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Erschienen in: General Thoracic and Cardiovascular Surgery 4/2024

Open Access 29.02.2024 | Annual Report

Thoracic and cardiovascular surgeries in Japan during 2021

Annual report by the Japanese Association for Thoracic Surgery

verfasst von: Naoki Yoshimura, 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, Masanori Tsuchida, Kenji Suzuki, Hirofumi Takemura, Tsuyoshi Taketani, Yasushi Toh, Wataru Tatsuishi, Hiroyuki Yamamoto, Takushi Yasuda, Masayuki Watanabe, Goro Matsumiya, Yoshiki Sawa, Hideyuki Shimizu, Masayuki Chida, Committee for Scientific Affairs, The Japanese Association for Thoracic Surgery

Erschienen in: General Thoracic and Cardiovascular Surgery | Ausgabe 4/2024

Hinweise
Naoki Yoshimura, Yukio Sato, and Hiroya Takeuchi 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 (JATS) 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 2021.
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 cardiovascular, general thoracic, and esophageal surgeries in Japan during 2020 [24]. We have to continue the estimation of the nationwide effect of SARS-CoV-2 pandemic on thoracic surgery 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 JATS 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: 2021

(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 35 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 63,054 cardiovascular surgeries, including 59 heart transplants, had been performed in 2021, with a 1.6% decrease compared to that in 2020 (n = 64,075) [3]. Following on from 2020, a decline in the number of cases has been observed for the second consecutive year. Although the impact of the COVID-19 pandemic is suggested, verification from various perspectives is necessary.
Compared to data for 2020 [3] and 2011 [5], data for 2021 showed 2.9% (8349 vs. 8595) and 15.3% fewer surgeries for congenital heart disease, 3.8% (17,661 vs. 18,366) fewer and 7.8% fewer surgeries for valvular heart disease, 1.4% (11,364 vs. 11,524) and 27.1% fewer surgeries for ischemic heart procedures, and 2.0% (22,982 vs. 22,540) more and 62.7% more surgeries for thoracic aortic aneurysm, respectively. Data for individual categories are summarized in Tables 1, 2, 3, 4, 5, and 6.
Table 1
Congenital (total; 8349)
(1) CPB ( +) (total; 6510)
 
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
6
0
0
0
5
1 (20.0)
0
1 (20.0)
3
0
0
0
14
0
0
0
28
1 (3.6)
0
1 (3.6)
Coarctation (simple)
9
0
0
1 (11.1)
14
0
0
0
9
0
0
0
12
0
0
0
44
0
0
1 (2.3)
 + VSD
39
0
0
0
46
0
0
0
10
0
0
0
1
0
0
0
96
0
0
0
 + DORV
3
0
0
0
4
0
0
0
4
0
0
0
0
0
0
0
11
0
0
0
 + AVSD
5
0
0
0
5
0
0
1 (20.0)
1
0
0
0
0
0
0
0
11
0
0
1 (9.1)
 + TGA
1
0
0
0
1
0
0
0
1
0
0
0
0
0
0
0
3
0
0
0
 + SV
2
0
0
0
9
1 (11.1)
0
1 (11.1)
3
0
0
0
0
0
0
0
14
1 (7.1)
0
1 (7.1)
 + Others
7
0
0
0
4
0
0
0
5
0
0
0
1
0
0
0
17
0
0
0
Interrupt. of Ao (simple)
0
0
0
0
1
0
0
0
0
0
0
0
0
0
0
0
1
0
0
0
 + VSD
26
1 (3.8)
0
2 (7.7)
24
1 (4.2)
0
2 (8.3)
14
0
0
0
0
0
0
0
64
2 (3.1)
0
4 (6.3)
 + DORV
0
0
0
0
2
0
0
0
0
0
0
0
0
0
0
0
2
0
0
0
 + Truncus
2
0
0
0
3
0
0
0
3
0
0
0
0
0
0
0
8
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
2
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
0
0
0
0
0
0
0
0
1
0
0
0
PS
6
0
0
0
30
0
0
0
62
0
0
0
17
0
0
0
115
0
0
0
PA・IVS or critical PS
5
0
0
0
37
0
0
0
57
0
0
0
9
0
0
0
108
0
0
0
TAPVR
104
4 (3.8)
0
9 (8.7)
43
1 (2.3)
0
2 (4.7)
11
0
0
0
0
0
0
0
158
5 (3.2)
0
11 (7.0)
PAPVR ± ASD
1
0
0
0
2
0
0
0
45
0
0
0
12
0
0
0
60
0
0
0
ASD
0
0
0
0
48
1 (2.1)
0
1 (2.1)
466
0
0
1 (0.2)
788
7 (0.9)
0
7 (0.9)
1302
8 (0.6)
0
9 (0.7)
Cor triatriatum
3
0
0
0
13
0
0
0
6
0
0
0
2
0
0
0
24
0
0
0
AVSD (partial)
0
0
0
0
7
0
0
0
35
0
0
0
13
0
0
0
55
0
0
0
AVSD (complete)
1
0
0
0
87
1 (1.1)
0
2 (2.3)
104
1 (1.0)
0
2 (1.9)
4
0
0
0
196
2 (1.0)
0
4 (2.0)
 + TOF or DORV
0
0
0
0
5
0
0
0
10
0
0
0
2
0
0
0
17
0
0
0
 + Others
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
VSD (subarterial)
1
0
0
0
77
0
0
0
138
0
0
0
8
0
0
0
224
0
0
0
VSD (perimemb./muscular)
6
0
0
0
645
0
0
0
331
0
0
1 (0.3)
17
0
0
0
999
0
0
1 (0.1)
VSD (type unknown)
0
0
0
0
0
0
0
0
3
0
0
0
112
2 (1.8)
0
2 (1.8)
115
2 (1.7)
0
2 (1.7)
VSD + PS
1
0
0
0
31
0
0
0
10
0
0
0
0
0
0
0
42
0
0
0
DCRV ± VSD
0
0
0
0
9
0
0
0
10
0
0
0
12
0
0
0
31
0
0
0
Aneurysm of sinus of Valsalva
0
0
0
0
0
0
0
0
1
0
0
0
0
0
0
0
1
0
0
0
TOF
14
0
0
0
157
0
0
1 (0.6)
157
0
0
0
57
0
0
1 (1.8)
385
0
0
2 (0.5)
PA + VSD
7
0
0
1 (14.3)
85
0
0
0
107
2 (1.9)
0
3 (2.8)
10
0
0
0
209
2 (1.0)
0
4 (1.9)
DORV
13
0
0
2 (15.4)
117
2 (1.7)
0
7 (6.0)
136
1 (0.7)
0
1 (0.7)
4
0
0
0
270
3 (1.1)
0
10 (3.7)
TGA (simple)
83
1 (1.2)
0
4 (4.8)
8
0
0
1 (12.5)
3
0
0
0
6
0
0
0
100
1 (1.0)
0
5 (5.0)
 + VSD
34
1 (2.9)
0
1 (2.9)
10
0
0
0
13
0
0
0
1
0
0
0
58
1 (1.7)
0
1 (1.7)
 VSD + PS
0
0
0
0
1
0
0
0
0
0
0
0
1
0
0
0
2
0
0
0
Corrected TGA
1
0
0
0
7
0
0
0
33
0
0
0
10
0
0
0
51
0
0
0
Truncus arteriosus
5
0
0
1 (20.0)
16
0
0
0
27
0
0
0
2
0
0
0
50
0
0
1 (2.0)
SV
16
2 (12.5)
0
2 (12.5)
141
2 (1.4)
0
6 (4.3)
188
0
0
4 (2.1)
19
0
0
1 (5.3)
364
4 (1.1)
0
13 (3.6)
TA
4
0
0
0
33
0
0
0
48
0
0
0
3
0
0
0
88
0
0
0
HLHS
30
3 (10.0)
0
7 (23.3)
101
5 (5.0)
0
9 (8.9)
80
0
0
1 (1.3)
1
0
0
0
212
8 (3.8)
0
17 (8.0)
Aortic valve lesion
5
0
0
1 (20.0)
17
2 (11.8)
0
2 (11.8)
110
1 (0.9)
0
1 (0.9)
43
0
0
0
175
3 (1.7)
0
4 (2.3)
Mitral valve lesion
0
0
0
0
28
0
0
1 (3.6)
76
0
0
0
21
0
0
2 (9.5)
125
0
0
3 (2.4)
Ebstein
12
2 (16.7)
0
2 (16.7)
10
1 (10.0)
0
1 (10.0)
21
0
0
0
15
0
0
0
58
3 (5.2)
0
3 (5.2)
Coronary disease
0
0
0
0
3
0
0
0
21
0
0
0
2
0
0
0
26
0
0
0
Others
10
1 (10.0)
0
1 (10.0)
27
0
0
3 (11.1)
53
1 (1.9)
0
1 (1.9)
237
1 (0.4)
0
1 (0.4)
327
3 (0.9)
0
6 (1.8)
Conduit failure
0
0
0
0
1
0
0
0
20
0
0
0
9
0
0
0
30
0
0
0
Redo (excluding conduit failure)
1
0
0
0
50
1 (2.0)
0
2 (4.0)
106
2 (1.9)
0
2 (1.9)
69
0
0
0
226
3 (1.3)
0
4 (1.8)
Total
465
15 (3.2)
0
34 (7.3)
1967
19 (1.0)
0
43 (2.2)
2544
8 (0.3)
0
17 (0.7)
1534
10 (0.7)
0
14 (0.9)
6510
52 (0.8)
0
108 (1.7)
(), % 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; 1839)
 
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
230
7 (3.0)
0
11 (4.8)
130
1 (0.8)
0
6 (4.6)
6
0
0
0
4
0
0
0
370
8 (2.2)
0
17 (4.6)
Coarctation (simple)
6
0
0
1 (16.7)
7
0
0
0
1
0
0
0
5
0
0
0
19
0
0
1 (5.3)
 + VSD
40
2 (5.0)
0
2 (5.0)
12
0
0
0
0
0
0
0
0
0
0
0
52
2 (3.8)
0
2 (3.8)
 + DORV
4
0
0
0
3
0
0
0
0
0
0
0
0
0
0
0
7
0
0
0
 + AVSD
8
0
0
0
1
0
0
0
1
0
0
0
0
0
0
0
10
0
0
0
 + TGA
1
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
1
0
0
0
 + SV
6
0
0
1 (16.7)
0
0
0
0
0
0
0
0
0
0
0
0
6
0
0
1 (16.7)
 + Others
3
0
0
1 (33.3)
6
0
0
0
0
0
0
0
0
0
0
0
9
0
0
1 (11.1)
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
21
0
0
2 (9.5)
5
0
0
0
1
0
0
0
0
0
0
0
27
0
0
2 (7.4)
 + DORV
1
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
1
0
0
0
 + Truncus
6
0
0
0
1
0
0
0
0
0
0
0
0
0
0
0
7
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
1
0
0
0
4
0
0
0
0
0
0
0
7
0
0
0
Vascular ring
0
0
0
0
20
0
0
0
6
0
0
0
0
0
0
0
26
0
0
0
PS
1
0
0
0
3
0
0
0
4
0
0
0
0
0
0
0
8
0
0
0
PA・IVS or Critical PS
14
0
0
1 (7.1)
13
1 (7.7)
0
1 (7.7)
1
0
0
0
1
0
0
0
29
1 (3.4)
0
2 (6.9)
TAPVR
8
1 (12.5)
0
2 (25.0)
5
0
0
0
1
0
0
0
0
0
0
0
14
1 (7.1)
0
2 (14.3)
PAPVR ± ASD
0
0
0
0
1
0
0
0
0
0
0
0
0
0
0
0
1
0
0
0
ASD
1
0
0
0
3
0
0
0
4
0
0
0
0
0
0
0
8
0
0
0
Cor triatriatum
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
AVSD (partial)
1
0
0
0
1
0
1 (100.0)
0
6
0
0
0
1
0
0
0
9
0
1(11.1)
0
AVSD (complete)
37
0
0
0
70
1 (1.4)
0
3 (4.3)
8
0
0
0
2
0
0
0
117
1 (0.9)
0
3 (2.6)
 + TOF or DORV
0
0
0
0
3
0
0
0
1
0
0
0
0
0
0
0
4
0
0
0
 + Others
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
VSD (subarterial)
4
0
0
0
9
0
0
0
0
0
0
0
0
0
0
0
13
0
0
0
VSD (perimemb./muscular)
58
1 (1.7)
0
4 (6.9)
143
3 (2.1)
0
4 (2.8)
4
0
0
0
2
0
0
0
207
4 (1.9)
0
8 (3.9)
VSD (Type Unknown)
0
0
0
0
0
 
