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General Thoracic and Cardiovascular Surgery

, Volume 62, Issue 12, pp 734–764 | Cite as

Thoracic and cardiovascular surgery in Japan during 2012

Annual report by The Japanese Association for Thoracic Surgery
  • Committee for Scientific Affairs, The Japanese Association for Thoracic Surgery
  • Munetaka Masuda
  • Hiroyuki Kuwano
  • Meinoshin Okumura
  • Jun Amano
  • Hirokuni Arai
  • Shunsuke Endo
  • Yuichiro Doki
  • Junjiro Kobayashi
  • Noboru Motomura
  • Hiroshi Nishida
  • Yoshikatsu Saiki
  • Fumihiro Tanaka
  • Kazuo Tanemoto
  • Yasushi Toh
  • Hiroyasu Yokomise
Open Access
ANNUAL REPORT
The Japanese Association for Thoracic Surgery has conducted annual surveys of thoracic surgery throughout Japan since 1987 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 2012.

Table 1 Questionnaires sent out and received back by the end of December 2013

 

Sent out

Returned

Response rate (%)

(A) Cardiovascular surgery

601

583

97.0

(B) General thoracic surgery

802

777

96.9

(C) Esophageal surgery

582

555

95.4

Table 2 Categories subclassified according to the number of operations performed

Number of operations performed

Category

Cardiovascular surgery

General thoracic surgery

0

39

41

1–24

46

92

25–49

99

92

50–99

163

193

100–149

86

134

150–199

60

107

≧200

90

118

Total

583

777

Number of operations performed

Esophageal surgery

0

86

1–4

99

5–9

81

10–19

105

20–29

48

30–39

35

40–49

30

≧50

71

Total

555

Fig. 1

Cardiovascular surgery, IHD ischemic heart disease

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 the 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.

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 Congenital (total; 9,558)

(1) CPB (+) (total; 7,171)

  

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

15

0

0

0

2

0

0

0

4

0

0

0

24

1 (4.2)

0

1 (4.2)

45

1 (2.2)

0

1 (2.2)

2

Coarctation (simple)

7

0

0

0

13

0

0

0

17

0

0

0

7

0

0

0

44

0

0

0

3

 +VSD

32

2 (6.3)

0

2 (6.3)

34

0

0

0

8

0

0

0

2

0

0

0

76

2 (2.6)

0

2 (2.6)

4

 +DORV

2

0

0

1 (50.0)

3

0

0

0

2

0

0

0

0

0

0

0

7

0

0

1 (14.3)

5

 +AVSD

5

0

0

0

4

0

0

0

1

0

0

0

0

0

0

0

10

0

0

0

6

 +TGA

3

1 (33.3)

0

1 (33.3)

3

0

0

0

1

0

0

0

0

0

0

0

7

1 (14.3)

0

1 (14.3)

7

 +SV

9

2 (22.2)

0

2 (22.2)

7

0

0

0

4

0

0

0

0

0

0

0

20

2 (10.0)

0

2 (10.0)

8

 +Others

2

0

0

0

5

0

0

0

4

0

0

0

1

0

0

0

12

0

0

0

9

Interrupt. of Ao (simple)

1

0

0

0

2

1 (50.0)

0

1 (50.0)

2

0

0

0

1

0

0

0

6

1 (16.7)

0

1 (16.7)

10

 +VSD

25

2 (8.0)

0

2 (8.0)

16

0

0

0

4

0

0

0

10

0

0

0

55

2 (3.6)

0

2 (3.6)

11

 +DORV

3

1 (33)

0

1 (33.3)

4

0

0

0

2

0

0

0

0

0

0

0

9

1 (11.1)

0

1 (11.1)

12

 +Truncus

2

1 (50.0)

0

1 (50.0)

2

0

0

0

0

0

0

0

0

0

0

0

4

1 (25.0)

0

1 (25.0)

13

 +TGA

2

0

0

0

1

0

0

0

0

0

0

0

0

0

0

0

3

0

0

0

14

 +Others

4

0

0

0

10

1 (10.0)

0

1 (10.0)

2

0

0

0

1

0

0

0

17

1 (5.9)

0

1 (5.9)

15

Vascular ring

0

0

0

0

4

0

0

0

3

0

0

0

0

0

0

0

7

0

0

0

16

PS

1

0

0

0

15

0

0

0

14

0

0

0

4

0

0

1 (25.0)

34

0

0

1 (2.9)

17

PAIVS or critical PS

12

0

0

0

50

1 (2.0)

0

1 (2.0)

55

0

0

0

2

0

0

1 (50.0)

119

1 (0.8)

0

2 (1.7)

18

TAPVR

126

9 (7.1)

0

15 (11.9)

49

1 (2)

2 (4.08)

2 (4.1)

8

0

0

0

0

0

0

0

183

10 (5)

2 (1.1)

17 (9)

19

PAPVR ± ASD

0

0

0

0

4

0

0

0

52

0

0

0

29

0

0

0

85

0

0

0

20

ASD

11

1 (9.1)

0

1 (9.1)

54

0

0

0

693

0

0

0

573

2 (0.3)

1 (0.2)

2 (0.3)

1,331

3 (0.2)

1 (0.08)

3 (0.2)

21

Cor triatriatum

1

0

0

0

13

2 (15.4)

0

2 (15.4)

3

0

0

0

4

0

0

0

21

2 (9.5)

0

2 (9.5)

22

AVSD (partial)

1

1 (100.0)

0

1 (100.0)

19

1 (5.3)

0

1 (5.3)

40

0

0

0

13

0

0

0

73

2 (2.7)

0

2 (2.7)

23

AVSD (complete)

4

0

0

1 (25.0)

108

5 (4.6)

0

5 (4.6)

69

0

0

0

4

0

0

0

185

5 (2.7)

0

6 (3.2)

24

 +TOF or DORV

0

0

0

0

6

1 (16.7)

0

2 (33.3)

21

0

0

0

3

0

0

0

30

1 (3.3)

0

2 (6.7)

25

 +Others

1

0

0

0

10

1 (10.0)

0

1 (10.0)

8

0

0

0

1

0

0

0

20

1 (5.0)

0

1 (5.0)

26

VSD (subarterial)

3

0

0

0

128

0

0

0

197

0

0

0

29

0

0

0

357

0

0

0

27

VSD (perimemb./muscular)

10

0

0

0

770

0

1 (0.13)

0

390

0

0

0

90

0

0

0

1,260

0

1 (0.1)

0

28

VSD + PS

0

0

0

0

39

0

0

0

33

0

0

0

7

0

0

0

79

0

0

0

29

DCRV ± VSD

2

0

0

0

16

0

0

0

39

0

0

0

19

0

0

0

76

0

0

0

30

Aneurysm of sinus valsalva

0

0

0

0

6

0

0

0

1

0

0

0

24

0

0

0

31

0

0

0

31

TOF

15

1 (6.7)

0

1 (6.7)

168

0

0

0

231

2 (0.9)

0

2 (0.9)

22

0

0

2 (9.1)

436

3 (0.7)

0

5 (1.1)

32

PA + VSD

4

0

0

0

78

1 (1.3)

0

1 (1.3)

125

3 (2.4)

0

5 (4.0)

9

0

0

0

216

4 (1.9)

0

6 (2.8)

33

DORV

17

1 (5.9)

0

1 (5.9)

91

1 (1.1)

0

3 (3.3)

112

2 (1.8)

0

2 (1.8)

3

1 (33.3)

0

1 (33.3)

223

5 (2.2)

0

7 (3.1)

34

TGA (simple)

101

2 (2.0)

0

3 (3.0)

12

0

0

0

0

0

0

0

4

0

0

0

117

2 (1.7)

0

3 (2.6)

35

 +VSD

44

1 (2.3)

0

1 (2.3)

17

1 (5.9)

0

1 (5.9)

2

0

0

0

0

0

0

0

63

2 (3.2)

0

2 (3.2)

36

 VSD + PS

4

0

0

0

8

0

0

0

26

0

0

0

2

0

0

0

40

0

0

0

37

Corrected TGA

2

0

0

0

11

0

0

0

42

1 (2.4)

0

1 (2.4)

13

0

0

0

68

1 (1.5)

0

1 (1.5)

38

Truncus arteriosus

4

0

0

0

26

2 (7.7)

0

3 (11.5)

12

0

0

0

1

0

0

0

43

2 (4.7)

0

3 (7.0)

39

SV

27

5 (18.5)

0

8 (29.6)

219

7 (3.2)

0

11 (5.0)

282

4 (1.4)

0

9 (3.2)

21

2 (9.5)

0

2 (9.5)

549

18 (3.3)

0

30 (5.5)

40

TA

2

0

0

0

30

0

0

0

53

0

0

0

5

0

0

0

90

0

0

0

41

HLHS

45

10 (22.2)

0

10 (22.2)

130

11 (8.5)

1 (0.77)

15 (11.5)

71

0

0

0

0

0

0

0

246

21 (8.5)

1 (11.7)

25 (10.2)

42

Aortic valve lesion

7

3 (42.9)

0

3 (42.9)

16

0

0

0

75

3 (4.0)

0

3 (4.0)

19

1 (5.3)

0

1 (5.3)

117

7 (6.0)

0

7 (6.0)

43

Mitral valve lesion

2

1 (50.0)

0

1 (50.0)

56

0

0

2 (3.6)

75

1 (1.3)

0

1 (1.3)

14

0

0

0

147

2 (1.4)

0

4 (2.7)

44

Ebstein

10

1 (10.0)

0

1 (10.0)

17

1 (5.9)

0

1 (5.9)

31

0

0

0

12

0

0

0

70

2 (2.9)

0

2 (2.9)

45

Coronary disease

0

0

0

0

11

0

0

0

16

0

0

0

13

0

0

0

40

0

0

0

46

Others

11

0

0

1 (9.1)

27

3 (11.1)

0

3 (11.1)

34

2 (5.9)

0

2 (5.9)

14

0

0

0

86

5 (5.8)

0

6 (7.0)

47

Redo VSD

0

0

0

0

6

0

0

0

10

0

0

0

7

0

0

0

23

0

0

0

48

PS release

0

0

0

0

8

0

0

0

42

0

0

0

23

0

0

0

73

0

0

0

49

RV-PA conduit replace

0

0

0

0

3

0

0

0

68

1 (1.5)

0

1(1.5)

17

0

0

1 (5.9)

88

1 (1.1)

0

2 (2.3)

50

Others

1

0

0

0

62

6 (9.7)

0

7 (11.3)

121

2 (1.7)

0

4 (3.3)

46

1 (2.2)

0

1 (2.2)

230

9 (3.9)

0

12 (5.2)

Total

 

580

45 (7.8)

0

58 (10.0)

2,393

47 (2.0)

4 (0.17)

63 (2.6)

3,105

21 (0.7)

0

30 (1.0)

1,093

8 (0.7)

1 (0.1)

13 (1.2)

7,171

121 (1.7)

5 (0.1)

164 (2.3)

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., interrupted aortic arch, 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; 2,387)

  

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

358

2 (0.6)

0

3 (0.8)

225

0

0

2 (0.9)

46

0

0

0

1

0

0

0

630

2 (0.3)

0

5 (0.8)

2

Coarctation (simple)

21

0

0

0

14

0

0

0

4

0

0

0

1

0

0

0

40

0

0

0

3

 +VSD

38

1 (2.6)

1 (2.6)

1 (2.6)

26

1 (3.8)

0

1 (3.8)

0

0

0

0

0

0

0

0

64

2 (3.1)

1 (1.6)

2 (3.1)

4

 +DORV

5

0

0

1 (20.0)

2

0

0

0

0

0

0

0

0

0

0

0

7

0

0

1 (14.3)

5

 +AVSD

5

1 (20.0)

0

1 (20.0)

0

0

0

0

0

0

0

0

0

0

0

0

5

1 (20.0)

0

1

6

 +TGA

7

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

7

0

0

0

7

 +SV

5

0

0

0

2

0

0

0

0

0

0

0

0

0

0

0

7

0

0

0

8

 +Others

4

0

0

0

2

0

0

0

0

0

0

0

0

0

0

0

6

0

0

0

9

Interrupt. of Ao (simple)

1

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

1

0

0

0

10

 +VSD

21

0

0

1 (4.8)

