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General Thoracic and Cardiovascular Surgery

, Volume 64, Issue 11, pp 665–697 | Cite as

Thoracic and cardiovascular surgery in Japan during 2014

Annual report by The Japanese Association for Thoracic Surgery
  • Committee for Scientific Affairs, The Japanese Association for Thoracic Surgery
  • Munetaka MasudaEmail author
  • Meinoshin Okumura
  • Yuichiro Doki
  • Shunsuke Endo
  • Yasutaka Hirata
  • Junjiro Kobayashi
  • Hiroyuki Kuwano
  • Noboru Motomura
  • Hiroshi Nishida
  • Yoshikatsu Saiki
  • Aya Saito
  • Hideyuki Shimizu
  • Fumihiro Tanaka
  • Kazuo Tanemoto
  • Yasushi Toh
  • Hiroyuki Tsukihara
  • Shinji Wakui
  • Hiroyasu Yokomise
Open Access
ANNUAL REPORT

The Japanese Association for Thoracic Surgery has conducted annual surveys of thoracic surgery throughout Japan since 1986 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 2014.

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 Questionnaires sent out and received back by the end of December 2015

 

Sent out

Returned

Response rate (%)

(A) Cardiovascular surgery

578

561

97.1

(B) General thoracic surgery

762

732

96.1

(C) Esophageal surgery

626

601

96.0

Table 2 Categories subclassified according to the number of operations performed

Number of operations performed

Category

Cardiovascular surgery

General thoracic surgery

0

21

30

1–24

42

81

25–49

86

108

50–99

157

202

100–149

103

137

150–199

52

80

≧200

100

94

Total

561

732

Number of operations performed

Esophageal surgery

 

0

98

 

1–4

145

 

5–9

117

 

10–19

108

 

20–29

39

 

30–39

27

 

40–49

25

 

≧50

42

 

Total

601

 

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 the 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 in the categories of cardiovascular surgery and esophageal surgery: transfer to a nursing home or a rehabilitation unit is considered hospital discharge unless the patient subsequently dies of complications of the operation. While hospital-to-hospital transfer after 30 days of operation is considered discharge in the categories of general thoracic surgery, because data of national clinical database (NCD) 2014 were used in this category, and hospital-to-hospital transfer after 30 days of operation is considered discharge in NCD.

Abstract of the survey

We sent out survey questionnaire forms to the departments of each category in all 1039 institutions (578 cardiovascular, 762 general thoracic, and 626 esophageal) nationwide in early April 2014. The response rates in each category by the end of December 2015 were 97.1, 96.1, and 96.0 %, respectively. This high response rate has been keep throughout recent survey, and more than 96 % response rate in all fields in 2014 survey has to be congratulated.

2014 Final report

(A) Cardiovascular surgery

First, we are very pleased with the high response rate to our survey of cardiovascular surgery (97.1 %), 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 28 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 66,453 cardiovascular operations were performed at 561 institutions during 2014 alone and included 30 heart transplantations, which were restarted in 1999.
Fig. 1

Cardiovascular surgery. IHD ischemic heart disease

The number of operations for congenital heart disease (9269 cases) decreased slightly (1.0 %) compared with that of 2013 (9366 cases), and 2.9 % decrease when compared with the data of 10 years ago (9545 cases in 2004). The number of operations for adult cardiac disease (21,939 cases in valvular heart disease, 17,498 cases in thoracic aortic aneurysm, and 2118 cases for other procedures) increased compared with those of 2013 (0.8, 11.0, and 13.2 %, respectively) except for ischemic heart disease (15,629 cases), which decreased 5.6 % of that in 2013. During the last 10 years, the numbers of operations for adult heart disease increased constantly except for that for ischemic heart disease (73.8 % increase in valvular heart disease, 26.5 % decrease in ischemic heart disease, 114.5 % increase in thoracic aortic aneurysm, and 56.5 % increase in other procedures compared those of 2004). 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 and thoracic aneurysm in our study, and then, the number of CABG still remained over 20,000 cases per year (20,991 cases) in 2014.

