pancreatic
528
2 (0.4)
1 (0.2)
4 (0.8)
489
 Uterine
512
0
1 (0.2)
0
476
 Mammary
549
0
2 (0.4)
0
515
 Ovarian
80
0
0
0
72
 Testicular
59
0
0
0
51
 Renal
768
0
0
0
712
 Skeletal
115
0
0
0
100
 Soft tissue
257
0
0
1 (0.4)
220
 Otorhinolaryngological
517
0
2 (0.4)
1 (0.2)
480
 Pulmonary
537
2 (0.4)
0
3 (0.6)
431
 Others
1099
4 (0.4)
0
8 (0.7)
1006
(), Mortality %
A total of 98 procedures for tracheal tumors, including 49, 30, and 19 cases of primary malignant, metastatic, and benign tracheal tumors, respectively, were performed in 2020. Further, 17 patients underwent sleeve resection and reconstruction (Table 12).
Table 12
Tracheal tumor
 
Cases
30-Day mortality
Hospital mortality
Hospital
After discharge
4. Tracheal tumor
98
1 (1.0)
2 (2.0)
1 (1.0)
  A. Primary malignant tumor
  Histological classification
    Squamous cell carcinoma
17
0
1 (5.9)
0
    Adenoid cystic carcinoma
17
0
0
0
    Mucoepidermoid carcinoma
2
0
0
0
    Others
13
0
0
0
    Total
49
0
1 (2.0)
0
  B. Metastatic/invasive malignant tumor, e.g. invasion of thyroid cancer
 
30
0
1 (3.3)
1 (3.3)
  C. Benign tracheal tumor
  Histological classification
    Papilloma
3
0
0
0
    Adenoma
2
0
0
0
    Neurofibroma
0
0
0
0
    Chondroma
0
0
0
0
    Leiomyoma
1
0
0
0
    Others
13
0
0
0
    Histology unknown
0
0
0
0
    Total
19
0
0
0
  Operation
    Sleeve resection with reconstruction
17
0
0
0
    Wedge with simple closure
2
0
0
0
    Wedge with patch closure
0
0
0
0
    Total laryngectomy with tracheostomy
0
0
0
0
    Others
2
0
0
0
    Unknown
0
0
0
0
    Total
21
0
0
0
(), Mortality %
Overall, 584 pleural tumors had been diagnosed in 2020 (Table 13), with diffuse malignant pleural mesothelioma as the most frequent histologic diagnosis. Total pleurectomy was performed in 105 cases and extrapleural pneumonectomy in 33 cases. The 30-day mortality rate was 2% and 3% after total pleurectomy and extrapleural pneumonectomy, respectively.
Table 13
Tumor of pleural origin
5. Tumor of pleural origin
Histological classification
Cases
30-Day mortality
Hospital mortality
Hospital
After discharge
Solitary fibrous tumor
106
0
0
0
Diffuse malignant pleural mesothelioma
213
4 (1.9)
0
7 (3.3)
Localized malignant pleural mesothelioma
32
0
0
1 (3.1)
Others
233
0
2 (0.9)
4 (1.7)
Total
584
4 (0.7)
2 (0.3)
12 (2.1)
Operative procedure
Cases
30-Day mortality
Hospital mortality
Hospital
After discharge
Extrapleural pneumonectomy
33
1 (3.0)
0
2 (6.1)
Total pleurectomy
105
2 (1.9)
0
3 (2.9)
Others
75
1 (1.3)
1 (1.3)
2 (2.7)
Total
213
4 (1.9)
1 (0.5)
7 (3.3)
(), Mortality %
Overall, 652 chest wall tumor resections had been performed in 2020, including 103, 209, and 340 cases of primary malignant, metastatic, and benign tumors, respectively (Table 14).
Table 14
Chest wall tumor
 
Cases
30-Day mortality
Hospital mortality
VATS
Hospital
After discharge
6. Chest wall tumor
 Primary malignant tumor
103
0
0
0
42
 Metastatic malignant tumor
209
0
1 (0.5)
0
66
 Benign tumor
340
0
0
0
251
 Total
652
0
1 (0.2)
0
359
(), Mortality %
In 2020, 5573 mediastinal tumors were resected, which decreased by 5% compared to that in 2019 (5881) (Table 15), which showed similar trend as primary lung cancer. Thymic epithelial tumors, including 2226 thymomas, 341 thymic carcinomas, and 48 thymic carcinoids, were the most frequently diagnosed mediastinal tumor subtype in 2020.
Table 15
Mediastinal tumor
 
Cases
30-Day mortality
Hospital mortality
By VATS
Robotic surgery
Hospital
After discharge
7. Mediastinal tumor
5573
5 (0.09)
0
9 (0.2)
4224
938
 Thymoma*
2226
0
0
3 (0.1)
1511
366
 Thymic cancer
341
0
0
0
186
37
 Thymus carcinoid
48
0
0
0
27
6
 Germ cell tumor
86
1 (1.2)
0
1 (1.2)
54
13
  Benign
68
1 (1.5)
0
1 (1.5)
48
11
  Malignant
18
0
0
0
6
2
 Neurogenic tumor
393
0
0
0
373
77
 Congenital cyst
1239
0
0
0
1164
270
 Goiter
73
0
0
0
27
5
 Lymphatic tumor
168
1 (0.6)
0
1 (0.6)
124
16
 Excision of pleural recurrence of thymoma
30
0
0
0
20
1
 Thymolipoma
19
0
0
0
8
1
 Others
950
3 (0.3)
0
4 (0.4)
730
146
(), Mortality %
A total of 484 patients underwent thymectomy for myasthenia gravis (Table 16), among which 354 procedures were associated with thymoma in 2020.
Table 16
Thymectomy for myasthenia gravis
 