5

0

0

0

2

0

0

0

0

0

0

0

28

0

0

1 (3.6)

11

 +DORV

4

1 (25)

0

2 (50)

0

0

0

0

0

0

0

0

0

0

0

0

4

1 (25)

0

2 (50)

12

 +Truncus

3

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

3

0

0

0

13

 +TGA

2

0

0

0

1

0

0

0

0

0

0

0

0

0

0

0

3

0

0

0

14

 +Others

7

0

0

1 (14.3)

0

0

0

0

0

0

0

0

0

0

0

0

7

0

0

1 (14.3)

15

Vascular ring

1

0

0

0

12

1 (8.3)

0

1 (8.3)

9

0

0

0

0

0

0

0

22

1 (4.5)

0

1 (4.5)

16

PS

0

0

0

0

1

0

0

0

0

0

0

0

0

0

0

0

1

0

0

0

17

PAIVS or critical PS

30

3 (10.0)

0

3 (10.0)

26

0

0

0

3

0

0

0

2

0

0

0

61

3 (4.9)

0

3 (4.9)

18

TAPVR

1

0

0

0

2

0

0

0

0

0

0

0

0

0

0

0

3

0

0

0

19

PAPVR ± ASD

0

0

0

0

0

0

0

0

0

0

0

0

1

0

0

0

1

0

0

0

20

ASD

0

0

0

0

0

0

0

0

12

0

0

0

15

0

0

0

27

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

22

AVSD (partial)

2

0

0

0

4

0

0

0

1

0

0

0

0

0

0

0

7

0

0

0

23

AVSD (complete)

32

0

0

0

68

0

0

1 (1.5)

4

0

0

0

0

0

0

0

104

0

0

1 (1.0)

24

 +TOF or DORV

3

0

0

0

13

1 (7.7)

0

1 (7.7)

6

0

0

0

0

0

0

0

22

1 (4.5)

0

1 (4.5)

25

 +Others

3

1 (33.3)

0

1 (33.3)

4

0

0

0

2

0

0

0

0

0

0

0

9

1 (11.1)

0

1 (11.1)

26

VSD (subarterial)

2

0

0

0

11

0

0

0

2

0

0

0

2

0

0

0

17

0

0

0

27

VSD (perimemb./muscular)

38

0

0

0

117

1 (0.9)

0

3 (2.6)

5

0

0

0

1

0

0

0

161

1 (0.6)

0

3 (1.9)

28

VSD + PS

0

0

0

0

1

0

0

0

0

0

0

0

0

0

0

0

1

0

0

0

29

DCRV ± VSD

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

30

Aneurysm of sinus valsalva

1

0

0

0

0

0

0

0

0

0

0

0

1

0

0

0

2

0

0

0

31

TOF

24

0

0

0

100

2 (2.0)

0

2 (2.0)

13

0

0

0

4

0

0

0

141

2 (1.4)

0

2 (1.4)

32

PA + VSD

26

0

0

0

83

0

0

0

15

0

0

0

1

0

0

0

125

0

0

0

33

DORV

27

0

0

0

55

1 (1.8)

0

2 (3.6)

14

0

0

0

2

0

0

0

98

1 (1.0)

0

2 (2.0)

34

TGA (simple)

7

0

0

0

1

0

0

0

1

0

0

0

1

0

0

0

10

0

0

0

35

 +VSD

7

0

0

0

3

0

0

0

0

0

0

0

0

0

0

0

10

0

0

0

36

 VSD + PS

9

1 (11.1)

0

1 (11.1)

5

0

0

0

2

0

0

0

0

0

0

0

16

1 (6.3)

0

1 (6.3)

37

Corrected TGA

8

0

0

0

18

1 (5.6)

0

1 (5.6)

4

0

0

0

0

0

0

0

30

1 (3.3)

0

1 (3.3)

38

Truncus arteriosus

20

0

0

1 (5.0)

1

0

0

0

5

0

0

0

0

0

0

0

26

0

0

1 (3.8)

39

SV

72

2 (2.8)

0

3 (4.2)

57

1 (1.8)

0

3 (5.3)

21

1 (4.8)

0

1

3

1 (33.3)

0

1 (33.3)

153

5 (3.3)

0

8 (5.2)

40

TA

18

0

0

0

20

0

0

0

12

0

0

0

1

0

0

0

51

0

0

0

41

HLHS

81

2 (2.5)

0

3 (3.7)

19

0

0

0

3

0

0

0

0

0

0

0

103

2 (1.9)

0

3 (2.9)

42

Aortic valve lesion

4

0

0

0

2

0

0

0

4

0

0

0

2

0

0

0

12

0

0

0

43

Mitral valve lesion

0

0

0

0

0

0

0

0

1

0

0

0

0

0

0

0

1

0

0

0

44

Ebstein

6

1 (16.7)

0

2 (33.3)

4

0

0

0

1

0

0

0

3

0

0

0

14

1 (7.1)

0

2 (14.3)

45

Coronary disease

1

1 (100.0)

0

1 (100.0)

0

0

0

0

2

0

0

0

1

0

0

0

4

1 (25.0)

0

1 (25.0)

46

Others

24

1 (4.2)

0

1 (4.2)

65

1 (1.5)

0

1 (1.5)

75

1 (1.3)

0

1

23

0

0

0

187

3 (1.6)

0

3 (1.6)

47

Redo VSD

0

0

0

0

3

0

0

0

36

0

0

0

1

0

0

0

40

0

0

0

48

PS release

0

0

0

0

0

0

0

0

1

0

0

0

0

0

0

0

1

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

18

0

0

1 (5.6)

36

0

0

0

45

0

0

0

16

1 (6.3)

0

1 (6.3)

115

1 (0.9)

0

2 (1.7)

Total

946

17 (1.8)

1 (0.1)

27 (2.9)

1,008

10 (1.0)

0

18 (1.8)

351

2 (0.6)

0

2

82

2 (2.4)

0

2 (2.4)

2,387

31 (1.3)

1 (0.04)

49 (2.1)

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. interrupted aortic arch, 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

170

5 (2.9)

0

9 (5.3)

425

9 (2.1)

0

12 (2.8)

58

1 (1.7)

0

1 (1.7)

1

0

0

0

654

15 (2.3)

0

22 (3.4)

2

PAB

359

6 (1.7)

0

10 (2.8)

250

3 (1.2)

0

5 (2.0)

15

0

0

0

2

0

0

0

626

9 (1.4)

0

15 (2.4)

3

Bidirectional Glenn or hemi-Fontan ± α

0

0

0

0

265

6 (2.3)

0

6 (2.3)

106

0

0

2 (1.9)

4

0

0

0

375

6 (1.6)

0

8 (2.1)

4

Damus–Kaye–Stansel operation

4

1 (25.0)

0

2

45

2

0

2

21

0

0

0

0

0

0

0

70

3 (4.3)

0

4 (5.7)

5

PA reconstruction/repair (including redo)

9

0

0

0

99

1 (1.0)

0

2 (2.0)

108

0

0

1 (0.9)

18

0

0

1 (5.6)

234

1 (0.4)

0

4 (1.7)

6

RVOT reconstruction/repair

16

2 (12.5)

0

2 (12.5)

107

0

0

1 (0.9)

231

2 (0.9)

0

2 (0.9)

17

0

0

0

371

4 (1.1)

0

5 (1.3)

7

Rastelli procedure

3

1 (33.3)

0

1 (33.3)

44

2 (4.5)

0

2 (4.5)

108

2 (1.9)

0

3 (2.8)

10

0

0

0

165

5 (3.0)

0

6 (3.6)

8

Arterial switch procedure

154

5 (3.2)

0

8 (5.2)

23

1 (4.3)

0

1 (4.3)

6

0

0

0

0

0

0

0

183

6 (3.3)

0

9 (4.9)

9

Atrial switch procedure

4

0

0

0

0

0

0

0

2

0

0

0

1

0

0

0

7

0

0

0

10

Double switch procedure

0

0

0

0

0

0

0

0

11

0

0

0

0

0

0

0

11

0

0

0

11

Repair of anomalous origin of CA

1

0

0

0

6

0

0

0

14

0

0

0

7

0

0

0

28

0

0

0

12

Closure of coronary AV fistula

0

0

0

0

1

0

0

0

5

0

0

1 (20.0)

24

0

0

0

30

0

0

1 (3.3)

13

Fontan/TCPC

1

0

0

0

3

0

0

0

408

4 (1.0)

0

6 (1.5)

26

2 (7.7)

0

3 (11.5)

438

6 (1.4)

0

9 (2.1)

14

Norwood procedure

42

8 (19.0)

1 (2.4)

7 (16.7)

78

7 (9.0)

0

11 (14.1)

10

1 (10.0)

0

2 (20.0)

0

0

0

0

130

16 (12.3)

1 (8.1)

20 (15.4)

15

Ventricular septation

0

0

0

0

7

2 (28.6)

0

2 (28.6)

4

0

0

0

1

0

0

0

12

2 (16.7)

0

2 (16.7)

16

Left side AV valve repair (including redo)

0

0

0

0

66

1 (1.5)

0

1 (1.5)

63

1 (1.6)

0

1 (1.6)

11

1 (9.1)

0

1 (9.1)

140

3 (2.1)

0

3 (2.1)

17

Left side AV valve replace (including redo)

1

1 (100)

0

1 (100)

15

1 (6.7)

0

1 (6.7)

41

2 (4.9)

0

2 (4.9)

20

0

0

0

77

4 (5.2)

0

4 (5.2)

18

Right side AV valve repair (including redo)

2

0

0

0

13

0

0

0

34

0

0

0

30

0

0

0

79

0

0

0

19

Right side AV valve replace (including redo)

0

0

0

0

1

0

0

0

6

0

0

0

8

0

0

0

15

0

0

0

20

Common AV valve repair (including redo)

2

1 (50.0)

0

1 (50.0)

34

5 (14.7)

0

5 (14.7)

19

1 (5.3)

0

1 (5.3)

1

0

0

0

56

7 (12.5)

0

7 (12.5)

21

Common AV valve replace (including redo)

2

1 (50.0)

0

1 (50.0)

6

1 (16.7)

0

1 (16.7)

8

0

0

1 (12.5)

3

0

0

0

19

2 (10.5)

0

3 (15.8)

22

Repair of supra-aortic stenosis

1

0

0

0

6

1 (16.7)

0

1 (16.7)

9

1 (11.1)

0

1 (11.1)

0

0

0

0

16

2 (12.5)

0

2 (12.5)

23

Repair of subaortic stenosis (including redo)

1

1 (100.0)

0

1 (100.0)

7

0

0

1 (14)

36

0

0

0

4

0

0

0

48

1 (2.1)

0

2 (4.2)

24

Aortic valve plasty ± VSD closure

3

0

0

0

12

0

0

1 (8.3)

24

0

0

0

4

0

0

0

43

0

0

1 (2.3)

25

Aortic valve replacement

0

0

0

0

2

0

0

0

22

0

0

0

23

0

0

0

47

0

0

0

26

AVR with annular enlargement

1

0

0

0

3

0

0

0

13

0

0

0

6

1 (16.7)

0

1 (16.7)

23

1 (4.3)

0

1 (4.3)

27

Aortic root replace (except Ross)

0

0

0

0

0

0

0

0

6

0

0

0

5

0

0

0

11

0

0

0

28

Ross procedure

0

0

0

0

3

0

0

0

10

0

0

0

1

0

0

0

14

0

0

0

Total

776

32 (4.1)

1 (0.1)

43 (5.5)

1,521

42 (2.8)

0

55 (3.6)

1,398

15 (1.1)

0

24 (1.7)

227

4 (1.8)

0

6 (2.6)

3,922

93 (2.4)

1 (0.03)

128 (3.3)

Values in parenthesis represent mortality %

SP systemic pulmonary, PAB pulmonary artery banding, PA pulmonary artery, RVOT right ventricular outflow tract, CA coronary artery, AV fustula arteriovenous fistula, TCPC total cavopulmonary connection, AV valve atrioventricular valve, VSD ventricular septal defect, AVR aortic valve replacement

Abstract of the survey

We sent out survey questionnaire forms to the departments of each category in all 1,986 institutions (601 cardiovascular, 802 general thoracic and 582 esophageal) nationwide in early April 2013. The response rates in each category by the end of December 2013 were 97.0, 96.8, and 95.2 %, respectively. This high response rate has been keep throughout recent survey, and more than 95 % response rate in all fields in 2012 survey has to be congratulated.

