OBJECTIVES:Uniportal video-assisted thoracoscopic surgery (U-VATS) is gaining global recognition as a minimally invasive approach. However, its current status and issues in Japan remain unclear. This study aimed to assess U-VATS adoption and barriers among Japanese thoracic surgeons through a nationwide survey. METHODS:The Japanese Uniportal VATS Interest Group conducted an online survey of 3287 thoracic surgeons on the Japan Association for Chest Surgery mail list. Responses were collected from October 25 to November 30, 2024, yielding 851 valid responses (25.9%) from 497 institutions (78.0% of JACS-registered institutions). RESULTS:The adoption rate of U-VATS among the institutions was 42.5%. However, the proportions of thoracic surgeons who primarily performed lobectomy, segmentectomy, and wedge resection using U-VATS were 10.3%, 10.2%, and 22.0%, respectively. The main reasons for non-adoption included concerns regarding safety and surgical precision (57.2%), preference for other approaches (50.9%), and lack of instruments (48.8%). Among surgeons with no prior U-VATS experience, 34.1% were willing to adopt it. To facilitate broader adoption, respondents highlighted the need for troubleshooting resources (61.3%), high-precision surgical videos (59.0%), and hands-on training programs (51.5%). CONCLUSION:Despite the relatively high institutional adoption rate, the proportion of thoracic surgeons using U-VATS as the primary approach remained low. Key barriers include concerns about safety and surgical precision, limited educational opportunities, and a lack of scientific evidence on U-VATS in Japan. To promote the wider adoption of U-VATS, it is essential to develop structured educational programs and generate evidence to ensure both safety and surgical precision.

The blood-brain barrier (BBB) protects the brain from harmful substances, but it also limits drug delivery, hindering the treatment of brain diseases. Claudin 5, a tight junction protein in endothelial cells, plays a key role in maintaining the BBB integrity. Although modulation of Claudin 5 is a promising strategy for transiently opening the BBB, the currently available modulators often cause adverse effects due to strong or prolonged activity. Thus, we aimed to develop a moderate Claudin 5 modulator that enables safe and transient opening of the BBB. We identified a Claudin 5-binding small molecule (CL5B), capable of binding Claudin 5 via a high-throughput screening of 9600 compounds using a Claudin 5 antibody and proteoliposomes. CL5B increased endothelial permeability and tracer permeation across the endothelial monolayer by altering the localization of Claudin 5 without affecting its expression. In mice, CL5B transiently opened the BBB for less than 30 min, delivering drugs specifically to the brain. Notably, CL5B-facilitated delivery of methylscopolamine, a drug with limited brain penetration, alleviated seizure symptoms in a mouse epilepsy model. These findings demonstrate that CL5B is a safe BBB modulator that enhances brain drug delivery and holds therapeutic potential for brain diseases.

Objectives: Previous studies reported worse outcomes for radiographically central tumors, but the impact of pathologically confirmed tumor origin remains unclear. This study investigated whether pathologically determined inner lesions are associated with nodal upstaging and poorer prognosis than outer lesions, and examined segmentectomy feasibility versus lobectomy. Methods: We retrospectively analyzed participants with clinical stage IA (Union for International Cancer Control version 8) non-small cell lung cancer who underwent segmentectomy and lobectomy between November 2007 and December 2022 at 2 Japanese centers. The location of the tumor origin was confirmed pathologically via the Walter classification. Tumors classified as central and intermediate were allocated to the inner group, whereas those classified as peripheral type were allocated to the outer group. The oncologic outcomes were compared between the 2 groups. After propensity score matching analysis on the basis of sex, age, pulmonary function, serum carcinoembryonic antigen level, and radiographic findings, we compared oncologic outcomes in patients who underwent segmentectomy (n = 99) and lobectomy (n = 99) in the inner group. Results: The cohort comprised inner (n = 654) and outer (n = 1275) groups. Nodal upstaging was greater in the inner group (13.1% [86/654] vs 9.5% [121/1275], P = .015). Five-year recurrence-free survival (RFS) was lower in the inner group (73.1%; 95% CI, 69.4%-77.3% vs 79.4%; 95% CI, 76.7%-81.8%, P = .002). Multivariable analysis did not identify segmentectomy as significant for RFS (hazard ratio, 0.81; 95% CI, 0.58-1.13; P = .20). In matched inner lesions, segmentectomy and lobectomy showed similar RFS (83.6%; 95% CI, 76.3-93.1% vs 76.4%; 95% CI, 66.8-87.4%; P = .80). Conclusions: Although worse prognosis and increased nodal upstaging should be considered in inner primary tumors, segmentectomy is an acceptable treatment option compared with lobectomy for pathologically confirmed inner-located early-stage NSCLC.

