The patient was a 72-year-old man. Chest computed tomography (CT) scan revealed a mass in the right lower lobe, so he underwent bronchoscopy. The pathological findings revealed squamous cell carcinoma. He was discharged the day after the examination, but was admitted to the hospital seven days later for fever. Chest CT scan showed a lung abscess at the site of the mass in the right lower lobe, so he was admitted to the hospital on an emergency basis. After admission, treatment with tazobactam and piperacin 13.5 g/day was started, but there was little improvement, so the decision was made to perform surgery, and a right lower lobectomy was performed via thoracotomy five days after the admission. The postoperative course was uneventful, and the patient was discharged on the 19th day after surgery. As the surgery was immediately performed after confirming that antimicrobial agents were ineffective, the patient was cured without any complications.

Aim: We aimed to determine whether SGLT2 inhibitor dapagliflozin treatment affects body composition and amino acid (AA) metabolism. Methods: Fifty-two overweight patients treated by oral antidiabetic agents were randomly assigned to dapagliflozin (Dapa) or a standard treatment (Con) and followed for 24 weeks. The primary outcome was the change in body mass (BM) between baseline and week 24. Body composition, intrahepatic triglyceride (IHTG) content, and plasma AA concentrations were examined as secondary outcomes. Results: The change in BM was significantly larger in the Dapa than in the Con group, with a difference in the mean change of-1.72 kg (95 %CI:-2.85,-0.59; P = 0.004) between the groups. Total fat mass was reduced by dapagliflozin treatment, but fat-free mass was maintained. IHTG content was significantly reduced in the Dapa than in the Con (P = 0.033). Changes in AAs showed small differences between the groups, but only serine concentrations were significantly reduced in the Dapa. Intra-group analysis showed that positive associations were observed between changes in branched chain AA concentrations and body composition only in the Dapa. Conclusions: Dapagliflozin treatment causes a reduction in BM mainly by reducing fat mass. AA metabolism shows subtle changes with dapagliflozin treatment.

A 71-year-old woman with chest pain and exertional dyspnea was referred to our hospital. Computed tomography revealed a huge intrathoracic tumor with left parietal pleural dissemination. Transthoracic echocardiography showed the left ventricular dysfunction due to external compression by the tumor. After excision of the tumor, marked improvement of the left ventricular dysfunction was obtained for eight years. But the patient died due to cardiac invasion of the tumor 9th year after surgery.

Backgrounds and Objectives Recent studies have suggested that insulinoma-associated protein 1 (INSM1) is a useful marker for pathological diagnosis of pulmonary neuroendocrine tumors. In the present study, we investigated the association between INSM1 expression and prognosis in patients with pulmonary high-grade neuroendocrine carcinomas (HGNEC) and assessed the usefulness of INSM1 as a prognostic biomarker in these patients. Methods Seventy-five consecutive patients with HGNEC who underwent complete surgical resections from January 2000 to December 2018 were enrolled in this study. We classified these patients into two groups: the INSM1-positive group (n = 59) and INSM1-negative group (n = 16). We compared the clinicopathological characteristics, overall survival (OS), and recurrence-free survival (RFS) between the groups. In addition, we performed univariate and multivariate analyses to identify the prognostic factors associated with postoperative survival. Results Significant differences in tumor diameter and vascular invasion between the groups were found. OS and RFS were significantly poorer in the INSM1-positive group than in the INSM1-negative group. Univariate and multivariate analyses revealed that INSM1 expression was the strongest predictor of poor prognosis for OS and RFS. Conclusions INSM1 expression had the greatest influence on the prognosis in patients with HGNEC and may be a prognostic biomarker in these patients.