2012 Final report

(A) Cardiovascular surgery

First, we are very pleased with the high response rate to our survey of cardiovascular surgery (97.0 %), 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.

Figure 1 shows the development of cardiovascular surgery in Japan over the last 26 years. Aneurysm surgery includes only operations for thoracic and thoracoabdominal aortic aneurysm. Pacemaker implantation includes only transthoracic implantation and transvenous 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 63,800 cardiovascular operations were performed at 583 institutions during 2012 alone and included 28 heart transplantations, which were restarted in 1999.
Fig. 1

Annual trend of in-patients with esophageal diseases, EMR endoscopic mucosal resection (including endoscopic submucosal)

The number of operations for congenital heart disease (9,558 cases) decreased slightly (3.1 %) compared with that of 2011 (9,859 cases), while there was 3.9 % increase when compared with the data of 10 years ago (9,202 cases in 2002). The number of operations for adult cardiac disease (20,913 cases in valvular heart disease, 16,752 cases in ischemic heart disease, 14,944 cases in thoracic aortic aneurysm and 1,663 cases for other procedures) increased compared with those of 2011 in all categories (9.1, 7.5, 5.8 and 5.1 %, respectively). During the last 10 years, the numbers of operations for adult heart disease increased constantly except for that of ischemic heart disease (81.0 % increase in valvular heart disease, 26.6 % decrease in ischemic heart disease, 112.4 % increase in thoracic aortic aneurysm, and 40.7 % increase in other procedures compared those of 2002). 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 in our study, then, the number of CABG still remained over 20,000 cases per year (21,569 cases) in 2012, which is 89.4 % of that in 2002 (24,135 cases).

Data for individual categories are summarized in tables through 1 to 7.

In 2012, 7,171 open-heart operations for congenital heart disease were performed with overall hospital mortality of 2.3 %. The number of operations for congenital heart disease was quite steady throughout these 10 years (maximum 7,386 cases in 2006), while overall hospital mortality decreased gradually from that of 3.6 % in 2002. In detail, the most common disease was atrial septal defect (1,331 cases), however, its number deceased to 71.7 % of that in 2002, 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 (13.9 % in 2002 to 3.6 % in 2012), complete atrio-septal defect (4.2 to 3.2 %), Tetralogy of Fallot (3.8 to 1.1 %), transposition of the great arteries with and without ventricular septal defect (14.0 to 3.2 % and 7.4 to 2.6 %, respectively), single ventricle and tricuspid atresia (9.2 to 5.5 % and 3.9 to 0 %, respectively), and hypoplastic left heart syndrome (37.9 to 10.2 %). Right heart bypass surgery is now commonly performed (375 bidirectional Glenn procedures and 438 Fontan type procedures including total cavopulmonary connection) with acceptable hospital mortality (2.1 % in each procedure). Norwood type I procedure was performed in 130 cases with relatively low hospital mortality rate of 15.4 %.

As previously mentioned, the number of operations for valvular heart disease increased by 81 % in the last 10 years, and the hospital mortality associated with primary single valve replacement was 3.0 and 4.5 % for the aortic and the mitral position, while that for primary mitral valve repair was 1.3 %. However, hospital mortality rate for redo valve surgery was still high and was 9.3 and 6.7 % for aortic and mitral procedure, respectively. Finally, overall hospital mortality did not show any improvement during the last 10 years (3.1 % in 2002 and 3.2 % in 2012), which might be partially due to the recent progression of age of the patients. Repair of the valve became popular procedure (484 cases in the aortic, 6,002 cases in the mitral, and 4,947 case in the tricuspid), and mitral valve repair constituted 28.7 % of all valvular heart disease operation and 57.6 % of all mitral valve procedure (10,425 procedures), which are similar to those of the last 4 years and increased compared with those of 2002 (19.5 and 34.9 %, respectively). Aortic and mitral valve replacement with bioprosthesis were performed in 8,926 cases and 3,002 cases, respectively, with the number consistently increasing. The ratio of prostheses changed dramatically during the last 10 years, and the usage of bioprosthesis is 74.3 % at the aortic position (37.3 % in 2002) and 61.0 % at the mitral position (24.2 % in 2002). CABG as a concomitant procedure increased gradually to 23.9 % of operations for all valvular heart disease (12.1 % in 2002).

Isolated CABG was performed in 15,462 cases which were only 71.5 % of that of 10 years ago (2002), however, there was an increase of 8.5 % compared with that in 2011. Among these 15,462 cases, off-pump CABG was intended in 9,499 cases (61.4 %) with a success rate of 97.9 %, so final success rate of off-pump CABG was 60.2 %. 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. Conversion rate from off-pump CABG to on-pump CABG of 2.1 % was just same as that in 2011. In 15,462 isolated CABG patients, 96.5 % of them received at least one arterial graft, while, all arterial graft CABG was performed in only 23.5 % of them.

The operative and hospital mortality rates associated with primary elective CABG procedures in 13,004 cases were 0.6 and 1.1 %, 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 have been improved. However, hospital mortality of primary emergency CABG in 2,224 cases was 7.4 %, which was still high in spite of slight improvement 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 to 2.1 %) and hospital mortality (8.5 to 5.1 %).

A total of 1,274 patients underwent surgery for complications of myocardial infarction, including 413 operations for a left ventricular aneurysm or ventricular septal perforation or cardiac rupture and 296 operations for ischemic mitral regurgitation.

Operations for arrhythmia were performed mainly as a concomitant procedure in 3,992 cases with satisfactory mortality (1.8 % hospital mortality) including 3,771 MAZE procedures. MAZE procedure has become quite popular procedure when compared with that in 2002 (1,141 cases).

Operations for thoracic aortic dissection were performed in 6,266 cases. For 4,186 Stanford type A acute aortic dissections, hospital mortality was 10.6 %, which was similar to that in 2011 (11.1 %) and better than that in 2002 (15.5 %). Operations for a non-dissected thoracic aneurysm were carried out in 8,678 cases, with overall hospital mortality of 5.4 %, which was better than that in 2011 (6.7 %). The hospital mortality associated with unruptured aneurysm was 4.0 %, and that of ruptured aneurysm was 22.2 %, which remains markedly high.

The number of stent graft procedures remarkably increased recently. A total of 835 patients with aortic dissection underwent stent graft placement: thoracic endovascular aortic repair (TEVAR) in 723 cases, open stent grafting in 109 cases, and unspecified in 3 cases. The number of TEVAR for type B chronic aortic dissections increased from 359 cases in 2011 to 492 cases in 2012. The hospital mortality rates associated with TEVAR for type B aortic dissection were 7.3 % in acute cases and 2.6 % for chronic cases, respectively.

A total of 3,236 patients with non-dissected aortic aneurysm underwent stent graft placement with 18.8 % increase compared with that in 2011 (2,725 cases); TEVAR in 3,006 cases (23.6 % increase compared with that in 2011), open stent grafting in 226 cases (20.8 % decrease compared with that in 2011), and unspecified in 4 cases. The hospital mortality rates for TEVAR were 2.5 and 16.1 % for non-ruptured and ruptured aneurysm, respectively.

In summary, the total cardiovascular operations increased during 2012 by 3,516 cases, with steadily improving results in almost all categories compared with those in 2011.

Table 2 Acquired (total, (1) + (2) + (4) + (5) + (6) + (7) + isolated ope. for arrhythmia in (3); 39,177

(1) Valvular heart disease (total; 20,913)

 

Valve

Cases

Operation

30-day mortality

Hospital mortality

Redo

Mechanical

Bioprosthesis

Ross procedure

Repair

With CABG

Hospital

After discharge

30-day mortality

Hospital mortality

Replace

Repair

Replace

Repair

Replace

Repair

Cases

Hospital

After discharge

Isolated

A

9,688

2,219

7,074

3

392

2,316

189 (2.0)

6 (1.5)

9 (0.1)

0

275 (3.0)

6 (1.5)

365

20 (5.5)

0

34 (9.3)

 

M

4,617

721

847

0

3,049

773

45 (2.9)

23 (0.8)

1 (0.1)

2 (0.1)

71 (4.5)

41 (1.3)

356

14 (3.9)

0

24 (6.7)

 

T

312

9

92

 

211

42

5 (5.0)

2 (0.9)

0

0

8 (7.9)

5 (2.4)

66

2 (3.0)

0

6 (9.1)

 

P

18

0

15

 

3

1

0

0

0

0

0

0

10

0

0

0

A + M

A

1,380

444

882

0

54

215

65

(4.7)

0

 

96

(7.0)

100

   
 

M

 

303

383

0

694

     

8 (8.0)

0

11 (11.0)

A + T

A

400

110

281

1

8

45

15

(3.8)

0

 

29

(7.3)

55

   
 

T

 

3

23

0

374

     

2 (3.6)

0

5 (9.1)

M + T

M

3,388

634

925

 

1,829

294

65

(1.9)

0

 

91

(2.7)

274

   
 

T

 

6

50

 

3,332

     

14 (5.1)

0

26 (9.5)

A + M + T

A

1,040

321

689

0

30

117

37

(3.6)

0

 

51

(4.9)

76

   
 

M

262

348

0

430

4 (5.3)

0

5 (6.6)

 

T

0

9

1

1,030

   

Others

 

70

18

38

0

16

5

3

(4.3)

0

 

3

(4.3)

7

1 (14.3)

0

1 (14.3)

Total

 

20,913

5,050

11,656

5

11,452

3,808

455

(2.2)

12

 

676

(3.2)

1,309

65 (5.0)

0

112 (8.6)

Number of redo cases is included in total case number of 18,713

Values in parenthesis represent mortality %

CABG coronary artery bypass grafting, A aortic valve, M mitral valve, T tricuspid valve, P pulmonary valve

(2) Ischemic heart disease (total, (A) + (B) + (C); 16,752)

(A) Isolated CABG (total; (a) + (b); 15,462)

(a-1) On-pump arrest CABG (total; 3,749)

 

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

79

0

0

1 (1.3)

20

2 (10.0)

0

2 (10.0)

2

0

0

0

0

0

0

0

66

6

29

0

2VD

454

4 (0.9)

0

5 (1.1)

44

2 (4.5)

0

2 (4.5)

10

1 (10.0)

0

1 (10.0)

4

2 (50.0)

0

2 (50.0)

111

367

34

0

3VD

1,648

13 (0.8)

0

17 (1.0)

203

12 (5.9)

0

14 (6.9)

12

0

0

0

0

0

0

0

132

1,691

40

0

LMT

1,003

16 (1.6)

0

20 (2.0)

255

13 (5.1)

0

17 (6.7)

14

2 (14.3)

0

2 (14.3)

1

1 (100.0)

0

1 (100.0)

146

1,080

47

0

Uncertain

     

0

              

Total

3,184

33 (1.0)

0

43 (1.4)

522

29 (5.6)

 

35 (6.7)

38

3 (7.9)

 

3 (7.9)

5

3 (60.0)

 

3 (60.0)

455

3,144

150

0

Kawasaki

10

0

0

0

1

0

0

0

0

0

0

0

0

0

0

0

7

4

0

0

Hemodialysis

193

7 (3.6)

0

8 (4.1)

40

9 (22.5)

0

10 (25.0)

4

0

0

0

2

0

0

0

13

217

9

0

Values in parenthesis represent mortality %

LMT includes LMT alone or LMT with other branch diseases. 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

(a-2) On-pump beating CABG (total; 2,214)

 

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

23

0

0

1 (4.3)

14

0

0

1 (7.1)

4

0

0

0

4

1 (25.0)

0

2 (50.0)

22

5

18

0

2VD

235

2 (0.9)

0

6 (2.6)

65

7 (10.8)

0

7 (10.8)

11

1 (9.1)

0

1 (9.1)

3

0

0

0

65

223

25

1

3VD

805

8 (1.0)

1 (0.1)

16 (2.0)

211

20 (9.5)

0

28 (13.3)

12

0

0

1 (8.3)

1

0

0

0

107

889

33

0

LMT

550

4 (0.7)

0

9 (1.6)

264

27 (10.2)

1 (0.4)

36 (13.6)

10

0

0

0

2

0

0

0

139

639

48

0

Total

1,613

14 (0.9)