Purpose To evaluate the safety and efficacy of new staple-line reinforcement (SLR) in pulmonary resection through a prospective study and to compare the results of this study with historical control data in an exploratory study. Methods The subjects of this study were 48 patients who underwent thoracoscopic lobectomy. The primary endpoint was air leakage from the staple line. The secondary endpoints were the location of air leakage, duration of air leakage, and postoperative pulmonary complications. Results The incidence of intraoperative air leakage from the staple line was 6.3%. Three patients had prolonged air leakage as a postoperative pulmonary complication. No malfunction was found in patients who underwent SLR with the stapling device. When compared with the historical group, the SLR group had a significantly lower incidence of air leakage from the staple line (6.3% vs. 28.5%, P < 0.001) and significantly shorter indwelling chest drainage time ( P = 0.049) and length of hospital stay ( P < 0.001). Conclusions The use of SLR in pulmonary resection was safe and effective. When compared with conventional products, SLR could control intraoperative air leakage from the staple line and shorten time needed for indwelling chest drainage and the length of hospital stay.

Accumulating evidence suggests that endothelial cells can be useful therapeutic targets. One of the potential targets is an endothelial cell-specific protein, Roundabout4 (ROBO4). ROBO4 has been shown to ameliorate multiple diseases in mice, including infectious diseases and sepsis. However, its mechanisms are not fully understood. In this study, using RNA-seq analysis, we found that ROBO4 downregulates prostaglandin-endoperoxide synthase 2 (PTGS2), which encodes cyclooxygenase-2. Mechanistic analysis reveals that ROBO4 interacts with IQ motif-containing GTPase-activating protein 1 (IQGAP1) and TNF receptor-associated factor 7 (TRAF7), a ubiquitin E3 ligase. In this complex, ROBO4 enhances IQGAP1 ubiquitination through TRAF7, inhibits prolonged RAC1 activation, and decreases PTGS2 expression in inflammatory endothelial cells. In addition, Robo4-deficiency in mice exacerbates PTGS2-associated inflammatory diseases, including arthritis, edema, and pain. Thus, we reveal the molecular mechanism by which ROBO4 suppresses the inflammatory response and vascular hyperpermeability, highlighting its potential as a promising therapeutic target for inflammatory diseases. ROBO4 suppresses PTGS2/COX-2 expression by inhibiting prolonged RAC1 activation in endothelial cells, ameliorating inflammatory diseases in mice; these endothelial molecules represent potential therapeutic targets for inflammatory diseases.

This study evaluated the efficacy of ninjin’yoeito for alleviating postoperative symptoms after lung cancer surgery. Overall, 140 patients who underwent lobectomy were randomized into a conventional treatment group and a ninjin’yoeito group. The primary endpoint was change in the Cancer Fatigue Scale (CFS) score from baseline and the secondary endpoints were the Cancer Dyspnea Scale (CDS) scores, the Kihon Checklist, and respiratory function. The mean change in the CFS score 8 weeks postoperatively was − 5.56 in the ninjin’yoeito group and − 5.53 in the conventional treatment group (P = 0.425), but this outcome did not meet the primary endpoint. Changes in the mean CDS scores 8 weeks postoperatively were − 5.60 and − 3.38 in the ninjin’yoeito and conventional groups, respectively, with a difference of − 1.95 (P = 0.049). The changes in the mean vital capacity 8 weeks postoperatively were − 340.5 mL in the ninjin’yoeito group and − 473.5 mL in the conventional treatment group, with a difference of + 135.1 mL (P = 0.041). The ninjin’yoeito group had a significantly lower proportion of patients with malnutrition 16 weeks postoperatively than the conventional treatment group (P = 0.040). The results of this study show that ninjin’yoeito is effective for alleviating respiratory symptoms and improving malnutrition after lung cancer surgery.

