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A 66-year-old woman underwent right lower lobectomy and partial resection of the middle lobe for Stage I A double lung cancer. Five years after the operation, a routine computed tomography (CT) scan showed a mass on the staple line at the middle lobe. The mass was enlarged on CT scan after 6 months. A definitive diagnosis could not be made by bronchoscopic examination and fluoro-2-deoxy-glucose(FDG)/positron emission tomography( PET)-CT showed FDG uptake in the mass( early phase:SUVmax=3.24, late phase:SUVmax=4.31). Local recurrence of lung cancer was not completely denied, and right middle lobectomy was performed. Histopathologically, the resected specimen revealed granuloma with foreign body reaction. We should keep in mind the possibility of granuloma as differential diagnosis of lung cancer when using stapler.

Anastomotic airway complications still remain an important issue after lung transplantation. Most of the complications are stenosis and anastomotic leakage. Stent insertion is one option for the stenosis. We review the anastomotic airway complications and report our recent experience of stent insertion using 3-dimensional printed airway model.

The number of patients with cardiovascular comorbidities is increasing due to aged society. We evaluated perioperative management of primary lung cancer patients with cardiovascular comorbidities. Between 2010 and 2013, 458 patients underwent lung cancer surgery at out hospital. 60(13%)patients had cardiovascular comorbidities (excluding hypertension and arrhythmia). Forty three(72%) patients were angina pectoris and myocardial infarction, and 7 (12%)were valve disease. In patients with cardiovascular comorbidities, high age, renal dysfunction, low % diffusing capacity for carbon monoxide and limited lymph node dissection were significantly seen. There was one patient with no symptoms of angina with the calcification of coronary artery detected by chest computed tomography(CT)before surgery. Percutaneous coronary artery intervention followed elective lung surgery was successfully performed. Short-term surgical results of patients with cardiovascular comorbidities were acceptable compared to those without.

This study describes minimally invasive surgery using video-assisted thoracic surgery (VATS) for thymic diseases. Our procedure has been changed in the last decade from sternum-lifting thoracoscopic surgery with mini-thoracotomy to complete thoracoscopic surgery. Indications for this method include benign thymic disease, non-invasive thymoma or myasthenia gravis (MG). We performed these procedures for 27 cases, including 12 cases of thymic cyst, 10 cases of thymoma without MG, 3 cases of thymoma with MG and 2 cases of MG alone. In all cases of thymoma, tumor size was less than 5 cm. Complete VATS, VATS with mini-thoracotomy and sternum-lifting VATS were performed in 20, 4 and 3 patients, respectively. Complications were phrenic nerve palsy in 2 cases and postoperative bleeding in 1 case. We always use ultrasonic devices in this procedure. No recurrences have been identified in any cases. Even though definitive evidence is lacking for use of a unilateral approach with VATS for thymoma and MG, VATS thymectomy appears acceptable as a less-invasive procedure with less pain and rapid recovery.