The Japanese Association for Thoracic Surgery has conducted annual surveys of thoracic surgery throughout Japan since 1986 to determine the statistics regarding the number of procedures according to operative category. Here, we have summarized the results from our annual survey of thoracic surgery performed during 2013.
The incidence of hospital mortality was added to the survey to determine the nationwide status, which has contributed to the Japanese surgeons to understand the present status of thoracic surgery in Japan and to make progress to improve operative results by comparing their work with those of others. The Association was able to gain a better understanding of present problems as well as future prospects, which has been reflected to its activity including education of its members. Thirty-day mortality (so called “operative mortality”) is defined as death within 30 days of operation regardless of the patient’s geographic location and even though the patient had been discharged from the hospital.
Anzeige
Hospital mortality is defined as death within any time interval after an operation if the patient had not been discharged from the hospital. Hospital-to-hospital transfer is not considered discharge: transfer to a nursing home or a rehabilitation unit is considered hospital discharge unless the patient subsequently dies of complications of the operation. (The definitions of the Ad Hoc Liaison Committee for Standardizing Definitions of Prosthetic Heart Valve Morbidity of the Society of Thoracic Surgeons and the American Association for Thoracic Surgery (Edmunds et al. Ann Thorac Surg 1996;62:932–5; J Thorac Cardiovasc Surg 1996;112:708–11).
Thoracic surgery was classified into three categories—cardiovascular, general thoracic, and esophageal surgery—and the patient data were examined and analyzed for each group. Access to the computerized data is offered to all members of this Association. We honor and value all member’s continued kind support and contributions (Tables 1, 2).
Table 1 Questionnaires sent out and received back by the end of December 2014
Sent out
Returned
Response rate (%)
(A) Cardiovascular surgery
602
589
97.8
(B) General thoracic surgery
793
761
96.0
(C) Esophageal surgery
577
559
96.9
Table 2 Categories subclassified according to the number of operations performed
Number of operations performed
Category
Cardiovascular surgery
General thoracic surgery
0
44
34
1–24
44
101
25–49
92
125
50–99
172
210
100–149
86
124
150–199
56
83
≧200
95
85
Total
589
762
Number of operations performed
Esophageal surgery
0
84
1–4
96
5–9
84
10–19
109
20–29
56
30–39
35
40–49
26
≧50
69
Total
559
Abstract of the survey
We sent out survey questionnaire forms to the departments of each category in all 1535 institutions (602 cardiovascular, 793 general thoracic and 577 esophageal) nationwide in early April 2014. The response rates in each category by the end of December 2014 were 97.8, 96.0, and 96.9 %, respectively. This high response rate has been keep throughout recent survey, and more than 96 % response rate in all fields in 2013 survey has to be congratulated.
2013 Final report
(A) Cardiovascular surgery
First, we are very pleased with the high response rate to our survey of cardiovascular surgery (97.8 %), which definitely enhances the quality of this annual report. We very much appreciate the enormous effort put into completing the survey at each participating institution.
Anzeige
Figure 1 shows the development of cardiovascular surgery in Japan over the last 27 years. Aneurysm surgery includes only operations for thoracic and thoracoabdominal aortic aneurysm. Pacemaker implantation includes only trans-thoracic implantation and trans-venous implantation is excluded. The number of pacemaker and assist device implantation operations is not included in the total number of surgical operations. A total of 67,325 cardiovascular operations were performed at 589 institutions during 2013 alone and included 36 heart transplantations, which were re-started in 1999, and 1 heart and lung transplantation.
The number of operations for congenital heart disease (9366 cases) decreased slightly (2.0 %) compared with that of 2012 (9558 cases), while there was 2.1 % increase when compared with the data of 10 years ago (9168 cases in 2003). The number of operations for adult cardiac disease (21,758 cases in valvular heart disease, 15,757 cases in thoracic aortic aneurysm and 1871 cases for other procedures) increased compared with those of 2012 (4.0, 4.6 and 14.6 %, respectively) except for ischemic heart disease (16,752 cases,) which decreased 1.9 % of that in 2012. During the last 10 years, the numbers of operations for adult heart disease increased constantly except for that for ischemic heart disease (83.4 % increase in valvular heart disease, 25.4 % decrease in ischemic heart disease, 120.9 % increase in thoracic aortic aneurysm, and 45.7 % increase in other procedures compared those of 2003). The concomitant coronary artery bypass grafting procedure (CABG) is not included in ischemic heart disease but included in other categories such as valvular heart disease and thoracic aneurysm in our study; then, the number of CABG still remained over 20,000 cases per year (21,242 cases) in 2013, which is 87.8 % of that in 2003 (24,204 cases).