Cases
30-Day mortality
Hospital mortality
By VATS
Robotic surgery
Hospital
After discharge
8. Thymectomy for myasthenia gravis
484
0
0
2 (0.4)
319
19
 With thymoma
354
0
0
2 (0.6)
209
2
(), Mortality %
Overall, 22,043 patients underwent procedures for non-neoplastic disease. Accordingly, 2397 patients underwent lung resection for inflammatory lung diseases (Tables 17, 18), among which 492 and 311 patients were associated with mycobacterial and fungal infections, respectively. Procedures for inflammatory pseudotumor were performed in 1011 cases (42%).
Table 17
Operations for non-neoplastic diseases: A + B + C + D + E + F + G + H + I
 
Cases
30-Day mortality
Hospital mortality
Hospital
After discharge
9. Operations for non-neoplastic diseases
22,043
250 (1.1)
48 (0.2)
502 (2.3)
Table 18
A. Inflammatory pulmonary disease
 
Cases
30-Day mortality
Hospital mortality
VATS
Hospital
After discharge
A. Inflammatory pulmonary disease
2397
9 (0.4)
3 (0.1)
26 (1.1)
2047
 Tuberculous infection
43
0
0
0
33
 Mycobacterial infection
492
3 (0.6)
0
3 (0.6)
443
 Fungal infection
311
1 (0.3)
0
11 (3.5)
203
 Bronchiectasis
45
1 (2.2)
0
2 (4.4)
30
 Tuberculous nodule
51
0
0
0
42
 Inflammatory pseudotumor
1011
0
0
2 (0.2)
936
 Interpulmonary lymph node
57
0
0
0
52
 Others
387
4 (1.0)
3 (0.8)
8 (2.1)
308
(), Mortality %
A total of 3138 procedures were performed for empyema (Table 19), among which 2456 (78%) were acute and 682 (22%) were chronic. Further, bronchopleural fistulas developed in 465 and 346 patients with acute and chronic empyema, respectively. The hospital mortality rate was 16% among patients with acute empyema with fistula.
Table 19
B. Empyema
 
Cases
30-Day mortality
Hospital mortality
By VATS
Hospital
After discharge
Acute empyema
2456
67 (2.7)
7 (0.3)
133 (5.4)
2002
 With fistula
465
32 (6.9)
3 (0.6)
72 (15.5)
241
 Without fistula
1952
34 (1.7)
4 (0.2)
59 (3.0)
1727
 Unknown
39
1 (2.6)
0
2 (5.1)
34
Chronic empyema
682
22 (3.2)
3 (0.4)
63 (9.2)
321
 With fistula
346
15 (4.3)
1 (0.3)
37 (10.7)
116
 Without fistula
303
7 (2.3)
2 (0.7)
23 (7.6)
180
 Unknown
33
0
0
3 (9.1)
25
Total
3138
89 (2.8)
10 (0.3)
196 (6.2)
2323
(), Mortality %
Further, 99 operations were performed for descending necrotizing mediastinitis (Table 20), with a hospital mortality rate of 6%.
Table 20
C. Descending necrotizing mediastinitis
 
Cases
30-Day mortality
Hospital mortality
VATS
Hospital
After discharge
C. Descending necrotizing mediastinitis
99
4 (4.0)
0
6 (6.1)
76
(), Mortality %
A total of 317 procedures were conducted for bullous diseases (Table 21), while only 14 patients underwent lung volume reduction surgery.
Table 21
D. Bullous diseases
 