This study examined the learning curve of segmentectomy using the “fused surgery” approach. We retrospectively collected data from 100 patients who underwent segmentectomy via fused robot-assisted thoracoscopy at our institution between September 2020 and February 2024. The learning curve was evaluated using the cumulative sum of the operative times in all cases and was analyzed separately for simple and complex segmentectomies. After applying the cumulative sum method to all cases, we obtained a graph of the operative time that showed three well-differentiated phases: phase 1 (n = 23), the initial learning phase; phase 2 (n = 28), the increased competence phase; and phase 3 (n = 49), the highest skill phase. Comparing phases 1 and 2 with phase 3, we found significant differences in operative time (P < 0.001); however, no significant differences were observed in bleeding or rate of postoperative complications. We observed a significant reduction in operative time after 25 simple segmentectomies and 22 complex segmentectomies. The data suggested that the inflection point of the learning curve was achieved in 51 cases. Complex segmentectomy requires the same cases to achieve the same level of competence as simple segmentectomy.

PURPOSE:Robotic-assisted thoracoscopic surgery (RATS) is a relatively new approach to lung cancer surgery. To promote the development of RATS procedures, we investigated the factors related to short-term postoperative outcomes. METHODS:We analyzed the records of patients who underwent RATS lobectomy for primary lung cancer at our institution between June, 2018 and January, 2023. The primary outcome was operative time, and the estimated value of surgery-related factors was calculated by linear regression analysis. The secondary outcome was surgical morbidity and the risk was assessed by logistic regression analysis. RESULTS:The study cohort comprised 238 patients. Left upper lobectomy had the longest mean operative time, followed by right upper lobectomy. Postoperative complications occurred in 13.0% of the patients. Multivariate analysis revealed that upper lobectomy, the number of staples used for interlobular fissures, and the number of cases experienced by the surgeon were significantly associated with a longer operative time. The only significant risk factor for postoperative complications was heavy smoking. CONCLUSION:Patients with well-lobulated middle or lower lobe lung cancer who are not heavy smokers are recommended for the introductory period of RATS lobectomy. Improving the procedures for upper lobectomy and dividing incomplete interlobular fissures will promote the further development of RATS.

There is an urgent need to develop novel drugs to reduce the mortality from severe infectious diseases with the emergence of new pathogens, including Coronavirus disease 2019 (COVID-19). Although current drugs effectively suppress the proliferation of pathogens, immune cell activation, and inflammatory cytokine functions, they cannot completely reduce mortality from severe infections and sepsis. In this study, we focused on the endothelial cell-specific protein, Roundabout 4 (Robo4), which suppresses vascular permeability by stabilizing endothelial cells, and investigated whether enhanced Robo4 expression could be a novel therapeutic strategy against severe infectious diseases. Endothelial-specific overexpression of Robo4 suppresses vascular permeability and reduces mortality in lipopolysaccharide (LPS)-treated mice. Screening of small molecules that regulate Robo4 expression and subsequent analysis revealed that two competitive small mothers against decapentaplegic (SMAD) signaling pathways, activin receptor-like kinase 5 (ALK5)-SMAD2/3 and ALK1-SMAD1/5, positively and negatively regulate Robo4 expression, respectively. An ALK1 inhibitor was found to increase Robo4 expression in mouse lungs, suppress vascular permeability, prevent extravasation of melanoma cells, and decrease mortality in LPS-treated mice. The inhibitor suppressed severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)-induced endothelial barrier disruption and decreased mortality in mice infected with SARS-CoV-2. These results indicate that enhancing Robo4 expression is an efficient strategy to suppress vascular permeability and mortality in severe infectious diseases, including COVID-19, and that small molecules that upregulate Robo4 can be potential therapeutic agents against these diseases.