Data for individual categories are summarized in tables through 3 to 9.
Table 3 Congenital (total; 9366)
(1) CPB (+) (total; 7150)
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
PDA
3
0
0
0
1
0
0
0
2
0
0
0
14
1 (7.1)
0
1 (7.1)
20
1 (5.0)
0
1 (5.0)
2
Coarctation (simple)
6
0
0
0
10
0
0
0
11
0
0
0
8
0
0
0
35
0
0
0
3
+VSD
59
1 (12.5)
0
0
50
1 (2.0)
0
2 (4.0)
9
0
0
0
2
0
0
0
120
1 (0.8)
0
2 (1.7)
4
+DORV
8
0
0
1 (12.5)
3
0
0
0
5
0
0
0
0
0
0
0
16
1 (6.3)
0
1 (6.3)
5
+AVSD
2
2 (100.0)
0
2 (100.0)
2
1 (50.0)
0
1 (50.0)
0
0
0
0
1
0
0
0
5
3 (60.0)
0
3 (60.0)
6
+TGA
6
0
0
0
2
0
0
0
0
0
0
0
0
0
0
0
8
0
0
0
7
+SV
8
0
0
0
6
0
0
0
2
0
0
0
0
0
0
0
16
0
0
0
8
+Others
9
0
0
0
2
0
0
0
5
0
0
0
3
0
0
0
19
0
0
0
9
Interrupt. of Ao (simple)
1
0
0
0
1
0
0
0
0
0
0
0
0
0
0
0
2
0
0
0
10
+VSD
30
2 (6.7)
0
2 (6.7)
24
1 (4.2)
0
1 (4.2)
5
0
0
0
2
0
0
0
61
3 (4.9)
0
3 (4.9)
11
+DORV
4
0
0
0
1
0
0
0
0
0
0
0
0
0
0
0
5
0
0
0
12
+Truncus
0
0
0
0
1
0
0
0
0
0
0
0
0
0
0
0
1
0
0
0
13
+TGA
0
0
0
0
0
0
0
0
1
0
0
0
0
0
0
0
1
0
0
0
14
+Others
2
0
0
0
9
1 (11.1)
0
1 (11.1)
4
0
0
0
0
0
0
0
15
1 (6.7)
0
1 (6.7)
15
Vascular ring
0
0
0
0
3
0
0
0
1
0
0
0
0
0
0
0
4
0
0
0
16
PS
0
0
0
0
10
0
0
0
22
1 (4.5)
0
0
3
0
0
0
35
1 (2.9)
0
0
17
PAIVS or critical PS
20
0
0
2 (10.0)
57
0
0
0
55
0
0
1 (1.8)
5
1 (20.0)
0
1 (20.0)
137
1 (0.7)
0
4 (2.9)
18
TAPVR
108
12 (11.1)
0
15 (13.9)
55
2 (4)
0
2 (3.6)
12
0
0
0
0
0
0
0
175
14 (8)
0
17 (10)
19
PAPVR ± ASD
8
0
0
0
13
0
0
0
46
0
0
0
28
0
0
0
95
0
0
0
20
ASD
35
0
2 (5.7)
0
65
0
0
0
676
0
0
0
545
0
0
2 (0.4)
1321
0
2 (0.15)
2 (0.2)
21
Cor triatriatum
0
0
0
0
12
0
0
0
5
0
0
0
2
0
0
0
19
0
0
0
22
AVSD (partial)
0
0
0
0
18
0
0
0
57
0
0
0
16
1 (6.3)
0
1 (6.3)
91
1 (1.1)
0
1 (1.1)
23
AVSD (complete)
1
0
0
0
90
0
0
0
75
1 (1.3)
0
1 (1.3)
2
0
0
0
168
1 (0.6)
0
1 (0.6)
24
+TOF or DORV
2
0
0
0
13
0
0
0
23
1 (4.3)
0
1 (4.3)
0
0
0
0
38
1 (2.6)
0
1 (2.6)
25
+Others
1
0
0
1 (100.0)
4
0
0
1 (25.0)
9
0
0
1 (11.1)
0
0
0
0
14
0
0
3 (21.4)
26
VSD (subarterial)
3
0
0
0
122
0
0
0
179
0
0
0
33
0
0
0
337
0
0
0
27
VSD (perimemb/muscular)
12
0
0
0
809
4 (0.5)
0
5 (0.6)
384
0
0
1 (0.3)
81
1 (1.2)
0
1 (1.2)
1286
5 (0.4)
0
7 (0.5)
28
VSD + PS
0
0
0
0
15
0
0
0
15
0
0
0
3
0
0
0
33
0
0
0
29
DCRV ± VSD
0
0
0
0
15
0
0
0
37
0
0
0
14
0
0
0
66
0
0
0
30
Aneurysm of sinus valsalva
0
0
0
0
0
0
0
0
2
0
0
0
33
1 (3.0)
0
1 (3.0)
35
1 (2.9)
0
1 (2.9)
31
TOF
8
0
0
0
206
1 (0.5)
0
2 (1.0)
235
2 (0.9)
0
4 (1.7)
40
0
0
1 (2.5)
489
3 (0.6)
0
7 (1.4)
32
PA + VSD
8
1 (12.5)
0
2 (25.0)
58
3 (5.2)
0
3 (5.2)
100
2 (2.0)
0
2 (2.0)
9
0
0
0
175
6 (3.4)
0
7 (4.0)
33
DORV
12
1 (8.3)
0
1 (8.3)
98
3 (3.1)
0
3 (3.1)
111
0
0
0
8
0
0
0
229
4 (1.7)
0
4 (1.7)
34
TGA (simple)
98
3 (3.1)
0
4 (4.1)
6
0
0
0
4
0
0
0
2
0
0
0
110
3 (2.7)
0
4 (3.6)
35
+VSD
31
1 (3.2)
0
2 (6.5)
18
1 (5.6)
0
1 (5.6)
7
0
0
0
2
0
0
0
58
2 (3.4)
0
3 (5.2)
36
VSD + PS
1
0
0
0
11
0
0
0
13
0
0
1 (7.7)
3
0
0
0
28
0
0
1 (3.6)
37
Corrected TGA
1
0
1 (100.0)
0
11
0
0
0
37
0
0
0
11
0
0
1 (9.1)
60
0
1 (1.7)
1 (1.7)
38
Truncus arteriosus
6
0
0
0
21
2 (9.5)
0
2 (9.5)
14
0
0
0
1
0
0
0
42
2 (4.8)
0
2 (4.8)
39
SV
31
5 (16.1)
0
9 (29.0)
193
10 (5.2)
0
15 (7.8)
287
4 (1.4)
0
6 (2.1)
16
0
0
0
527
19 (3.6)
0
30 (5.7)
40
TA
2
1 (50.0)
0
2 (100.0)
38
1 (2.6)
1 (2.6)
1 (2.6)
45
0
0
0
4
0
0
0
89
2 (2.2)
1 (1.1)
3 (3.4)
41
HLHS
38
7 (18.4)
0
11 (28.9)
109
3 (2.8)
0
9 (8.3)
72
0
0
0
0
0
0
0
219
10 (4.6)
0
20 (9.1)
42
Aortic valve lesion
4
0
0
0
21
0
0
2 (9.5)
89
0
0
0
27
0
0
0
141
0
0
2 (1.4)
43
Mitral valve lesion
5
0
0
1 (20.0)
38
1 (2.6)
0
1 (2.6)
62
1 (1.6)
0
1 (1.6)
11
0
0
0
116
2 (1.7)
0
3 (2.6)
44
Ebstein
16
1 (6.3)
0
3 (18.8)
16
1 (6.3)
0
1 (6.3)
25
0
0
0
21
0
0
0
78
2 (2.6)
0
4 (5.1)
45
Coronary disease
2
0
0
0
21
0
0
0
9
0
0
0
17
1 (5.9)
0
1 (5.9)
49
1 (2.0)
0
1 (2.0)
46
Others
11
0
0
2 (18.2)
29
3 (10.3)
0
4 (13.8)
47
1 (2.1)
0
2 (4.3)
11
0
0
0
98
4 (4.1)
0
8 (8.2)
47
Redo VSD
1
0
0
0
7
0
0
1 (14.3)
9
0
0
0
5
0
0
0
22
0
0
1 (4.5)
48
PS release
0
0
0
0
12
0
0
0
57
2 (3.5)
0
2 (3.5)
20
0
0
0
89
2 (2.2)
0
2 (2.2)
49
RV-PA conduit replace
2
0
0
0
5
0
0
0
60
0
0
0
35
0
0
0
102
0
0
0
50
Others
8
2 (25.0)
0
2 (25.0)
57
1 (1.8)
0
2 (3.5)
117
2 (1.7)
0
3 (2.6)
69
1 (1.4)
0
1 (1.4)
251
6 (2.4)
0
8 (3.2)
Total
613
39 (6.4)
3 (0.5)
62 (10.1)
2388
40 (1.7)
1 (0.04)
60 (2.5)
3042
17 (0.6)
0
26 (0.9)
1107
7 (0.6)
0
11 (1.0)
7150
103 (1.4)
4 (0.1)
159 (2.2)
Values in parenthesis represent mortality %
CPB cardiopulmonary bypass, PDA patient ductus arteriosus, VSD ventircular septal defect, DORV double outlet right ventricle, AVSD atrioventricular septal defect, TGA transposition of great arteries, SV single ventricle, Interupt. 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; 2216)
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
PDA
422
4 (0.9)
0
8 (1.9)
211
2 (0.9)
0
5 (2.4)
33
0
0
0
2
0
0
0
668
6 (0.9)
0
13 (1.9)
2
Coarctation (simple)
13
0
0
0
15
0
0
0
5
0
0
0
2
0
0
0
35
0
0
0
3
+VSD
47
1 (2.1)
0
2 (4.3)
23
0
0
0
1
0
0
0
0
0
0
0
71
1 (1.4)
0 (0.0)
2 (2.8)
4
+DORV
14
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
14
0
0
0
5
+AVSD
4
1 (25.0)
0
1 (25.0)
4
0
0
0
1
0
0
0
0
0
0
0
9
1 (11.1)
0
1 (11.1)
6
+TGA
6
0
0
0
1
0
0
0
0
0
0
0
0
0
0
0
7
0
0
0
7
+SV
12
0
0
0
3
