並列タイトル等Altered lymphatic structure and function in pleural anthracosis: Negative role in skip N2 metastasis
学位博士(医学)
Doctor of Philosophy in Medical Science
一般注記博士論文全文, 博士論文要旨, 最終試験結果の要旨, 論文審査の要旨
OBJECTIVES: The present study investigated whether or not pleural anthracosis is associated with changes in the pleural lymphatic structures or function, which would interfere with nodal skip metastasis.
METHODS: This study comprised 2 different case series. In the first series, we observed pleural lymphatic drainage using near-infrared fluorescent endoscopy by the subpleural injection of indocyanine green immediately after thoracotomy for lung cancer. We also performed a histological assessment of the pleura. In the second series, we reviewed the nodal metastatic pattern (skip or non-skip metastasis) in pathological N2 lung cancer involving the pleura. These findings were compared with the severity of pleural anthracosis, which was quantified by thoracoscopic vision and a software-based imaging analysis.
RESULTS: In the first series (n = 42), pleural lymphatic drainage was not visualized in 19 (45%) patients who had relatively severe anthracosis, while it was visualized in the remaining 23 (55%) patients who had relatively minimal anthracosis. Histologically, severe anthracosis was associated with pleural thickening accompanied by a decreased incidence of straight-running lymphatic vessels and, in turn, an increased incidence of short lymphatic vessels, which was suggested to be the result of pleural remodelling. In the second series (n = 53), a skip metastatic pattern was found in 24 (45%) patients who predominantly had less-severe anthracosis, while a non-skip metastatic pattern was found in 29 (55%) patients who predominantly had severe anthracosis.
CONCLUSIONS: Pleural anthracosis was associated with pathological changes in the pleural lymphatics and decreased pleural lymphatic drainage, thereby interfering with nodal skip metastasis.
This is a pre-copyedited, author-produced version of an article accepted for publication in [European Journal of Cardio-Thoracic Surgery] following peer review. The version of record [Aya Takeda, Kazuhiro Ueda, Masaya Aoki, Toshiyuki Nagata, Go Kamimura, Tadashi Umehara, Takuya Tokunaga, Kazuhiro Tabata, Akihide Tanimoto, Masami Sato, "Altered lymphatic structure and function in pleural anthracosis: negative role in skip N2 metastasis"; European Journal of Cardio-Thoracic Surgery 2022, 62(3), ezac123] is available online at: https://academic.oup.com/ejcts/article/62/3/ezac123/6535926 [https://doi.org/10.1093/ejcts/ezac123].
連携機関・データベース国立情報学研究所 : 学術機関リポジトリデータベース（IRDB）（機関リポジトリ）