Cases
30-Day mortality
Hospital mortality
VATS
Hospital
After discharge
D. Bullous diseases
317
1 (0.3)
0
2 (0.6)
285
 Emphysematous bulla
235
1 (0.4)
0
2 (0.9)
219
 Bronchogenic cyst
10
0
0
0
8
 Emphysema with LVRS
14
0
0
0
12
 Others
58
0
0
0
46
(), Mortality %
LVRS lung volume reduction surgery
A total of 13,514 procedures were performed for pneumothorax (Table 22). Among the 9592 procedures for spontaneous pneumothorax, 2523 (26%) were bullectomies alone, while 6428 (67%) required additional procedures, such as coverage with artificial material, as well as parietal pleurectomy. A total of 3922 procedures for secondary pneumothorax were performed, with chronic obstructive pulmonary disease (COPD) being the most prevalent associated disease (2775 cases, 71%). The hospital mortality rate for secondary pneumothorax associated with COPD was 3%.
Table 22
E. Pneumothorax
Cases
30-Day mortality
Hospital mortality
VATS
Hospital
After discharge
13,514
67 (0.5)
27 (0.2)
146 (1.1)
13,115
Spontaneous pneumothorax
Operative procedure
Cases
30-Day mortality
Hospital mortality
VATS
Hospital
After discharge
Bullectomy
2523
1 (0.0)
3 (0.1)
6 (0.2)
2770
Bullectomy with additional procedure
6428
4 (0.1)
4 (0.06)
9 (0.1)
7535
 Coverage with artificial material
6220
4 (0.1)
4 (0.06)
9 (0.1)
7291
 Parietal pleurectomy
22
0
0
0
27
 Coverage and parietal pleurectomy
68
0
0
0
54
 Others
118
0
0
0
163
Others
639
3 (0.5)
1 (0.2)
8 (1.3)
610
Unknown
2
0
0
0
9
Total
9592
8 (0.1)
8 (0.1)
23 (0.2)
10,924
Secondary pneumothorax
Associated disease
Cases
30-Day mortality
Hospital mortality
VATS
Hospital
After discharge
COPD
2775
41 (1.5)
11 (0.4)
83 (3.0)
2644
Tumorous disease
173
5 (2.9)
4 (2.3)
10 (5.8)
160
Catamenial
178
0
0
0
176
LAM
37
0
0
0
37
Others (excluding pneumothorax by trauma)
759
13 (1.7)
4 (0.5)
30 (4.0)
706
Unknown
0
0
0
0
0
Operative procedure
Cases
30 Day mortality
Hospital mortality
VATS
Hospital
After discharge
Bullectomy
718
4 (0.6)
4 (0.6)
12 (1.7)
690
Bullectomy with additional procedure
2243
32 (1.4)
8 (0.4)
53 (2.4)
2174
Coverage with artificial material
2152
29 (1.3)
7 (0.3)
48 (2.2)
2088
Parietal pleurectomy
10
1 (10.0)
0
1 (10.0)
10
Coverage and parietal pleurectomy
23
0
0
2 (8.7)
22
Others
58
2 (3.4)
1 (1.7)
2 (3.4)
54
Others
959
23 (2.4)
7 (0.7)
58 (6.0)
857
Unknown
2
0
0
0
2
Total
3922
59 (1.5)
19 (0.5)
123 (3.1)
3723
(), Mortality %
The 2020 survey reported 180 procedures for chest wall deformity (Table 23). However, this may have been underestimated because the Nuss procedure for pectus excavatum was more likely performed in pediatric surgery centers not associated with the Japanese Association for Thoracic Surgery.
Table 23
F. Chest wall deformity
 
Cases
30-Day mortality
Hospital mortality
Hospital
After discharge
F. Chest wall deformity
180
0
0
0
 Funnel chest
168
0
0
0
 Others
12
0
0
0
(), Mortality %
Surgical treatment for diaphragmatic hernia was performed in 41 patients (Table 24). This may have been underestimated because procedures may have been classified as gastrointestinal surgery.
Table 24
G. Diaphragmatic hernia
 
Cases
30-Day mortality
Hospital mortality
VATS
Hospital
After discharge
G. Diaphragmatic hernia
41
0
0
1 (2.4)
21
 Congenital
8
0
0
0
2
 Traumatic
11
0
0
0
6
 Others
22
0
0
1 (4.5)
13
(), Mortality %
The survey reported 458 procedures for chest trauma, excluding iatrogenic injuries (Table 25), with a hospital mortality rate of 6.6%.
Table 25
H. Chest trauma
 
Cases
30-Day mortality
Hospital mortality
VATS
Hospital
After discharge
H. Chest trauma
458
26 (5.7)
0
30 (6.6)
253
(), Mortality %
Table 26 summarizes the procedures for other diseases, including 92 and 99 cases of arteriovenous malformation and pulmonary sequestration, respectively.
Table 26
I. Other respiratory surgery
 
Cases
30-Day mortality
Hospital mortality
VATS
Hospital
After discharge
I. Other respiratory surgery
1899
54 (2.8)
8 (0.4)
95 (5.0)
1407
 Arteriovenous malformation*
92
0
0
0
86
 Pulmonary sequestration
99
0
0
0
83
 Postoperative bleeding ·air leakage
541
21 (3.9)
4 (0.7)
37 (6.8)
362
 Chylothorax
67
0
0
2 (3.0)
56
 Others
1100
33 (3.0)
4 (0.4)
56 (5.1)
820
(), Mortality %
A total of 75 lung transplantations were performed in 2020 (Table 27), among which 58 and 17 were from brain-dead and living-related donors, respectively.
Table 27
Lung transplantation
 
Cases
30-Day mortality
Hospital mortality
Hospital
After discharge
Single lung transplantation from brain-dead donor
31
0
0
0
Bilateral lung transplantation from brain-dead donor
27
1 (3.7)
0
1 (3.7)
Lung transplantation from living donor
17
2 (11.8)
0
3 (17.6)
Total lung transplantation
75
0
0
4 (5.3)
Donor of living donor lung transplantation
29
0
0
0
(), Mortality %
In 2020, the number of VATS procedures decreased by 1.2% from 77,059 to 76,073 compared to that of 2019 with the decrease of all procedures in general thoracic surgery (− 5.3%). However, the population of VATS procedures in all procedures increased to 88% in 2020 compared that in 2019 (84%) (Table 28).
Table 28
Video-assisted thoracic surgery
 
Cases
30-Day mortality
Hospital mortality
Hospital
After discharge
11. Video-assisted thoracic surgery
76,073
242 (0.3)
79 (0.1)
469 (0.6)
(), Mortality % (including thoracic sympathectomy 330)
A total of 665 tracheobronchoplasty procedures were performed in 2020, including 401 sleeve lobectomies, 17 carinal reconstructions and 10 sleeve pneumonectomies (Table 29). 30-day mortality for sleeve lobectomy, carinal reconstruction and sleeve lobectomy were 2, 6 and 10% respectively.
Table 29
Tracheobronchoplasty
 