BackgroundSyphilis is a chronic disease that progresses in the primary, secondary, latent, and tertiary stages. Pulmonary manifestations of syphilis are rare, and their histological features have not been well-described.Case presentationA 78-year-old man was referred to our hospital because of a solitary nodular shadow in the right middle lung field on a chest radiograph. Five years prior, a rash appeared on both legs. He was tested for syphilis at a public health center, and the non-treponemal test result was negative. When he was approximately 35 years old, he had unspecified sexual intercourse. Chest computed tomography showed a 13-mm nodule with a cavity in S6 of the right lower lobe of the lung. Robot-assisted resection of the right lower lobe was performed because of suspected localized right lower lobe lung cancer. A cicatricial variant of organizing pneumonia (CiOP) was observed, and immunohistochemistry identified Treponema pallidum inside the macrophages in the nodule cavity. The rapid plasma regain (RPR) value was negative, and the Treponema pallidum hemagglutination assay was positive. The patient was diagnosed as having secondary syphilis with pulmonary involvement. Insidious progression of secondary syphilis may result in CiOP and a negative RPR test result.ConclusionsWe report the first case of pulmonary syphilis with a histological pattern of CiOP. It may be asymptomatic and difficult to diagnose because the RPR test may be negative for a long period of time. When either non-treponemal or treponemal test results are positive, the possibility of pulmonary syphilis should be considered along with appropriate medical treatment.

骨肉腫は小児および青年の長管骨に好発する．高齢者の肋骨に発生することは稀で，血胸で発見される肋骨原発骨肉腫はさらに稀である．症例は80歳，男性．労作時呼吸困難を主訴に前医を受診し，右血胸と胸壁腫瘍を認めたため胸腔ドレナージ後に当院へ転院した．胸部造影CT検査で右血胸と右胸壁に7.5 cm大の造影効果を伴う腫瘤を認めた．腫瘤は第7肋間から胸腔内外の両側へ隆起していた．緩徐な貧血の進行を認め，腫瘍からの持続性出血があると判断し，出血制御目的に胸壁腫瘍切除術を施行した．病理組織診断で肋骨原発骨肉腫と診断されたが，高齢のため術後化学療法は施行せず追加治療として放射線照射を施行した．術後1年経過し再発は認めていない．肋骨原発骨肉腫は稀であるが，胸壁腫瘍の鑑別の一つとして考慮する必要がある．

Many effective vaccines against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) have been developed, but a weaker response in individuals undergoing anticancer treatment has been reported. This study evaluates the immunogenic status and safety of SARS-CoV-2 vaccines for patients with non-small-cell lung cancer (NSCLC), receiving tegafur–uracil (UFT) as postoperative adjuvant chemotherapy. The subjects of this prospective study were 40 patients who underwent surgery for NSCLC and received SARS-CoV-2 vaccines postoperatively. We compared the antibody titers of SARS-CoV-2 vaccines and the adverse events between patients who received adjuvant UFT and patients who did not. The mean anti-S1 IgG titers were not significantly different between the UFT and without-UFT groups (mean optimal density, 0.194 vs. 0.205; P = 0.76). Multivariate analysis identified the period after the second vaccination as an independent predictor of anti-S1 IgG titer (P = 0.049), but not the UFT status (with or without-UFT treatment; P = 0.47). The prevalence of adverse events did not differ significantly between the groups, and no severe adverse events occurred. The efficacy and safety of the SARS-CoV-2 vaccines for NSCLC patients who received postoperative adjuvant UFT chemotherapy were comparable to those for NSCLC patients who did not receive postoperative adjuvant UFT chemotherapy. This study was registered with the University Hospital Medical Information Network (UMIN) in Japan (UMIN000047380).

Curcumin (CUR), a polyphenol, is an attractive component of functional foods, owing to various physiological activities. However, CUR is highly hydrophobic, insoluble in water, and difficult to absorb in the body. Here, we report an amorphous CUR formulation containing the dispersant polyglycerol fatty acid ester (PGFE), demonstrating high and stable water solubility. Improved water solubility enhanced the absorbability of CUR in our amorphous formulation along with enhanced triglyceride inhibition, compared to that in a commercial formulation. Nuclear Overhauser effect spectroscopy (NOESY) analysis revealed that PGFE reduced CUR-CUR interaction, resulting in higher dispersion and improved solubility of CUR. Taylor dispersion analysis showed a lower diffusion coefficient of CUR in the highly water-soluble formulation (with PGFE) than that in the low water-soluble formulation (without PGFE), which prevents recontact and recrystallization of CUR, which is trapped by PGFE. Overall, the amorphous CUR with high solubility could be used as a promising functional food.