OBJECTIVES: Segmentectomies such as S1+2, S1+2+3 and S4+5 segmentectomy are used to treat patients with non-small-cell lung cancer (NSCLC) in the left upper lobe. However, the preservable lung volume and changes after such segmentectomies remain unknown. We compared the residual pulmonary function after thoracoscopic segmentectomy or lobectomy in the left upper lobe and examined the efficacy of S1+2 segmentectomy regarding postoperative pulmonary function. METHODS: Patients with left upper lobe NSCLC who underwent thoracoscopic segmentectomy or lobectomy were included. Spirometry and computed tomography were performed before and 6 months after resection, and the ipsilateral preserved lobe volume was calculated using 3-dimensional computer tomography. The percentage of postoperative/preoperative forced expiratory volume in 1s and actual/predicted regional forced expiratory volume in 1s (preservation rate) in the residual lobe were compared. RESULTS: Eighty-eight patients underwent lobectomy and 70 patients underwent segmentectomy (23 S1+2, 35 S1+2+3 and 12 S4+5 segmentectomies). The percentage of postoperative/preoperative forced expiratory volume in 1s was 97 in S1+2, 82 in S1+2+3, 86 in S4+5 segmentectomy and 73 in left upper lobectomy, indicating that segmentectomy could be a meaningful approach to preserve pulmonary function. The preservation rate was 83% in S1+2 and 62% in S1+2+3 segmentectomy and was significantly higher in S1+2 than in S1+2+3 segmentectomy (P<0.001). CONCLUSIONS: Postoperative pulmonary function and the preservable lung volume of the residual lobe after thoracoscopic S1+2 segmentectomy were well-preserved among other segmentectomies and lobectomy. Thoracoscopic S1+2 segmentectomy is a good alternative for preserving postoperative function.

A pneumatocele is a cystic change of the lung that is caused by a check valve in the bronchiole due to infection, trauma and positive-pressure ventilation. We herein report a case of pneumatocele triggered by using of continuous positive airway pressure (CPAP) for sleep apnea syndrome (SAS) after pulmonary resection. A 69-year-old man underwent right upper lobectomy for lung cancer and developed interstitial pneumonia (IP) 10th postoperative day (POD). He was treated with steroid pulse therapy (solmedrol 500 mg × 3 days), and thereafter with oral steroid therapy (predonin 30mg/day). Well responded to the steroid therapy, IP was improved. However, he noticed bloody sputum 29th POD, and chest computed tomography showed a giant cystic lesion on the dorsal right lower lobe. We resected the cyst and the pathological findings revealed that the cystic lesion was pneumatocele, and CPAP was strongly suspected of triggering this disease.

A 30-year-old female was admitted for diagnosis of an abnormal shadow on chest X-ray. A computed tomography scan showed honeycombing in bilateral dorso-basal segments of the lung and a tumor obstructing the orifice of right middle lobe bronchus. Resection of the tumor by a bronchofiberscope was performed. However, a part of the tumor remained in the bronchus. Histlogical examination confirmed the tumor to be epithelial-myoepithelial carcinoma. In order to assure a complete resection of the tumor, we performed right middle wedge bronchoplastic lobectomy. The patient is doing well, without recurrence 5 years after surgery.