Cases
30-Day mortality
Hospital mortality
Hospital
After discharge
12. Tracheobronchoplasty
665
5 (0.8)
4 (0.6)
16 (2.4)
Trachea
38
0
0
0
 Sleeve resection with reconstruction
25
0
0
0
 Wedge with simple closure
6
0
0
0
 Wedge with patch closure
0
0
0
0
 Total laryngectomy with tracheostomy
0
0
0
0
 Others
7
0
0
0
Carinal reconstruction
17
0
0
1 (5.9)
Sleeve pneumonectomy
10
1 (10.0)
0
1 (10.0)
Sleeve lobectomy
401
2 (0.5)
0
8 (2.0)
Sleeve segmental excision
13
0
0
0
Bronchoplasty without lung resection
17
0
0
1 (5.9)
Others
169
2 (1.2)
4 (2.4)
5 (3.0)
(), Mortality %
Tables 30, 31, 32 present the details regarding pediatric surgery and combined resection of neighboring organs.
Table 30
Pediatric surgery
 
Cases
30-Day mortality
Hospital mortality
Hospital
After discharge
13. Pediatric surgery
297
9 (3.0)
0
10 (3.4)
(), Mortality %
Table 31
Combined resection of neighboring organ(s)
 
Cases
30-Day mortality
Hospital mortality
Hospital
After discharge
14. Combined resection of neighboring organ(s)
1300
7 (0.5)
0
16 (1.2)
Organ resected
Cases
30-Day mortality
Hospital mortality
Hospital
After discharge
A. Primary lung cancer
 Aorta
9
0
0
0
 Superior vena cava
24
0
0
0
 Brachiocephalic vein
7
0
0
1 (14.3)
 Pericardium
63
2 (3.2)
0
2 (3.2)
 Pulmonary artery
117
1 (0.9)
0
2 (1.7)
 Left atrium
14
0
0
1 (7.1)
 Diaphragm
63
0
0
2 (3.2)
 Chest wall (including ribs)
276
3 (1.1)
0
8 (2.9)
 Vertebra
10
0
0
0
 Esophagus
3
0
0
0
 Total
586
6 (1.0)
0
16 (2.7)
B. Mediastinal tumor
 Aorta
1
0
0
0
 Superior vena cava
63
1 (1.6)
0
2 (3.2)
 Brachiocephalic vein
130
0
0
0
 Pericardium
364
0
0
0
 Pulmonary artery
4
0
0
0
 Left atrium
0
0
0
0
 Diaphragm
43
0
0
0
 Chest wall (including ribs)
9
0
0
0
 Vertebra
7
0
0
0
 Esophagus
8
0
0
0
 Lung
524
0
0
0
 Total
1153
1 (0.1)
0
2 (0.2)
(), Mortality %
Table 32
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
655
3 (0.5)
0
7 (1.1)
(), 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 following each institution belonging to the Japanese Association for Thoracic Surgery to an automatic package downloaded from the NCD in Japan. Consequently, the registry excluded data for non-surgical cases with esophageal diseases. 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 because 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 2020, 5909 patients underwent surgery for esophageal diseases (860 and 5049 for benign and malignant esophageal diseases, respectively) from institutions across Japan. Compared to 2019, there was a total decrease of 1326 cases (18.3%) observed, with a decrease of 214 cases (19.9%) in benign diseases and a decrease of 1112 cases (18.0%) in malignant diseases. It is considered that this significant decline was largely influenced by the COVID-19 pandemic that began in 2020, with factors such as surgical restrictions, reduced medical visits, and postponed screenings being considered as contributing factors (Fig. 3).
Concerning benign esophageal diseases (Table 33), thoracoscopic and/or laparoscopic surgeries were performed in 90.7% (68/75), 84.6% (357/422), 100% (27/27), and 36.7% (62/169) of patients with esophagitis (including esophageal ulcer), hiatal hernia, benign tumors, and achalasia, respectively. Conversely, 100% (92/92) of patients with spontaneous rupture of the esophagus underwent open surgery. Hospital mortality rates within 30 postoperative days were 0.5% (2/422), 4.3% (4/92) for hiatal hernia and spontaneous rupture of the esophagus, respectively.
Table 33
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
169
0
0
0
62
0
0
0
2. Benign tumor
27
0
0
0
27
0
0
0
3. Diverticulum
28
0
0
0
5
0
0
0
4. Hiatal hernia
422
2 (0.5)
0
2 (0.5)
357
1 (0.3)
 
1 (0.3)
5. Spontaneous rupture of the esophagus
92
4 (4.3)
3 (3.3)
7 (7.6)
0
0
0
0
6. Esophago-tracheal fistula
3
0
0
0
0
0
0
0
7. Esophagitis, Esophageal ulcer
75
0
0
0
68
0
0
0
8. Corrosive stricture of the esophagus
44
0
0
0
17
0
0
0
Total
860
6 (0.7)
3 (0.3)
9 (1.0)
536
1 (0.2)
0
1 (0.2)
(), Mortality %
T/L thoracoscopic and/or laparoscopic
The most common tumor location for malignant esophageal diseases was the thoracic esophagus (Table 34). Among 5049 cases with esophageal malignancies, esophagectomy for superficial and advanced cancers was performed in 1927 (38.2%) and 3122 (61.8%), respectively. Hospital mortality rates within 30 days after esophagectomy were 0.6% and 0.5% for patients with superficial and advanced cancer, respectively.
Table 34
Malignant esophageal disease
 