 

32 (2.0)

554

54 (9.7)

 

72 (13.0)

37

1 (2.7)

 

2 (5.4)

10

1 (10.0)

 

2 (20.0)

333

1,756

124

1

Kawasaki

1

0

0

0

1

0

0

0

0

0

0

0

0

0

0

0

1

1

0

0

Hemodialysis

158

2 (1.3)

0

8 (5.1)

46

5 (10.9)

0

5 (10.9)

3

0

0

1 (33.3)

3

0

0

0

18

176

16

0

Values in parenthesis represent mortality %

LMT includes LMT alone or LMT with other branch diseases. 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

(b) Off-pump CABG (total; 9,499)

(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

582

1 (0.2)

0

6 (1.0)

67

2 (3.0)

0

3 (4.5)

40

0

1

0

8

0

0

0

590

48

59

0

2VD

1,484

6 (0.4)

0

12 (0.8)

135

3 (2.2)

0

5 (3.7)

18

2 (11.1)

0

2 (11.1)

5

0

0

0

630

961

41

0

3VD

3,645

11 (0.3)

1 (0.03)

31 (0.9)

390

14 (3.6)

0

21 (5.4)

22

0

0

0

3

1 (33.3)

0

1 (33.3)

772

3,221

61

2

LMT

2,496

14 (0.6)

0

24 (1.0)

574

23 (4.0)

0

31 (5.4)

24

0

0

0

6

1 (16.7)

0

1 (16.7)

855

2,161

75

0

Total

8,207

32 (0.4)

1 (0.01)

73 (0.9)

1,166

42 (3.6)

 

60 (5.1)

104

2 (1.9)

 

2 (1.9)

22

2 (9.1)

 

2 (9.1)

2,847

6,391

236

2

Kawasaki

6

0

0

0

1

0

0

0

1

0

0

0

0

0

0

0

7

1

0

0

Hemodialysis

659

7 (1.1)

0

15 (2.3)

94

10 (10.6)

0

17 (18.1)

10

0

0

0

0

0

0

0

163

581

19

0

Values in parenthesis represent mortality %

LMT includes LMT alone or LMT with other branch diseases. 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

(c) Includes cases of conversion, during surgery, from off-pump CABG to on-pump CABG or on-pump beating-heart CABG (total; 197)

 

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

1 (3.0)

0

1 (3.0)

5

0

0

0

0

0

0

0

0

0

 

0

A conversion to on-pump beating-heart CABG

117

5 (4.3)

0

6 (5.1)

41

3 (7.3)

0

3 (7.3)

1

0

0

0

0

0

 

0

Total

150

7 (4.7)

0

7 (4.7)

46

3 (6.5)

 

3 (6.5)

1

0

0

0

0

0

0

0

Hemodialysis

13

1 (7.7)

0

1 (7.7)

6

2 (33.3)

 

2 (33.3)

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; 1,274)

 

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

350

18 (5.1)

0

29 (8.3)

26

2 (7.7)

0

3 (11.5)

263

107

15

VSP closure

49

4 (8.2)

0

7 (14.3)

240

53 (22.1)

1

64 (26.7)

89

7

10

Cardiac rupture

14

1 (7.1)

0

1 (7.1)

224

75 (33.5)

0

85 (37.9)

40

2

4

Mitral regurgitation

           

 1) Papillary muscle rupture

11

0

0

0

35

9 (25.7)

0

11 (31.4)

18

10

23

 2) Ischemic

285

18 (6.3)

0

30 (10.5)

28

4 (14.3)

0

4 (14.3)

262

225

48

Others

5

0

0

0

7

1 (14.3)

0

1 (14.3)

2

0

0

Total

714

41 (5.7)

0

67 (9.4)

560

144 (25.7)

1

168 (30.0)

674

351

100

Values in parenthesis represent mortality %

Acute, within 2 weeks from the onset of myocardial infarction

MI myocardial infarction, CABG coronary artery bypass grafting, MVP mitral valve repair, MVR mitral valve replacement, VSP ventricular septal perforation

(C) TMLR (total; 16)

 

Cases

30-day mortality

Hospital mortality

Hospital

After discharge

Isolated

14

2 (14.29)

0

2 (14.29)

With CABG

2

0

0

0

Total

16

2 (12.5)

0

2 (12.5)

Values in parenthesis represent mortality %

TMLR transmyocardial laser revascularization

(3) Operation for arrhythmia (total; 4,183)

 

Cases

30-day mortality

Hospital mortality

Concomitant operation

Isolated

Congenital

Valve

IHD

Others

Multiple combination

Hospital

After discharge

2 Categories

3 Categories

Maze

3,935

42 (1.1)

0

62 (1.6)

15

197

3,471

493

198

462

24

For WPW

0

0

0

0

0

0

0

0

0

0

0

For ventricular tachyarrhythmia

44

1 (2.3)

0

2 (4.5)

2

3

13

27

7

8

0

Others

204

10 (4.9)

0

13 (6.4)

3

39

141

43

18

38

1

Total

4,183

53 (1.3)

0

77 (1.8)

20

239

3,625

563

223

508

25

Values in parenthesis represent mortality %. Except for 20 isolated cases, all remaining 4,163 cases are doubly allocated, one for this subgroup and the other for the subgroup corresponding to the concomitant operations

WPW Wolff–Parkinson–White syndrome, IHD ischemic heart disease

(4) Operation for constrictive pericarditis (total; 195)

 

CPB (+)

CPB (−)

Cases

30-day mortality

Hospital mortality

Cases

30-day mortality

Hospital mortality

Hospital

After discharge

Hospital

96

Total

96

9 (9.4)

0

18 (18.8)

99

5 (5.1)

0

9 (9.1)

Values in parenthesis represent mortality %

CPB cardiopulmonary bypass

(5) Cardiac tumor (total; 628)

 

Cases

30-day mortality

Hospital mortality

Concomitant operation

Hospital

After discharge

AVR

MVR

CABG

Others

Benign tumor

553

6 (1.1)

 

8 (1.4)

14

7

25

58

 Cardiac myxoma

405

2 (0.5)

0

3 (0.7)

4

3

17

41

 Papillary fibroelastoma

47

0

0

0

6

2

0

7

 Rhabdomyoma

4

0

0

0

0

0

0

1

 Others

97

4 (4.1)

0

5 (5.2)

4

2

8

9

Malignant tumor

75

2 (2.7)

1 (1.3)

6 (8.0)

0

0

2

8

 Primary

43

2 (4.7)

1 (2.3)

5 (11.6)

0

0

2

5

 Metastatic

32

0

0

1 (3.1)

0

0

0

3

Values in parenthesis represent mortality %

AVR aortic valve replacement, MVR mitral valve replacement, CABG coronary artery bypass grafting

(6) HOCM and DCM (total; 217)

 

Cases

30-day mortality

Hospital mortality

Concomitant operation

Hospital

After discharge

AVR

MVR

MVP

CABG

Myectomy

133

4 (3.0)

0

16 (12.0)

67

21

12

12

Myotomy

6

0

0

0

1

0

3

0

No-resection

38

1 (2.6)

0

7 (18.4)

8

21

13

3

Volume reduction surgery of the left ventricle

40

3 (7.5)

0

4 (10.0)

1

8

24

7

Total

217

8 (3.7)

0

27 (12.4)

77

50

52

22

Values in parenthesis represent mortality %

HOCM hypertrophic obstructive cardiomyopathy, DCM dilated cardiomyopathy, AVR aortic valve replacement, MVR mitral valve replacement, MVP mitral valve repair, CABG coronary artery bypass grafting

(7) Other open-heart operation (total; 452)

 

Cases

30-day mortality

Hospital mortality

Hospital

After discharge

Total

452

38 (8.4)

0

53 (11.7)

Values in parenthesis represent mortality %

Table 3 Thoracic aortic aneurysm (total; 14,944)

(1) Dissection (total; 6,266)

Replaced site

Stanford type

Acute

Chronic

Concomitant operation

Redo

A

B

A

B

Cases

30-day mortality

Hospital mortality

Cases

30-day mortality

Hospital mortality

Cases

30-day mortality

Hospital mortality

Cases

30-day mortality

Hospital mortality

AVP

AVR

MVP

MVR

CABG

Cases

30-day mortality

Hospital mortality

Hospital

After discharge

Hospital

After discharge

Hospital

After discharge

Hospital

After discharge

Hospital

After discharge

1. Ascending Ao.

2,447

190 (7.8)

2 (0.1)

232 (9.5)

3

1 (33.3)

0

1 (33.3)

222

5 (2.3)

0

6 (2.7)

8

1 (12.5)

0

1 (12.5)

240

134

17

10

125

49

8 (16.3)

0

8 (16.3)

2. Aortic Root

149

28 (18.8)

0

33 (22.1)

0

0

0

0

68

7 (10.3)

0

9 (13.2)

4

0

0

0

21

118

5

1

42

48

9 (18.8)

0

11 (22.9)

3. Ascending Ao.+Arch

1,340

116 (8.7)

2 (0.15)

150 (11.2)

16

3 (18.8)

0

3 (18.8)

302

8 (2.6)

1 (0.3)

18 (6.0)

107

4 (3.7)

0

9 (8.4)

112

61

10

3

87

90

4 (4.4)

0

5 (5.6)

4. Arch+Descending Ao.

30

4 (13.3)

0

4 (13.3)

10

4 (40.0)

0

5 (50.0)

21

1 (4.8)

0

1 (4.8)

79

6 (7.6)

0

9 (11.4)

0

1

0

0

5

9

1 (11.1)

0

2 (22.2)

5. Aortic Root+Asc. Ao.+Arch

96

21 (21.9)

1 (1.0)

22 (22.9)

0

0

0

0

27

0

0

0 (0.0)

4

0

0

0

18

51

0

1

13

10

0

0

0

6. Descending Ao.

11

0

0

1 (9.1)

52

8 (15.4)

0

11 (21.2)

77

4 (5.2)

0

6 (7.8)

217

8 (3.7)

0

14 (6.5)

1

4

0

0

4

38

6 (15.8)

0

7 (18.4)

7. Thoracoabdominal Ao.

5

0

0

0

12

1 (8.3)

0

2 (16.7)

49

3 (6.1)

0

3 (6.1)

151

13 (8.6)

0

16 (10.6)

0

0

0

0

0

43

4 (9.3)

0

4 (9.3)

8. Extra-anatomical bypass

11

0

0

1 (9.1)

19

1 (5.3)

0

2 (10.5)

4

0

0

0 (0.0)

1

0

0

0

0

0

0

0

0

0

0

0

0

9. Stent graft*a

97

1 (1.0)

0

1 (1.0)

120

6 (5.0)

0

8 (6.7)

100

3 (3.0)

0

5 (5.0)

518

8 (1.5)

0

15 (2.9)

5

3

0

0

5

99

2 (2.0)

0

3 (3.0)

 1) TEVARl*b

35

1 (2.9)

0

1 (2.9)

110

6 (5.5)

0

8 (7.3)

86

3 (3.5)

0

5 (5.8)

492

7 (1.4)

0

13 (2.6)

2

0

0

0

0

97

2 (2.1)

0

3 (3.1)

 2) Open stent

62

0

0

0

10

0

0

0

14

0

0

0

23

1 (4.3)

0

2 (8.7)

3

3

0

0

5

2

0

0

0

  a) With total arch*c

3

0

0

0

4

0

0

0

1

0

0

0

4

0

0

0

1

0

0

0

0

1

0

0

0

  b) Without total arch*d

59

0

0

0

6

0

0

0

13

0

0

0

19

1 (5.3)

0

2 (10.5)

2

3

0

0

5

1

0

0

0

 3) Unspecified

0

0

0

0

0

0

0

0

0

0

0

0

3

0

0

0

0

0

0

0

0

0

0

0

0

Total

4,186

360

5 (0.12)

444 (10.6)

232

24 (10.3)

0

30 (12.9)

865

36 (4.2)

1 (0.1)

52 (6.0)

983

34 (3.5)

0

42 (4.3)

339

326

32

16

294

335

29 (8.7)

0

35 (10.4)

Values in parenthesis represent mortality %

Ao aorta, AVP aortic valve repair, AVR aortic valve replacement, MVP mitral valve repair, MVR mitral valve replacement, CABG. coronary artery bypass grafting, TEVAR thoracic endovascular aortic(aneurysm) repair