Data for individual categories are summarized in tables through 3, 4, 5, 6, 7, 8 and 9.

Table 3 Congenital (total; 9269)

(1) CPB (+) (total; 6894)

 

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

1

1 (100.0)

0

1 (100.0)

2

0

0

0

1

0

0

0

13

0

0

0

17

1 (5.9)

0

1 (5.9)

2

Coarctation (simple)

11

0

0

0

10

0

0

0

11

0

0

0

7

0

0

0

39

0

0

0

3

 +VSD

39

0

0

0

51

0

0

0

12

0

0

0

6

0

0

0

108

0

0

0

4

 +DORV

8

0

0

0

12

0

0

1 (8.3)

3

0

0

0

0

0

0

0

23

0

0

1 (4.3)

5

 +AVSD

1

0

0

0

3

1 (33.3)

0

1 (33.3)

3

0

0

0

1

0

0

0

8

1 (12.5)

0

1 (12.5)

6

 +TGA

9

0

0

1 (11.1)

4

0

0

0

3

0

0

0

4

0

0

0

20

0

0

1 (5.0)

7

 +SV

4

1 (25.0)

0

1 (25.0)

8

0

0

0

2

0

0

0

1

0

0

0

15

1 (6.7)

0

1 (6.7)

8

 +Others

3

1 (33.3)

0

1 (33.3)

8

0

0

0

3

0

0

0

1

0

0

0

15

1 (6.7)

0

1 (6.7)

9

Interrupt. of Ao (simple)

4

0

0

0

1

0

0

0

1

0

0

0

0

0

0

0

6

0

0

0

10

 +VSD

33

1 (3.0)

0

3 (9.1)

23

1 (4.3)

0

2 (8.7)

9

0

0

0

5

0

0

0

70

2 (2.9)

0

5 (7.1)

11

 +DORV

1

0

0

0

3

0

0

0

0

0

0

0

0

0

0

0

4

0

0

0

12

 +Truncus

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

13

 +TGA

1

1 (100.0)

0

1 (100.0)

0

0

0

0

12

0

0

0

0

0

0

0

13

1 (7.7)

0

1 (7.7)

14

 +Others

5

0

0

0

3

0

0

0

2

0

0

1 (50.0)

0

0

0

0

10

0

0

1 (10.0)

15

Vascular ring

0

0

0

0

8

0

0

0

2

0

0

0

0

0

0

0

10

0

0

0

16

PS

1

0

0

0

10

0

0

0

19

0

0

0

9

1 (11.1)

0

1 (11.1)

39

1 (2.6)

0

1 (2.6)

17

PAIVS or critical PS

18

0

0

1 (5.6)

44

1 (2.3)

0

1 (2.3)

84

0

0

0

6

0

0

0

152

1 (0.7)

0

2 (1.3)

18

TAPVR

113

8 (7.1)

0

15 (13.3)

65

4 (6.2)

0

6 (9.2)

5

0

0

0

0

0

0

0

183

12 (6.6)

0

21 (11.5)

19

PAPVR ± ASD

0

0

0

0

5

0

0

0

45

0

0

1 (2.2)

27

1 (3.7)

0

1 (3.7)

77

1 (1.3)

0

2 (2.6)

20

ASD

20

0

0

0

67

0

0

1 (1.5)

667

0

0

1 (0.1)

494

0

0

0

1248

0

0

2 (0.2)

21

Cor triatriatum

2

0

0

0

14

1 (7.1)

0

1 (7.1)

11

0

0

0

4

0

0

0

31

1 (3.2)

0

1 (3.2)

22

AVSD (partial)

1

0

0

0

7

0

0

0

33

1 (3.0)

0

1 (3.0)

24

0

0

0

65

1 (1.5)

0

1 (1.5)

23

AVSD (complete)

2

0

0

0

108

0

1 (0.9)

2 (1.9)

67

0

0

0

4

0

0

1 (25.0)

181

0

1 (0.6)

3 (1.7)

24

 +TOF or DORV

1

0

0

0

11

1 (9.1)