Operation (+)
Thoracoscopic and/or laparoscopic procedure
Cases
Hospital mortality
Cases
Conversion to thoracotomy
Hospital mortality
~ 30 days
31–90 days
Total (including after 91 days mortality)
~ 30 days
31–90 days
Total (including after 91 days mortality)
Location
 (1) Cervical esophagus
138
   
64
    
 (2) Thoracic esophagus
4222
23 (0.5)
13 (0.3)
36 (0.9)
3675
33 (0.9)
20 (0.5)
10 (0.3)
31 (0.8)
 (3) Abdominal esophagus
410
1 (0.2)
 
1 (0.2)
331
2 (0.6)
1 (0.3)
 
1 (0.3)
Total
4770
24 (0.5)
13 (0.3)
37 (0.8)
4070
35 (0.9)
21 (0.5)
10 (0.2)
32 (0.8)
Tumor depth
(A) Superficial cancer (T1)
 (1) Transhiatal esophagectomy
8
        
 (2) Mediastinoscopic esophagectomy and reconstruction
115
   
115
    
 (3) Transthoracic (rt.) esophagectomy and reconstruction
1221
9 (0.7)
4 (0.3)
13 (1.1)
1102
9 (0.8)
9 (0.8)
3 (0.3)
12 (1.1)
 (4) Transthoracic (lt.) esophagectomy and reconstruction
25
1 (4.0)
  
14
    
 (5) Cervical esophageal resection and reconstruction
20
        
 (6) Robot-assisted esophagectomy and reconstruction
357
1 (0.3)
 
2 (0.6)
355
1 (0.3)
1 (0.3)
 
1 (0.3)
 (7) Others
12
        
 (8) Esophagectomy without reconstruction
169
   
60
    
Subtotal
1927
11 (0.6)
4 (0.2)
15 (0.8)
1646
10 (0.6)
10 (0.6)
3 (0.2)
13 (0.8)
(B) Advanced cancer (T2–T4)
         
 (1) Transhiatal esophagectomy
11
        
 (2) Mediastinoscopic esophagectomy and reconstruction
127
 
1 (0.8)
1 (0.8)
127
  
1 (0.8)
1 (0.8)
 (3) Transthoracic (rt.) esophagectomy and reconstruction
2267
10 (0.4)
6 (0.3)
16 (0.7)
1836
23 (1.3)
8 (0.4)
5 (0.3)
13 (0.7)
 (4) Transthoracic (lt.) esophagectomy and reconstruction
42
1 (2.4)
1 (2.4)
2 (4.8)
26
 
1 (3.8)
 
1 (3.8)
 (5) Cervical esophageal resection and reconstruction
51
        
 (6) Robot-assisted esophagectomy and reconstruction
479
2 (0.4)
1 (0.2)
3 (0.6)
479
1 (0.2)
2 (0.4)
1 (0.2)
3 (0.6)
 (7) Others
35
        
 (8) Esophagectomy without reconstruction
110
2 (1.8)
5 (4.5)
7 (6.4)
     
Subtotal
3122
15 (0.5)
14 (0.4)
29 (0.9)
2468
24 (1.0)
11 (0.4)
7 (0.3)
18 (0.7)
Total
5049
26 (0.5)
18 (0.4)
44 (0.9)
4114
34 (0.8)
21 (0.5)
10 (0.2)
31 (0.8)
 
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
138
87 (63.0)
40 (29.0)
15 (10.9)
13 (9.4)
13 (9.4)
21 (15.2)
17 (12.3)
2 (1.4)
 (2) Thoracic esophagus
4222
2406 (57.0)
954 (22.6)
322 (7.6)
172 (4.1)
371 (8.8)
573 (13.6)
622 (14.7)
69 (1.6)
 (3) Abdominal esophagus
410
212 (51.7)
93 (22.7)
28 (6.8)
17 (4.1)
33 (8.0)
62 (15.1)
30 (7.3)
4 (1.0)
Total
4770
2705 (56.7)
1087 (22.8)
365 (7.7)
202 (4.2)
417 (8.7)
656 (13.8)
669 (14.0)
75 (1.6)
Tumor depth
(A) Superficial cancer (T1)
 (1) Transhiatal esophagectomy
8
3 (37.5)
2 (25.0)
1 (12.5)
   
1 (12.5)
 
 (2) Mediastinoscopic esophagectomy and reconstruction
115
77 (67.0)
32 (27.8)
9 (7.8)
4 (3.5)
6 (5.2)
22 (19.1)
37 (32.2)
1 (0.9)
 (3) Transthoracic (rt.) esophagectomy and reconstruction
1221
680 (55.7)
270 (22.1)
96 (7.9)
46 (3.8)
110 (9.0)
185 (15.2)
161 (13.2)
20 (1.6)
 (4) Transthoracic (lt.) esophagectomy and reconstruction
25
13 (52.0)
6 (24.0)
1 (4.0)
2 (8.0)
2 (8.0)
3 (12.0)
1 (4.0)
 
 (5) Cervical esophageal resection and reconstruction
20
12 (60.0)
6 (30.0)
2 (10.0)
4 (20.0)
1 (5.0)
4 (20.0)
2 (10.0)
1 (5.0)
 (6) Robot-assisted esophagectomy and reconstruction
357
190 (53.2)
72 (20.2)
27 (7.6)
15 (4.2)
31 (8.7)
46 (12.9)
42 (11.8)
3 (0.8)
 (7) Others
12
4 (33.3)
1 (8.3)
  
1 (8.3)
  