0
0
0
0
0
0
0
0
0
0
0
0
0
0
VSD + PS
1
0
0
0
3
0
0
0
0
0
0
0
0
0
0
0
4
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
9
0
0
0
50
0
0
0
4
0
0
0
0
0
0
0
63
0
0
0
PA + VSD
22
0
0
1 (4.5)
35
1 (2.9)
0
2 (5.7)
7
1 (14.3)
0
1 (14.3)
0
0
0
0
64
2 (3.1)
0
4 (6.3)
DORV
47
0
0
3 (6.4)
58
0
0
2 (3.4)
6
0
0
0
1
1(100.0)
0
1(100.0)
112
1 (0.9)
0
6 (5.4)
TGA (simple)
10
0
0
0
6
0
0
0
0
0
0
0
0
0
0
0
16
0
0
0
 + VSD
8
1 (12.5)
0
1 (12.5)
2
0
0
0
1
0
0
0
0
0
0
0
11
1 (9.1)
0
1 (9.1)
 VSD + PS
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
Corrected TGA
5
0 0
0
0
7
0
0
0
10
0
0
0
6
0
0
0
28
0
0
0
Truncus arteriosus
11
0
1 (9.1)
1
0
0
0
0
0
0
0
0
0
0
0
12
0
0
1 (8.3)
SV
40
0
0
3 (7.5)
58
3 (5.2)
0
6 (10.3)
8
0
0
0
3
0
0
2(66.7)
109
3 (2.8)
0
11 (10.1)
TA
22
0
0
0
12
0
0
0
8
0
0
0
3
0
0
0
45
0
0
0
HLHS
66
1 (1.5)
0
8 (12.1)
27
1 (3.7)
1 (3.7)
1 (3.7)
11
0
0
1 (9.1)
1
0
0
0
105
2 (1.9)
1(1.0)
10 (9.5)
Aortic valve lesion
7
0
0
0
9
1 (11.1)
0
1 (11.1)
4
0
0
0
0
0
0
0
20
1 (5.0)
0
1 (5.0)
Mitral valve lesion
3
0
0
0
1
0
0
0
1
0
0
0
0
0
0
0
5
0
0
0
Ebstein
10
1 (10.0)
0
1 (10.0)
3
1 (33.3)
0
1 (33.3)
0
0
0
0
0
0
0
0
13
2 (15.4)
0
2 (15.4)
Coronary disease
0
0
0
0
1
0
0
0
0
0
0
0
0
0
0
0
1
0
0
0
Others
12
1 (8.3)
0
2 (16.7)
8
0
0
1 (12.5)
16
3 (18.8)
0
5 (31.3)
1
0
0
0
37
4 (10.8)
0
8 (21.6)
Conduit failure
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
Redo (excluding conduit failure)
14
0
0
0
69
2 (2.9)
0
3 (4.3)
120
5 (4.2)
0
8 (6.7)
39
1(2.6)
0
2(5.1)
242
8 (3.3)
0
13 (5.4)
Total
739
15 (2.0)
0
45 (6.1)
787
15 (1.9)
2 (0.3)
31 (3.9)
244
9 (3.7)
0
15 (6.1)
69
2(2.9)
0
5(7.2)
1839
41 (2.2)
2(0.11)
96 (5.2)
(), % mortality
CPB cardiopulmonary bypass; PDA patent ductus arteriosus; VSD ventricular septal defect; DORV double outlet right ventricle; AVSD atrioventricular septal defect; TGA transposition of 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
Cases
30-day mortality
Cases
30-day mortality
Cases
30-day mortality
Cases
30-day mortality
 
After discharge
Hospital mortality
Hospital
After discharge
Hospital mortality
Hospital
After discharge
Hospital mortality
Hospital
After discharge
Hospital mortality
Hospital
After discharge
Hospital mortality
1
SP Shunt
100
0
0
3 (3.0)
267
0
0
6 (2.2)
37
0
0
0
1
0
0
0
405
0
0
9 (2.2)
2
PAB
236
1 (0.4)
0
9 (3.8)
314
4 (1.3)
1 (0.3)
8 (2.5)
9
0
0
0
0
0
0
0
559
5 (0.9)
1 (0.2)
17 (3.0)
3
Bidirectional Glenn or hemi-Fontan ± α
0
0
0
0
217
2 (0.9)
0
6 (2.8)
73
0
0
1 (1.4)
1
0
0
0
291
2 (0.7)
0
7 (2.4)
4
Damus-Kaye-Stansel operation
0
0
0
0
17
0
0
1 (5.9)
6
0
0
0
0
0
0
0
23
0
0
1 (4.3)
5
PA reconstruction/repair (including redo)
13
1 (7.7)
0
1 (7.7)
179
2 (1.1)
0
4 (2.2)
194
2 (1.0)
0
4 (2.1)
23
1 (4.3)
0
1 (4.3)
409
6 (1.5)
0
10 (2.4)
6
RVOT reconstruction/repair
6
1 (16.7)
0
1 (16.7)
224
1 (0.4)
0
3 (1.3)
267
2 (0.7)
0
3 (1.1)
42
0
0
0
539
4 (0.7)
0
7 (1.3)
7
Rastelli procedure
2
0
0
0
43
0
0
0
97
0
0
0
2
0
0
0
144
0
0
0
8
Arterial switch procedure
122
3 (2.5)
1 (0.8)
7 (5.7)
17
0
0
0
2
0
0
0
0
0
0
0
141
3 (2.1)
1 (0.7)
7 (5.0)
9
Atrial switch procedure
0
0
0
0
4
1 (25.0)
0
1 (25.0)
4
0
0
0
2
0
0
0
10
1 (10.0)
0
1 (10.0)
10
Double switch procedure
0
0
0
0
0
0
0
0
8
0
0
0
0
0
0
0
8
0
0
0
11
Repair of anomalous origin of CA
0
0
0
0
1
0
0
0
4
0
0
0
0
0
0
0
5
0
0
0
12
Closure of coronary AV fistula
0
0
0
0
0
0
0
0
1
0
0
0
0
0
0
0
1
0
0
0
13
Fontan / TCPC
0
0
0
0
1
0
0
0
356
0
0
2 (0.6)
28
0
0
1 (3.6)
385
0
0
3 (0.8)
14
Norwood procedure
28
2 (7.1)
0
5 (17.9)
76
4 (5.3)
0
7 (9.2)
0
0
0
0
0
0
0
0
104
6 (5.8)
0
12 (11.5)
15
Ventricular septation
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
16
Left side AV valve repair (including Redo)
0
0
0
0
43
0
0
1 (2.3)
84
0
0
0
28
0
0
1 (3.6)
155
0
0
2 (1.3)
17
Left side AV valve replace (including Redo)
0
0
0
0
11
0
0
0
36
0
0
0
20
0
0
1 (5.0)
67
0
0
1 (1.5)
18
Right side AV valve repair (including Redo)
18
2 (11.1)
0
2 (11.1)
71
1 (1.4)
0
4 (5.6)
85
0
0
0
64
0
0
0
238
3 (1.3)
0
6 (2.5)
19
Right side AV valve replace (including Redo)
0
0
0
0
1
0
0
0
8
0
0
0
24
0
0
0
33
0
0
0
20
Common AV valve repair (including Redo)
1
0
0
0
11
0
0
2 (18.2)
8
0
0
0
1
0
0
0
21
0
0
2 (9.5)
21
Common AV valve replace (including Redo)
0
0
0
0
2
1 (50.0)
0
1 (50.0)
14
1 (7.1)
0
2 (14.3)
8
0
0
0
24
2 (8.3)
0
3 (12.5)
22
Repair of supra-aortic stenosis
0
0
0
0
9
0
0
1 (11.1)
23
0
0
1 (4.3)
0
0
0
0
32
0
0
2 (6.3)
23
Repair of subaortic stenosis (including Redo)
0
0
0
0
7
0
0
0
41
0
0
0
3
0
0
0
51
0
0
0
24
Aortic valve plasty ± VSD Closure
2
0
0
0
5
0
0
0
36
0
0
0
6
0
0
0
49
0
0
0
25
Aortic valve replacement
0
0
0
0
2
0
0
0
28
0
0
0
36
0
0
0
66
0
0
0
26
AVR with annular enlargement
0
0
0
0
1
0
0
0
14
0
0
0
6
0
0
0
21
0
0
0
27
Aortic root Replace (except Ross)
0
0
0
0
1
1 (100.0)
0
1 (100.0)
8
1 (12.5)
0
1 (12.5)
17
0
0
0
26
2 (7.7)
0
2 (7.7)
28
Ross procedure
0
0
0
0
4
0
0
0
19
0
0
0
23
0
0
0
    
29
Bilateral pulmonary artery banding
180
9 (5.0)
0
25 (13.9)
23
1 (4.3)
1 (4.3)
2 (8.7)
0
0
0
0
0
0
0
0
203
10 (4.9)
1 (0.5)
27 (13.3)
Total
 
708
19 (2.7)
1 (0.1)
53 (7.5)
1551
18 (1.2)
2 (0.1)
48 (3.1)
1462
6 (0.4)
0
14 (1.0)
312
1 (0.3)
0
4 (1.3)
4033
44 (1.1)
3 (0.07)
119 (3.0)
(), % 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); 31,479
(1) Valvelar heart disease (total; 17,661)
 
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
Hospital
After discharge
Isolated
A
8206
879
7142
113
72
2020
118 (1.5)
0
4 (0.05)
1 (0.9)
202 (2.5)
2 (1.8)
625
23 (3.7)
0
33 (5.3)
 
M
4415
384
847
3155
29
557
63 (5.1)
21 (0.7)
0
2 (0.06)
97 (7.9)
39 (1.2)
527
18 (3.3)
1 (0.2)
34 (6.5)
 