0
0
0
0
0
0
0
0
0
0
0
15
0
0
0
8
+Others
3
0
0
0
4
1 (25.0)
0
1 (25.0)
0
0
0
0
0
0
0
0
7
1 (14.3)
0
1 (14.3)
9
Interrupt. of Ao (simple)
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
10
+VSD
27
1 (3.7)
0
1 (3.7)
0
0
0
0
0
0
0
0
0
0
0
0
27
1 (3.7)
0
1 (3.7)
11
+DORV
7
0
0
1 (14)
2
0
0
0
0
0
0
0
0
0
0
0
9
0
0
1 (11.1)
12
+Truncus
1
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
1
0
0
0
13
+TGA
2
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
2
0
0
0
14
+Others
8
1 (12.5)
0
2 (25.0)
1
0
0
0
0
0
0
0
0
0
0
0
9
1 (11.1)
0
2 (22.2)
15
Vascular ring
8
0
0
0
12
0
0
0
2
0
0
0
1
0
0
0
23
0
0
0
16
PS
0
0
0
0
2
0
0
0
2
0
0
0
0
0
0
0
4
0
0
0
17
PAIVS or critical PS
35
2 (5.7)
0
4 (11.4)
24
0
0
1 (4.2)
4
0
0
0
0
0
0
0
63
2 (3.2)
0
5 (7.9)
18
TAPVR
2
0
0
0
2
0
0
0
0
0
0
0
0
0
0
0
4
0
0
0
19
PAPVR ± ASD
0
0
0
0
0
0
0
0
2
0
0
0
0
0
0
0
2
0
0
0
20
ASD
0
0
0
0
0
0
0
0
8
0
0
0
11
0
0
0
19
0
0
0
21
Cor triatriatum
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
22
AVSD (partial)
1
0
0
0
1
0
0
0
0
0
0
0
0
0
0
0
2
0
0
0
23
AVSD (complete)
32
0
0
1 (3.1)
74
0
0
0
5
0
0
0
0
0
0
0
111
0
0
1 (0.9)
24
+TOF or DORV
2
0
0
0
13
0
0
0
2
0
0
0
0
0
0
0
17
0
0
0
25
+Others
7
2 (28.6)
0
2 (28.6)
1
0
0
0
1
0
0
0
0
0
0
0
9
2 (22.2)
0
2 (22.2)
26
VSD (subarterial)
3
0
0
0
11
0
0
0
0
0
0
0
0
0
0
0
14
0
0
0
27
VSD (perimemb/muscular)
37
0
0
0
116
2 (1.7)
0
2 (1.7)
5
0
0
0
3
0
0
0
161
2 (1.2)
0
2 (1.2)
28
VSD + PS
0
0
0
0
2
0
0
0
0
0
0
0
0
0
0
0
2
0
0
0
29
DCRV ± VSD
0
0
0
0
1
0
0
0
0
0
0
0
1
0
0
0
2
0
0
0
30
Aneurysm of sinus valsalva
1
1 (100.0)
0
1 (100.0)
1
1 (100.0)
0
1 (100.0)
0
0
0
0
0
0
0
0
2
2 (100.0)
0
2 (100.0)
31
TOF
25
1 (4.0)
0
1 (4.0)
126
1 (0.8)
0
1 (0.8)
17
0
0
0
2
0
0
0
170
2 (1.2)
0
2 (1.2)
32
PA + VSD
21
0
0
0
64
0
0
0
18
0
0
0
2
0
0
1 (50.0)
105
0
0
1 (1.0)
33
DORV
35
1 (2.9)
0
2 (5.7)
55
1 (1.8)
0
2 (3.6)
7
0
0
0
1
0
0
0
98
2 (2.0)
0
4 (4.1)
34
TGA (simple)
1
0
0
0
3
0
0
0
0
0
0
0
0
0
0
0
4
0
0
0
35
+VSD
4
0
0
0
2
0
0
0
1
0
0
0
1
0
0
0
8
0
0
0
36
VSD + PS
6
0
0
0
8
0
0
0
0
0
0
0
0
0
0
0
14
0
0
0
37
Corrected TGA
7
0
0
0
15
0
0
0
8
0
0
0
0
0
0
0
30
0
0
0
38
Truncus arteriosus
20
1 (5.0)
0
1 (5.0)
10
1 (10.0)
0
1 (10.0)
0
0
0
0
0
0
0
0
30
2 (6.7)
0
2 (6.7)
39
SV
69
1 (1.4)
0
1 (1.4)
59
2 (3.4)
0
4 (6.8)
16
0
0
0
2
0
0
0
146
3 (2.1)
0
5 (3.4)
40
TA
16
1 (6.3)
0
1 (6.3)
20
0
0
0
5
0
0
0
1
0
0
0
42
1 (2.4)
0
1 (2.4)
41
HLHS
78
1 (1.3)
0
5 (6.4)
9
2 (22.2)
0
2 (22.2)
7
0
0
0
0
0
0
0
94
3 (3.2)
0
7 (7.4)
42
Aortic valve lesion
3
0
0
0
0
0
0
0
2
0
0
0
0
0
0
0
5
0
0
0
43
Mitral valve lesion
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
44
Ebstein
2
1 (50.0)
0
1 (50.0)
7
0
0
0
2
0
0
0
0
0
0
0
11
1 (9.1)
0
1 (9.1)
45
Coronary disease
1
0
0
0
1
0
0
0
3
0
0
0
0
0
0
0
5
0
0
0
46
Others
11
0
0
0
18
1 (5.6)
0
1 (5.6)
35
0
0
1 (2.9)
8
0
0
0
72
1 (1.4)
0
2 (2.8)
47
Redo VSD
0
0
0
0
0
0
0
0
1
0
0
0
0
0
0
0
1
0
0
0
48
PS release
0
0
0
0
3
0
0
0
4
0
0
0
2
0
0
0
9
0
0
0
49
RV-PA conduit replace
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
50
Others
13
0
0
0
23
0
0
0
24
0
0
0
3
0
0
0
63
0
0
0
Total
1006
20 (2.0)
0
35 (3.5)
947
14 (1.5)
0
21 (2.2)
221
0
0
1 (0.5)
42
0
0
1 (2.4)
2216
34 (1.5)
0 (0.00)
58 (2.6)
Values in parenthesis represent mortality %
CPB cardiopulmonary bypass, PDA patient ductus arteriosus, VSD ventricular septal defect, DORV double outlet right ventricle, AVSD atrioventricular septal defect, TGA transposition of great arteries, SV single ventricle, Interupt. 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
182
5 (2.7)
0
11 (6.0)
395
8 (2.0)
0
12 (3.0)
67
0
0
0
5
0
0
1 (20.0)
649
13 (2.0)
0
24 (3.7)
2
PAB
375
11 (2.9)
0
19 (5.1)
282
5 (1.8)
0
9 (3.2)
18
0
0
0
4
0
0
0
679
16 (2.4)
0
28 (4.1)
3
Bidirectional Glenn or hemi-Fontan ± α
15
0
0
1 (6.7)
254
3 (1.2)
0
5 (2.0)
84
1 (1.2)
0
1 (1.2)
3
0
0
0
356
4 (1.1)
0
7 (2.0)
4
Damus–Kaye–Stansel operation
3
1 (33.3)
0
1
50
4
0
6
24
0
0
0
0
0
0
0
77
5 (6.5)
0
7 (9.1)
5
PA reconstruction/repair (including redo)
12
0
0
0
72
4 (5.6)
0
7 (9.7)
107
1 (0.9)
0
2 (1.9)
15
0
0
0
206
5 (2.4)
0
9 (4.4)
6
RVOT reconstruction/repair
22
2 (9.1)
0
2 (9.1)
105
1 (1.0)
0
1 (1.0)
163
1 (0.6)
0
1 (0.6)
22
0
0
0
312
4 (1.3)
0
4 (1.3)
7
Rastelli procedure
5
0
0
0
67
2 (3.0)
0
2 (3.0)
98
0
0
0
10
0
0
0
180
2 (1.1)
0
2 (1.1)
8
Arterial switch procedure
129
5 (3.9)
0
6 (4.7)
27
2 (7.4)
0
2 (7.4)
8
0
0
0
0
0
0
0
164
7 (4.3)
0
8 (4.9)
9
Atrial switch procedure
3
0
0
0
0
0
0
0
1
0
0
0
0
0
0
0
4
0
0
0
10
Double switch procedure
0
0
0
0
2
0
0
0
10
0
0
0
1
0
0
0
13
0
0
0
11
Repair of anomalous origin of CA
1
0
0
0
9
0
0
0
4
0
0
0
6
0
0
0
20
0
0
0
12
Closure of coronary AV fistula
3
0
0
0
1
0
0
0
5
0
0
0
21
1 (4.8)
0
1 (4.8)
30
1 (3.3)
0
1 (3.3)
13
Fontan/TCPC
3
0
0
0
6
0
0
0
417
4 (1.0)
0
5 (1.2)
24
2 (8.3)
0
2 (8.3)
450
6 (1.3)
0
7 (1.6)
14
Norwood procedure
35
5 (14.3)
0
9 (25.7)
70
5 (7.1)
0
11 (15.7)
3
0
0
0
0
0
0
0
108
10 (9.3)
0
20 (18.5)
15
Ventricular septation
0
0
0
0
1
0
0
0
0
0
0
0
1
0
0
0
2
0
0
0
16
Left side AV valve repair (including Redo)
2
0
0
0
51
0
0
0
64
0
0
0
17
0
0
0
134
0
0
0
17
Left side AV valve replace (including Redo)
2
0
0
0
16
1 (6.3)
0
2 (12.5)
40
1 (2.5)
0
1 (2.5)
15
0
0
0
73
2 (2.7)
0
3 (4.1)
18
Right side AV valve repair (including Redo)
8
2 (25.0)
0
2 (25.0)
21
0
0
0