0
 (8) Esophagectomy without reconstruction
169
        
Subtotal
1927
979 (50.8)
389 (20.2)
136 (7.1)
71 (3.7)
151 (7.8)
260 (13.5)
244 (12.7)
25 (1.3)
(B) Advanced cancer (T2–T4)
 (1) Transhiatal esophagectomy
11
7 (63.6)
4 (36.4)
1 (9.1)
1 (9.1)
2 (18.2)
3 (27.3)
2 (18.2)
 
 (2) Mediastinoscopic esophagectomy and reconstruction
127
82 (64.6)
30 (23.6)
13 (10.2)
10 (7.9)
15 (11.8)
22 (17.3)
22 (17.3)
3 (2.4)
 (3) Transthoracic (rt.) esophagectomy and reconstruction
2267
1313 (57.9)
544 (24.0)
170 (7.5)
97 (4.3)
210 (9.3)
313 (13.8)
313 (13.8)
40 (1.8)
 (4) Transthoracic (lt.) esophagectomy and reconstruction
42
20 (47.6)
3 (7.1)
3 (7.1)
1 (2.4)
4 (9.5)
5 (11.9)
2 (4.8)
0
 (5) Cervical esophageal resection and reconstruction
51
33 (64.7)
7 (13.7)
7 (13.7)
4 (7.8)
3 (5.9)
3 (5.9)
10 (19.6)
0
 (6) Robot-assisted esophagectomy and reconstruction
479
253 (52.8)
104 (21.7)
33 (6.9)
16 (3.3)
31 (6.5)
46 (9.6)
76 (15.9)
7 (1.5)
 (7) Others
35
18 (51.4)
6 (17.1)
2 (5.7)
2 (5.7)
1 (2.9)
4 (11.4)
  
 (8) Esophagectomy without reconstruction
110
        
Subtotal
3122
1726 (55.3)
698 (22.4)
229 (7.3)
131 (4.2)
266 (8.5)
396 (12.7)
425 (13.6)
50 (1.6)
Total
5049
2705 (53.6)
1087 (21.5)
365 (7.2)
202 (4.0)
417 (8.3)
656 (13.0)
669 (13.3)
75 (1.5)
 
Cases
Nonsurgical complications
Readmission within 30 days
Reoperation within 30 days
Pneumonia
Unplanned intubation
Prolonged ventilation > 48 h
Pulmonary embolism
Atelectasis
Renal failure
CNS events
Cardiac events
Septic shock
Location
 (1) Cervical esophagus
138
14 (10.1)
8 (5.8)
12 (8.7)
1 (0.7)
1 (0.7)
 
1 (0.7)
1 (0.7)
 
3 (2.2)
21 (15.2)
 (2) Thoracic esophagus
4222
637 (15.1)
165 (3.9)
192 (4.5)
51 (1.2)
204 (4.8)
20 (0.5)
15 (0.4)
20 (0.5)
29 (0.7)
114 (2.7)
279 (6.6)
 (3) Abdominal esophagus
410
47 (11.5)
17 (4.1)
19 (4.6)
4 (1.0)
24 (5.9)
 
1 (0.2)
1 (0.2)
3 (0.7)
3 (0.7)
30 (7.3)
Total
4770
698 (14.6)
190 (4.0)
223 (4.7)
56 (1.2)
229 (4.8)
20 (0.4)
17 (0.4)
22 (0.5)
32 (0.7)
120 (2.5)
330 (6.9)
Tumor depth
(A) Superficial cancer (T1)
  
 (1) Transhiatal esophagectomy
8
1 (12.5)
         
1 (12.5)
 (2) Mediastinoscopic esophagectomy and reconstruction
115
14 (12.2)
4 (3.5)
5 (4.3)
 
6 (5.2)
  
4 (3.5)
 
4 (3.5)
7 (6.1)
 (3) Transthoracic (rt.) esophagectomy and reconstruction
1221
173 (14.2)
52 (4.3)
63 (5.2)
11 (0.9)
39 (3.2)
7 (0.6)
6 (0.5)
5 (0.4)
10 (0.8)
25 (2.0)
79 (6.5)
 (4) Transthoracic (lt.) esophagectomy and reconstruction
25
3 (12.0)
2 (8.0)
2 (8.0)
 
5 (20.0)
    
1 (4.0)
 
 (5) Cervical esophageal resection and reconstruction
20
4 (20.0)
2 (10.0)
  
1 (5.0)
     
2 (10.0)
 (6) Robot-assisted esophagectomy and reconstruction
357
41 (11.5)
6 (1.7)
10 (2.8)
6 (1.7)
20 (5.6)
1 (0.3)
  
1 (0.3)
5 (1.4)
21 (5.9)
 (7) Others
12
1 (8.3)
   
1 (8.3)
      
 (8) Esophagectomy without reconstruction
169
           
Subtotal
1927
237 (12.3)
66 (3.4)
80 (4.2)
17 (0.9)
72 (3.7)
8 (0.4)
6 (0.3)
9 (0.5)
11 (0.6)
35 (1.8)
110 (5.7)
(B) Advanced cancer (T2–T4)
 (1) Transhiatal esophagectomy
11
1 (9.1)
        
2 (18.2)
 
 (2) Mediastinoscopic esophagectomy and reconstruction
127
18 (14.2)
6 (4.7)
5 (3.9)
1 (0.8)
7 (5.5)
1 (0.8)
 