BackgroundThe mammalian Notch family ligands delta‐like 3 (DLL3) is reported to be a potential therapeutic target for large cell neuroendocrine carcinomas (LCNEC). The effect of DLL3 expression on LCNEC prognosis has not yet been elucidated.MethodsWe reviewed the medical records of 70 LCNEC patients undergoing surgical resection between 2001 and 2015 using a prospectively maintained database. We performed immunohistochemistry for DLL3 and investigated the correlation between the sensitivity of LCNEC to platinum‐based adjuvant chemotherapy.ResultsDLL3 expression was positive in 26 (37.1%) LCNEC patients. A total of 23 patients (32.9%) received platinum‐based adjuvant chemotherapy. Among patients with DLL3 expression‐positive tumors, no difference was found in the five‐year overall survival (OS) or recurrence‐free survival (RFS) between patients with and without adjuvant chemotherapy (surgery + chemotherapy vs. surgery alone, five‐year OS: 58.3% vs. 35.7% P = 0.36, five‐year RFS: 41.7% vs. 35.7% P = 0.74). In contrast, among patients with DLL3‐negative tumors, significantly greater five‐year OS and RFS rates were observed for patients with adjuvant chemotherapy than for those without it (surgery + chemotherapy vs. surgery alone: five‐year OS: 90.0% vs. 26.9% P<0.01, five‐year RFS: 80.0% vs. 21.7% P < 0.01). A multivariate analysis for the RFS revealed that adjuvant chemotherapy was a significant independent prognostic factor among patients with DLL3‐negative tumors (hazard ratio [HR]: 0.05, 95% confidence interval [CI]: 0.01–0.41, P < 0.01), although it was not a factor among patients with DLL3‐positive tumors (HR: 0.73, 95% CI: 0.23–2.27, P = 0.58).ConclusionsOur results revealed that DLL3 is a predictive marker of sensitivity to platinum‐based adjuvant chemotherapy for LCNEC.Key pointsSignificant findings of the studyDLL3 was a predictive marker of sensitivity to platinum‐based adjuvant chemotherapy for LCNEC. Among patients with DLL3 expression‐negative LCNEC, platinum‐based adjuvant chemotherapy significantly improved the OS and RFS, although it did not do so among patients with DLL3 expression‐positive LCNEC.What this study addsOur results suggest that DLL3 expression‐positive LCNEC may be better treated with other types of adjuvant chemotherapy, such as the anti‐DLL3 therapies if these effects are confirmed by ongoing clinical research.

The concept of oligo-recurrence, which is theoretically curable by definitive local therapy, has been proposed in several cancers. But the efficacy of local therapy for patients with pulmonary oligo-recurrence of non-small cell lung cancer (NSCLC) is unclear. The aim of this study was to investigate the efficacy of local therapy for pulmonary oligo-recurrence of NSCLC. We retrospectively analyzed the data on 35 patients who underwent lung resection or radiotherapy for pulmonary oligo-recurrence in our institution, between 2000 and 2016. We evaluated independent risk factors for overall survival and progression-free survival after local treatment for patients with pulmonary oligo-recurrence of non-small cell lung cancer. In this study, pulmonary oligo-recurrence was defined as local recurrences limited within lungs after local or systemic treatment for NSCLC. There were 26 men and 9 women with median age of 72 years [interquartile range (IQR), 64-75]. The median follow-up time was 48.8 months [IQR, 16.3-66.7]. Previous therapies for NSCLC were pulmonary resections in 26 patients (74.2%), stereotactic radiosurgery for brain metastasis in 3 (8.6%), radiotherapy for lung tumors in 3 (8.6%), chemoradiotherapy in 2 (5.7%) and chemotherapy (ALK-TKI) in 1 (2.9%). The median progression-free interval between previous therapy and local treatment for oligo-recurrence was 29.0 months [IQR, 16.0-44.5]. Histopathology were adenocarcinoma in 26 patients (74.2%), squamous cell carcinoma in 7 (20.0%), adenosquamous carcinoma and large cell neuroendocrine carcinoma in 1 (2.9 %). Among 21 patients (60.0%) who underwent surgical resection for pulmonary oligo-recurrence, surgical procedures were wedge resection in 11 patients, segmentectomy in 3, lobectomy in 5 and pneumonectomy in 2. Among 14 patients (40.0%) who underwent radiotherapy for pulmonary oligo-recurrence, 11 patients (31.4%) underwent stereotactic body radiotherapy. There were no treatment-related death. Three-year overall survival and progression-free survival were 60.3% and 49.6%. Post-treatment recurrence occurred in 16 (60.4%) patients (local; 6, distant; 2, local and distant; 8). Univariate analyses identified progression-free interval between previous therapy and local treatment for pulmonary oligo-recurrence as independent risk factor for overall survival (HR 0.97 [95% CI 0.95-1]; p=0.039). Local therapy for pulmonary oligo-recurrence of NSCLC are feasible and the post-therapeutic survival is acceptable. But there are highly selective patients in our study, further study is needed for curative intent treatment.