T
221
7
44
167
3
37
0
7 (4.2)
0
0
3 (5.9)
11 (6.6)
57
1 (1.8)
0
3 (5.3)
 
P
20
0
17
0
3
1
0
0
0
0
0
0
16
0
0
0
A + M
 
971
    
152
42 (4.3)
 
1 (0.1)
 
74 (7.6)
 
143
11 (7.7)
0
17 (11.9)
 
A
 
171
777
22
1
           
 
M
 
134
308
520
9
           
A + T
 
366
    
50
6 (1.6)
 
0
 
16 (4.4)
 
55
2 (3.6)
0
4 (7.3)
 
A
 
38
323
5
0
           
 
T
 
0
0
358
8
           
M + T
 
2663
    
274
44 (1.7)
 
1 (0.04)
 
81 (3.0)
 
317
7 (2.2)
0
13 (4.1)
 
M
 
255
750
1631
27
           
 
T
 
6
17
2622
18
           
A + M + T
 
738
    
89
29 (3.9)
 
0
 
49 (6.6)
 
99
5 (5.1)
0
6 (6.1)
 
A
 
100
624
12
2
           
 
M
 
96
278
356
8
           
 
T
 
3
6
728
1
           
others
 
61
    
3
1 (1.6)
 
0
 
3 (4.9)
 
23
1 (4.3)
0
1 (4.3)
Total
 
17,661
    
3183
303 (1.7)
 
6 (0.03)
 
525 (3.0)
 
1862
68 (3.7)
1 (0.05)
111 (6.0)
 
Cases
30-day mortality
TAVR
12,202
140 (1.1)
(2) Ischemic heart disease (total, (A) + (B); 11,364)
(A) Isolated CABG (total; (a) + (b); 10,184)
(a-1) On-pump arrest CABG (total; 2374)
 
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
46
0 (0.0)
0
0 (0.0)
11
3 (27.3)
0
3 (27.3)
0
0
0
0
0
0
0
0
16
24
15
2
0
2VD
296
1 (0.3)
0
4 (1.4)
27
3 (11.1)
0
3 (11.1)
0
0
0
0
1
0 (0.0)
0
0 (0.0)
38
263
22
1
0
3VD
877
12 (1.4)
0
17 (1.9)
111
8 (7.2)
0
10 (9.0)
3
0 (0.0)
0
0 (0.0)
0
0
0
0
45
916
22
8
0
LMT
796
8 (1.0)
0
11 (1.4)
168
6 (3.6)
0
13 (7.7)
6
0
0
0
0
0
0
0
69
851
43
6
1
No info
21
1
0
1 (4.8)
8
1 (12.5)
0
4 (50.0)
1
0 (0.0)
0
1 (100.0)
2
1 (50.0)
0
1 (50.0)
3
15
11
1
2
Total
2036
22 (1.1)
0
33 (1.6)
325
21 (6.5)
0
33 (10.2)
10
0 (0.0)
0
1 (10.0)
3
1 (33.3)
0
1 (33.3)
171
2069
113
18
3
Kawasaki
4
1 (25.0)
0
0 (0.0)
0
0
0
0
0
0
0
0
0
0
0
0
4
0
0
0
0
on dialysis
250
10 (4.0)
0
14 (5.6)
36
4
0
6 (16.7)
3
0
0
1
0
0
0
0
20
252
16
1
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; 2003)
 
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
38
0 (0.0)
0 (0.0)
0 (0.0)
11
1 (9.1)
0
2 (18.2)
0
0
0
0
1
0
0
0
23
17
10
0
0
2VD
206
1 (0.5)
2 (1.0)
3 (1.5)
38
1 (2.6)
0
3 (7.9)
5
0
0
0
1
0
0
0
52
174
22
2
0
3VD
662
11 (1.7)
0 (0.0)
18 (2.7)
110
13 (11.8)
0
19 (17.3)
4
0
0
0 (0.0)
3
1 (33.3)
0
1 (33.3)
81
668
28
2
0
LMT
643
17 (2.6)
1 (0.2)
27 (4.2)
228
19 (8.3)
0
26 (11.4)
11
1 (9.1)
0
2 (18.2)
3
0
0
1 (33.3)
116
731
32
5
1
no info
27
0 (0.0)
0 (0.0)
1 (3.7)
9
1 (11.1)
0
1 (11.1)
0
0
0
0
3
0
0
1 (33.3)
14
18
7
0
0
Total
1576
29 (1.8)
3 (0.2)
49 (3.1)
396
35 (8.8)
0 (0.0)
51 (12.9)
20
1 (5.0)
0
2 (10.0)
11
1 (9.1)
0
3 (27.3)
286
1608
99
9
1
Kawasaki
2
0
0
0
2
0
0
0
2
0
0
0
0
0
0
0
3
2
1
0
0
on dialysis
255
11 (4.3)
1
21 (8.2)
59
9 (15.3)
0 (0.0)
11 (18.6)
6
1 (16.7)
0
2 (33.3)
1
1 (100.0)
0
1 (100.0)
23
278
19
1
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; 5807)
(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
307
0 (0.0)
0
5 (1.6)
36
3 (8.3)
0
6 (16.7)
7
0
0
0
0
0
0
0
244
72
32
0
2
2VD
786
6 (0.8)
0
9 (1.1)
63
1 (1.6)
0
4 (6.3)
8
0
0
1 (12.5)
0
0
0
0
299
533
20
4
1
3VD
2093
21 (1.0)
1 (0.0)
35 (1.7)
186
5 (2.7)
0
11 (5.9)
14
0
0
0
1
0
0
0
462
1780
36
15
1
LMT
1873
14 (0.7)
1 (0.1)
26 (1.4)
331
10 (3.0)
1 (0.3)
18 (5.4)
13
0
0
1 (7.7)
2
0
0
0
603
1562
44
10
0
no info
67
1 (1.5)
0 (0.0)
1 (1.5)
15
1
0
1 (6.7)
4
0
0
0
1
1 (100.0)
0
1 (100.0)
34
45
7
1
0
Total
5126
42 (0.8)
2 (0.0)
76 (1.5)
631
20 (3.2)
1 (0.2)
40 (6.3)
46
0
0
2 (4.3)
4
1 (25.0)
0
1 (25.0)
1642
3992
139
30
4
Kawasaki
15
0
0
0
1
0
0
0
1
0
0
0
0
0
0
0
7
9
0
0
1
On dialysis
566
12 (2.1)
1 (0.2)
26 (4.6)
55
6 (10.9)
0
10 (18.2)
13
0
0
2 (15.4)
1
0
0
0
154
458
18
5
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
2 (8.3)
8
0 (0.0)
0
1 (12.5)
0
0
0
0
0
0
0
0
Converted to beating
107
5 (4.7)
0
6 (5.6)
17
3 (17.6)
0
6 (35.3)
1
0
0
0
0
0
0
0
Total
131
7 (5.3)
0
8 (6.1)
25
3 (12.0)
0
7 (28.0)
1
0
0
0
0
0
0
0
On dialysis
28
5 (17.9)
0
5 (17.9)
3
1 (33.3)
0
1 (33.3)
0
0
0
0
0
0
0
0
(), % mortality
CABG coronary artery bypass grafting
(B) Operation for complications of MI (total; 1180)
 
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
90
6 (6.7)
0
8 (8.9)
36
10 (27.8)
1 (2.8)
15 (41.7)
56
14
6
VSP closure
86
12 (14.0)
0
21 (24.4)
244
60 (24.6)
0
77 (31.6)
85
9
0
Cardiac rupture
50
7 (14.0)
0
10 (20.0)
231
64 (27.7)
0
78 (33.8)
38
3
4
Mitral regurgitation
           
 (1) Papillary muscle rupture
23
2 (8.7)
0
2 (8.7)
70
14 (20.0)
0
20 (28.6)
35
15
78
 (2) Ischemic
142
9 (6.3)
0
11 (7.7)
39
6 (15.4)
0
9 (23.1)
134
111
70
Others
90
1 (1.1)
0
2 (2.2)
79
20 (25.3)
0
25 (31.6)
59
10
4
Total
481
37 (7.7)
0
54 (11.2)
699
174 (24.9)
1 (0.1)
224 (32.0)
407
162
162
(), % 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; 6720)
 
Cases
30-day mortality
Hospital mortality
Concomitant operation
Isolated
Congenital
Valve
IHD
Others
Multiple combination
Hospital
After discharge
2 categories
3 categories
Maze
3442
53 (1.5)
0
98 (2.8)
155
172
2918
572
319
660
36
For WPW
1
0
0
0
0
0
1
1
0
1
0
For ventricular tachyarrhythmia
23
0
0
1 (4.3)
1
1
4
10
5
3
0
Others
3254
74 (2.3)
2 (0.06)
127 (3.9)
80
153
2680
635
382
654
38
Total
6720
127 (1.9)
2 (0.03)
226 (3.4)
236
326
5603
1218
706
1318
74
(), % 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; 190)
 
CPB ( +)
CPB ( −)
Cases
30-day mortality
Hospital mortality
Cases
30-day mortality
Hospital mortality
Hospital
After discharge
Hospital
After discharge
Total
102
6 (5.9)
0
12 (11.8)
88
4 (4.5)
2 (2.3)
7 (8.0)
(), % mortality
CPB cardiopulmonary bypass
(5) Cardiac tumor (total; 618)
 
Cases
30-day mortality
Hospital mortality
Concomitant operation
Hospital
After discharge
AVR
MVR
CABG
Others
Benign tumor
550
6 (1.1)
0
8 (1.5)
24
15
40
120
(Cardiac myxoma)
392
2 (0.5)
0
3 (0.8)
7
3
22
73
Malignant tumor
68
8 (11.8)
0
8 (11.8)
0
2
7
13
(Primary)
38
3 (7.9)
0
3 (7.9)
0
1
4
8
(), % mortality
AVR aortic valve replacement; MVR mitral valve replacement; CABG coronary artery bypass grafting
(6) HOCM and DCM (total; 226)
 
Cases
30-day mortality
Hospital mortality
Concomitant operation
Hospital
After discharge
AVR
MVR
MVP
CABG
Myectomy
116
4 (3.4)
0
5 (4.3)
41
16
14
6
Myotomy
4
0
0
0
1
1
0
0
No-resection
100
7 (7.0)
0
13 (13.0)
20
51
49
4
Volume reduction surgery of the left ventricle
6
0
0
1 (16.7)
1
0
4
1
Total
226
11 (4.9)
0
19 (8.4)
63
68
67
11
(), % 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; 1184)
 