25
0
0
0
23
0
0
1 (4.3)
77
2 (2.6)
0
3 (3.9)
19
Right side AV valve replace (including Redo)
0
0
0
0
6
0
0
1 (16.7)
2
0
0
0
14
0
0
0
22
0
0
1 (4.5)
20
Common AV valve repair (including Redo)
2
1 (50.0)
0
1 (50.0)
19
1 (5.3)
0
2 (10.5)
28
1 (3.6)
0
1 (3.6)
3
0
0
0
52
3 (5.8)
0
4 (7.7)
21
Common AV valve replace (including Redo)
0
0
0
0
2
0
0
0
6
0
0
1 (16.7)
0
0
0
0
8
0
0
1 (12.5)
22
Repair of supra-aortic stenosis
0
0
0
0
1
0
0
0
19
0
0
0
5
0
0
0
25
0
0
0
23
Repair of subaortic stenosis (including Redo)
3
0
0
0
9
0
0
0
29
0
0
0
5
0
0
0
46
0
0
0
24
Aortic valve plasty ± VSD Closure
6
0
0
0
12
0
0
1 (8.3)
21
0
0
0
6
0
0
0
45
0
0
1 (2.2)
25
Aortic valve replacement
0
0
0
0
1
0
0
0
25
1 (4.0)
0
1 (4.0)
26
0
0
0
52
1 (1.9)
0
1 (1.9)
26
AVR with annular enlargement
0
0
0
0
0
0
0
0
11
0
0
0
1
0
0
0
12
0
0
0
27
Aortic root Replace (except Ross)
0
0
0
0
1
0
0
0
4
0
0
0
6
0
0
0
11
0
0
0
28
Ross procedure
0
0
0
0
3
0
0
0
13
0
0
0
0
0
0
0
16
0
0
0
Total
811
32 (3.9)
0 (0.0)
52 (6.4)
1483
36 (2.4)
0
61 (4.1)
1296
10 (0.8)
0
13 (1.0)
233
3 (1.3)
0
5 (2.1)
3823
81 (2.1)
0
131 (3.4)
Values in parenthesis represent mortality %
SP systemic-pulmonary, PAB pulmonary artery banding, PA pulmonary artery, RVOT right ventricular outflow tract, CA coronary artery, AVfustula arteriovenous fistula, TCPC total cavopulmonary connection, AV valve atrioventricular valve, VSD ventricular septal defect, AVR aortic valve replacement
CABG coronary artery bypass grafting, 1VD one-vessel disease, 2VD two-vessel disease, 3VD three-vessel disease, LMT left main trunk, SVG saphenous vein graft, LMT includes LMT alone or LMT with other branch diseases
(a-2) On-pump beating CABG (total; 2121)
Primary, elective
Primary, emergency
Redo, elective
Redo, emergency
Arterial graft only
Artery graft + SVG
SVG only
Others
Unclear
Cases
30-day mortality
Hospital mortality
Cases
30-day mortality
Hospital mortality
Cases
30-day mortality
Hospital mortality
Cases
30-day mortality
Hospital mortality
Hospital
After discharge
Hospital
After discharge
Hospital
After discharge
Hospital
After discharge
1VD
42
1 (2.4)
0
2 (4.8)
17
4 (23.5)
0
4 (23.5)
11
0
0
1 (9.1)
5
2 (40.0)
0
2 (40.0)
34
10
30
0
1
2VD
248
1 (0.4)
0
2 (0.8)
84
13 (15.5)
0
18 (21.4)
4
0
0
0
1
0
0
0
58
249
28
1
1
3VD
860
14 (1.6)
0 (0.0)
27 (3.1)
196
18 (9.2)
0
22 (11.2)
12
0
0
0
0
0
0
0
90
921
57
0
0
LMT
434
5 (1.2)
1 (0.2)
5 (1.2)
195
13 (6.7)
0 (0.0)
17 (8.7)
10
0
0
0
2
1 (50.0)
0
1 (50.0)
87
521
31
0
2
Total
1584
21 (1.3)
1 (0.1)
36 (2.3)
492
48 (9.8)
61 (12.4)
37
0
1 (2.7)
8
3 (37.5)
3 (37.5)
269
1701
146
1
0
Kawasaki
1
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
1
0
0
0
0
Hemodialysis
154
2 (1.3)
0
4 (2.6)
67
5 (7.5)
0
8 (11.9)
3
0
0
0
2
0
0
0
14
193
18
0
1
Values in parenthesis represent 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; 9790)
(The present section also includes cases of planned off-pump CABG in which, during surgery, the change is made to an on-pump CABG or on-pump beating-heart procedure)
Primary, elective
Primary, emergency
Redo, elective
Redo, emergency
Arterial graft only
Artery graft + SVG
SVG only
Others
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
573
2 (0.3)
0
3 (0.5)
73
3 (4.1)
0
8 (11.0)
34
1 (2.9)
0
1 (2.9)
9
0
0
0
570
47
72
0
2VD
1533
13 (0.8)
0
26 (1.7)
150
7 (4.7)
0
10 (6.7)
19
0
0
0
2
0
0
0
625
1024
55
0
3VD
3947
30 (0.8)
0
50 (1.3)
383
13 (3.4)
0
20 (5.2)
12
0
0
1 (8.3)
1
0
0
0
840
3433
70
2
LMT
2468
8 (0.3)
1 (0.0)
19 (0.8)
553
21 (3.8)
0
25 (4.5)
28
0
0
0
5
0
0
2 (40.0)
818
2168
68
0
Total
8521
53 (0.6)
1 (0.0)
98 (1.2)
1159
44 (3.8)
63 (5.4)
93
1 (1.1)
2 (2.2)
17
0
2 (11.8)
2853
6672
265
2
Kawasaki
7
0
0
0
1
0
0
0
0
0
0
0
0
0
0
0
6
1
1
0
Hemodialysis
581
7 (1.2)
0
15 (2.6)
79
7 (8.9)
0
9 (11.4)
7
0
0
0
5
0
0
0
131
511
30
0
Values in parenthesis represent 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) Includes cases of conversion, during surgery, from off-pump CABG to on-pump CABG or on- pump beating-heart CABG (total; 171)
Primary, elective
Primary, emergency
Redo, elective
Redo, emergency
Cases
30-day mortality
Hospital mortality
Cases
30-day mortality
Hospital mortality
Cases
30-day mortality
Hospital mortality
Cases
30-day mortality
Hospital mortality
Hospital
After discharge
Hospital
After discharge
Hospital
After discharge
Hospital
After discharge
A conversion to on-pump CABG arrest heart
33
2 (6.1)
0
2 (6.1)
3
0
0
0
0
0
0
0
0
0
0
A conversion to on-pump beating-heart CABG
104
4 (3.8)
0
5 (4.8)
31
4 (12.9)
0
4 (12.9)
0
0
0
0
0
0
0
Total
137
6 (4.4)
0
7 (5.1)
34
4 (11.8)
4 (11.8)
0
0
0
0
0
0
0
0
Hemodialysis
10
1 (10.0)
0
1 (10.0)
3
2 (66.7)
2 (66.7)
0
0
0
0
0
0
0
0
Values in parenthesis represent mortality %
CABG coronary artery bypass grafting
(B) Operation for complications of MI (total; 1226)
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
336
10 (3.0)
0
17 (5.1)
29
5 (17.2)
1 (3.4)
7 (24.1)
247
115
19
VSP closure
57
5 (8.8)
1 (1.8)
5 (8.8)
221
64 (29.0)
3 (1.4)
85 (38.5)
76
2
5
Cardiac rupture
21
3 (14.3)
0
4 (19.0)
176
52 (29.5)
1 (0.6)
59 (33.5)
23
1
3
Mitral regurgitation
1) Papillary muscle rupture
9
0
0
0
43
10 (23.3)
0
12 (27.9)
20
3
36
2) Ischemic
289
11 (3.8)
0
26 (9.0)
30
11 (36.7)
1 (3.3)
13 (43.3)
254
222
55
Others
8
2 (25.0)
0
2 (25.0)