0

1 (9.1)

15

3 (20.0)

0

3 (20.0)

0

0

0

0

27

4 (14.8)

0

4 (14.8)

25

 +Others

3

0

0

0

4

0

0

1 (25.0)

6

0

0

0

9

0

0

0

22

0

0

1 (4.5)

26

VSD (subarterial)

4

1 (25.0)

0

1 (25.0)

100

0

0

0

199

0

0

0

33

0

0

0

336

1 (0.3)

0

1 (0.3)

27

VSD (perimemb./muscular)

9

0

0

0

742

3 (0.4)

0

4 (0.5)

353

2 (0.6)

1 (0.3)

2 (0.6)

71

0

0

0

1175

5 (0.4)

1 (0.1)

6 (0.5)

28

VSD + PS

0

0

0

0

15

0

0

0

20

0

0

0

3

0

0

0

38

0

0

0

29

DCRV ± VSD

1

0

0

0

16

0

0

0

28

0

0

0

20

0

0

0

65

0

0

0

30

Aneurysm of sinus valsalva

0

0

0

0

1

0

0

0

8

0

0

0

22

0

0

0

31

0

0

0

31

TOF

9

0

0

0

176

1 (0.6)

0

2 (1.1)

212

0

0

1 (0.5)

42

1 (2.4)

0

2 (4.8)

439

2 (0.5)

0

5 (1.1)

32

PA + VSD

4

0

0

0

49

1 (2.0)

0

3 (6.1)

92

0

0

1 (1.1)

7

0

0

0

152

1 (0.7)

0

4 (2.6)

33

DORV

17

0

0

0

106

3 (2.8)

0

3 (2.8)

108

0

0

2 (1.9)

11

1 (9.1)

0

1 (9.1)

242

4 (1.7)

0

6 (2.5)

34

TGA (simple)

102

8 (7.8)

1 (1.0)

8 (7.8)

13

0

0

0

5

0

0

0

1

0

0

0

121

8 (6.6)

1 (0.8)

8 (6.6)

35

 +VSD

31

1 (3.2)

0

1 (3.2)

12

1 (8.3)

0

1 (8.3)

8

0

0

0

0

0

0

0

51

2 (3.9)

0

2 (3.9)

36

 VSD + PS

1

0

0

0

11

0

0

1 (9.1)

15

1 (6.7)

0

1 (6.7)

6

0

0

0

33

1 (3.0)

0

2 (6.1)

37

Corrected TGA

3

0

0

0

23

0

0

0

40

1 (2.5)

0

2 (5.0)

13

0

0

0

79

1 (1.3)

0

2 (2.5)

38

Truncus arteriosus

11

1 (9.1)

0

1 (9.1)

22

0

0

1 (4.5)

14

0

0

0

2

0

0

0

49

1 (2.0)

0

2 (4.1)

39

SV

22

2 (9.1)

0

7 (31.8)

202

4 (2.0)

0

6 (3.0)

263

4 (1.5)

1 (0.4)

8 (3.0)

20

1 (5.0)

0

1 (5.0)

507

11 (2.2)

1 (0.2)

22 (4.3)

40

TA

5

0

0

0

44

1 (2.3)

0

1 (2.3)

53

0

0

1 (1.9)

10

0

0

0

112

1 (0.9)

0

2 (1.8)

41

HLHS

40

2 (5.0)

0

5 (12.5)

124

9 (7.3)

0

15 (12.1)

60

1 (1.7)

0

2 (3.3)

0

0

0

0

224

12 (5.4)

0

22 (9.8)

42

Aortic valve lesion

6

0

0

0

14

1 (7.1)

0

1 (7.1)

89

1 (1.1)

0

1 (1.1)

16

1 (6.3)

0

1 (6.3)

125

3 (2.4)

0

3 (2.4)

43

Mitral valve lesion

2

0

0

0

28

1 (3.6)

0

1 (3.6)

72

1 (1.4)

0

2 (2.8)

8

0

0

0

110

2 (1.8)