Cases
30-day mortality
Hospital mortality
Hospital
After discharge
Open-heart operation
491
57 (11.6)
0
82 (16.7)
Non-open-heart operation
693
81 (11.7)
0
115 (16.6)
Total
1184
138 (11.7)
0
197 (16.6)
(), % mortality
Table 3
Thoracic aortic aneurysm (total; 22,982)
(1) Dissection (total; 11,247)
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
1934
129 (6.7)
2 (0.10)
175 (9.0)
4
1 (25.0)
0
1 (25.0)
222
6 (2.7)
0
7 (3.2)
3
0
0
0
56
130
18
11
84
35
Aortic Root
188
22 (11.7)
0
25 (13.3)
0
0
0
0
94
3 (3.2)
1 (1.1)
5 (5.3)
5
0
0
0
29
194
2
1
66
6
Arch
2092
143 (6.8)
1 (0.05)
190 (9.1)
21
0
0
0
393
5 (1.3)
0
11 (2.8)
176
9 (5.1)
0
13 (7.4)
66
133
11
11
124
32
Aortic root + asc. Ao. + Arch
170
20 (11.8)
0
27 (15.9)
1
0
0
0
60
2 (3.3)
0
3 (5.0)
7
1 (14.3)
0
1 (14.3)
31
151
2
0
56
0
Descending Ao
20
0
0
1 (5.0)
33
4 (12.1)
0
5 (15.2)
73
1 (1.4)
0
3 (4.1)
201
3 (1.5)
0
9 (4.5)
2
2
0
0
2
0
Thoracoabdominal
2
0
0
0
19
2 (10.5)
0
4 (21.1)
55
4 (7.3)
0
6 (10.9)
163
12 (7.4)
0
18 (11.0)
0
0
0
0
0
0
Simple TEVAR
105
9 (8.6)
0
12 (11.4)
450
37 (8.2)
1 (0.2)
43 (9.6)
251
2 (0.8)
1 (0.4)
4 (1.6)
1186
14 (1.2)
1 (0.1)
22 (1.9)
0
1
0
0
0
1
Open SG with BR
1350
112 (8.3)
2 (0.15)
135 (10.0)
59
3 (5.1)
0
6 (10.2)
193
4 (2.1)
1 (0.5)
8 (4.1)
229
8 (3.5)
0
11 (4.8)
48
132
7
3
103
13
Open SG without BR
526
50 (9.5)
0
62 (11.8)
21
2 (9.5)
0
2 (9.5)
74
1 (1.4)
0
3 (4.1)
85
3 (3.5)
0
4 (4.7)
17
47
3
1
34
2
Arch TEVAR with BR
20
0
0
0
146
11 (7.5)
0
13 (8.9)
67
1 (1.5)
0
2 (3.0)
431
5 (1.2)
0
7 (1.6)
0
0
0
0
0
0
Thoracoabdominal TEVAR with BR
3
0
0
0
3
0
0
0
8
0
0
0
23
2 (8.7)
0
3 (13.0)
0
0
0
0
0
0
Other
6
2 (33.3)
0
2 (33.3)
21
4 (19.0)
0
6 (28.6)
19
1 (5.3)
0
1 (5.3)
35
0
0
1 (2.9)
0
0
0
0
0
0
Total
6416
323 (5.0)
5 (0.08)
629 (9.8)
778
64 (8.2)
1 (0.1)
80 (10.3)
1509
30 (2.0)
3 (0.2)
53 (3.5)
2544
57 (2.2)
1 (0.0)
89 (3.5)
249
790
43
27
469
89
(), % 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; 11,735)
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
1334
20 (1.5)
3 (0.22)
38 (2.8)
53
3 (5.7)
0
9 (17.0)
37
929
69
40
154
88
Aortic Root
1114
27 (2.4)
0
42 (3.8)
50
10 (20.0)
0
14 (28.0)
285
790
67
34
148
63
Arch
2041
35 (1.7)
1 (0.05)
71 (3.5)
98
10 (10.2)
0
15 (15.3)
34
571
47
17
260
83
Aortic root + asc. Ao. + Arch
259
9 (3.5)
0
15 (5.8)
16
5 (31.3)
0
5 (31.3)
49
190
9
4
39
11
Descending Ao
276
10 (3.6)
0
22 (8.0)
36
4 (11.1)
0
6 (16.7)
1
3
1
0
10
3
Thoracoabdominal
322
12 (3.7)
0
21 (6.5)
35
7 (20.0)
0
8 (22.9)
0
0
0
0
0
0
Simple TEVAR
2417
36 (1.5)
5 (0.21)
65 (2.7)
349
49 (14.0)
2 (0.57)
64 (18.3)
0
0
0
0
1
6
Open SG with BR
1200
36 (3.0)
0
70 (5.8)
81
11 (13.6)
0
17 (21.0)
21
134
13
6
185
24
Open SG without BR
464
7 (1.5)
0
21 (4.5)
38
4 (10.5)
0
7 (18.4)
6
79
6
4
49
19
Arch TEVAR with BR
1190
19 (1.6)
3
44 (3.7)
75
9 (12.0)
0
13 (17.3)
0
3
0
0
5
4
Thoracoabdominal TEVAR with BR
98
4 (4.1)
1 (1.02)
10 (10.2)
14
1 (7.1)
0
2 (14.3)
0
0
0
0
0
0
Other
153
6 (3.9)
1 (0.65)
9 (5.9)
22
4 (18.2)
0
5 (22.7)
0
13
0
1
5
5
Total
10,868
221 (2.0)
14 (0.13)
428 (3.9)
867
117 (13.5)
2 (0.23)
165 (19.0)
433
2712
212
106
856
306
(), % 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; 185)
 
Cases
30-day mortality
Hospital mortality
Hospital
After discharge
Acute
125
12 (9.6)
1 (0.8)
15 (12.0)
Chronic
60
 
0
0
Total
185
12 (6.5)
1 (0.5)
15 (8.1)
(), % mortality
Table 5
Implantation of VAD (total; 144)
 
Cases
30-day mortality
Hospital mortality
Hospital
After discharge
Implantation of VAD
144
1 (0.7)
0
9 (6.3)
(), % mortality
VAD ventricular assist devise
Table 6
Heart transplantation (total; 59)
 
Cases
Hospital mortality
Heart transplantation
59
0
Heart and lung transplantation
0
0
Total
59
0 (0.0)
(), % mortality
Among the 8349 procedures for congenital heart disease conducted in 2021, 6510 were open-heart surgeries, with an overall hospital mortality rate of 1.7% (Table 1). The number of surgeries for neonates and infants in 2021 significantly decreased compared to that in 2011 (3958 vs 5048); on the other hands, hospital mortality did not significantly differ compared to those in 2011 (7.1% vs 6.6% for neonates and 2.4–2.7% for infants) despite the increasing ratio of surgeries for severe cases. In 2021, atrial septal defect (1302 cases) and ventricular septal defect (1338 cases) were the most common diseases as previously reported, with patients aged ≥ 18 years accounting for 59% of atrial septal defect and ventricular septal defect surgeries.
Hospital mortality of open heart surgeriews for complex congenital heart disease within the past 10 years was as follows (2011 [5], 2016 [6], and 2021): complete atrioventricular septal defect (2.6%, 2.4%, and 2.0%); tetralogy of Fallot (0.7%, 1.6%, and 0.5%); transposition of the great arteries with the intact septum (2.5%, 4.4%, and 5.0%), ventricular septal defect (3.6%, 8.3%, and 1.7%), single ventricle (4.4%, 5.1%, and 3.6%); and hypoplastic left heart syndrome (14.3%, 7.5%, and 8.0%). Currently, right heart bypass surgery has been commonly performed (291 bidirectional Glenn procedures, excluding 23 Damus–Kaye–Stansel procedures, and 385 Fontan type procedures, including total cavopulmonary connection) with acceptable hospital mortality rates (2.4% and 0.8%). The Norwood type I procedure was performed in 104 cases, with a relatively low hospital mortality rate (11.5%) (Table 1).
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 = 8206) was 4.5% fewer than that in the previous year (n = 8592) and 13.4% fewer than that 5 years ago (n = 9472 in 2016), as opposed to the rapid increase of transcatheter aortic valve replacement (n = 9774 and 12,202 in 2020 and 2021). Isolated mitral valve replacement/repairs with/without CABG (n = 4415) was not differ compared that in the previous year (n = 4471) and 3.5% fewer than that 5 years ago (n = 4576 in 2016). Aortic and mitral valve replacement with bioprosthesis were performed in 8866 and 2183 cases, respectively. The rate at which bioprosthesis was used had dramatically increased from 30% in the early 2000s [7, 8] to 88.2% and 71.5% in 2021 for aortic and mitral positions, respectively. Additionally, CABG was performed concurrently in 18.0% of all valvular procedures (17.5% in 2011 [5] and 18.4% in 2016 [6]). Valve repair was common in mitral and tricuspid valve positions (5662 and 3875 cases, respectively) but less common in aortic valve positions (152 patients, only 1.5% of all aortic valve procedures). Mitral valve repair accounted for 64.4% of all mitral valve procedures. Hospital mortality rates for isolated valve replacement for aortic and mitral positions were 2.5% and 7.9%, respectively, but only 1.2% for mitral valve repair. Moreover, hospital mortality rates for redo isolated valve surgery for the aortic and mitral positions were 5.3% and 6.5%, respectively. Finally, overall hospital mortality rates did not significantly improve over the past 10 years (3.4% in 2011 [5], 3.4% in 2016 [6], and 3.0% in 2021) (Table 2).
Isolated CABG had been performed in 10,184 cases, accounting for only 71.4% of the procedures performed 10 years ago (n = 14,256 in 2011) [5]. Of the aforementioned cases, 5807 (57.0%) underwent off-pump CABG, with a success rate of 97.3%. The percentage of planned off-pump CABG in 2021 was similar to that in 2020. Hospital mortality associated with primary elective CABG procedures among 8738 cases accounted for 1.8%, which is slightly higher than that in 2011 (1.1%) [5]. Hospital mortality for primary emergency CABG among 1352 cases remained high (9.2%). The percentage of conversion from off-pump to on-pump CABG or on-pump beating-heart CABG was 2.6% among the primary elective CABG cases, with a hospital mortality rate of 5.6%. 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 15,158 (Table 2).
Arrhythmia management was primarily performed as concomitant procedures in 6720 cases, with a hospital mortality rate of 3.4%. Pacemaker and implantable cardioverter-defibrillator implantation were not included in this category (Table 2).
In 2021, 22,982 procedures for thoracic and thoracoabdominal aortae diseases were performed, among which aortic dissection and non-dissection accounted for 11,247 and 11,735, respectively. The number of surgeries for aortic dissection this year was 3.6% higher than that in the preceding year (n = 10,855 in 2020). Hospital mortality rates for the 6416 Stanford type A acute aortic dissections remained high (9.8%). The number of procedures for non-dissected aneurysms increased by 0.4%, with a hospital mortality rate of 5.1% for all aneurysms and 3.9% and 19.0% 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 5230 patients with aortic dissection, including 2693 TEVARs and 2537 open stent graftings. Moreover, 1640 and 314 cases underwent TEVAR and open stent grafting for type B chronic aortic dissection, accounting for 60.9% and 12.4% of the total number of cases, respectively. Hospital mortality rates associated with simple TEVAR for type B aortic dissection were 9.6% and 1.9% for acute and chronic cases, respectively. Stent graft placement was performed in 5926 patients with non-dissected aortic aneurysms, among which 4143 were TEVARs (an 1.3% increase compared to that in 2020, n = 4090) and 1783 were open stent graftings (a 10.6% increase compared to that in 2020, n = 1612). Hospital mortality rates were 3.2% and 18.0% for TEVARs and 5.5% and 20.2% for open stenting in unruptured and ruptured aneurysms, respectively (Table 3).