1 (0.8)
2 (1.6)
5 (3.9)
9 (7.1)
 (3) Transthoracic (rt.) esophagectomy and reconstruction
2267
361 (15.9)
99 (4.4)
116 (5.1)
30 (1.3)
125 (5.5)
9 (0.4)
9 (0.4)
10 (0.4)
12 (0.5)
71 (3.1)
168 (7.4)
 (4) Transthoracic (lt.) esophagectomy and reconstruction
42
4 (9.5)
2 (4.8)
2 (4.8)
1 (2.4)
2 (4.8)
1 (2.4)
  
2 (4.8)
 
2 (4.8)
 (5) Cervical esophageal resection and reconstruction
51
3 (5.9)
1 (2.0)
2 (3.9)
 
1 (2.0)
 
1 (2.0)
  
1 (2.0)
5 (9.8)
 (6) Robot-assisted esophagectomy and reconstruction
479
69 (14.4)
14 (2.9)
16 (3.3)
7 (1.5)
22 (4.6)
1 (0.2)
1 (0.2)
2 (0.4)
5 (1.0)
6 (1.3)
35 (7.3)
 (7) Others
35
4 (11.4)
2 (5.7)
2 (5.7)
 
1 (2.9)
  
1 (2.9)
  
1 (2.9)
 (8) Esophagectomy without reconstruction
110
           
Subtotal
3122
460 (14.7)
124 (4.0)
143 (4.6)
39 (1.2)
158 (5.1)
12 (0.4)
11 (0.4)
14 (0.4)
21 (0.7)
85 (2.7)
220 (7.0)
Total
5049
697 (13.8)
190 (3.8)
223 (4.4)
56 (1.1)
230 (4.6)
20 (0.4)
17 (0.3)
23 (0.5)
32 (0.6)
120 (2.4)
330 (6.5)
Among esophagectomy procedures, transthoracic esophagectomy via right thoracotomy or right thoracoscopy was most commonly adopted for patients with superficial (1221/1927, 63.7%) and advanced cancer (2267/3122, 72.6%) (Table 34). Transhiatal esophagectomy, which is commonly performed in Western countries, was adopted in only 8 (0.4%) and 11 (0.4%) patients with superficial and advanced cancer who underwent esophagectomy in Japan, respectively. Thoracoscopic and/or laparoscopic esophagectomy was utilized in 1646 (85.4%) and 2468 (79.0%) patients with superficial and advanced cancer, respectively. Incidence of thoracoscopic and/or laparoscopic surgery (minimally invasive esophagectomy: MIE) for superficial or advanced cancer have been increasing, whereas that of open surgery, especially for advanced cancer, has been decreasing annually (Fig. 4). Mediastinoscopic esophagectomy was slightly increased, and performed for 115 (6.0%) and 127 (4.1%) patients with superficial and advanced esophageal cancer, respectively. Robot-assisted esophagectomy has been remarkably increased since 2018 when the insurance approval was obtained in Japan, and performed for 355 (18.4%) and 479 (15.3%) patients with superficial and advanced esophageal cancer, respectively in 2020. Patients who underwent robot-assisted surgery are increasing for both superficial and advancer esophageal cancers compared to that in 2019 (12.3% and 9.9% in 2019, respectively). Hospital mortality rates within 30 days after thoracoscopic and/or laparoscopic esophagectomy were 0.6% and 0.4% for patients with superficial and advanced cancer, respectively (Table 34).
Detailed data collection regarding postoperative surgical and non-surgical complications was initiated in 2018. Overall, 1087 (21.5%) of 5049 patients developed grade III or higher complications based on the Clavien–Dindo classification in 2020 (Table 34). The incidence of grade III or higher complications was relatively higher in cervical esophageal cancer compared to thoracic or abdominal esophageal cancer. Among surgical complications, anastomotic leakage and recurrent nerve palsy occurred in 14.2% and 13.6% of the patients who underwent right transthoracic esophagectomy, in 11.0% and 14.1% of those who underwent robot-assisted esophagectomy, and in 18.2% and 24.4% of those who underwent mediastinoscopic esophagectomy, respectively. Among non-surgical postoperative complications, pneumonia occurred in 13.8% of the patients, 3.8% of whom underwent unplanned intubation. Postoperative pulmonary embolism occurred in 1.1% of the patients. These complication rates, including the others, were similar to those in 2019.
Salvage surgery following definitive (chemo)radiotherapy was safely performed in 300 patients in 2020, with hospital mortality rates of 0% within 30 days postoperatively. (Table 35).
Table 35
Salvage surgery
 
Operation (+)
Thoracoscopic and/or laparoscopic procedure
EMR or ESD
Cases
Hospital mortality
Cases
Conversion to thoracotomy
Hospital mortality
~ 30 days
31–90 days
Total (including after 91 days mortality)
~ 30 days
31–90 days
Total (including after 91 days mortality)
Salvage surgery
300
0
2 (0.7)
2 (0.7)
188
4 (2.1)
0
0
0
89
We aim to continue our efforts in collecting comprehensive survey data through more active collaboration with the Japan Esophageal Society and other related institutions, with caution due to the impact of COVID-19 pandemic.

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. We also appreciate Mr. Hiroaki Miyata for his contribution as one of the founders of the JCVSD.

Declarations

Conflict of interest

Hiroyuki Yamamoto and Hiraku Kumamaru are affiliated with the Department of Healthcare Quality Assessment at the University of Tokyo. The department is a social collaboration department supported by grants from the National Clinical Database, Johnson & Johnson K.K., Nipro Corporation and Intuitive Surgical Sàrl.
Open Access This 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/​.