BackgroundPartner of Sld five 3 (Psf3) is a member of the heterotetrameric complex that consists of SLD5, Psf1, Psf2, and Psf3. We have shown in previous studies that high Psf3 expression was a poor prognostic marker for pulmonary adenocarcinoma. Here, we statistically evaluated the relationship between clinicopathologic factors and Psf3 expression in stage I pulmonary adenocarcinoma.MethodsA total of 583 patients who had undergone complete resection of stage I pulmonary adenocarcinoma from January 2002 to December 2009 were included in the study. Tissue microarrays were performed, and the resected tumors were divided into groups according to Psf3 expression.ResultsOf 583 patients, high expression of Psf3 was observed in 211 (36.2%) and low expression of Psf3 observed in 372 (63.8%) patients. Among stage I patients, the five‐year survival rate was 76.7% in the Psf3 high expression group and 90.9% in the Psf3 low expression group (P < 0.0001). On multivariate analysis, Psf3 was found to be the independent prognostic factor. Among stage I patients in the Psf3 high expression group, a significantly greater five‐year survival rate was observed in patients who received postoperative chemotherapy with tegafur‐uracil than in those who underwent surgery alone (P < 0.0001). In contrast, among stage I patients in the Psf3 low expression group, no difference was found in the five‐year survival, regardless of the presence or absence of tegafur‐uracil (P = 0.873).ConclusionThe Psf3 expression was an independent prognostic factor and could be a biomarker of adjuvant tegafur‐uracil for stage I pulmonary adenocarcinoma.Key pointsSignificant findings of the study: The Psf3 expression could be a biomarker of adjuvant tegafur‐uracil administration for stage I pulmonary adenocarcinoma.What this study adds: Appropriate patients of adjuvant chemotherapy for stage I pulmonary adenocarcinoma using Psf3 expression could be selected.

AbstractBackgroundThe aim of this study was to identify subgroups with good or bad prognosis in patients with pulmonary large cell neuroendocrine carcinoma (LCNEC) based on immunostaining patterns with neuroendocrine markers and compare them with small cell lung carcinoma (SCLC).MethodsFrom January 2001 to December 2017, of all patients with resected LCNEC and SCLC, we selected patients whose pathological tumor sizes were ≤30 mm in diameter (defined as small‐sized tumors) and who underwent complete resection with lymphadenectomy. We classified patients with small‐sized LCNEC (sLCNEC) into two subgroups based on immunostaining patterns with three neuroendocrine markers (chromogranin A, synaptophysin, and NCAM) and compared them to small‐sized SCLC (sSCLC).ResultsA total of 48 patients with sLCNEC and 39 patients with sSCLC were enrolled. Of 48 patients with sLCNEC, 21 were categorized as the small‐sized triple‐positive group (sTP), whose patients were positive for the three neuroendocrine markers, and 27 patients were categorized as the small‐sized nontriple‐positive group (sNTP), whose patients were not positive for all three neuroendocrine markers. The percentage of lymph node metastasis was significantly lower in sNTP than in sTP and sSCLC. There was no significant difference in overall survival, but recurrence‐free survival (RFS) and tumor‐specific survival (TSS) were significantly poorer in sTP and sSCLC than in sNTP. Multivariate analysis revealed sTP and sSCLC were independent prognostic factors for poorer RFS and TSS than those of sNTP.ConclusionsThe sNTP subgroup had a good prognosis and the sTP subgroup a poor prognosis. There were some similarities in clinicopathological features between sTP and sSCLC.

Rhabdomyosarcoma is a well-known neoplasm in children that frequently occurs in the extremities, the head and neck region, and the genitourinary tract. To the best of our knowledge, pulmonary primary rhabdomyosarcoma in adults is exceedingly rare, and few resected cases have been reported. We report a case of pulmonary primary rhabdomyosarcoma that was surgically resected then treated with adjuvant chemotherapy (vincristine, actinomycin-D and cyclophosphamide). At 9 months after surgery, the patient is free from disease. Although the prognosis of rhabdomyosarcoma is unfavorable, surgical resection and adjuvant therapy could be a potential treatment strategy for pulmonary primary rhabdomyosarcoma.