(B) General thoracic surgery

The 2021 survey of general thoracic surgeries comprised 699 surgical units, with bulk data submitted via a web-based collection system established by the NCD [3]. General thoracic surgery departments reported 88,027 procedures in 2021 (Table 7), which is 2.1 times more than that in 2000 and 5834 more procedures than that in 2016 [6] (Fig. 2). It increased compared to that in 2020 (the first year of COVID-19 pandemic: 86,813) [3] by 1.4%. However it still decreased by 3.9% compared to that of 2019 (before COVID-19 pandemic: 91,626) [2], mostly because of the protraction of COVID-19 pandemic, despite the steadily increase up to 2019.
Table 7
Total cases of general thoracic surgery during 2021
 
Cases
%
Benign pulmonary tumor
2418
2.7
Primary lung cancer
46,624
53.0
Other primary malignant pulmonary tumor
405
0.5
Metastatic pulmonary tumor
9047
10.3
Tracheal tumor
90
0.1
Pleural tumor including mesothelioma
524
0.6
Chest wall tumor
716
0.8
Mediastinal tumor
5590
6.4
Thymectomy for MG without thymoma
139
0.2
Inflammatory pulmonary disease
2117
2.4
Empyema
3123
3.5
Bullous disease excluding pneumothorax
273
0.3
Pneumothorax
14,266
16.2
Chest wall deformity
282
0.3
Diaphragmatic hernia including traumatic
37
0.0
Chest trauma excluding diaphragmatic hernia
461
0.5
Lung transplantation
93
0.1
Others
1822
2.1
Total
88,027
100.0
In 2021, 46,624 procedures for primary lung cancer had been performed which increased by 2.6% compared to that of 2020 (45,436) [3], but still decreased by 3.0% compared to that of 2019 (48,052) [2], similarly to the total number of surgeries in general thoracic surgery. The number of procedures in 2021 was 2.5 times higher than that in 2000, with lung cancer procedures accounting for 53% 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, 24, 25, and 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 2021, respectively.
Table 8
Benign pulmonary tumor
 
Cases
30-day mortality
Hospital mortality
By VATS
Hospital
After discharge
1. Benign pulmonary tumor
     
Hamartoma
457
0
0
1 (0.2)
435
Sclerosing hemangioma
107
0
0
0
99
Papilloma
21
0
0
0
18
Mucous gland adenoma bronchial
19
0
0
0
19
Fibroma
118
0
0
0
112
Lipoma
9
0
0
0
9
Neurogenic tumor
16
0
0
0
13
Clear cell tumor
1
0
0
0
1
Leiomyoma
16
0
0
0
15
Chondroma
4
0
0
0
4
Inflammatory myofibroblastic tumor
1
0
0
0
1
Pseudolymphoma
18
0
0
0
15
Histiocytosis
17
0
0
0
17
Teratoma
7
0
0
0
4
Others
1607
0
0
3 (0.2)
1491
Total
2418
0
0
4 (0.17)
2253
(), Mortality %
Table 9
Primary malignant pulmonary tumor
 
Cases
30-Day mortality
Hospital mortality
VATS
Robotic surgery
Hospital
After discharge
2. Primary malignant pulmonary tumor
47,029
119 (0.3)
52 (0.1)
218 (0.5)
34,458
4253
 Lung cancer
46,624
119 (0.3)
52 (0.1)
216 (0.5)
34,458
4253
 Histological classification
      
  Adenocarcinoma
32,784
46 (0.1)
28 (0.09)
75 (0.2)
  
  Squamous cell carcinoma
8048
50 (0.6)
17 (0.2)
97 (1.2)
  
  Large cell carcinoma
323
0
2 (0.6)
3 (0.9)
  
  LCNEC
549
2 (0.4)
2 (0.4)
3 (0.5)
  
  Small cell carcinoma
901
3 (0.3)
2 (0.2)
6 (0.7)
  
  Adenosquamous carcinoma
541
2 (0.4)
0
5 (0.9)
  
  Carcinoma with pleomorphic, sarcomatoid or sarcomatous elements
520
8 (1.5)
0
14 (2.7)
  
  Carcinoid
226
0
0
0
  
  Carcinomas of salivary-gland type
46
0
0
0
  
  Unclassified
36
0
0
0
  
  Multiple lung cancer
2257
5 (0.2)
1 (0.0)
9 (0.4)
  
  Others
358
3 (0.8)
0
4 (1.1)
  
 Operative procedure
      
  Wedge resection
8683
14 (0.2)
8 (0.1)
22 (0.3)
7982
18
  Segmental excision
6781
8 (0.1)
4 (0.06)
17 (0.3)
5438
619
  (Sleeve segmental excision)
14
0
0
0
11
0
  Lobectomy
30,682
89 (0.3)
39 (0.13)
160 (0.5)
20,852
3609
  (Sleeve lobectomy)
351
2 (0.6)
1 (0.3)
8 (2.3)
46
8
  Pneumonectomy
205
5 (2.4)
0
12 (5.9)
22
2
  (Sleeve pneumonectomy)
6
0
0
0
0
0
  Other bronchoplasty
30
1 (3.3)
0
2 (6.7)
1
0
  Pleuropneumonectomy
2
0
0
0
1
0
  Others
206
2 (1.0)
1 (0.5)
3 (1.5)
133
4
  Multiple incision for multiple lung cancer
35
0
0
1 (2.9)
29
1
 Sarcoma
54
0
0
1 (1.9)
  
 AAH
103
0
0
0
  
 Lymphoma
197
0
0
1 (0.5)
  
 Others
51
0
0
0
  
(), Mortality %
A total of 2418 procedures for benign pulmonary tumors had been conducted in 2021 (Table 8). Hamartomas were the most frequent benign pulmonary tumors diagnosed, with 2253 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 (71% of all lung cancers), followed by squamous cell carcinoma (17%). Sublobar resection was performed in 15,464 lung cancer cases (33% of all cases) and lobectomy in 30,682 cases (66% of all cases). Sleeve lobectomy was performed in 351 cases (0.8% of all cases), while pneumonectomy was required in 205 cases (0.4% of all cases). VATS lobectomy was performed in 20,852 cases of lung cancer (68% of all lobectomy cases). RATS lobectomy was performed in 3609 cases of lung cancer (12% of all lobectomy cases). Patients aged ≥ 80 years who underwent lung cancer surgery accounted for 6912 (15%). Among those who died within 30 days postoperatively, 119 and 52 died before and after hospital discharge, respectively. Overall, 171 patients died within 30 days postoperatively (30-day mortality rate, 0.4%), while 119 died before discharge (hospital mortality rate, 0.3%). Moreover, 30-day mortality rates according to the procedure were 0.1%, 0.4%, and 2.4% for segmentectomy, lobectomy, and pneumonectomy, respectively. Interstitial pneumonia had been the leading cause of death after lung cancer surgery, followed by pneumonia, cardiovascular events and respiratory failure.
Table 10
Details of lung cancer operations
TNM
 
c-Stage
Cases
0
2126
IA1
8867
IA2
13,972
IA3
7991
IB
4994
IIA
1582
IIB
3570
IIIA
2422
IIIB
451
IIIC
18
IVA
400
IVB
95
NA
102
Total
46,590
Sex
Cases
Male
28,363
Female
18,226
NA
0
Total
46,589
Cause of death
Cases
Cardiovascular
37
Pneumonia
73
Pyothorax
2
Bronchopleural fistula
15
Respiratory failure
22
Pulmonary embolism
7
Interstitial pneumonia
109
Brain infarction or bleeding
18
Others
136
Unknown
35
Total
454
p-Stage
Cases
0(pCR)
3308
IA1
9431
IA2
10,842
IA3
5229
IB
6560
IIA
1310
IIB
4363
IIIA
3541
IIIB
732
IIIC
11
IVA
886
IVB
90
NA
286
Total
46,589
Age (y)
Cases
 < 20
20
20–29
65
30–39
235
40–49
1226
50–59
3828
60–69
11,020
70–79
23,283
80–89
6779
 ≥ 90
133
NA
0
Total
46,589
The procedures for metastatic pulmonary tumors performed in 2021 decreased 6.3% to 9047 cases compared to that in 2020 (9654) [3], 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
Robotic surgery
Hospital
After discharge
3. Metastatic pulmonary tumor
9047
5 (0.1)
9 (0.10)
10 (0.1)
8331
298
 Colorectal
4307
2 (0.05)
2 (0.05)
3 (0.1)
4000
157
 Hepatobiliary/Pancreatic
503
0
0
0
474
16
 Uterine
530
0
0
0
483
21
 Mammary
552
0
0
0
530
16
 Ovarian
91
0
0
0
82
2
 Testicular
50
0
0
0
45
0
 Renal
733
0
0
0
687
22
 Skeletal
89
0
0
0
72
5
 Soft tissue
236
0
0
0
207
2
 Otorhinolaryngological
469
0
2 (0.4)
1 (0.2)
434
16
 Pulmonary
443
1 (0.2)
1 (0.2)
2 (0.5)
362
4
 Others
1044
2 (0.2)
4 (0.4)
4 (0.4)
955
37
(), Mortality %
A total of 90 procedures for tracheal tumors, including 37, 25, and 28 cases of primary malignant, metastatic, and benign tracheal tumors, respectively, were performed in 2021. Further, 16 patients underwent sleeve resection and reconstruction (Table 12).
Table 12
Tracheal tumor
 
Cases
30-Day mortality
Hospital mortality
Hospital
After discharge
4. Tracheal tumor
90
6 (6.7)
1 (1.1)
8 (8.9)
A. Primary malignant tumor
Histological classification
  Squamous cell carcinoma
6
0
0
0
  Adenoid cystic carcinoma
22
0
0
0
  Mucoepidermoid carcinoma
1
0
0
0
  Others
8
0
0
0
  Total
37
0
0
0
B. Metastatic/invasive malignant tumor e.g. invasion of thyroid cancer
 
25
4 (16.0)
1 (4.0)
6 (24.0)
C. Benign tracheal tumor
  Papilloma
5
0
0
0
  Adenoma
0
0
0
0
  Neurofibroma
1
0
0
0
  Chondroma
0
0
0
0
  Leiomyoma
4
0
0
0
  Others
18
2(11.1)
0
2(11.1)
  Histology unknown
0
0
0
0
  Total
28
2(7.1)
0
2(7.1)
Operative procedure
  Sleeve resection with reconstruction
16
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
0
0
0
0
  Unknown
0
0
0
0
  Total
18
0
0
0
(), Mortality %
Overall, 524 pleural tumors had been diagnosed in 2021 (Table 13), with diffuse malignant pleural mesothelioma as the most frequent histologic diagnosis. Total pleurectomy was performed in 123 cases and extrapleural pneumonectomy in 26 cases. The 30-day mortality rate was 0% and 4% after total pleurectomy and extrapleural pneumonectomy, respectively.
Table 13
Tumor of pleural origin
Histological classification
Cases
30-Day mortality
Hospital mortality
Hospital
After discharge
Solitary fibrous tumor
101
0
0
0
Diffuse malignant pleural mesothelioma
203
3 (1.5)
0
4 (2.0)
Localized malignant pleural mesothelioma
26
0
0
0
Others
194
5 (2.6)
0
6 (3.1)
Total
524
8 (1.5)
0
10 (1.9)
Operative procedure
Cases
30-Day mortality
Hospital mortality
Hospital
After discharge
Extrapleural pneumonectomy
26
1 (3.8)
0
1 (3.8)
Total pleurectomy
123
0
0
0
Others
54
2 (3.7)
0
3 (5.6)
Total
203
3 (1.5)
0
4 (2.0)
(), Mortality %
Overall, 716 chest wall tumor resections had been performed in 2021, including 137, 188, and 391 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
137
0
0
0
37
 Metastatic malignant tumor
188
0
2(1.1)
2(1.1)
61
 Benign tumor
391
1(0.3)
0
1(0.3)
297
 Total
716
1(0.1)
2(0.3)
3(0.4)
395
(), Mortality %
In 2021, 5590 mediastinal tumors were resected, which was similar to that in 2020 (5573) (Table 15) [3]. Thymic epithelial tumors, including 2174 thymomas, 380 thymic carcinomas, and 49 thymic carcinoids, were the most frequently diagnosed mediastinal tumor subtype in 2021.
Table 15
Mediastinal tumor
 