Acute, within 2 weeks from the onset

*a = *b + *c + *d + unspecified

(2) Non-dissection (total; 8,678)

Replaced site

Unruptured

Ruptured

Concomitant operation

Redo

CPB(−)

Cases

30-day mortality

Hospital mortality

Cases

30-day mortality

Hospital mortality

AVP

AVR

MVP

MVR

CABG

Cases

30-day mortality

Hospital mortality

Cases

30-day mortality

Hospital mortality

Hospital

After discharge

Hospital

After discharge

Hospital

After discharge

Hospital

After discharge

1. Ascending Ao.

1,184

19 (1.6)

1 (0.1)

38 (3.2)

50

7 (12.9)

0

10 (20.0)

111

755

66

35

159

88

3 (3.4)

0

11 (12.5)

5

0

0

1 (20.0)

2. Aortic Root

824

16 (1.9)

0

29 (3.5)

31

4 (30.8)

0

9 (29.0)

187

448

47

9

89

109

13 (11.9)

0

24 (22.0)

14

0

0

0

3. Ascending Ao.+Arch

2,106

47 (2.2)

3

87 (4.1)

168

32 (14.8)

0

44 (26.2)

26

202

28

2

338

89

8 (9.0)

0

11 (12.4)

29

0

0

1 (3.4)

4. Arch+Descending Ao.

111

10 (9.0)

0

13 (11.7)

7

2 (34.3)

0

2 (28.6)

0

2

0

0

8

9

3 (33.3)

0

3 (33.3)

9

0

0

0

5. Aortic Root+Asc.Ao.+Arch

93

5 (5.4)

0

9 (9.7)

2

1 (50.0)

0

1 (50.0)

12

47

3

1

9

18

3 (16.7)

0

4 (22.2)

3

0

0

0

6. Descending Ao.

323

15 (4.6)

0

23 (7.1)

85

18 (19.7)

0

21 (24.7)

4

1

0

0

10

33

13 (39.4)

0

14 (42.4)

15

0

0

0

7. Thoracoabdominal Ao.

368

23 (6.3)

0

33 (9.0)

43

8 (24.3)

0

10 (23.3)

0

0

0

0

4

40

4 (10.0)

0

5 (12.5)

15

0

0

0

8. Extra-anatomical bypass

44

2 (4.5)

0

3 (6.8)

3

2 (66.7)

0

2 (66.7)

0

0

0

0

4

1

0

0

0

9

1 (11.1)

0

2 (22.2)

9. Stent graft*a

2,889

56 (1.9)

1 (0.03)

80 (2.8)

347

40 (12.9)

1 (0.3)

56 (16.1)

6

8

0

0

20

193

10 (5.2)

0

14 (7.3)

1,212

37 (3.1)

0

50 (4.1)

1) TEVARl*b

2,671

47 (1.8)

1 (0.04)

66 (2.5)

335

40 (13.7)

1 (0.3)

54 (16.1)

6

2

0

0

8

184

10 (5.4)

0

14 (7.6)

1,152

37 (3.2)

0

48 (4.2)

2) Open stent

216

9 (4.2)

0

14 (6.5)

10

0

0

2 (20.0)

0

6

0

0

12

9

1 (11.1)

0

0

56

0

0

2 (3.6)

 a) With total arch*c

78

5 (6.4)

0

7 (9.0)

4

0

0

0

0

0

0

0

3

4

0

0

0

31

0

0

1 (3.2)

 b) Without total arch*d

138

4 (2.9)

0

7 (5.1)

6

0

0

2 (33.3)

0

6

0

0

9

5

0

0

0

25

0

0

1 (4.0)

3) Unspecified

2

0

 

0

2

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

Total

7,942

193 (2.4)

5 (0.06)

315 (4.0)

736

114 (15.5)

1 (0.1)

155 (22.2)

346

1,463

144

47

641

580

57 (9.8)

0

86 (14.8)

1,311

38 (3.0)

0

54 (4.1)

Values in parenthesis represent mortality %

Ao aorta, AVP aortic valve repair, AVR aortic valve replacement, MVP mitral valve repair, MVR mitral valve replacement, CABG coronary artery bypass grafting, TEVAR thoracic endovascular aortic (aneurysm) repair

*a = *b + *c + *d + unspecified

Table 4 Pulmonary thromboembolism (total; 121)

 

Cases

30-day mortality

Hospital mortality

Hospital

After discharge

Acute

65

11 (16.9)

0

13 (20.0)

Chronic

56

0

0

1 (1.8)

Total

121

11 (9.1)

0

14 (11.6)

Values in parenthesis represent mortality %

Table 5 Assisted circulation (total; 1,875)

Sites

VAD

Heart–Lung assist

Device

Results

Method

Results

Centrifugal

VAS

Others

Not weaned

Weaned

PCPS

Others

Not weaned

Weaned

On going

Death

Transplant

Alive

Deaths

Transplant

Deaths

Transplant

Deaths

Alive

Post-cardiotomy

           

 Left

4

6

3

2

10 (76.9)

0

0

1 (10.0)

0

      

 Right

3

0

0

0

1 (33.3)

0

2

0

0

      

Biventricle

               

 Right

6

1

0

2

5 (71.4)

0

0

0

0

517

70

268 (51.8)

0

99 (19.1)

220

 Left

2

5

0

Congestive heart failure

               

 Left

23

38

57

70

32 (27.1)

0

8

5 (4.2)

3

      

 Right

0

0

0

0

0

0

0

0

0

      

Biventricle

               

 Right

23

6

0

5

18 (62.1)

0

5

1 (9.1)

0

888

68

439 (49.4)

1

139 (15.7)

376

 Left

8

19

2

Respiratory failure

         

75

51

40 (53.3)

0

15 (20.0)

71

Total

69

75

62

79

66 (32.0)

0

15

7 (3.4)

3

1,480

189

747 (50.4)

2

253 (17.1)

667

Values in parenthesis represent mortality %

VAD ventricular assist device, VAS ventricular assist system, PCPS percutaneous cardiopulmonary support

Table 6 Heart transplantation (total; 28)

 

Cases

30-day mortality

Hospital mortality

Hospital

After discharge

Heart transplantation

28

1 (3.6)

0

2 (7.1)

Heart and lung transplantation

0

0

0

0

Total

28

1 (3.6)

0

2 (7.1)

Values in parenthesis represent mortality %

Table 7 Pacemaker + ICD (total; 6,971)

 

Pacemaker

ICD

V

A-V

CRT

CRTD

ICD

Initial

942

2,715

117

299

342

Exchange

727

1,439

32

113

197

Unclear

2

46

0

0

0

Total

1,671

4,200

149

412

539

ICD implantable cardioverter-defibrillator, CRTD cardiac resynchronization therapy device with incorporated ICD device

(B) General thoracic surgery

The total number of operations reported in 2012 in general thoracic surgery has reached 72,899, which means an increase of 3,676 cases compared with the number of operations in 2011. This is largely owing to the steady increase in lung cancer surgery (31,301; 2009, 32,801; 2010, 33,878:2011, 35,667:2012).

Surgery for lung cancer consists more than 49 % of all the general thoracic surgery. Among lung cancer subtypes, adenocarcinoma comprises an overwhelming percentage of 69.4 % of the total lung cancer surgery, followed by squamous cell carcinoma of 19.0 %. Limited resection by wedge resection or segmentectomy was performed in 6,789 lung cancer patients, which is 19.0 % of the entire cases. Lobectomy was performed 26,079 patients, which is 73.1 % of the entire cases. Sleeve lobectomy was done in 429 patients. Pneumonectomy was done in 571 patients, which is only 1.6 % of the entire cases. VATS (video-assisted thoracic surgery) procedure is performed in 65.6 % among the total lung cancer surgeries in 2012. 123 patients died within 30 days after lung cancer surgery (30-day mortality rate 0.34 %), and 248 patients died without discharge (Hospital mortality rate 0.70 %). 30-day mortality rate in regard to procedures is 0.26 % in segmentectomy, 0.31 % in lobectomy, and 2.45 % in pneumonectomy.

Interstitial pneumonia was the leading cause of death after lung cancer surgery, followed by pneumonia, cardiovascular event, bronchopleural fistula, and respiratory failure.

7,403 patients with metastatic pulmonary tumor were operated in 2012 with steady increase similar to lung cancer surgery (6,248:2009, 6,748:2010, 7,210:2011). VATS was adopted in 5,828 cases, which comprises 78.7 % of the entire cases. Colorectal cancer was by far the leading primary malignancy indicated for resection of metastatic tumors.

73 tracheal tumors were operated in 2012. Adenoid cystic carcinoma and squamous cell carcinoma were frequent primary tracheal tumor.

409 tumors of pleural origin were operated in 2012. Diffuse malignant pleural mesothelioma was the most frequent histology. Extrapleural pneumonectomy was the most frequently chosen operative method (135 cases) with a hospital death of 6.7 %.

752 chest wall tumors were resected in 2012.

4,671 mediastinal tumors were operated in 2012. There were 2,151 thymic epithelial tumors (1,842 thymomas, 271 thymic carcinomas, and 38 thymic carcinoid), followed by 906 congenital cysts, 495 neurogenic tumors, and 231 germ cell tumors. 2,425 cases (51.9 %) were resected by VATS.

Thymectomy for myasthenia gravis was done in 446 patients, and 302 among them were associated with thymoma, indicating that thymectomy for non-thymomatous myasthenia gravis was done only in 144 patients. Advancement in medical control of myasthenia gravis by immunosuppressants might reduce indication of extended thymectomy for non-thymomatous myasthenia gravis. This possibility should be further examined.

2,250 operations for empyema were reported in 2012. There were 1,710 patients (76 %) with acute empyema and 540 patients with chronic empyema. Bronchopleural fistula was associated in 348 patients (20.4 %) with acute empyema and 274 patients (50.7 %) with chronic empyema. It should be noted that hospital mortality was as high as 12.1 % in patients of acute empyema with fistula.

14,410 operations for pneumothorax were reported in 2012. 13,555 operations (94.1 %) were performed by VATS, similarly to cases in 2011.

44 lung transplantations were reported in 2012. The number of the brain-dead donors is slightly increasing after revision of the law on organ transplantation.

The number of lung transplantation operation is still small compared to those in North America and European countries because of shortage of donors, but the number of brain-dead donors is increasing slowly in Japan after revision of the law of organ transplantation in 2010.

Table 1 Total entry cases of general thoracic surgery during 2012

 

Cases

%

Benign pulmonary tumor

863

1.2

Primary lung cancer

35,667

48.9

Other primary malignant pulmonary tumor

348

0.5

Metastatic pulmonary tumor

7,403

10.2

Tracheal tumor

73

0.1

Mesothelioma

409

0.6

Chest wall tumor

752

1.0

Mediastinal tumor

4,671

6.4

Thymectomy for MG without thymoma

302

0.4

Inflammatory pulmonary disease

3,405

4.7

Empyema

2,250

3.1

Bullous disease excluding pneumothorax

569

0.8

Pneumothorax

14,410

19.8

Chest wall deformity

415

0.6

Diaphragmatic hernia including traumatic

112

0.2

Chest trauma excluding diaphragmatic hernia

393

0.5

Lung transplantation

44

0.1

Others

813

1.1

Total

72,899

100.0

Table 2

1. Benign pulmonary tumor

 

Cases

30-day mortality

Hospital mortality

By VATS

Hospital

After discharge

Hamartoma

421

0

0

0

371

Sclerosing hemangioma

104

0

0

0

84

Papilloma

9

0

0

0

7

Mucous gland adenoma bronchial

5

0

0

0

5

Fibroma

34

0

0

0

26

Lipoma

5

0

0

0

4

Neurogenic tumor

13

0

0

0

10

Clear cell tumor

1

0

0

0

1

Leiomyoma

13

0

0

0

8

Chondroma

3

0

0

0

3

Inflammatory myofibroblastic tumor

3

0

0

0

2

Pseudolymphoma

23

0

0

0

17

Histiocytosis

11

0

0

0

8

Teratoma

4

0

0

0

2

Others

214

0

0

0

171

Total

863

0

0

0

719

Values in parenthesis represent mortality %

Table 3

2. Primary malignant pulmonary tumor

 