7
1 (14.3)
0
1 (14.3)
6
0
1
Total
720
31 (4.3)
1 (0.1)
54 (7.5)
506
143 (28.3)
6 (1.2)
177 (35.0)
626
343
119
Values in parenthesis represent mortality %
Acute, within 2 weeks from the onset of myocardial infarction
Values in parenthesis represent mortality %. Except for 68 isolated cases, all remaining 3932 cases are doubly allocated, one for this subgroup and the other for the subgroup corresponding to the concomitant operations
In 2013, 7150 open-heart operations for congenital heart disease were performed with overall hospital mortality of 2.2 % (Table 3). The number of operations for congenital heart disease was quite steady throughout these 10 years (maximum 7386 cases in 2006), while overall hospital mortality decreased gradually from that of 3.7 % in 2003. In detail, the most common disease was atrial septal defect (1321 cases); however, its number deceased to 71.7 % of that in 2003, which might be due to the recent development of catheter closure of atrial septal defect in Japan. Hospital mortality for complex congenital heart disease improved dramatically in the last 10 years such as interrupted aortic arch with ventricular septal defect (6.7 % in 2003 to 4.9 % in 2013), complete atrio-septal defect (5.7–0.6 %), tetralogy of Fallot (2.6–1.4 %), transposition of the great arteries with and without ventricular septal defect (10.5–5.2 % and 7.5–3.6 %, respectively), single ventricle (7.1–5.7 %), and hypoplastic left heart syndrome (27.2–9.1 %). Right heart bypass surgery is now commonly performed (356 bidirectional Glenn procedures excluding 77 Damus–Kaye–Stansel procedures and 450 Fontan type procedures including total cavo-pulmonary connection) with acceptable hospital mortality (2.0 and 1.6 %). Norwood type I procedure was performed in 108 cases with relatively low hospital mortality rate of 18.5 %.
As previously mentioned, the number of operations for valvular heart disease increased by 83.4 % in the last 10 years, and the hospital mortality associated with primary single valve placement was 2.2 and 3.7 % for the aortic and the mitral position, while that for primary mitral valve repair was 0.8 % (Table 4 (1)). However, hospital mortality rate for redo valve surgery were still high, and was 9.1 and 5.6 % for aortic and mitral procedure, respectively. Finally, overall hospital mortality did not show significant improvement during the last 10 years (3.7 % in 2003 and 3.1 % in 2013), which might be partially due to the recent progression of age of the patients. Repair of the valve became popular procedure (436 cases in the aortic, 6231 cases in the mitral, and 4910 cases in the tricuspid), and mitral valve repair constituted 28.6 % of all valvular heart disease operation and 55.5 % of all mitral valve procedure (10,577 procedures), which are similar to those of the last 5 years and increased compared with those of 2003 (21.3 and 38.7 %, respectively). Aortic and mitral valve replacement with bioprosthesis were performed in 10,000 cases and 2580 cases, respectively, with the number consistently increasing in the aortic position. The ratio of prostheses changed dramatically during the last 10 years and the usage of bioprosthesis is 78.1 % at the aortic position (38.2 % in 2003) and 41.9 % at the mitral position (23.4 % in 2003). CABG as a concomitant procedure performed in 17.8 % of operations for all valvular heart disease (12.7 % in 2003).
Isolated CABG was performed in 15,333 cases which were only 72.9 % of that of 10 years ago (2003) (Table 4 (2)). Among these 15,333 cases, off-pump CABG was intended in 9790 cases (63.8 %) with a success rate of 98.3 %; so final success rate of off-pump CABG was 62.7 %. The percentage of intended off-pump CABG was 55.2 % in 2003, and was increased to 60.3 % in 2004, then was kept over 60 % until now. In 15,333 isolated CABG patients, 96.1 % of them received at least one arterial graft, while, all arterial graft CABG was performed in only 23.4 % of them.
The operative and hospital mortality rates associated with primary elective CABG procedures in 13,024 cases were 1.0 and 1.7 %, respectively. Similar data analysis of CABG including primary/redo and elective/emergency data was begun in 2003, and the operative and hospital mortality rates associated with primary elective CABG procedures in 2003 were 1.0 and 1.5 %, respectively; so operative results of primary CABG has been stable. However, hospital mortality of primary emergency CABG in 2121 cases was 5.5 %, which has been improved compared with 9.7 % of hospital mortality rate in 2003. In comparison with data in 2003, the results of conversion improved both conversion rate (3.1–1.7 %) and hospital mortality (8.5–6.4 %).
A total of 1226 patients underwent surgery for complications of myocardial infarction, including 414 operations for a left ventricular aneurysm or ventricular septal perforation or cardiac rupture and 298 operations for ischemic mitral regurgitation.
Anzeige
Operations for arrhythmia were performed mainly as a concomitant procedure in 4000 cases with satisfactory mortality (1.6 % hospital mortality) including 3763 MAZE procedures. MAZE procedure has become quite popular procedure when compared with that in 2003 (1472 cases).