High-grade neuroendocrine carcinomas (HGNECs) include Large-cell neuroendocrine carcinoma (LCNEC) and small-cell lung cancer (SCLC), which represent ∼18% of primary lung cancer. The mammalian Notch family ligands delta-like 3 (DLL3) is considered to be a potential therapeutic target for HGNECs. The clinicopathological significance of DLL3 for HGNEC was still unclear. We used the prospectively maintained database of Hyogo Cancer Center (Akashi, Japan), and reviewed the medical records of patients who underwent tumor resection and were diagnosed with HGNEC between January 2001 and December 2009. We performed immunohistochemistry for DLL3(E3J5R, monoclonal, 1:300 dilution, CST), and all samples were evaluated by an expert pathologist without knowledge of the patient’s outcome. The results were reported as negative (no positive cell) or positive (more than 1% positive cells). We investigated the correlation between the sensitivity of HGNEC to adjuvant chemotherapy and the results of immunohistochemical staining for DLL3. Overall survival (OS) and recurrence-free survival (RFS) was estimated by the Kaplan–Meier method, and differences in distribution were evaluated using the log-rank test. We identified 58 patients who underwent complete resection of the primary tumor and who were diagnosed with HGNEC (LCNEC n=39, SCLC n=19). The mean follow-up period was 50.9months. Twenty-one patients (LCNEC n=12, SCLC n=9) received adjuvant chemotherapy. All of them received platinum-based anticancer drugs. DLL3 was positive in 16 (51.7%) LCNEC patients and 14 (73.7 %) SCLC patients. The distribution of pathologic stage in DLL 3 positive and negative patients was stage I in 17 and 14 patients, stage II in 5 and 9 patients, and stage III in 8 and 5 patients. There was no significant difference in OS and RFS between DLL3 positive and negative patients (DLL3 positive vs. negative, 5-year OS: 40.0% vs. 39.3% p=0.79, 5-year RFS: 46.4% vs. 41.5% p=0.87). Amon patients with DLL3 positive tumors, no difference was found in 5-year OS and RFS between patients with adjuvant chemotherapy and those without adjuvant chemotherapy (Adjuvant chemotherapy vs. Surgery alone, 5-year OS: 57.1% vs. 25.0% p=0.28, 5-year RFS: 42.9% vs. 36.5% p=0.92). In contrast, when the tumors were negative for DLL3, a significantly greater 5-year OS and RFS was observed for the patients with adjuvant chemotherapy than for those without adjuvant chemotherapy (Adjuvant chemotherapy vs. Surgery alone: 5-year OS: 100.0% vs. 19.1% p<0.01, 5-year RFS: 85.8% vs. 33.3% p=0.02). DLL3 might be a predictive marker of sensitivity to adjuvant chemotherapy for HGNEC.

Background Large-cell neuroendocrine carcinoma (LCNEC) and small cell lung cancer (SCLC) are categorized as high-grade neuroendocrine carcinoma (HGNEC). We analyzed the efficacy of perioperative chemotherapy for HGNEC and the prognostic factors. Methods We retrospectively reviewed the medical records of patients who underwent tumor resection and were diagnosed with HGNEC between January 2001 and December 2014. The overall survival (OS) was estimated by the Kaplan-Meier method. Propensity score matching was performed to compare the OS between the treatment groups. Multivariate analyses using a Cox proportional hazards model were performed to search for prognostic factors for HGNEC. Results We analyzed 146 HGNEC patients (LCNEC n=92, SCLC n=54) without synchronous multiple cancers, who underwent complete resection. Seventy patients (LCNEC n=31, SCLC n=32) received perioperative chemotherapy and all of them received a platinum-based anticancer drug. Perioperative chemotherapy significantly improved the 5-year OS rates of HGNEC patients (all stages: 74.5% vs. 34.7%, P<0.01, stage I: 88.5% vs. 40.0%, P<0.01). The efficacy of perioperative chemotherapy was similar between LCNEC and SCLC patients [LCNEC all stages: hazard ratio (HR) 0.27, P<0.01, LCNEC stage I: HR 0.27, P=0.01; SCLC all stages: HR 0.38, P=0.02, SCLC stage I: HR 0.34, P=0.06]. The survival benefit of perioperative chemotherapy for HGNEC patients was confirmed by propensity score matching analysis (HR 0.31, P<0.01). The multivariate analysis revealed that perioperative chemotherapy (HR 0.29, P<0.01), sublobar resection (HR 2.11, P=0.04), and lymph node metastasis (HR 3.34, P<0.01) were independently associated with survival. Conclusions Surgical resection combined with perioperative chemotherapy was considered to be effective even for stage I HGNEC patients. Sublobar resection might increase the risk of death in HGNEC patients.