Abstract Background Identifying the preoperative risk factors for lymph node upstaging could contribute to the development of individualized perioperative treatment for patients with non‐small cell lung cancer (NSCLC). The current study aimed to evaluate the risk factors for lymph node upstaging, including gene mutation and programmed death ligand‐1 expression in patients with resectable NSCLC. Methods Data on the clinicopathological characteristics of patients who underwent lobectomy for clinical N0 NSCLC at our institution were collected. The clinicopathological findings of the pathological N0 and lymph node upstaging groups were then analyzed. Univariate and multivariate analyses were performed to examine the predictive factors for nodal upstaging. Results Of 291 patients, 40 had postoperative nodal upstaging (n = 25, N1; n = 15, N2). Large tumor size and high maximum standardized uptake value were significantly associated with nodal upstaging. The nodal upstaging group had a higher proportion of patients with solid adenocarcinoma and lymphatic, vascular, and pleural invasion than the pathological N0 group. Further, the nodal upstaging group had a higher proportion of patients with positive programmed death ligand‐1 expression than the pathological N0 group. Univariate and multivariate analyses showed that tumor size and positive programmed death ligand‐1 expression were associated with nodal upstaging. Conclusion The appropriate therapeutic strategy including preoperative treatment and resection should be cautiously considered preoperatively in patients with clinical N0 NSCLC who have large tumors and positive programmed death ligand‐1 expression.

Knowledge of the histologic type and primary origin of pulmonary tumors is essential when preparing a surgical strategy. Intraoperative diagnosis of hematoxylin and eosin (H&E)-stained frozen sections is the gold standard, but reliable pathology requires time-consuming immunohistochemistry (IHC) to distinguish among histological types/organ origins and to analyze molecular status. The aim of this study was to evaluate the clinical reliability of a new rapid-IHC technique for intraoperative diagnosis of pulmonary tumors. In total, 169 patients with undiagnosed pulmonary tumors were enrolled in a multicenter prospective observational study. At three institutes, pulmonary tumor samples were collected through core needle biopsy and/or surgery to determine surgical strategies. Using a new device for rapid IHC, we applied a high-voltage, low-frequency alternating current (AC) field, which mixes the available antibody as the voltage is switched on/off. Rapid IHC can provide tumor histologic type/origin diagnoses within 20 min, as opposed to the 3-6 h required for conventional IHC. No false diagnoses of malignancy were rendered in any of the cases when using simple H&E staining. With H&E staining alone, the overall definitive diagnosis rate, the rate of defined tumor origin, and the rate of determined histological type were 76.92%, 85.80%, and 90.53%, respectively. When rapid IHC was added, those rates were significantly improved to 88.76%, 94.67%, and 91.72%, respectively. By providing prompt and accurate intraoperative histological/molecular analysis, rapid IHC driven by AC mixing could serve as an effective clinical tool guiding the surgical strategy for undiagnosed pulmonary tumors.

Objective: The human epidermis is formed by the proliferation and differentiation of keratinocytes adjacent to the basement membrane. The outermost layer. the stratum corneum, is equipped with a barrier function that prevents water evaporation, and intercellular lipids play an important role in this harrier function. When the barrier is functioning normally, evaporation is prevented; however, when barrier function is impaired, moisture evaporates, resulting in dry and rough skin. Therefore, maintenance of normal barrier function is critical for maintaining normal skin function. Peroxisome proliferator-activated receptor alpha (PPAR alpha) is mainly not only involved in lipid metabolism in the liver but is also expressed in the epidermis and is involved in inducing keratinocyte differentiation, promoting lipid production, maintaining barrier function and suppressing skin inflammation. Hence, compounds that activate PPAR alpha are expected to control skin function. Therefore, we identified PPAR alpha activators from among extracts of natural resources that have been approved for use in humans and analysed the effects of these extracts on skin function. Methods: First, extracts of 474 natural resources were screened using a PPAR alpha activator screening cell line independently constructed in our laboratory. Next, reporter assays were performed using the Ga14-chimera system to evaluate whether these extracts act as ligands for PPAR alpha. We then analysed their effect on primary normal human epidermal keratinocyte cells by using real-time RT-PCR. Finally, we evaluated PPAR alpha activation effect by the combination of these extracts. Results: We identified 36 extracts having the effect of activating PPAR alpha. In particular, #419, a Typha angustifolia spike extract, showed concentration-dependent transcriptional activation through PPAR alpha-LBD and was considered to be likely to contain a compound that is a ligand of PPAR alpha. #419 increased the expression of PPAR alpha target genes and genes related to skin function in primary cultured human epidermal keratinocytes. Finally, the use of #419 in combination with nine extracts increased PPAR activity more than twice as much as #419 alone treatment. Conclusions: These results showed that the reporter cell line could be useful for discovering extracts of natural resources and that the identified Typha angustifoha spike extract could he used in cosmetics that activate PPAR alpha, which expected to improve skin function.