Operations for thoracic aortic dissection were performed in 6787 cases (Table 5). For 4444 Stanford type A acute aortic dissections, hospital mortality was 9.1 %, which was slightly improved compared to that in 2012 (10.6 %) and better than that in 2003 (14.5 %). Operations for a non-dissected thoracic aneurysm were carried out in 8171 cases, with overall hospital mortality of 4.5 %, which was better than that in 2012 (5.4 %). The hospital mortality associated with un-ruptured aneurysm was 2.2 %, and that of ruptured aneurysm was 22.2 %, which remains markedly high.
The number of stent graft procedures remarkably increased recently. A total of 1014 patients with aortic dissection underwent stent graft placement: thoracic endovascular aortic repair (TEVAR) in 902 cases and open stent grafting in 112 cases. The number of TEVAR for type B chronic aortic dissections increased from 77 cases in 2003 to 556 cases in 2013. The hospital mortality rates associated with TEVAR for type B aortic dissection were 11.2 % in acute cases and 2.2 % for chronic cases, respectively.
A total of 3296 patients with non-dissected aortic aneurysm underwent stent graft placement with a dramatic increase compared with that in 2003 (399 cases); TEVAR in 3132 cases (42 % increase compared with that in 2012) and open stent grafting in 164 cases (27.4 % decrease compared with that in 2012). The hospital mortality rates for TEVAR were 2.4 and 14.8 % for non-ruptured and ruptured aneurysm, respectively.
Anzeige
In summary, the total cardiovascular operations increased during 2013 by 3525 cases. With steadily improving results in almost all categories compared with those in 2012.
(B) General thoracic surgery
The total number of operations reported in 2013 in general thoracic surgery has reached 75,306, which means increase of 2559 cases compared with the number of operations in 2012 (Fig. 2 Table 10).
Table 10 Total entry cases of general thoracic surgery during 2013
Cases
%
Benign pulmonary tumor
948
1.3
Primary lung cancer
37,008
49.1
Other primary malignant pulmonary tumor
362
0.5
Metastatic pulmonary tumor
7829
10.4
Tracheal tumor
85
0.1
Mesothelioma
439
0.6
Chest wall tumor
692
0.9
Mediastinal tumor
4780
6.3
Thymectomy for MG without thymoma
253
0.3
Inflammatory pulmonary disease
3445
4.6
Empyema
2368
3.1
Bullous disease excluding pneumothorax
566
0.8
Pneumothorax
14,612
19.4
Chest wall deformity
403
0.5
Diapharagmatic hernia including traumatic
101
0.1
Chest trauma excluding diaphragmatic hernia
434
0.6
Lung transplantation
61
0.1
Others
920
1.2
Total
75,306
100.0
Fig. 2
General thoracic surgery
×
Figure 2 shows the development of thoracic surgery in Japan over 27 years. Data for individual categories are summarized in table through 10 to 34. The number of operations for primary lung cancer in 2013 was 37,008, showing the steady increase (31,301, 2009; 32,801, 2010; 33,878, 2011; 35,667, 2012). Surgery for lung cancer consists of 49.1 % of all the general thoracic surgery. Among lung cancer subtypes, adenocarcinoma comprises an overwhelming percentage of 69.1 % of the total lung cancer surgery, followed by squamous cell carcinoma of 19.9 %. Limited resection by wedge resection or segmentectomy was performed in 8771 lung cancer patients, which is 23.7 % of the entire cases. Lobectomy was performed in 27,469 patients, which is 74.2 % of the entire cases. Sleeve lobectomy was done in 449 patients. Pneumonectomy was done in 559 patients which is only 1.5 % of the entire cases. VATS (video assisted thoracic surgery) procedure is performed in 70.8 % among the total lung cancer surgeries. VATS procedure was adopted in 4270 patients (86.2 %) in wedge resection, 2800 patients (73.4 %) in segmentectomy, 18,925 patients (68.9 %) in lobectomy, and 82 patients (14.7 %) in pneumonectomy. There were 123 patients who died within 30 days after lung cancer surgery (30-day mortality rate; 0.33 %), and 224 patients died without discharge (hospital mortality rate; 0.60 %). 30-day mortality rate in regard to procedures is 0.21 % in segmentectomy, 0.34 % in lobectomy, and 1.97 % in pneumonectomy (Table 12).
Table 11
1. Benign pulmonary tumor
Cases
30 day mortality
Hospital mortality
By VATS
Hospital
After discharge
Hamartoma
475
0
0
0
409
Sclerosing hemangioma
95
0
0
0
77
Papilloma
17
0
0
0
13
Mucous gland adenoma bronchial
7
0
0
0
5
Fibroma
60
0
0
0
55
Lipoma
12
0
0
0
9
Neurogenic tumor
9
0
0
0
6
Clear cell tumor
5
0
0
0
4
Leiomyoma
12
0
0
0
9
Chondroma
3
0
0
0
2
Inflamatory myofibroblastic tumor
1
0
0
0
1
Pseudolymphoma
30
0
0
0
21
Histiocytosis
9
0
0
0
9
Teratoma
3
0
0
0
1
Others
210
1 (0.5)
0
1 (0.5)
168
Total
948
1 (0.1)
0
1 (0.1)
789
Values in parenthesis represent mortality %
Table 12
2. Primary malignant pulmonary tumor
Cases
30 day mortality
Hospital mortality
By VATS
Hospital
After discharge
2. Primary malignant pulmonary tumor
37,370
113 (0.3)
11 (0.03)
227 (0.6)
Lung cancer
37,008
112 (0.3)
11 (0.03)
225 (0.6)
26,213
Adenocarcinoma
25,555
54 (0.2)
4 (0.02)
97 (0.4)
Squamous cell carcinoma
7365
41 (0.6)
6 (0.08)
89 (1.2)
Large cell carcinoma
908
6 (0.7)
1
10 (1.1)
(LCNEC)
517
3 (0.6)
1
6 (1.2)
Small cell carcinoma
577
3 (0.5)
0
5 (0.9)
Adenosquamous carcinoma
586
1 (0.2)
0
7 (1.2)
Carcinoma with pleomorphic, sarcomatoid or sarcomatous elements
Bilateral lung transplantation from brain dead donor
24
0
0
1 (4.2)
Lung transplantation from living donor
20
0
0
1 (5.0)
Total of lung transplantation
61
0
0
2 (3.3)
Donor of living donor lung transplantation
31
0
0
0
Values in parenthesis represent mortality %
Table 30
11. Video-assisted thoracic surgery
Cases
30 day mortality
Hospital mortality
Hospital
After discharge
11. Video-assisted thoracic surgery
58,466
84 (0.1)
9 (0.02)
135 (0.2)
Values in parenthesis represent mortality %
(Including Thoracic sympathectomy 160)
Table 31
12. Tracheobronchoplasty
Cases
30 day mortality
Hospital mortality
Hospital
After discharge
12. Tracheobronchoplasty
564
2 (1.2)
0
4 (0.7)
Trachea
102
1 (1.0)
0
2 (2.0)
Sleeve resection with reconstruction
53
0
0
0
Wedge with simple closure
32
0
0
0
Wedge with patch closure
1
0
0
0
Total laryngectomy with tracheostomy
4
0
0
1 (25.0)
Others
12
1 (8.3)
0
1 (8.3)
Carinal reconstruction
5
0
0
1 (20.0)
Sleeve pneumonectomy
12
0
0
0
Sleeve lobectomy
388
1 (0.3)
0
1 (0.3)
Sleeve segmental excision
15
0
0
0
Bronchoplasty without lung resection
13
0
0
0
Others
29
0
0
0
Values in parenthesis represent mortality %
Table 32
13. Pediatric surgery
Cases
30 day mortality
Hospital mortality
Hospital
After discharge
13. Pediatric surgery
329
2 (0.6)
0
4 (1.2)
Values in parenthesis represent mortality %
Table 33
14. Combined resection of neighboring organ(s)
Cases
30 day mortality
Hospital mortality
Hospital
After discharge
14. Combined resection of neighboring organ(s)
1581
7 (1.4)
3 (0.2)
19 (1.2)
(A) Primary lung cancer (organ resected)
Aorta
16
0
0
0
Superior vena cava
40
0
0
0
Brachiocephalic vein
12
0
0
0
Pericardium
177
2 (1.1)
0
3 (1.7)
Pulmonary artery
227
1 (0.4)
0
1 (0.4)
Left atrium
45
0
0
1 (2.2)
Diaphragm
98
1 (1.0)
0
1 (1.0)
Chest wall (including ribs)
500
1 (0.2)
0
9 (1.8)
Vertebra
31
0
0
3 (9.7)
Esophagus
12
0
0
0
Total
1158
5 (0.4)
0
18 (1.6)
(B) Mediastinal tumor (organ resected)
Aorta
3
0
0
0
Superior vena cava
69
0
0
1 (1.4)
Brachiocephalic vein
93
1 (1.1)
0
1 (1.1)
Pericardium
267
1 (0.4)
0
2 (0.7)
Pulmonary artery
9
0
0
0
Left atrium
2
0
0
0
Diaphragm
16
0
0
0
Chest wall (including ribs)
20
0
0
0
Vertebra
7
0
0
0
Esophagus
1
0
0
0
Lung
277
1 (0.4)
0
1 (0.4)
Total
764
3 (0.4)
0
5 (0.7)
Values in parenthesis represent mortality %
Table 34
15. 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
98
0
0
1 (0.01)
Values in parenthesis represent mortality %
Includes tumors invading the anterior apical chest wall and posterior apical chest wall (superior sulcus tumor, so called Pancoast type)
Interstitial pneumonia was the leading cause of death after lung cancer surgery, followed by pneumonia, respiratory failure, cardiovascular event, and bronchopleural fistula (Table 13).