A 69-year-old man with hypertension was referred for an abnormal shadow detected on chest computed tomography(CT) at a medical checkup. Enhanced CT showed a highly enhanced posterior mediastinal tumor of 34×27 mm. Magnetic resonance imaging (MRI) revealed a low signal intensity on T1-weighted images and high signal intensity on T2-weighted images. Thus, a neurogenic tumor was suspected and the surgery was performed. The tumor was carefully dissected as it was hyper-vascular and hemorrhagic. Immediately after tumor resection, the patient's blood pressure rapidly decreased, and phenylephrine hydrochloride was needed to maintain the blood pressure. The pathological diagnosis was paraganglioma.

Background. Segmentectomy has shown a beneficial effect on preserving lung function after resection. However, the preservable lung volume and changes after thoracoscopic segmentectomy remain unknown. We compared the residual lung function after thoracoscopic segmentectomy and lobectomy, using a novel three-dimensional computed tomography-based volumetric method. Methods. Seventy-four patients who received thoracoscopic segmentectomy were matched to the 74 patients who received thoracoscopic lobectomy. Spirometry and computed tomography were performed before and 6 months after resection, and the ipsilateral residual preserved and nonoperated lobe volume and the contralateral lung volume were calculated using three-dimensional computed tomography. The percentage of actual/predicted regional forced expiratory volume in 1 second (the preservation rate) in each lobe (measured by volumetry and spirometry) was compared with the extent of resection and procedural difficulty (typical or atypical segmentectomy). Results. The postoperative lung function was significantly more well preserved in segmentectomy than in lobectomy. After segmentectomy and lobectomy, the regional forced expiratory volume in 1 second of the ipsilateral unaffected lobe was increased in comparison with the preoperative value, whereas that of the residual lobe rescued by segmentectomy was decreased. The preservation rates of the residual and unaffected lobes were inversely and positively correlated, respectively, with the extent of the resected segment. The preservation rates of the residual lobe after typical or atypical segmentectomy were not significantly different. Conclusions. Although the decrease in the actual lung function of the residual lobe was greater than predicted and increased with increasing extent of resection, segmentectomy preserved the whole lung function better than lobectomy. (C) 2019 by The Society of Thoracic Surgeons

There have been conflicting results about the clinical features and prognosis of primary lung cancer with cavity lesion (LC-CL). We, therefore, revisited the clinicopathological features of primary LC-CL and reassessed whether they exhibited poor prognosis in non-small-cell lung cancer. Between 2006 and 2014, 377 patients underwent complete resection for clinical T1aN0 non-small-cell lung cancer. Clinical stage was adapted to the seventh edition of the lung cancer stage classification system. Among these cases, 23 (6.1%) were diagnosed as LC-CL. We compared the characteristics and prognosis between LC-CL and the others. LC-CL showed higher CEA (≥5 ng/mL) (p<0.01), higher SUV max (≥2.5) (p=0.02), the status of smoking history (p<0.01), larger actual pathologic tumor size (≥3cm) (p<0.01), lymphatic invasion (p=0.03), as compared with the others. The overall and recurrence-free survival of the patients with LC-CL were shorter than those of the others (p=0.01 and 0.03, respectively). Univariate analysis revealed that sex (p=0.01), age (≥70) (p<0.01), CEA (p<0.01), SUV max (p<0.01), smoking history (p<0.01), pathologic tumor stage (≥Ⅱ) (p=0.01), vascular invasion (p<0.01), lymphatic invasion (p=0.04), pleural invasion (p<0.01) and cavity lesion (p=0.01) showed significant poor prognostic factors. Multivariate analysis revealed that age (p=0.02) and SUV max (p<0.01) remained significant prognostic factors, but cavity lesion was not significant (p=0.17). Although the value of its prognostic factor was not significant, primary LC-CL should be considered to have aggressive malignant behavior in non-small-cell lung cancer.