Cases

30-day mortality

Hospital mortality

By VATS

Hospital

After discharge

2. Primary malignant pulmonary tumor

36,015

103 (0.3)

15 (0.04)

243 (0.7)

 

Lung cancer

35,667

112 (0.3)

11 (0.03)

248 (0.7)

23,411

 Adenocarcinoma

24,749

48 (0.2)

5 (0.02)

84 (0.3)

 

 Squamous cell carcinoma

7,114

47 (0.7)

4 (0.06)

122 (1.7)

 

 Large cell carcinoma

917

3 (0.3)

0

14 (1.5)

 

 (LCNEC)

471

2 (0.4)

0

6 (1.3)

 

 Small cell carcinoma

591

2 (0.3)

0

3 (0.5)

 

 Adenosquamous carcinoma

612

6 (1.0)

1

11 (1.8)

 

 Carcinoma with pleomorphic, sarcomatoid or sarcomatous elements

473

2 (0.4)

1

6 (1.3)

 

 Carcinoid

195

0

1 (0.5)

0

 

 Carcinomas of salivary gland type

29

0

0

0

 

 Unclassified

73

0

0

0

 

 Multiple lung cancer

803

1 (0.1)

0

4 (0.5)

 

 Others

110

3 (2.7)

0

4 (3.6)

 

 Unclear

1

0

   

 Wedge resection

4,952

11 (0.2)

0

18 (0.4)

4,135

 Segmental excision

3,780

8 (0.2)

2 (0.1)

10 (0.3)

2,654

 (Sleeve segmental excision)

16

0

0

0

4

 Lobectomy

26,079

72 (0.3)

9 (0.03)

178 (0.7)

16,416

 (Sleeve lobectomy)

429

4 (0.9)

1 (0.2)

7 (1.6)

29

 Pneumonectomy

571

14 (2.5)

0

30 (5.3)

75

 (Sleeve pneumonectomy)

16

0

0

0

0

 Other bronchoplasty

10

0

0

0

3

 Pleuropneumonectomy

4

0

0

0

1

 Others

265

3 (1.1)

0

5 (1.9)

127

 Unclear

11

4 (36.4)

 

7 (63.6)

 

Sarcoma

36

0

0

1 (2.8)

 

AAH

143

0

0

1 (0.7)

 

Others

169

0

0

2 (1.2)

 

Values in parenthesis represent mortality %

Table 4 Details of lung cancer operation

TNM

 

Cases

c-Stage

 

 Ia

20,510

 Ib

7,019

 IIa

2,712

 IIb

1,783

 IIIa

2,493

 IIIb

256

 IV

414

 NA

480

 Total

35,667

Sex

 

 Male

22,103

 Female

13,426

 NA

138

 Total

35,667

Cause of death

 

 Cardiovascular

25

 Pneumonia

52

 Pyothorax

8

 Bronchopleural fistula

25

 Respiratory failure

25

 Pulmonary embolism

3

 Interstitial pneumonia

71

 Brain infarction or bleeding

15

 Others

32

 Unknown

3

 Total

259

p-Stage

 

 0 (pCR)

157

 Ia

17,804

 Ib

7,264

 IIa

3,011

 IIb

2,093

 IIIa

3,806

 IIIb

306

 IV

943

 NA

283

 Total

35,667

Age

 

 <20

4

 20–29

22

 30–39

223

 40–49

1,001

 50–59

3,630

 60–69

12,336

 70–79

14,299

 80–89

4,100

 ≥90

50

 NA

2

 Total

35,667

Table 5

3. Metastatic pulmonary tumor

 

Cases

30-day mortality

Hospital mortality

By VATS

Hospital

After discharge

3. Metastatic pulmonary tumor

7,403

3 (0.04)

0

9 (0.1)

5,828

 Colorectal

3,639

0

0

3 (0.1)

2,910

 Hepatobiliary/Pancreatic

311

0

0

1 (0.3)

240

 Uterine

380

1 (0.26)

0

0

302

 Mammary

456

0

0

1 (0.2)

386

 Ovarian

68

0

0

0

56

 Testicular

64

0

0

0

49

 Renal

600

0

0

0

500

 Skeletal

160

0

0

0

121

 Soft tissue

275

0

0

0

214

 Otorhinolaryngological

446

0

0

0

338

 Pulmonary

384

3 (0.8)

0

3 (0.8)

238

 Others

620

1

0

1 (0.2)

474

Values in parenthesis represent mortality %

Table 6

4. Tracheal tumor

 

Cases

30-day mortality

Hospital mortality

Hospital

After discharge

4. Tracheal tumor

73

0

0

1 (1.4)

(A) Primary malignant tumor (histological classification)

 Squamous cell carcinoma

4

0

0

0

 Adenoid cystic carcinoma

19

0

0

0

 Mucoepidermoid carcinoma

1

0

0

0

 Others

1

0

0

0

 Total

25

0

0

0

(B) Metastatic/invasive malignant tumor e.g. invasion of thyroid cancer

23

0

0

1 (4.3)

(C) Benign tracheal tumor (histological classification)

 Papilloma

1

0

0

0

 Adenoma

2

0

0

0

 Neurofibroma

2

0

0

0

 Chondroma

1

0

0

0

 Leiomyoma

0

0

0

0

 Others

19

0

0

0

 Histology unknown

0

0

0

0

 Total

25

0

0

0

Operation

 Sleeve resection with reconstruction

28

0

0

0

 Wedge with simple closure

4

0

0

0

 Wedge with patch closure

0

0

0

0

 Total laryngectomy with tracheostomy

2

0

0

1 (50.0)

 Others

38

0

0

0

 Unknown

1

0

0

0

 Total

73

0

0

1 (1.4)

Values in parenthesis represent mortality %

Table 7

5. Tumor of pleural origin

 

Cases

30-day mortality

Hospital mortality

Hospital

After discharge

Histological classification

 Solitary fibrous tumor

130

0

0

0

 Diffuse malignant pleural mesothelioma

198

5 (2.5)

0

9 (4.5)

 Localized malignant pleural mesothelioma

29

0

0

1

 Others

52

0

0

0

 Total

409

3 (0.7)

0

10 (2.4)

Operative procedure

 Extrapleural pneumonectomy

135

5 (3.7)

0

9 (6.7)

 Total pleurectomy

22

0

0

0

 Total parietal pleurectomy

0

0

0

0

 Partial pleurectomy

0

0

0

0

 Exploratory thoracotomy

0

0

0

0

 Others

41

0 (0.0)

0

0

 Total

198

5 (2.5)

0

9 (4.5)

Values in parenthesis represent mortality %

Table 8

6. Chest wall tumor

 

Cases

30-day mortality

Hospital mortality

By VATS

Hospital

After discharge

Primary malignant tumor

147

1 (0.68)

0

1 (0.7)

26

Metastatic malignant tumor

232

0

0

2 (0.9)

34

Benign tumor

373

0

0

0

199

Total

752

1 (0.1)

0

3 (0.4)

259

Values in parenthesis represent mortality %

Table 9

7. Mediastinal tumor

 

Cases

30-day mortality

Hospital mortality

By VATS

Hospital

After discharge

7. Mediastinal tumor

4,671

6 (0.13)

0

7 (0.1)

2,425

 Thymoma*

1,842

2 (0.1)

0

2 (0.1)

659

 Thymic cancer

271

2 (0.7)

0

3 (1.1)

56

 Thymus carcinoid

38

0

0

0

15

 Germ cell tumor

231

1 (0.4)

0

1 (0.4)

80

  Benign

159

0

0

0

72

  Malignant

72

1 (1.4)

0

1 (1.4)

8

 Neurogenic tumor

495

0

0

0

412

 Congenital cyst

906

0

0

0

759

 Goiter

115

0

0

0

28

 Lymphatic tumor

210

1 (0.5)

0

1 (0.5)

124

 Excision of pleural recurrence of thymoma

93

0

0

0

35

 Others

470

0

0

0

257

* Includes those with myasthenia gravis

Values in parenthesis represent mortality %

Table 10

8. Thymectomy for myasthenia gravis

 

Cases

30-day mortality

Hospital mortality

By VATS

Hospital

After discharge

8. Thymectomy for myasthenia gravis

446

0

0

0

171

With thymoma

302

1 (0.3)

0

2 (0.7)

81

Values in parenthesis represent mortality %

Table 11

9. Operation for non-neoplasmic disease

(A) Inflammatory pulmonary disease

 

Cases

30-day mortality

Hospital mortality

 

Hospital

After discharge

9. Operation for non-neoplasmic disease

22,367

109 (0.5)

2 (0.01)

181 (0.8)

 
 

Cases

30-day mortality

Hospital mortality

By VATS

Hospital

After discharge

(A) Inflammatory pulmonary disease

3,405

4 (0.1)

0

7 (0.2)

2,556

 Tuberculous infection

107

0

0

0

70

 Mycobacterial infection

514

0

0

0

395

 Fungal infection

439

4 (0.9)

0

5 (1.1)

218

 Bronchiectasis

93

0

0

0

60

  Tuberculous nodule

351

0

0

0

291

  Inflammatory pseudo tumor

1,007

0

0

0

812

  Intrapulmonary lymph node

175

0

0

0

161

Others

719

0

0

2 (0.3)

549

Values in parenthesis represent mortality %

Table 12

9. Operation for non-neoplasmic disease

(B) Empyema

 

Cases

30-day mortality

Hospital mortality

By VATS

Hospital

After discharge

Acute empyema

1,710

29 (1.7)

0

61 (3.6)

1,142

 With fistula

348

15 (4.3)

0

42 (12.1)

97

 Without fistula

1,349

13 (1.0)

0

18 (1.3)

1,037

 Unknown

13

1 (7.7)

0

1 (7.7)

8

Chronic empyema

540

5 (0.9)

0

15 (2.8)

133

 With fistula

274

4 (1.5)

0

10 (3.6)

44

 Without fistula

263

1 (0.4)

0

5 (1.9)

87

 Unknown

3

0

0

0

2

Total

2,250

34 (1.5)

0

76 (3.4)

1,275

Values in parenthesis represent mortality %

Table 13

9. Operation for non-neoplasmic disease

(C) Descending necrotizing mediastinitis

 

Cases

30-day mortality

Hospital mortality

By VATS

Hospital

After discharge

(C) Descending necrotizing mediastinitis

92

6 (6.5)

0

7 (7.6)

50

Values in parenthesis represent mortality %

Table 14

9. Operation for non-neoplasmic disease

(D) Bullous disease

 

Cases

30-day mortality

Hospital mortality

By VATS

Hospital

After discharge

(D) Bullous disease

569

0

0

2 (0.4)

443

 Emphysematous bulla

438

0

0

2 (0.5)

355

 Bronchogenic cyst

74

0

0

0

58

 Emphysema with volume reduction surgery

22

0

0

0

16

 Others

35

0

0

0

14

Values in parenthesis represent mortality %

LVRS lung volume reduction surgery

Table 15

9. Operation for non-neoplasmic disease

(E) Pneumothorax

 

Cases

30-day mortality

Hospital mortality

By VATS

Hospital

After discharge

(E) Pneumothorax

14,410

37 (0.3)

1 (0.01)

53 (0.4)

13,555

Spontaneous pneumothorax

 Operative procedure

  Bullectomy

3,588

3 (0.08)

0

3 (0.08)

3,400

  Bullectomy with additional procedure

7,751

1 (0.01)

0

1 (0.01)

7,456

   Coverage with artificial material

7,374

1 (0.01)

0

1 (0.01)

7,088

   Parietal pleurectomy

34

0

0

0

33

   Coverage and parietal pleurectomy

85

0

0

0

81

   Others

258

0

0

0

254

  Others

475

3 (0.6)

0

0

432

  Total

11,814

7 (0.1)

0

4 (0.0)

11,288

Secondary pneumothorax

 Associated disease

     

  COPD

1,977

19 (1.0)

1 (0.1)

25 (1.3)

1,748

  Tumorous disease

92

3 (3.3)

0

6 (6.5)

75

  Catamenial

153

0

0

0

152

  LAM

38

2 (5.26)

0

2

33

  Others (excluding pneumothorax by trauma)

333

9 (2.7)

0

16 (4.8)

258

  Unknown

3

   

1

 Operative procedure

     

  Bullectomy

28

5 (17.9)