Anzeige
7829 patients with metastatic pulmonary tumor were operated in 2013 with steady increase similarly to lung cancer surgery (6248, 2009; 6748, 2010; 7210, 2011; 7403, 2012). VATS was adopted in 6323 cases, which comprises 80.8 % of the entire cases. Colo-rectal cancer was by far the leading primary malignancy indicated for resection of metastatic tumors, which comprises 49.8 % of the entire cases (Table 14).
85 tracheal tumors were operated in 2013. Adenoid cystic carcinoma and squamous cell carcinoma were frequent primary tracheal tumors (Table 15).
439 tumors of pleural origin were operated in 2013. Diffuse malignant pleural mesothelioma was the most frequent histology. Extrapleural pneumonectomy was the most frequently chosen operative method (119 cases) with a hospital death of 8.4 % (Table 16).
692 chest wall tumors were resected in 2013 (Table 17).
4780 mediastinal tumors were operated in 2013. There were 2230 thymic epithelial tumors (1904 thymomas, 279 thymic carcinomas, and 47 thymic neuroendocrine carcinoma including carcinoid), followed by 974 congenital cysts, 513 neurogenic tumors, and 243 germ cell tumors. 2624 cases (54.9 %) were resected by VATS (Table 18).
Thymectomy for myasthenia gravis was done in 524 patients, and 271 patients were associated with thymoma, 253 patients were not associated with thymoma. VATS was adopted in 176 cases, which comprises 33.6 % of the entire cases (Table 19).
Lung resection for inflammatory lung diseases were done in 3, 445 patients in 2013. Inflammatory pseudotumor comprised 38.8 % of the entire cases, followed by atypical mycobacterium infection (16.7 %) and fungal infections (13.0 %) (Table 20).
2368 operations for empyema were reported in 2013. There were 1827 patients (77.2 %) with acute empyema and 541 patients with chronic empyema. Bronchopleural fistura was associated in 403 patients (22.1 %) with acute empyema and 287 patients (53.0 %) with chronic empyema. It should be noted that hospital mortality was as high as 10.9 % in patients of acute empyema with fistura (Table 21).
14,612 operations for pneumothorax were reported in 2013. 13,961 operations (95.5 %) were performed by VATS (Table 24).
61 lung transplantations were reported in 2013. Brain-dead donor lung transplantation and living-related donor lung transplantation were done in 41 recipients and 20 recipients, respectively. The number of lung transplantation is still small compared to those in North America and European countries because of shortage of donors (Table 29).
(C) Esophageal surgery
During 2013 alone, a total of 17,656 patients with esophageal diseases were registered from 559 institutions (response rate 96.9 %) which affiliated to the Japanese Association for Thoracic Surgery and/or to the Japan Esophageal Society (Table 1). Among these institutions, those where 20 or more patients underwent esophageal surgeries within the year of 2013 were 186 institutions (33.3 %), which shows no definite shift of esophageal operations to high volume institutions when compared to the data of 2012 (33.2 %) (Table 35). Of 7562 patients with a benign esophageal disease, 1300 (17.2 %) patients underwent surgery, and 761 (10.1 %) patients underwent endoscopic resection, while 5501 (72.7 %) patients did not undergo any surgical treatment (Table 36). Of 10,094 patients with a malignant esophageal tumor, 7677 (76.1 %) patients underwent resection, esophagectomy for 5824 (57.7 %) and endoscopic mucosal resection (EMR) or endoscopic submucosal dissection (ESD) for 1853 (18.4 %), while 2417 (23.9 %) patients did not undergo any resection (Tables 37, 38). The increase of registered patients with endoscopic resection and nonsurgically treated benign esophageal diseases is obvious during 2012 and 2013. The patients registered, particularly those undergoing ESD or EMR and nonsurgical therapy for a malignant esophageal disease, have been increasing since 1990 (Fig. 3).
Table 35
Distribution of number of esophageal operations in 2013 in each institution
Annual trend of in-patients with esophageal diseases. EMR endoscopic mucosal resection (including endoscopic submucosal dissection)
×
Among benign esophageal diseases (Table 36), hiatal hernia, esophageal varices, esophagitis (including reflux esophagitis) and achalasia were the most common conditions in Japan. On the other hand, spontaneous rupture of the esophagus, benign esophageal tumors and congenital esophageal atresia were common diseases which were surgically treated as well as the above-mentioned diseases. The thoracoscopic and/or laparoscopic procedures have been widely adopted for benign esophageal diseases, in particular achalasia, hiatal hernia and benign tumors. Open surgery was performed in 989 patients with a benign esophageal disease, with 30-day mortality in 10 (1.0 %), while thoracoscopic and/or laparoscopic surgery was performed for 311 patients, with 2 (0.6 %) of the 30-day mortality The difference in these death rates between open and scopic surgery seem to be related the conditions requiring open surgery.
The majority of malignant diseases were carcinomas (Table 37). Among esophageal carcinomas, the incidence of squamous cell carcinoma was 91.1 %, while that of adenocarcinomas including Barrett cancer was 6.4 %. The resection rate for patients with a squamous cell carcinoma was 75.0 %, while that for patients with an adenocarcinoma was 91.0 %.