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Literatur
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Zurück zum Zitat Committee for Scientific Affairs, The Japanese Association for Thoracic Surgery, Minatoya K, Sato Y, Toh Y, et al. Thoracic and cardiovascular surgery in Japan during 2019—Annual report by the Japanese Association for Thoracic Surgery. Gen Thorac Cardiovasc Surg. 2023;71:595–628.CrossRef Committee for Scientific Affairs, The Japanese Association for Thoracic Surgery, Minatoya K, Sato Y, Toh Y, et al. Thoracic and cardiovascular surgery in Japan during 2019—Annual report by the Japanese Association for Thoracic Surgery. Gen Thorac Cardiovasc Surg. 2023;71:595–628.CrossRef
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Zurück zum Zitat Kuwano H, Amano J, Yokomise H. Thoracic and cardiovascular surgery in Japan during 2010—annual report by the Japanese Association for Thoracic Surgery. Gen Thorac Cardiovasc Surg. 2012;60:680–708.CrossRefPubMed Kuwano H, Amano J, Yokomise H. Thoracic and cardiovascular surgery in Japan during 2010—annual report by the Japanese Association for Thoracic Surgery. Gen Thorac Cardiovasc Surg. 2012;60:680–708.CrossRefPubMed
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Zurück zum Zitat Committee for Scientific Affairs, The Japanese Association for Thoracic Surgery, Masuda M, Endo S, Natsugoe S, et al. Thoracic and cardiovascular surgery in Japan during 2015—annual report by the Japanese Association for Thoracic Surgery. Gen Thorac Cardiovasc Surg. 2018;66:581–615.CrossRef Committee for Scientific Affairs, The Japanese Association for Thoracic Surgery, Masuda M, Endo S, Natsugoe S, et al. Thoracic and cardiovascular surgery in Japan during 2015—annual report by the Japanese Association for Thoracic Surgery. Gen Thorac Cardiovasc Surg. 2018;66:581–615.CrossRef
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Zurück zum Zitat Kazui T, Wada H, Fujita H, Japanese Association for Thoracic Surgery Committee of Science. Thoracic and cardiovascular surgery in Japan during 2003—annual report by the Japanese Association for Thoracic Surgery. Jpn J Thorac Cardiovasc Surg. 2005;53:517–36.CrossRefPubMed Kazui T, Wada H, Fujita H, Japanese Association for Thoracic Surgery Committee of Science. Thoracic and cardiovascular surgery in Japan during 2003—annual report by the Japanese Association for Thoracic Surgery. Jpn J Thorac Cardiovasc Surg. 2005;53:517–36.CrossRefPubMed
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Zurück zum Zitat Kazui T, Osada H, Fujita H, Japanese Association for Thoracic Surgery Committee of Science. Thoracic and cardiovascular surgery in Japan during 2004—annual report by the Japanese Association for Thoracic Surgery. Jpn J Thorac Cardiovasc Surg. 2006;54:363–85.CrossRefPubMed Kazui T, Osada H, Fujita H, Japanese Association for Thoracic Surgery Committee of Science. Thoracic and cardiovascular surgery in Japan during 2004—annual report by the Japanese Association for Thoracic Surgery. Jpn J Thorac Cardiovasc Surg. 2006;54:363–85.CrossRefPubMed
Metadaten
Titel
Thoracic and cardiovascular surgeries in Japan during 2020
Annual report by the Japanese Association for Thoracic Surgery
verfasst von
Goro Matsumiya
Yukio Sato
Hiroya Takeuchi
Tomonobu Abe
Shunsuke Endo
Yasutaka Hirata
Michiko Ishida
Hisashi Iwata
Takashi Kamei
Nobuyoshi Kawaharada
Shunsuke Kawamoto
Kohji Kohno
Hiraku Kumamaru
Kenji Minatoya
Noboru Motomura
Rie Nakahara
Morihito Okada
Hisashi Saji
Aya Saito
Hideyuki Shimizu
Kenji Suzuki
Hirofumi Takemura
Tsuyoshi Taketani
Yasushi Toh
Wataru Tatsuishi
Hiroyuki Yamamoto
Takushi Yasuda
Masayuki Watanabe
Naoki Yoshimura
Masanori Tsuchida
Yoshiki Sawa
Committee for Scientific Affairs, The Japanese Association for Thoracic Surgery
Publikationsdatum
28.11.2023
Verlag
Springer Nature Singapore
Erschienen in
General Thoracic and Cardiovascular Surgery / Ausgabe 1/2024
Print ISSN: 1863-6705
Elektronische ISSN: 1863-6713
DOI
https://doi.org/10.1007/s11748-023-01979-8

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S3-Leitlinie „Diagnostik und Therapie des Karpaltunnelsyndroms“

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CME: 2 Punkte

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.

Prof. Dr. med. Gregor Antoniadis
Berufsverband der Deutschen Chirurgie e.V.

S2e-Leitlinie „Distale Radiusfraktur“

Radiusfraktur BDC Leitlinien Webinare
CME: 2 Punkte

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?

PD Dr. med. Oliver Pieske
Dr. med. Benjamin Meyknecht
Berufsverband der Deutschen Chirurgie e.V.

S1-Leitlinie „Empfehlungen zur Therapie der akuten Appendizitis bei Erwachsenen“

Appendizitis BDC Leitlinien Webinare
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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.

Dr. med. Mihailo Andric
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