0

3 (2.7)

44

Ebstein

15

0

0

3 (20.0)

14

0

0

1 (7.1)

34

0

0

0

16

2 (12.5)

0

2 (12.5)

79

2 (2.5)

0

6 (7.6)

45

Coronary disease

1

0

0

0

8

0

0

0

14

1 (7.1)

0

1 (7.1)

22

0

0

0

45

1 (2.2)

0

1 (2.2)

46

Others

21

0

0

1 (4.8)

46

1 (2.2)

0

3 (6.5)

35

0

0

0

9

0

0

1 (11.1)

111

1 (0.9)

0

5 (4.5)

47

Redo VSD

0

0

0

0

5

0

0

0

13

0

0

0

3

0

0

0

21

0

0

0

48

PS release

0

0

0

0

10

0

0

0

52

0

0

0

24

0

0

0

86

0

0

0

49

RV-PA conduit replace

0

0

0

0

4

0

0

0

54

0

0

0

37

0

0

0

95

0

0

0

50

Others

4

0

0

1 (25.0)

41

2 (4.9)

0

3 (7.3)

97

0

0

0

43

0

0

0

185

2 (1.1)

0

4 (2.2)

Total

589

28 (4.8)

1 (0.2)

52 (8.8)

2297

37 (1.6)

1 (0.04)

63 (2.7)

2,954

16 (0.5)

2 (0.1)

31 (1.0)

1054

8 (0.8)

0

11 (1.0)

6894

89 (1.3)

4 (0.1)

157 (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. interruption of aorta, 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; 2375)

 

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

430

4 (0.9)

0

5 (1.2)

230

2 (0.9)

0

4 (1.7)

40

0

0

0

2

0

0

0

702

6 (0.9)

0

9 (1.3)

2

Coarctation (simple)

21

1 (4.8)

0

1 (4.8)

27

0

0

0

4

0

0

0

0

0

0

0

52

1 (1.9)

0

1 (1.9)

3

 +VSD

39

0

0

0

16

0

0

0

3

0

0

0

1

0

0

0

59

0

0

0

4

 +DORV

9

0

0

0

9

0

0

0

0

0

0

0

0

0

0

0

18

0

0

0

5

 +AVSD

2

0

0

0

1

0

0

0

4

0

0

0

0

0

0

0

7

0

0

0

6

 +TGA

4

0

0

0

1

0

0

0

2

0

0

0

1

0

0

0

8

0

0

0

7

 +SV

12

0

0

1 (8.3)

8

0

0

0

0

0

0

0

0

0

0

0

20

0

0

1 (5.0)

8

 +Others

8

0

0

0

2

0

0

0

0

0

0

0

0

0

0

0

10

0

0

0

9

Interrupt. of Ao (simple)

2

0

0

0

1

0

0

0

1

0

0

0

1

0

0

0

5

0

0

0

10

 +VSD

25

0

0

0

8

0

0

0

1

0

0

0

1

0

0

0

35

0

0

0

11

 +DORV

3

0

0

0

1

0

0

0

0

0

0

0

0

0

0

0

4

0

0

0

12

 +Truncus

1

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

1

0

0

0

13

 +TGA

1

0

0

1 (100.0)

0

0

0

0

0

0

0

0

1

0

0

0

2

0

0

1 (50.0)

14

 +Others

1

0

0

0

1

0

0

0

0

0

0

0

0

0

0

0

2

0

0

0

15

Vascular ring

5

0

0

0

8

0

0

0

7

0

0

0

0

0

0

0

20

0

0

0

16

PS

1

0

0

0

0

0

0

0

3

0

0

0

0

0

0

0

4

0

0

0

17

PAIVS or critical PS

25

1 (4.0)

0

1 (4.0)

20

0

0

1 (5.0)

8

1 (12.5)

0

2 (25.0)

0

0

0

0

53

2 (3.8)

0

4 (7.5)

18

TAPVR

3

0

0

0

8

2 (25.0)

0

2 (25.0)

1

0

0

0

1

0

0

0

13

2 (15.4)