Background Myasthenia gravis (MG) is the most common paraneoplastic syndrome in thymoma. However, the association between MG and postoperative outcomes is controversial. Therefore, we examined the effect of MG on the surgical outcomes of patients with thymoma. Methods This study enrolled 145 consecutive patients with thymoma who underwent surgical resection at our institution between January 2000 and December 2020. The patients were classified into thymoma with MG (MG group) and without MG (non-MG group). Data about characteristics of patients, surgical outcomes, and prognostic factors were compared between the two groups. Results Of 145 patients, 47 (32%) presented with MG and 98 (68%) did not. There was no significant difference in terms of the incidence of postoperative complications, overall survival (OS), and recurrence-free survival (RFS) between the two groups. The deaths were not caused by thymoma. Among the patients aged >60 years, the MG group had a lower survival rate than the non-MG group. In the univariate analysis, age ≥60 years was a poor prognostic factor for OS, whereas in the multivariate analysis, Masaoka stage III and IV classifications were poor prognostic factors for RFS. Conclusion The incidence of postoperative complications did not differ between patients with thymoma and without MG. In the MG group, age ≥60 years was a poor prognostic factor for OS. The postoperative follow-up of patients aged ≥60 years with thymoma with MG should focus on not only recurrence but also progression of diseases other than thymoma.

AbstractBackgroundThe number of surgical procedures has increased among patients with early‐stage lung cancer. If the poor prognostic factors for stage I non‐small cell lung cancer (NSCLC) can be simply validated preoperatively, appropriate treatment will be provided. The current study aimed to evaluate the prognostic value of preoperative plasma fibrinogen levels in patients with resected stage I NSCLC.MethodsWe retrospectively analyzed the clinicopathological information of patients (n = 149) who underwent lobectomy for stage I NSCLC between May 2014 and July 2016. Data about peripheral blood analysis, histopathological finding, and follow‐up assessment results were collected from the databases. Patients were divided into the low and high fibrinogen groups. Univariate and multivariate analyses were performed to evaluate the predictors of recurrence and survival.ResultsCompared with the low fibrinogen group (<377 mg/dl), the high fibrinogen group (≥377 mg/dl) had a significantly greater number of male participants (p = 0.04), smokers (p < 0.001), and those with elevated cytokeratin antigen levels (p = 0.04), lymphatic invasion (p = 0.007), and squamous cell carcinoma (p < 0.001). Plasma fibrinogen level was considered a significant independent factor for recurrence and overall survival on both the univariate and multivariate analyses (p < 0.001 and p = 0.010) and the multivariate analysis alone (p = 0.020 and p < 0.012).ConclusionPreoperative plasma fibrinogen level might be a useful predictor of recurrence and survival in patients with stage I NSCLC. The treatment strategy for patients with high fibrinogen levels could be cautiously considered preoperatively.

症例は16歳男性．学校健診の胸部X線で異常陰影を指摘され精査加療目的に当院紹介となった．胸部CTでは右下葉S9，10に28 mm大の境界明瞭な結節影を認め，周囲に低吸収領域を伴っておりair trappingを疑う肺構造変化を認めた．胸部MRIではT1WI・T2WIともに高信号を示す境界明瞭・分葉状の結節を認めた．年齢・病歴・画像所見から先天性気管支閉鎖症が疑われた．病変およびその周囲が難治性感染症の温床となる可能性が危惧されたため，外科的治療の方針とした．手術は胸腔鏡下でアプローチした．右下葉S8，9，10臓側胸膜は肥厚していた．S7領域は肉眼的に異常を認めなかったが，B7区域気管支周囲は高度の炎症性変化を認め剥離困難であったため，底区域切除術を施行した．術後経過は良好であった．無症状で発見された先天性気管支閉鎖症に対して胸腔鏡下右底区域切除術を施行した一例を経験したため報告する．