0

8 (28.6)

344

  Bullectomy with additional procedure

1,881

19 (1.0)

1

29 (1.5)

1,656

   Coverage with artificial material

1,707

14 (0.8)

1 (0.06)

23 (1.3)

1,506

   Parietal pleurectomy

21

0

0

0

20

   Coverage and parietal pleurectomy

16

1 (6.3)

0

1 (6.3)

13

   Others

137

4 (2.9)

0

5 (3.6)

117

  Others

330

9 (2.7)

0

12 (3.6)

264

  Unknown

4

0

0

0

3

  Total

2,243

33 (1.5)

1 (0.04)

49 (2.2)

2,267

Values in parenthesis represent mortality %

Table 16

9. Operation for non-neoplasmic disease

(F) Chest wall deformity

 

Cases

30-day mortality

Hospital mortality

Hospital

After discharge

(F) Chest wall deformity

415

0

0

0

 Funnel chest

393

0

0

0

 Others

22

0

0

0

Values in parenthesis represent mortality %

Table 17

9. Operation for non-neoplasmic disease

(G) Diaphragmatic hernia

 

Cases

30-day mortality

Hospital mortality

By VATS

Hospital

After discharge

(G) Diaphragmatic hernia

112

3 (2.7)

0

4 (3.6)

34

 Congenital

54

1 (1.9)

0

2 (3.7)

11

 Traumatic

38

2 (5.3)

0

2 (5.3)

7

 Others

30

0

0

0

16

Values in parenthesis represent mortality %

Table 18

9. Operation for non-neoplasmic disease

(H) Chest trauma

 

Cases

30-day mortality

Hospital mortality

By VATS

Hospital

After discharge

(H) Chest trauma

393

18 (4.6)

1 (0.25)

20 (5.1)

127

Values in parenthesis represent mortality %

Table 19

9. Operation for non-neoplasmic disease

(I) Other respiratory surgery

 

Cases

30-day mortality

Hospital mortality

By VATS

Hospital

After discharge

(I) Other respiratory surgery

727

7 (1.0)

0

14 (1.9)

392

 Arteriovenous malformation*

95

1 (1.1)

0

1 (1.1)

73

 Pulmonary sequestration

126

0

0

0

68

 Others

506

6 (1.2)

0

13 (2.6)

251

* Includes those with myasthenia gravis

Values in parenthesis represent mortality %

Table 20

10. Lung transplantation

 

Cases

30-day mortality

Hospital mortality

Hospital

After discharge

Single lung transplantation from brain-dead donor

16

0

0

1 (6.3)

Bilateral lung transplantation from brain-dead donor

18

0

0

0

Lung transplantation from living donor

10

0

0

0

Total of lung transplantation 

44

0

0

1 (2.3)

Donor of living donor lung transplantation 

17

0

0

0

Values in parenthesis represent mortality %

Table 21

11. Video-assisted thoracic surgery

 

Cases

30-day mortality

Hospital mortality

Hospital

After discharge

11. Video-assisted thoracic surgery

54,616

83 (0.2)

5 (0.01)

141 (0.3)

Values in parenthesis represent mortality %

(Including thoracic sympathectomy 146)

Table 22

12. Tracheobronchoplasty

 

Cases

30-day mortality

Hospital mortality

Hospital

After discharge

12. Tracheobronchoplasty

554

3 (0.5)

1 (0.2)

9 (1.6)

Trachea

105

0

0

2 (1.9)

 Sleeve resection with reconstruction

58

0

0

0

 Wedge with simple closure

29

0

0

1

 Wedge with patch closure

1

0

0

0

 Total laryngectomy with tracheostomy

2

0

0

1

 Others

15

0

0

0

Cardinal reconstruction

7

0

0

0

Sleeve pneumonectomy

16

0

0

1 (6.3)

Sleeve lobectomy

383

3 (0.8)

1 (0.3)

6 (1.6)

Sleeve segmental excision

12

0

0

0

Bronchoplasty without lung resection

12

0

0

0

Others

19

0

0

0

Values in parenthesis represent mortality %

Table 23

13. Pediatric surgery

 

Cases

30-day mortality

Hospital mortality

Hospital

After discharge

13. Pediatric surgery

417

1 (0.2)

0

1 (0.2)

Values in parenthesis represent mortality %

Table 24

14. Combined resection of neighboring organ(s)

 

Cases

30-day mortality

Hospital mortality

Hospital

After discharge

14. Combined resection of neighboring organ(s)

1,002

5 (0.5)

3 (0.3)

15 (1.5)

(A) Primary lung cancer (organ resected)

  

 Aorta

9

1 (11.1)

0

1 (11.1)

 Superior vena cava

35

0

0

2 (5.7)

 Brachycephalic vein

12

1 (8.3)

0

1 (8.3)

 Pericardium

171

1 (0.6)

0

3 (1.8)

 Pulmonary artery

184

0

0

2 (1.1)

 Left atrium

33

1 (3.0)

0

1 (3.0)

 Diaphragm

94

0

0

1 (1.1)

 Chest wall (including ribs)

494

2 (0.4)

1 (0.2)

12 (2.4)

 Vertebra

30

0

0

2 (6.7)

 Esophagus

7

0

0

0

 Total

1,069

6 (0.6)

1 (0.1)

25 (2.3)

(B) Mediastinal tumor (organ resected)

  

 Aorta

2

0

0

0

 Superior vena cava

55

1 (1.8)

0

1 (1.8)

 Brachycephalic vein

85

0

0

1 (1.2)

 Pericardium

238

1 (0.4)

0

1 (0.4)

 Pulmonary artery

1

0

0

0

 Left atrium

0

0

0

0

 Diaphragm

24

0

0

0

 Chest wall (including ribs)

16

0

0

0

 Vertebra

6

0

0

0

 Esophagus

3

0

0

0

 Lung

290

0

0

0

 Total

720

2 (0.3)

0

3 (0.4)

Values in parenthesis represent mortality %

Table 25

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

128

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)

(C) Esophageal surgery

During 2012 alone, a total of 12,315 patients with esophageal diseases were registered from 555 institutions (response rate: 95.4 %), affiliated to the Japanese Association for Thoracic Surgery and/or to the Japan Esophageal Society. Among these institutions, 20 or more patients underwent esophageal surgeries within the year of 2012 in 184 institutions (33.2 %), which shows definite shift of esophageal operations to high volume institutions when compared to the data of 2011 (22.9 %) (Table 1) Of 2,281 patients with a benign esophageal disease, 1,141 (50.0 %) patients underwent surgery, and 30 (1.3 %) patients underwent endoscopic resection, while 1,110 (48.7 %) patients did not undergo any surgical treatment. (Table 2) Of 10,034 patients with a malignant esophageal tumor, 7,859 (78.3 %) patients underwent resection, esophagectomy for 6,055 (60.3 %) and endoscopic mucosal resection (EMR) or endoscopic submucosal dissection (ESD) for 1,804 (18.0 %), while 2,175 (21.6 %) patients did not undergo any resection. (Tables 3, 4) The decrease of registered patients with nonsurgically treated benign esophageal diseases is obvious during 2011 and 2012. The patients registered, particularly those undergoing nonsurgical therapy for a malignant esophageal disease, have been increasing since 1990 (Fig. 1).

Among benign esophageal diseases (Table 2), esophageal varices, hiatal hernia, achalasia and esophagitis (including reflux esophagitis) 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. 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 828 patients with a benign esophageal disease with 30-day mortality in 5 (0.6 %), while thoracoscopic and/or laparoscopic surgery was performed for 233 patients with 0 (0.0 %) of the 30-day mortality The difference in these death rates between open and scopic surgery seems to be related to the conditions requiring open surgery.

The majority of malignant diseases were carcinomas (Table 3). Among esophageal carcinomas, the incidence of squamous cell carcinoma was 91.8 %, while that of adenocarcinomas including Barrett cancer was 5.7 %. The resection rate for patients with a squamous cell carcinoma was 77.6 %, while that for patients with an adenocarcinoma was 91.5 %.

According to location, cancer in the thoracic esophagus was the most common (Table 4). Of the 3,793 patients (37.8 % of total esophageal malignancies) having superficial esophageal cancers within mucosal and submucosal layers, 1,759 (46.3 %) patients underwent esophagectomy, while 1,802 (47.5 %) patients underwent EMR or ESD. The 30-day mortality rate and hospital mortality rate after esophagectomy for patients with a superficial cancer were 0.6 and 1.5 %, respectively. There was no EMR or ESD-related death. Advanced esophageal cancer invading deeper than the submucosal layer was observed in 6,231 (62.1 %) patients. Of the 6,231 patients with advanced esophageal cancer, 4,288 (68.8 %) underwent esophagectomy, with 0.8 % of the 30-day mortality rate, and with 2.4 % of the hospital mortality rate.

Multiple primary cancers were observed in 1,644 (16.4 %) of all the 10,034 patients with esophageal cancer. Synchronous cancer was found in 868 (52.9 %) patients, while metachronous cancer (found before esophageal cancer) was observed in 772 (47.0 %) patients. The stomach is the commonest site for both synchronous and metachronous malignancy followed by head & neck cancer (Table 4).

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 5). Transhiatal esophagectomy commonly performed in Western countries was adopted in only 4.4 % of patients having a superficial cancer who underwent esophagectomy, and in 2.0 % of those having an advanced cancer in Japan. The thoracoscopic and/or laparoscopic esophagectomy were adopted for 855 patients (48.6 %) with a superficial cancer, and for 1,193 patients (27.8 %) 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. 2).
Fig. 2

Annual trend of video-assisted esophagectomy for esophageal malignancy

Combined resection of the neighboring organs during resection of an esophageal cancer was performed in 334 patients (Tables 5, 6). Resection of the aorta together with the esophagectomy was performed in 2 cases. Tracheal and/or bronchial resection combined with esophagectomy was performed in 23 patients, with the 30-day mortality rate at 4.3 % and the hospital mortality rate at 13.0 %. Lung resection combined with esophagectomy was performed in 69 patients, with the 30-day mortality rate at 0 % and the hospital mortality rate at 1.4 %.

Salvage surgery after definitive (chemo-)radiotherapy was performed in 256 patients, with the 30-day mortality rate at 2.7 % and with the hospital mortality rate at 6.3 %. (Table 5).

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.

Table 1 Distribution of number of esophageal operations in 2012 in each institution

Esophageal surgery

Number of operations in 2012

Benign esophageal diseases

Malignant esophageal disease

Benign + malignant

0

262

116

86

1–4

228

99

99

5–9

34

73

81

10–19

22

98

105

20–29

4

45

48

30–39

3

32

35

40–49

0

30

30

≧50

2

62

71

Total

555

555

555

Table 2 Benign esophageal diseases

 

Operation (+)

Endoscopic resection

Operation (−)

Total

Number of patients

30-day mortality

Hospital mortality

Total

Open

T/L*3

Open surgery

T/L*3

Total

Open surgery

T/L*3

Total

Hospital

After discharge

Total

Hospital

After discharge

1. Achalasia

190

129

61

0

0

0

0

0

0

0

0

0

 

40

230

2. Benign tumor

74

37

37

0

0

0

0

0

0

0

0

0

30

13

117

 (1) Leiomyoma

46

21

22

0

0

0

0

0

0

0

0

0

12

9

67

 (2) Cyst

7

3

4

0

0

0

0

0

0

0

0

0

0

1

8

 (3) Others

21

10

11

0

0

0

0

0

0

0

0

0

18

3

42

 (4) Not specified

0

0

0

0

0

0

0

0

0

0

0

0

 

0

0

3. Diverticulum

28

22

6

0

0

0

0

0

0

0

0

0

 

14

42

4. Hiatal hernia

382

284

98

0

0

0

0

0

0

0

0

0

 

136

518

5. Spontaneous rupture of the esophagus

86

79

7

1 (1.3)

1 (1.3)

0

0

0

0

1

1 (1.3)

0

 

9

95

6. Esophago-tracheal fistula

14

13

1

0

0

0

0

0

0

1

1 (7.7)

0

 

11

25

7. Congenital esophageal atresia

35

14

1

0

0

0

0

0

0

0 (0.0)

0

0

 

0

35

8. Congenital esophageal stenosis

12

11

1

0

0

0

0

0

0

0

0

0

 