The concept of oligo-recurrence, which is theoretically curable by definitive local therapy, has been proposed in several cancers. But the efficacy of surgical resection for pulmonary oligo-recurrence of lung cancer is unclear. The aim of this study was to investigate the efficacy of surgical resection of pulmonary oligo-recurrence of non-small cell lung cancer (NSCLC). We retrospectively analyzed the data on 21 patients who underwent lung resection for pulmonary oligo-recurrence in our institution, between 2000 and 2016. We evaluated independent risk factors for progression-free survival after pulmonary resection. There were 14 men and 7 women with median age of 71 years [interquartile range (IQR), 65-72]. The median follow-up time was 48.8 months [IQR, 17.2-69.2]. Previous therapies for NSCLC were pulmonary resections in 16 (76.2%) patients, stereotactic radiosurgery for brain metastasis in 2 (9.5%), chemoradiotherapy in 2 (9.5%) and chemotherapy (ALK-TKI) in 1 (4.8%). Median progression-free interval between previous therapy and pulmonary resection of oligo-recurrence was 28.0 months [IQR, 16.0-40.0]. Histopathology was adenocarcinoma in 18 (85.9%) patients, squamous cell carcinoma, adenosquamous carcinoma and large cell neuroendocrine carcinoma in 1 (4.7 %). Surgical procedures were wedge resection in 11 patients, segmentectomy in 3, lobectomy in 5 and pneumonectomy in 2. There were no perioperative deaths. Three-year overall survival and progression-free survival were 68.6% and 59.3%. Postoperative recurrence occurred in 8 (38.1%) patients (local; 4, distant; 2, local and distant; 4). Univariate analyses identified progression-free interval between previous therapy and pulmonary resection of oligo-recurrence as independent risk factor for progression-free survival after pulmonary resection. Surgical resections of pulmonary oligo-recurrence of NSCLC are feasible and the postoperative survival is acceptable. But there are highly selective patients in our study, further study is needed for curative intent treatment.

We aimed to assess and compare ex vivo MRI of resected colorectal carcinoma before and after formalin fixation.

AbstractAims/IntroductionSodium–glucose cotransporter 2 inhibitors reduce bodyweight (BW) by creating a negative energy balance. Previous reports have suggested that this BW reduction is mainly loss of body fat and that ~20% of the reduction is lean mass. However, the effects of sodium–glucose cotransporter 2 inhibitors on BW and body composition remain unclear. We examined these effects in Japanese patients with type 2 diabetes mellitus treated with insulin.Materials and MethodsIn this open‐label, randomized controlled trial, 49 overweight patients (body mass index ≥23 kg/m2) with inadequate glycemic control (hemoglobin A1c >7.0%) receiving insulin treatment were randomly assigned to receive add‐on ipragliflozin or no additional treatment (control group). Patients were followed for 24 weeks. The goal for all patients was to achieve glycated hemoglobin <7.0% without hypoglycemia. The primary end‐point was a change in BW from baseline to week 24. Body composition was assessed with dual‐energy X‐ray absorptiometry and bioelectrical impedance analysis.ResultsBW change was significantly larger in the ipragliflozin group than in the control group (−2.78 vs −0.22 kg, P < 0.0001). Total fat mass was reduced evenly in the arms, lower limbs and trunk in the ipragliflozin group. Total muscle mass and bone mineral content were maintained, but muscle mass in the arms might have been affected by ipragliflozin treatment.ConclusionsIpragliflozin treatment for 24 weeks resulted in reduced BW, mainly from fat mass loss. Muscle mass and bone mineral content were maintained. Further study is necessary to elucidate the long‐term effects of ipragliflozin.