Cases
30-Day mortality
Hospital mortality
By VATS
Robotic surgery
Hospital
After discharge
7. Mediastinal tumor
5590
7 (0.13)
1 (0.02)
10 (0.2)
4373
1261
 Thymoma*
2174
3 (0.1)
1 (0.0)
3 (0.1)
1557
517
 Thymic cancer
380
1 (0.3)
0
1 (0.3)
228
57
 Thymus carcinoid
49
0
0
0
27
13
 Germ cell tumor
105
1 (1.0)
0
1 (1.0)
70
19
 Benign
81
1 (1.2)
0
1 (1.2)
61
17
 Malignant
24
0
0
0
9
2
 Neurogenic tumor
479
0
0
0
448
102
 Congenital cyst
1188
0
0
1 (0.1)
1124
319
 Goiter
86
0
0
0
42
7
 Lymphatic tumor
164
1 (0.6)
0
1 (0.6)
130
28
 Excision of pleural recurrence of thymoma
34
0
0
0
24
2
 Thymolipoma
14
0
0
0
14
1
 Others
917
1 (0.1)
0
3 (0.3)
709
196
(), Mortality %
A total of 505 patients underwent thymectomy for myasthenia gravis (Table 16), among which 366 procedures were associated with thymoma in 2021.
Table 16
Thymectomy for myasthenia gravis
 
Cases
30-Day mortality
Hospital mortality
By VATS
Robotic surgery
Hospital
After discharge
8. Thymectomy for myasthenia gravis
505
0
0
0
352
38
 With thymoma
366
0
0
0
249
5
(), Mortality %
Overall, 22,381 patients underwent procedures for non-neoplastic disease. Accordingly, 2117 patients underwent lung resection for inflammatory lung diseases (Table 17, 18), among which 428 and 270 patients were associated with mycobacterial and fungal infections, respectively. Procedures for inflammatory pseudotumor were performed in 930 cases (44%).
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
22,381
252 (1.1)
46 (0.2)
479 (2.1)
Table 18
A. Inflammatory pulmonary disease
 
Cases
30-Day mortality
Hospital mortality
VATS
Hospital
After discharge
A. Inflammatory pulmonary disease
2117
8 (0.4)
3 (0.1)
14 (0.7)
1794
 Tuberculous infection
29
0
0
0
21
 Mycobacterial infection
428
2 (0.5)
1 (0.2)
2 (0.5)
374
 Fungal infection
270
0
0
3 (1.1)
193
 Bronchiectasis
41
0
0
0
29
 Tuberculous nodule
58
0
0
0
50
 Inflammatory pseudotumor
930
2 (0.2)
0
2 (0.2)
847
 Interpulmonary lymph node
37
0
0
0
36
 Others
324
4 (1.2)
2 (0.6)
7 (2.2)
244
(), Mortality %
A total of 3123 procedures were performed for empyema (Table 19), among which 2508 (80%) were acute and 615 (20%) were chronic. Further, pleural fistulas developed in 483 and 277 patients with acute and chronic empyema, respectively. The hospital mortality rate was 13% among patients with acute empyema with fistula.
Table 19
B. Empyema
 
Cases
30-Day mortality
Hospital mortality
By VATS
Hospital
After discharge
Acute empyema
2508
60 (2.4)
5 (0.2)
127 (5.1)
2038
 With fistula
483
32 (6.6)
2 (0.4)
64 (13.3)
235
 Without fistula
2000
25 (1.3)
3 (0.2)
60 (3.0)
1780
 Unknown
25
3 (12.0)
0
3 (12.0)
23
Chronic empyema
615
13 (2.1)
4 (0.7)
55 (8.9)
315
 With fistula
277
5 (1.8)
2 (0.7)
33 (11.9)
81
 Without fistula
299
6 (2.0)
2 (0.7)
18 (6.0)
202
 Unknown
39
2 (5.1)
0
4 (10.3)
32
Total
3123
73 (2.3)
9 (0.3)
182 (5.8)
2353
(), Mortality %
Further, 94 operations were performed for descending necrotizing mediastinitis (Table 20), with a hospital mortality rate of 11%.
Table 20
C. Descending necrotizing mediastinitis
 
Cases
30-Day mortality
Hospital mortality
VATS
Hospital
After discharge
C. Descending necrotizing mediastinitis
94
4 (4.3)
0
10 (10.6)
59
(), Mortality %
A total of 273 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
273
3 (1.1)
0
3 (1.1)
241
 Emphysematous bulla
198
2 (1.0)
0
2 (1.0)
183
 Bronchogenic cyst
7
0
0
0
6
 Emphysema with LVRS
14
1 (7.1)
0
1 (7.1)
11
 Others
54
0
0
0
41
(), Mortality %
LVRS lung volume reduction surgery
A total of 14,266 procedures were performed for pneumothorax (Table 22). Among the 10,329 procedures for spontaneous pneumothorax, 2465 (24%) were bullectomies alone, while 7217 (70%) required additional procedures, such as coverage with artificial material, as well as parietal pleurectomy. A total of 3937 procedures for secondary pneumothorax were performed, with chronic obstructive pulmonary disease (COPD) being the most prevalent associated disease (2745 cases, 70%). The hospital mortality rate for secondary pneumothorax associated with COPD was 2.4%.
Table 22
E. Pneumothorax
Cases
30-Day mortality
 
Hospital mortality
VATS
Hospital
After discharge
14,266
94 (0.7)
29 (0.2)
159 (1.1)
13,880
Spontaneous pneumothorax
Operative procedure
Cases
30-Day mortality
 
Hospital mortality
VATS
Hospital
After discharge
Bullectomy
2465
4 (0.2)
1 (0.0)
7 (0.3)
2424
Bullectomy with additional procedure
7217
9 (0.1)
2 (0.03)
14 (0.2)
7123
 Coverage with artificial material
7011
8 (0.1)
2 (0.03)
12 (0.2)
6924
 Parietal pleurectomy
40
0
0
1 (2.5)
39
 Coverage and parietal pleurectomy
63
0
0
0
61
 Others
103
1 (1.0)
0
1 (1.0)
99
Others
636
7 (1.1)
1 (0.2)
8 (1.3)
584
Unknown
11
0
1 (9.1)
0
9
Total
10,329
20 (0.2)
5 (0.0)
29 (0.3)
10,140
Secondary pneumothorax
Associated disease
Cases
30-Day mortality
Hospital mortality
VATS
Hospital
After discharge
COPD
2745
39 (1.4)
10 (0.4)
66 (2.4)
2625
Tumorous disease
156
11 (7.1)
4 (2.6)
16 (10.3)
147
Catamenial
200
0
0
0
199
LAM
39
0
0
0
39
Others (excluding pneumothorax by trauma)
797
24 (3.0)
8 (1.0)
48 (6.0)
730
Unknown
0
0
0
0
0
Operative procedure
Cases
30 Day mortality
Hospital mortality
VATS
Hospital
After discharge
Bullectomy
693
10 (1.4)
5 (0.7)
19 (2.7)
673
Bullectomy with additional procedure
2359
25 (1.1)
9 (0.4)
44 (1.9)
2285
coverage with artificial material
2265
25 (1.1)
9 (0.4)
41 (1.8)
2197
parietal pleurectomy
7
0
0
0
7
coverage and parietal pleurectomy
31
0
0
0
29
others
56
0
0
3 (5.4)
52
Others
882
39 (4.4)
8 (0.9)
67 (7.6)
776
Unknown
3
0
0
0
3
Total
3937
74 (1.9)
22 (0.6)
130 (3.3)
3737
(), Mortality %
The 2021 survey reported 282 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
282
0
0
0
 Funnel chest
268
0
0
0
 Others
14
0
0
1 (7.1)
(), Mortality %
Surgical treatment for diaphragmatic hernia was performed in 37 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
37
0
0
0
11
 Congenital
8
0
0
0
1
 Traumatic
12
0
0
0
3
 Others
17
0
0
0
7
(), Mortality %
The survey reported 461 procedures for chest trauma, excluding iatrogenic injuries (Table 25), with a hospital mortality rate of 7.6%.
Table 25
H. Chest trauma
 
Cases
30-Day mortality
Hospital mortality
VATS
Hospital
After discharge
H. Chest trauma
461
32 (6.9)
2 (0.4)
35 (7.6)
257
(), Mortality %
Table 26 summarizes the procedures for other diseases, including 98 and 87 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
1728
38 (2.2)
3 (0.2)
75 (4.3)
1267
 Arteriovenous malformation*
98
0
0
0
93
 Pulmonary sequestration
87
0
0
0
71
 Postoperative bleeding ・air leakage
553
14 (2.5)
2 (0.4)
38 (6.9)
344
 Chylothorax
55
0
0
0
45
 Others
935
24 (2.6)
1 (0.1)
37 (4.0)
714
(), Mortality %
A total of 93 lung transplantations were performed in 2021 (Table 27), among which 74 and 19 were from brain-dead and living-related donors, respectively. 30-day mortality for total lung transplantation was 1.1% (1/93).
Table 27
Lung transplantation
 
Cases
30-Day mortality
Hospital mortality
Hospital
After discharge
Single lung transplantation from brain-dead donor
44
0
0
0
Bilateral lung transplantation from brain-dead donor
30
1 (3.3)
0
3 (10.0)
Lung transplantation from living donor
19
0
0
1 (5.3)
Total lung transplantation
93
1 (1.1)
0
4 (4.3)
Donor of living donor lung transplantation
37
0
0
0
(), Mortality %
In 2021, the number of VATS procedures increased by 1.4% from 76,073 to 77,152 compared to that of 2020 [3]with the increase of all procedures in general thoracic surgery (1.4%). The population of VATS procedures in all procedures 88% in 2021 was similar as that in 2020 (88%) (Table 28).
Table 28
Video-assisted thoracic surgery
 