9

21

9. Corrosive stricture of the esophagus

11

10

1

0

0

0

0

0

0

0

0

0

 

18

29

10. Esophagitis, Esophageal ulcer

34

32

2

0

0

0

0

0

0

2 (5.9)

2 (6.3)

0

 

197

231

11. Esophageal varices

235

167

8

1 (0.6)

1 (0.6)

0

0

0

0

1 (0.4)

1 (0.6)

0

 

608

843

 (1) Laparotomy

31

23

8

0

0

0

0

0

0

0 (0.0)

0

0

  

31

 (2) Others

   

0

 

0

0

0

0

0

    

0

 (3) Sclerotherapy

   

0

 

0

0

0

0

0

   

497

497

12. Others

40

30

10

3 (10.0)

3 (10.0)

0

0

0

0

3 (7.5)

3 (10.0)

0

 

55

95

Total

1,141

828

233

5 (0.6)

5 (0.6)

0

0

0

0

8 (0.7)

8 (1.0)

0

30

1,110

2,281

Values in parenthesis represent mortality %

T/L thoracoscopic and/or laparoscopic

Table 3 Malignant esophageal diseases (histologic classification)

 

Resection (+)

Resection (−)

Total

Carcinomas

7,823

2,133

9,956

 1. Squamous cell carcinoma

7,097

2,044

9,141

 2. Basaloid(-squamous) carcinoma

86

11

97

 3. Carcinosarcoma

36

2

38

 4. Adenocarcinoma in the Barrett’s esophagus

315

26

341

 5. Other adenocarcinoma

200

22

222

 6. Adenosquamous carcinoma

32

2

34

 7. Mucoepidermoid carcinoma

4

0

4

 8. Adenoid cystic carcinoma

4

0

4

 9. Endocrine cell carcinoma

35

13

48

 10. Undifferentiated carcinoma

8

9

17

 11. Others

6

4

10

Other malignancies

22

7

29

 1. Malignant non-epithelial tumors

7

1

8

 2. Malignant melanoma

14

5

19

 3. Other malignant tumors

1

1

2

Not specified

14

35

49

Total

7,859

2,175

10,034

Resection: including endoscopic resection

Table 4 Malignant esophageal disease (clinical characteristics)

 

Operation (+)

EMR or ESD

Operation (−)

Total

Cases

30-day mortality

Hospital mortality

Total

Hospital

After discharge

1. Esophageal cancer

6,055

47 (0.8)

45 (0.7)

2 (0.0)

131 (2.2)

1,804

2,175

10,034

Location

       

0

 (1) Cervical esophagus

215

2 (0.9)

2 (0.9)

0

8 (3.7)

78

164

457

 (2) Thoracic esophagus

5,022

43 (0.9)

42 (0.8)

1 (0.0)

114 (2.3)

1,506

1,845

8,373

 (3) Abdominal esophagus

552

2 (0.4)

1 (0.2)

1 (0.2)

8 (1.4)

78

78

708

 (4) Multiple cancers

261

0

0

0

1 (0.4)

118

70

449

 (5) Others/not described

5

0

0

0

0

24

18

47

Tumor depth

        

 (A) Superficial cancer

1,759

11 (0.6)

10 (0.6)

1 (0.1)

26 (1.5)

1,802

232

3,793

 (B) Advanced cancer

4,288

36 (0.8)

35 (0.8)

1 (0.0)

104 (2.4)

0

1,943

6,231

 (C) Not specified

8

    

2

0

10

2. Multiple primary cancers

967

8 (0.8)

7 (0.7)

1 (0.1)

20 (2.1)

364

313

1,644

1) Synchronous

558

3 (0.5)

2 (0.4)

1 (0.2)

9 (1.6)

138

172

868

 (1) Head and neck

177

1 (0.6)

1 (0.6)

0

2 (1.1)

60

45

282

 (2) Stomach

221

0 (0.0)

0

0

4 (1.8)

35

55

311

 (3) Others

137

2 (1.5)

0

1 (0.7)

1 (0.7)

27

54

218

 (4) Triple cancers

23

1

1 (4.3)

0

2 (8.7)

16

18

57

2) Metachronous

409

5 (1.2)

5 (1.2)

0

11 (2.7)

225

138

772

 (1) Head and neck

82

2 (2.4)

2 (2.4)

0

2 (2.4)

93

30

205

 (2) Stomach

132

2 (1.5)

2 (1.5)

0

6 (4.5)

51

45

228

 (3) Others

171

1 (0.6)

1 (0.6)

0

2 (1.2)

48

43

262

 (4) Triple cancers

24

0

0

0

1 (4.2)

32

17

73

Values in parenthesis represent mortality %

EMR endoscopic mucosal resection (including endoscopic submucosal dissection)

Table 5 Malignant esophageal disease (surgical procedures)

 

Cases

Operation (+)

EMR or ESD

30-day mortality

Hospital mortality

Thoracoscopic and/or laparoscopic procedure

Hospital

After discharge

 

Cases

30-day mortality

Hospital mortality

  

Hospital

After discharge

Superficial cancer

         

Esophagectomy

1,759

10 (0.6)

1 (0.1)

26 (1.5)

855

6 (0.7)

0

13 (1.5)

1,802

 (1) Transhiatal esophagectomy

76

1 (1.3)

0

2 (2.6)

6

0

0

0

 

 (2) Transthoracic (rt.) esophagectomy and reconstruction

1,387

9 (0.6)

1 (0.1)

21 (1.5)

735

6 (0.8)

0

12 (1.6)

 

 (3) Transthoracic (lt.) esophagectomy and reconstruction

54

0

0

1 (1.9)

4

0

0

0

 

 (4) Cervical esophageal resection and reconstruction

18

0

0

0

3

0

0

0

 

 (5) Two-stage operation

27

0

0

0

7

0

0

0

 

 (6) Others

184

0

0

1 (0.5)

76

0

0

0

 

 (7) Not specified

13

0

0

1

24

0

0

1 (4.2)

 

Advanced cancer 

         

Esophagectomy

4,288

35 (0.8)

1 (0.0)

104 (2.4)

1,193

8 (0.7)

0

21 (1.8)

0

 (1) Transhiatal esophagectomy

84

1 (1.2)

0

6 (7.1)

8

0

0

0

 

 (2) Transthoracic (rt.) esophagectomy and reconstruction

3,479

22 (0.6)

0

79 (2.3)

1,004

5 (0.5)

0

18 (1.8)

 

 (3) Transthoracic (lt.) esophagectomy and reconstruction

227

2 (0.9)

1 (0.4)

3 (1.3)

32

0

0

0

 

 (4) Cervical esophageal resection and reconstruction

120

2 (1.7)

0

4 (3.3)

6

0

0

0

 

 (5) Two-stage operation

96

2 (2.1)

0

5 (5.2)

18

1 (5.6)

0

1 (5.6)

 

 (6) Others/not specified

268

5 (1.9)

0

6 (2.2)

116

2 (1.7)

0

2 (1.7)

 

 (7) Not specified

14

1 (7.1)

0

1 (7.1)

9

0 (0.0)

0

0

 

(Depth not specified)

8

0

0

1 (12.5)

     

Combined resection of other organs

334

2 (0.6)

0

9 (2.7)

     

 (1) Aorta

2

0

0

0

     

 (2) Trachea, bronchus

23

1 (4.3)

0

3 (13.0)

     

 (3) Lung

69

0

0

1 (1.4)

     

 (4) Others

240

1 (0.4)

0

5 (2.1)

     

Salvage surgery

256

7 (2.7)

0

16 (6.3)

31

1 (3.2)

0

4 (12.9)

35

Values in parenthesis represent mortality %

Table 6 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

4,194

120

2.86

7

3

42.86

24

0

0.00

50

2

4.00

78

4

5.13

1997

4,441

127

2.86

1

0

0.00

34

5

14.71

56

1

1.79

94

3

3.19

1998

4,878

136

2.79

4

0

0.00

29

0

0.00

74

1

1.35

128

2

1.56

1999

5,015

116

2.31

5

0

0.00

23

2

8.70

68

0

0.00

122

1

0.82

2000

5,350

81

1.51

2

0

0.00

23

2

8.70

69

0

0.00

96

1

1.04

2001

5,521

110

1.99

1

0

0.00

26

1

3.85

83

3

3.61

99

2

2.02

2002

4,904

66

1.35

3

1

33.33

20

2

10.00

63

0

0.00

63

1

1.59

2003

4,639

45

0.97

0

0

0.00

24

2

8.33

58

0

0.00

88

1

1.14

2004

4,739

64

1.35

2

0

0.00

17

0

0.00

59

5

8.47

119

2

1.68

2005

5,163

52

1.01

1

0

0.00

11

1

9.09

67

1

1.49

73

1

1.37

2006

5,236

63

1.20

0

0

0.00

17

0

0.00

62

2

3.23

122

3

2.46

2007

4,990

60

1.20

0

0

0.00

25

1

4.00

44

1

2.27

138

2

1.45

2008

5,124

63

1.23

0

0

0.00

17

1

5.88

48

1

2.08

185

0

0.00

2009

5,260

63

1.20

0

0

0.00

19

2

10.53

58

2

3.45

211

3

1.42

2010

5,180

45

0.87

2

0

0.00

33

0

0.00

58

0

0.00

245

5

2.04

2011

5,430

38

0.70

4

0

0.00

26

0

0.00

41

0

0.00

179

5

2.79

2012

6,055

47

0.78

2

0

0.00

23

1

4.35

69

0

0.00

240

1

0.42

Total

86,119

1,040

1.21

26

4

15.38

273

16

5.86

753

16

2.12

1,220

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

Fig. 1

General thoracic surgery

Notes

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.

Copyright information

© The Author(s) 2014

Open AccessThis article is distributed under the terms of the Creative Commons Attribution License which permits any use, distribution, and reproduction in any medium, provided the original author(s) and the source are credited.

Authors and Affiliations

  • Committee for Scientific Affairs, The Japanese Association for Thoracic Surgery
    • 16
  • Munetaka Masuda
    • 1
  • Hiroyuki Kuwano
    • 2
  • Meinoshin Okumura
    • 3
  • Jun Amano
    • 4
  • Hirokuni Arai
    • 5
  • Shunsuke Endo
    • 6
  • Yuichiro Doki
    • 7
  • Junjiro Kobayashi
    • 8
  • Noboru Motomura
    • 9
  • Hiroshi Nishida
    • 10
  • Yoshikatsu Saiki
    • 11
  • Fumihiro Tanaka
    • 12
  • Kazuo Tanemoto
    • 13
  • Yasushi Toh
    • 14
  • Hiroyasu Yokomise
    • 15
  1. 1.Department of SurgeryYokohama City UniversityYokohamaJapan
  2. 2.Department of General Surgical Science (Surgery I) Gunma UniversityGraduate School of MedicineGunmaJapan
  3. 3.Department of General Thoracic SurgeryOsaka University Graduate School of MedicineOsakaJapan
  4. 4.Department of Cardiovascular SurgeryFujimi-Kogen Medical CenterNaganoJapan
  5. 5.Department of Cardiovascular SurgeryTokyo Medical and Dental University Graduate School of Medical and Dental SciencesTokyoJapan
  6. 6.Department of Thoracic SurgeryJichi Medical UniversityTochigiJapan
  7. 7.Department of Gastroenterological Surgery Graduate School of MedicineOsaka UniversityOsakaJapan
  8. 8.Department of Cardiovascular SurgeryNational Cerebral and Cardiovascular CenterOsakaJapan
  9. 9.Department of Cardiovascular SurgeryToho University, Sakura Medical CenterChibaJapan
  10. 10.Department of Cardiovascular Surgery, The Heart Institute of JapanTokyo Women’s Medical UniversityTokyoJapan
  11. 11.Division of Cardiovascular SurgeryTohoku University Graduate School of MedicineMiyagiJapan
  12. 12.Second Department of SurgeryUniversity of Occupational and Environmental Health, JapanFukuokaJapan
  13. 13.Department of Cardiovascular SurgeryKawasaki Medical SchoolOkayamaJapan
  14. 14.Department of Gastroenterological SurgeryNational Kyushu Cancer CenterFukuokaJapan
  15. 15.Department of General Thoracic Surgery, Faculty of MedicineKagawa UniversityKagawaJapan
  16. 16.TokyoJapan

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