According to location, cancer in the thoracic esophagus was the most common (Table 38). Of the 3748 patients (37.1 % of total esophageal malignancies) having superficial esophageal cancers within mucosal and submucosal layers, 1799 (48.0 %) patients underwent esophagectomy, while 1757 (46.9 %) patients underwent EMR or ESD. The 30-day mortality rate and hospital mortality rate after esophagectomy for patients with a superficial cancer were 0.2 and 0.5 % respectively. Advanced esophageal cancer invading deeper than the submucosal layer was observed in 6224 (61.7 %) patients. Of the 6224 patients with advanced esophageal cancer, 4025 (64.7 %) underwent esophagectomy, with 0.8 % of the 30-day mortality rate, and with 2.3 % of the hospital mortality rate.
Multiple primary cancers were observed in 1662 (16.5 %) of all the 10,094 patients with esophageal cancer. Synchronous cancer was found in 873 (52.5 %) patients, while metachronous cancer (found before esophageal cancer) was observed in 786 (47.3 %) patients. The stomach is the commonest site for both synchronous and metachronous malignancy followed by head and neck cancer (Table 38).
Among esophagectomy procedures, transthoracic esophagectomy through right thoracotomy was the most commonly adopted for patients with a superficial cancer as well as for those with an advanced cancer (Table 39). Transhiatal esophagectomy commonly performed in Western countries was adopted in only 4.6 % of patients having a superficial cancer who underwent esophagectomy and in 1.5 % of those having an advanced cancer in Japan. The thoracoscopic and/or laparoscopic esophagectomy were adopted for 1049 patients (58.3 %) with a superficial cancer, and for 1326 patients (32.9 %) with an advanced cancer. The number of cases of thoracoscopic and/or laparoscopic surgery for superficial or advanced cancer has been increasing for these several years (Fig. 4).
(2) Transthoracic (rt.) esophagectomy and reconstruction
1451
6 (0.4)
0
15 (1.0)
886
1 (0.1)
0
5 (0.6)
(3) Transthoracic (lt.) esophagectomy and reconstruction
65
0
0
0
20
0
0
0
(4) Cervical esophageal resection and reconstruction
9
0
0
0
2
0
0
0
(5) Two stage operation
18
1 (5.6)
0
2 (11.1)
12
0
0
1 (8.3)
(6) Others
119
0
0
0
108
0
0
0
(7) Not specified
54
1 (1.9)
0
1 (1.9)
3
0
0
0
Advanced cancer (T2–T4)
Esophagectomy
4025
33 (0.8)
0
94 (2.3)
1326
14 (1.1)
0
35 (2.6)
1
(1) Transhiatal esophagectomy
60
1 (1.7)
0
4 (6.7)
6
0
0
0
(2) Transthoracic (rt.) esophagectomy and reconstruction
3340
25 (0.7)
0
69 (2.1)
1173
11 (0.9)
0
29 (2.5)
(3) Transthoracic (lt.) esophagectomy and reconstruction
158
3 (1.9)
0
3 (1.9)
4
1 (25.0)
0
1 (25.0)
(4) Cervical esophageal resection and reconstruction
105
0
0
2 (1.9)
5
0
0
0
(5) Two stage operation
97
1 (1.0)
0
10 (10.3)
20
0
0
2 (10.0)
(6) Others/not specified
241
3 (1.2)
0
6 (2.5)
114
2 (1.8)
0
3 (2.6)
(7) Not specified
24
0
0
0
4
0
0
0
(Depth not specified)
0
0
0
0
5
0
0
1 (20.0)
95
Combined resection of other organs
281
4 (1.4)
0
8 (2.8)
(1) Aorta
2
0
0
0
(2) Trachea, bronchus
44
0
0
1 (2.3)
(3) Lung
77
1
0
4 (5.2)
(4) Others
156
3 (1.9)
0
3 (1.9)
Unknown
2
0
0
0
Salvage surgery
234
2 (0.9)
0
14 (6.0)
38
0
0
2 (5.3)
34
Values in parenthesis represent mortality %
Fig. 4
Annual trend of video-assiste d esophagectomy for esophageal malignancy
×
Combined resection of the neighboring organs during resection of an esophageal cancer was performed in 281 patients (Tables 39, 40). Resection of the aorta together with the esophagectomy was performed in 2 cases. Tracheal and/or bronchial resection combined with esophagectomy was performed in 44 patients, with the 30-day mortality rate at 0 % and the hospital mortality rate at 2.3 %. Lung resection combined with esophagectomy was performed in 77 patients, with the 30-day mortality rate at 1.3 % and the hospital mortality rate at 5.2 %.
Table 40
Mortality after combined resection of the neighboring organs
Year
Esophagectomy
Combined resection
Aorta
Tracheobronchus
Lung
Others
a
b
c (%)
a
b
c (%)
a
b
c (%)
a
b
c (%)
a
b
c (%)
1996
4194
120
2.86
7
3
42.86
24
0
0.00
50
2
4.00
78
4
5.13
1997
4441
127
2.86
1
0
0.00
34
5
14.71
56
1
1.79
94
3
3.19
1998
4878
136
2.79
4
0
0.00
29
0
0.00
74
1
1.35
128
2
1.56
1999
5015
116
2.31
5
0
0.00
23
2
8.70
68
0
0.00
122
1
0.82
2000
5350
81
1.51
2
0
0.00
23
2
8.70
69
0
0.00
96
1
1.04
2001
5521
110
1.99
1
0
0.00
26
1
3.85
83
3
3.61
99
2
2.02
2002
4904
66
1.35
3
1
33.33
20
2
10.00
63
0
0.00
63
1
1.59
2003
4639
45
0.97
0
0
0.00
24
2
8.33
58
0
0.00
88
1
1.14
2004
4739
64
1.35
2
0
0.00
17
0
0.00
59
5
8.47
119
2
1.68
2005
5163
52
1.01
1
0
0.00
11
1
9.09
67
1
1.49
73
1
1.37
2006
5236
63
1.20
0
0
0.00
17
0
0.00
62
2
3.23
122
3
2.46
2007
4990
60
1.20
0
0
0.00
25
1
4.00
44
1
2.27
138
2
1.45
2008
5124
63
1.23
0
0
0.00
17
1
5.88
48
1
2.08
185
0
0.00
2009
5260
63
1.20
0
0
0.00
19
2
10.53
58
2
3.45
211
3
1.42
2010
5180
45
0.87
2
0
0.00
33
0
0.00
58
0
0.00
245
5
2.04
2011
5430
38
0.70
4
0
0.00
26
0
0.00
41
0
0.00
179
5
2.79
2012
6055
47
0.78
2
0
0.00
23
1
4.35
69
0
0.00
240
1
0.42
2013
5824
41
0.70
2
0
0.00
44
0
0.00
77
1
1.30
156
3
1.92
Total
91,943
1040
1.13
26
4
15.38
273
16
5.86
753
16
2.12
1220
23
1.89
a number of patients who underwent the operation, b number of patients died within 30 days after operation, c % ratio of b/a, i.e., direct operative mortality
Salvage surgery after definitive (chemo-) radiotherapy was performed in 234 patients, with the 30-day mortality rate at 0.9 % and with the hospital mortality rate at 6.0 % (Table 39).
Lastly, in spite of the efforts of the Committee to cover wider patient populations to this annual survey, the majority of the institutions which responded to the questionnaire were the departments of thoracic or esophageal surgery. It should be noted that larger number of patients with esophageal diseases should have been treated medically and endoscopically. We should continue our effort for complete survey through more active collaboration with the Japan Esophageal Society and other related societies.
Acknowledgments
On behalf of The Japanese Association for Thoracic Surgery, the authors thank the Heads of the Affiliate and Satellite Institutes of Thoracic Surgery for their cooperation, and the Councilors of the Japan Esophageal Society.
Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made.
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