Cases
30-Day mortality
Hospital mortality
Hospital
After discharge
11. Video-assisted thoracic surgery
77,152
256 (0.3)
86 (0.1)
434 (0.6)
(), Mortality % (including thoracic sympathectomy 330)
A total of 590 tracheobronchoplasty procedures were performed in 2021, including 352 sleeve lobectomies, 10 carinal reconstructions and 9 sleeve pneumonectomies (Table 29). 30-day mortality for sleeve lobectomy, carinal reconstruction and sleeve lobectomy were 10, 0 and 2% respectively.
Table 29
Tracheobronchoplasty
 
Cases
30-Day mortality
Hospital mortality
Hospital
After discharge
12. Tracheobronchoplasty
590
11 (1.9)
2 (0.3)
23 (3.9)
Trachea
30
0
0
0
 Sleeve resection with reconstruction
19
0
0
0
 Wedge with simple closure
3
0
0
0
 Wedge with patch closure
0
0
0
0
 Total laryngectomy with tracheostomy
0
0
0
0
 Others
8
0
0
0
Carinal reconstruction
10
0
0
1 (10.0)
Sleeve pneumonectomy
9
0
0
0
Sleeve lobectomy
 
352
1 (0.3)
7 (2.0)
Sleeve segmental excision
 
15
0
0
Bronchoplasty without lung resection
 
16
0
1 (6.3)
Others
158
8 (5.1)
1 (0.6)
14 (8.9)
(), Mortality %
Tables 30, 31, and 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
355
5 (1.4)
0
5 (1.4)
(), 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)
1229
11 (0.9)
1 (0.1)
21 (1.7)
Organ resected
Cases
30-Day mortality
Hospital mortality
Hospital
After discharge
A. Primary lung cancer
    
 Aorta
7
0
0
0
 Superior vena cava
22
1 (4.5)
0
4 (18.2)
 Brachiocephalic vein
7
0
0
0
 Pericardium
65
0
0
2 (3.1)
 Pulmonary artery
105
2 (1.9)
1 (1.0)
4 (3.8)
 Left atrium
9
0
0
1 (11.1)
 Diaphragm
52
0
0
0
 Chest wall (including ribs)
279
5 (1.8)
0
8 (2.9)
 Vertebra
9
0
0
0
 Esophagus
3
0
0
0
 Total
558
8 (1.4)
1 (0.2)
19 (3.4)
B. Mediastinal tumor
    
 Aorta
4
0
0
0
 Superior vena cava
58
1 (1.7)
0
1 (1.7)
 Brachiocephalic vein
111
0
0
0
 Pericardium
357
2 (0.6)
0
2 (0.6)
 Pulmonary artery
5
0
0
0
 Left atrium
1
0
0
0
 Diaphragm
40
0
0
0
 Chest wall (including ribs)
17
0
0
0
 Vertebra
4
0
0
0
 Esophagus
4
0
0
0
 Lung
457
1 (0.2)
0
1 (0.2)
 Total
1058
4 (0.4)
0
4 (0.4)
(), 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
588
6 (1.0)
1 (0.2)
11 (1.9)
(), Mortality %. Includes tumors invading the anterior apical chest wall and posterior apical chest wall (superior sulcus tumor, so called Pancoast type)

(C) Esophageal surgery

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 (Table 33).
Table 33
Diagnostic procedures
 
Cases
30-Day mortality
Hospital mortality
 
Hospital
After discharge
Mediastinoscopic biopsy
258
0
1 (0.4)
1 (0.4)
Lung biopsy for diffuse parenchymal lung disease
634
3 (0.5)
2 (0.3)
5 (0.8)
Biopsy for lymph node, tumor and pleura
2926
27 (0.9)
20 (0.7)
48 (1.6)
Others
1494
68 (4.6)
12 (0.8)
114 (7.6)
(), Mortality %
Throughout 2021, 5755 patients underwent surgery for esophageal diseases (752 and 4993 for benign and malignant esophageal diseases, respectively) from institutions across Japan. Compared to 2019, there was a total decrease of 1480 cases (20.5%) observed, and a decrease of 154 cases (2.6%) compared to 2020 with a decrease of 98 cases (11.4%) in benign diseases and a decrease of 56 cases (1.1%) in malignant diseases. These significant declines which were largely influenced by the COVID-19 pandemic that began in 2020, continued even in 2021, with factors such as surgical restrictions, reduced medical visits, and postponed screenings being considered as contributing factors (Fig. 3).
Concerning benign esophageal diseases (Table 34), thoracoscopic and/or laparoscopic surgeries were performed in 89.3% (42/47), 85.8% (363/423), 97.8% (44/45), and 43.5% (54/124) of patients with esophagitis (including esophageal ulcer), hiatal hernia, benign tumors, and achalasia, respectively. Conversely, 100% (93/93) of patients with spontaneous rupture of the esophagus underwent open surgery. Hospital mortality rates within 30 postoperative days were 0.9% (4/423), 1.1% (1/93) for hiatal hernia and spontaneous rupture of the esophagus, respectively.
Table 34
Benign esophageal diseases
  
Operation ( +)
 
T/L*3
Cases
Hospital mortality
Cases
Hospital mortality
 ~ 30 days
31–90 days
Total (including after 91days mortality)
 ~ 30days
31–90days
Total (including after 91days mortality)
1. Achalasia
124
0
0
0
54
0
0
0
2. Benign tumor
45
0
0
0
44
0
0
0
3. Diverticulum
25
0
0
0
5
0
0
0
4. Hiatal hernia
423
4 (0.9)
1 (0.2)
5 (1.2)
363
2 (0.6)
1 (0.3)
3 (0.8)
5. Spontaneous rupture of the esophagus
93
1 (1.1)
0
1 (1.1)
0
0
0
0
6. Esophago-tracheal fistula
5
0
0
0
0
0
0
0
7. Esophagitis, esophageal ulcer
47
0
0
0
42
0
0
0
Total
762
5 (0.7)
1 (0.1)
6 (0.8)
508
2 (0.4)
1 (0.2)
3 (0.6)
(), Mortality %
T/L thoracoscopic and/or laparoscopic
The most common tumor location for malignant esophageal diseases was the thoracic esophagus (Table 35). Among the cases with esophageal malignancies, esophagectomy for superficial and advanced cancers was performed in 1847 (40.0%) and 3146 (60.0%), respectively. Hospital mortality rates within 30 days after esophagectomy were 0.5% and 0.8% for patients with superficial and advanced cancer, respectively.
Table 35
Malignant Esophageal disease
 
Operation ( +)
Thoracoscopic and/or laparscopic procedure
Cases
Hospital mortality
Cases
Conversion to thoracotomy
Hospital mortality
 ~ 30days
31–90days
Total (including after 91days mortality)
 ~ 30days
31–90days
Total (including after 91days mortality)
Location
 (1) Cervical esophagus
118
2 (1.7)
0
2 (1.7)
51
1 (2.0)
1 (2.0)
0
1 (2.0)
 (2) Thoracic esophagus
4181
27 (0.6)
18 (0.4)
45 (1.1)
3788
19 (0.5)
23 (0.6)
15 (0.4)
38 (1.0)
 (3) Abdominal esophagus
436
4 (0.9)
2 (0.5)
6 (1.4)
361
2 (0.6)
3 (0.8)
2 (0.6)
5 (1.4)
Total
4735
33 (0.7)
20 (0.4)
53 (1.1)
4200
22 (0.5)
27 (0.6)
17 (0.4)
44 (1.0)
Tumor depth
(A) Superficial cancer(T1)
 (1) Transhiatal esophagectomy
4
0
0
0
0
0
0
0
0
 (2) Mediastinoscopic esophagectomy and reconstruction
103
0
1 (1.0)
1 (1.0)
103
0
0
1
1 (1.0)
 (3) Transthoracic (rt.) esophagectomy and reconstruction
1124
6 (0.5)
5 (0.4)
11 (1.0)
1043
4 (0.4)
6 (0.6)
5 (0.5)
11 (1.1)
 (4) Transthoracic (lt.) esophagectomy and reconstruction
31
0
0
0
26
0
0
0
0
 (5) Cervical esophageal resection and reconstruction
25
2 (8.0)
0
2 (8.0)
0
0
0
0
0
 (6) Robot-assisted esophagectomy and reconstruction
424
1 (0.2)
0
1 (0.2)
423
0
1 (0.2)
0
1 (0.2)
 (7) Others
17
0
0
0
0
0
0
0
0
 (8) Esophagectomy without reconstruction
119
0
0
0
0
0
0
0
0
subtotal
1847
9 (0.5)
6 (0.3)
15 (0.8)
1595
4 (0.3)
7 (0.4)
6 (0.4)
13 (0.8)
(B)Advanced cancer(T2-T4)
 (1) Transhiatal esophagectomy
7
0
0
0
0
0
0
0
0
 (2) Mediastinoscopic esophagectomy and reconstruction
129
0
1 (0.8)
1 (0.8)
129
0
0
1 (0.8)
1 (0.8)
 (3) Transthoracic (rt.) esophagectomy and reconstruction
2099
17 (0.8)
10 (0.5)
27 (1.3)
1791
18 (1.0)
14 (0.8)
7 (0.4)
21 (1.2)
 (4) Transthoracic (lt.) esophagectomy and reconstruction
58
1 (1.7)
0
1 (1.7)
33
0
0
0
0
 (5) Cervical esophageal resection and reconstruction
52
0
0
0
0
0
0
0
0
 (6) Robot-assisted esophagectomy and reconstruction
644
6 (0.9)
3 (0.5)
9 (1.4)
643
0
6 (0.9)
3 (0.5)
3 (0.5)
 (7) Others
18
0
0
0
0
0
0
0
0
 (8) Esophagectomy without reconstruction
139
0
0
0
0
0
0
0
0
Subtotal
3146
24 (0.8)
14 (0.4)
38 (1.2)
2596
18 (0.7)
20 (0.8)
11 (0.4)
25 (1.0)
Total
4993
33 (0.7)
20 (0.4)
53 (1.1)
4191
22 (0.5)
27 (0.6)
17 (0.4)
38 (0.9)
 
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
118
61 (51.7)
29 (24.6)
10 (8.5)
5 (4.2)
11 (9.3)
15 (12.7)
17 (14.4)
3 (2.5)
 (2) Thoracic esophagus
4181
2340 (56.0)
968 (23.2)
272 (6.5)
143 (3.4)
316 (7.6)
532 (12.7)
594 (14.2)
45 (1.1)
 (3) Abdominal esophagus
436
215 (49.3)
96 (22.0)
24 (5.5)
13 (3.0)
41 (9.4)
57 (13.1)
45 (10.3)
3 (0.7)
Total
4735
2616 (55.2)
1093 (23.1)
306 (6.5)
161 (3.4)
368 (7.8)
604 (12.8)
656 (13.9)
51 (1.1)
Tumor depth
         
(A)Superficial cancer(T1)
         
 (1) Transhiatal esophagectomy
4
1 (25.0)
0
0
0
0
0
0
0
 (2) Mediastinoscopic esophagectomy and reconstruction
103
64 (62.1)
31 (30.1)
7 (6.8)
3 (2.9)
13 (12.6)
23 (22.3)
28 (27.2)
0
 (3) Transthoracic (rt.) esophagectomy and reconstruction
1124
619 (55.1)
217 (19.3)
63 (5.6)
34 (3.0)
80 (7.1)
161 (14.3)
153 (13.6)
10 (0.9)
 (4) Transthoracic (lt.) esophagectomy and reconstruction
31
12 (38.7)
7 (22.6)
4 (12.9)
1 (3.2)
1 (3.2)
2 (6.5)
3 (9.7)
0
 (5) Cervical esophageal resection and reconstruction
25
12 (48.0)
7 (28.0)
3 (12.0)
0
1 (4.0)
1 (4.0)
4 (16.0)
0
 (6) Robot-assisted esophagectomy and reconstruction
424
200 (47.2)
85 (20.0)
20 (4.7)
11 (2.6)
27 (6.4)
53 (12.5)
53 (12.5)
2 (0.5)
 (7) Others
17
4 (23.5)
2 (11.8)
1 (5.9)
1 (5.9)
3 (17.6)
4 (23.5)
4 (23.5)
0
 (8) Esophagectomy without reconstruction
119
0
0
0
0
 
0
0
0
Subtotal
1847
912 (49.4)
349 (18.9)
98 (5.3)
50 (2.7)
125 (6.8)
244 (13.2)
245 (13.3)
12 (0.6)
(B) Advanced cancer (T2–T4)
 (1) Transhiatal esophagectomy
7
4 (57.1)
1 (14.3)
1 (14.3)
0
0
0
0
0
 (2) Mediastinoscopic esophagectomy and reconstruction
129
76 (58.9)
28 (21.7)
14 (10.9)
2 (1.6)
4 (3.1)
15 (11.6)
26 (20.2)
0
 (3) Transthoracic (rt.) esophagectomy and reconstruction
2099
1213 (57.8)
529 (25.2)
144 (6.9)
84 (4.0)
173 (8.2)
263 (12.5)
271 (12.9)
35 (1.7)
 (4) Transthoracic (lt.) esophagectomy and reconstruction
58
24 (41.4)
7 (12.1)
2 (3.4)
2 (3.4)
4 (6.9)
3 (5.2)
4 (6.9)
0
 (5) Cervical esophageal resection and reconstruction
52
33 (63.5)
13 (25.0)
5 (9.6)
4 (7.7)
5 (9.6)
8 (15.4)
12 (23.1)
2 (3.8)
 (6) Robot-assisted esophagectomy and reconstruction
644
345 (53.6)
160 (24.8)
41 (6.4)
19 (3.0)
53 (8.2)
66 (10.2)
102 (15.8)
2 (0.3)
 (7) Others
18
9 (50.0)
6 (33.3)
1 (5.6)
0
4 (22.2)
5 (27.8)
0
0
 (8) Esophagectomy without reconstruction
139
0
0
0
0
0
0
0
0
subtotal
3146
1704 (54.2)
744 (23.6)
208 (6.6)
111 (3.5)
243 (7.7)
360 (11.4)
415 (13.2)
39 (1.2)
Total
4993
2616 (52.4)
1093 (21.9)
306 (6.1)
161 (3.2)
368 (7.4)
604 (12.1)
660 (13.2)
51 (1.0)
 
Cases
Nonsurgical complications
Readmission within 30d
Reoperation within 30d
Pneumonia
Unplanned intubation
Prolonged ventilation > 48 h
Pulmonary embolism
Atelectasis
Renal failure
CNS events
Cardiac events
Septic shock
Location
 (1) Cervical esophagus
118
14 (11.9)
7 (5.9)
13 (11.0)
1 (0.8)
3 (2.5)
 
1 (0.8)
2 (1.7)
0
1 (0.8)
15 (12.7)
 (2) Thoracic esophagus
4181
670 (16.0)
162 (3.9)
166 (4.0)
39 (0.9)
187 (4.5)
16 (0.4)
16 (0.4)
18 (0.4)
29 (0.7)
104 (2.5)
246 (5.9)
 (3) Abdominal esophagus
436
50 (11.5)
10 (2.3)
18 (4.1)
6 (1.4)
27 (6.2)
3 (0.7)
2 (0.5)
1 (0.2)
4 (0.9)
5 (1.1)
25 (5.7)
Total
4735
734 (15.5)
179 (3.8)
197 (4.2)
46 (1.0)
217 (4.6)
19 (0.4)
19 (0.4)
21 (0.4)
33 (0.7)
110 (2.3)
286 (6.0)
Tumor depth
(A) Superficial cancer (T1)
 (1) Transhiatal esophagectomy
4
0
0
0
0
0
0
0
0
0
0
0
 (2) Mediastinoscopic esophagectomy and reconstruction
103
13 (12.6)
3 (2.9)
4 (3.9)
1 (1.0)
4 (3.9)
0
0
2 (1.9)
1 (1.0)
3 (2.9)
5 (4.9)
 (3) Transthoracic (rt.) esophagectomy and reconstruction
1124
163 (14.5)
42 (3.7)
37 (3.3)
5 (0.4)
51 (4.5)
2 (0.2)
7 (0.6)
4 (0.4)
8 (0.7)
23 (2.0)
68 (6.0)
 (4) Transthoracic (lt.) esophagectomy and reconstruction
31
4 (12.9)
1 (3.2)
1 (3.2)
0
3 (9.7)
1 (3.2)
0
0
0
1 (3.2)
2 (6.5)
 (5) Cervical esophageal resection and reconstruction
25
5 (20.0)
2 (8.0)
2 (8.0)
0
1 (4.0)
0
0
0
1 (4.0)
0
3 (12.0)
 (6) Robot-assisted esophagectomy and reconstruction
424
57 (13.4)
10 (2.4)
12 (2.8)
6 (1.4)
13 (3.1)
0
1 (0.2)
1 (0.2)
1 (0.2)
11 (2.6)
31 (7.3)
 (7) Others
17
0
0
0
0
0
0
0
0
0
1 (5.9)
2 (11.8)
 (8) Esophagectomy without reconstruction
119
0
0
0
0
0
0
0
0
0
0
0
subtotal
1847
242 (13.1)
58 (3.1)
56 (3.0)
12 (0.6)
72 (3.9)
3 (0.2)
8 (0.4)
7 (0.4)
11 (0.6)
39 (2.1)
111 (6.0)
(B)Advanced cancer (T2–T4)
 (1) Transhiatal esophagectomy
7
2 (28.6)
0
0
0
0
0
0
0
0
0
0
 (2) Mediastinoscopic esophagectomy and reconstruction
129
25 (19.4)
2 (1.6)
3 (2.3)
1 (0.8)
8 (6.2)
0
0
1 (0.8)
0
4 (3.1)
3 (2.3)
 (3) Transthoracic (rt.) esophagectomy and reconstruction
2099
354 (16.9)
91 (4.3)
106 (5.1)
23 (1.1)
101 (4.8)
11 (0.5)
9 (0.4)
10 (0.5)
14 (0.7)
50 (2.4)
130 (6.2)
 (4) Transthoracic (lt.) esophagectomy and reconstruction
58
8 (13.8)
3 (5.2)
3 (5.2)
0
2 (3.4)
1 (1.7)
0
0
1 (1.7)
1 (1.7)
2 (3.4)
(5) Cervical esophageal resection and reconstruction
52
5 (9.6)
4 (7.7)
5 (9.6)
1 (1.9)
0
0
0
0
0
0
5 (9.6)
 (6) Robot-assisted esophagectomy and reconstruction
644
96 (14.9)
21 (3.3)
24 (3.7)
9 (1.4)
33 (5.1)
4 (0.6)
2 (0.3)
1 (0.2)
7 (1.1)
17 (2.6)
35 (5.4)
 (7) Others
18
2 (11.1)
0
0
0
1 (5.6)
0
0
2 (11.1)
0
0
0
 (8) Esophagectomy without reconstruction
139
0
0
0
0
0
0
0
0
0
0
0
Subtotal
3146
492 (15.6)
121 (3.8)
141 (4.5)
34 (1.1)
145 (4.6)
16 (0.5)
11(0.3)
 
22 (0.7)
72 (2.3)
175 (5.6)
Total
4993
734 (14.7)
179 (3.6)
197 (3.9)
46 (0.9)
217 (4.3)
19 (0.4)
19 (0.4)
21 (0.4)
33 (0.7)
111 (2.2)
286 (5.7)
Among esophagectomy procedures, transthoracic esophagectomy via right thoracotomy or right thoracoscopy was most commonly adopted for patients with superficial (1124/1847, 60.9%) and advanced cancer (2099/3146, 66.7%) (Table 35). Transhiatal esophagectomy, which is commonly performed in Western countries, was adopted in only 4 (0.2%) and 7 (0.2%) patients with superficial and advanced cancer who underwent esophagectomy in Japan, respectively. Minimally invasive esophagectomy (MIE) including thoracoscopic and/or laparoscopic esophagectomy, robot-assisted esophagectomy and mediastinoscopic esophagectomy was utilized in 1595 (86.3%) and 2596 (82.5%) patients with superficial and advanced cancer, respectively. Incidence of MIE for superficial or advanced cancer have been increasing, whereas that of open surgery, especially for advanced cancer, has been decreasing annually (Fig. 4). Although mediastinoscopic esophagectomy was performed only for 103 (5.6%) and 129 (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 424 (23.0%) and 624 (20.5%) patients with superficial and advanced esophageal cancer, respectively in 2021. Patients who underwent robot-assisted surgery are increasing for both superficial and advancer esophageal cancers (18.8% and 34.4% increases compared to that in 2020, respectively). Hospital mortality rates within 30 days after MIE were 0.4% and 0.8% for patients with superficial and advanced cancer, respectively (Table 35).
Detailed data collection regarding postoperative surgical and non-surgical complications was initiated in 2018. Overall, 1093 (21.9%) of 4993 patients developed grade III or higher complications based on the Clavien–Dindo classification in 2021 (Table 35). 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 in patients with advanced esophageal cancer, anastomotic leakage and recurrent nerve palsy occurred in 12.5% and 12.9% of the patients who underwent right transthoracic esophagectomy, in 10.2% and 15.8% of those who underwent robot-assisted esophagectomy, and in 11.6% and 20.2% of those who underwent mediastinoscopic esophagectomy, respectively. Among non-surgical postoperative complications, pneumonia occurred in 14.7% of the patients, 3.6% of whom underwent unplanned intubation. Postoperative pulmonary embolism occurred in 0.9% of the patients. These complication rates, including the others, were similar to those in 2020.
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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Metadaten
Titel
Thoracic and cardiovascular surgeries in Japan during 2021
Annual report by the Japanese Association for Thoracic Surgery
verfasst von
Naoki Yoshimura
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
Masanori Tsuchida
Kenji Suzuki
Hirofumi Takemura
Tsuyoshi Taketani
Yasushi Toh
Wataru Tatsuishi
Hiroyuki Yamamoto
Takushi Yasuda
Masayuki Watanabe
Goro Matsumiya
Yoshiki Sawa
Hideyuki Shimizu
Masayuki Chida
Committee for Scientific Affairs, The Japanese Association for Thoracic Surgery
Publikationsdatum
29.02.2024
Verlag
Springer Nature Singapore
Erschienen in
General Thoracic and Cardiovascular Surgery / Ausgabe 4/2024
Print ISSN: 1863-6705
Elektronische ISSN: 1863-6713
DOI
https://doi.org/10.1007/s11748-023-01997-6

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