0

2 (15.4)

19

PAPVR ± ASD

0

0

0

0

0

0

0

0

1

0

0

0

1

0

0

0

2

0

0

0

20

ASD

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

21

Cor triatriatum

0

0

0

0

0

0

0

0

2

0

0

0

0

0

0

0

2

0

0

0

22

AVSD (partial)

1

0

0

0

3

0

0

0

2

0

0

0

1

0

0

0

7

0

0

0

23

AVSD (complete)

35

0

0

1 (2.9)

72

0

0

0

3

0

0

0

0

0

0

0

110

0

0

1 (0.9)

24

 +TOF or DORV

2

0

0

0

7

0

0

0

4

0

0

0

0

0

0

0

13

0

0

0

25

 +Others

7

0

0

0

1

0

0

0

0

0

0

0

0

0

0

0

8

0

0

0

26

VSD (subarterial)

1

0

0

0

8

0

0

0

1

0

0

0

0

0

0

0

10

0

0

0

27

VSD (perimemb./muscular)

49

0

0

2 (4.1)

107

0

0

2 (1.9)

2

0

0

0

2

0

0

0

160

0

0

4 (2.5)

28

VSD + PS

1

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

1

0

0

0

29

DCRV ± VSD

1

0

0

0

1

0

0

0

0

0

0

0

1

0

0

0

3

0

0

0

30

Aneurysm of sinus valsalva

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

31

TOF

28

2 (7.1)

0

2 (7.1)

88

0

0

0

7

0

0

0

1

0

0

0

124

2 (1.6)

0

2 (1.6)

32

PA + VSD

23

0

0

0

69

1 (1.4)

0

1 (1.4)

23

1 (4.3)

0

1 (4.3)

0

0

0

0

115

2 (1.7)

0

2 (1.7)

33

DORV

36

0

0

0

55

0

0

0

14

0

0

0

0

0

0

0

105

0

0

0

34

TGA (simple)

6

0

0

0

6

0

0

0

0

0

0

0

0

0

0

0

12

0

0

0

35

 +VSD

7

0

0

0

4

0

0

0

3

0

0

0

0

0

0

0

14

0

0

0

36

 VSD + PS

12

0

0

0

14

0

0

0

1

0

0

0

13

0

0

0

40

0

0

0

37

Corrected TGA

8

0

0

0

26

0

0

0

8

0

0

0

8

0

0

0

50

0

0

0

38

Truncus arteriosus

15

1 (6.7)

0

1 (6.7)

5

0

0

0

5

0

0

0

0

0

0

0

25

1 (4.0)

0

1 (4.0)

39

SV

73

2 (2.7)

0

4 (5.5)

58

2 (3.4)

0

3 (5.2)

24

0

0

0

6

0

0

0

161

4 (2.5)

0

7 (4.3)

40

TA

25

0

0

0

13

1 (7.7)

0

1 (7.7)

9

0

0

0

0

0

0

0

47

1 (2.1)

0

1 (2.1)

41

HLHS

97

3 (3.1)

0

7 (7.2)

14

0

0

0

16

0

0

2 (12.5)

1

0

0

0

128

3 (2.3)

0

9 (7.0)

42

Aortic valve lesion

1

0

0

0

2

0

0

0

1

0

0

0

0

0

0

0

4

0

0

0

43

Mitral valve lesion

2

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

2

0

0

0

44

Ebstein

6

0

0

0

1

0

0

0

3

0

0

0

1

0

0

0

11

0

0

0

45

Coronary disease

1

0

0

0

2

1 (50.0)

0

1 (50.0)

4

0

0

0

0

0

0

0

7

1 (14.3)

0

1 (14.3)

46

Others

15

1 (6.7)

0

1 (6.7)

52

0

0

0

56

0

0

0

18

0

0

0

141

1 (0.7)

0

1 (0.7)

47

Redo VSD

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

48

 PS release

1

0

0

1 (100.0)

2

0

0

0

1

0

0

0

0

0

0

0

4

0

0

1 (25.0)

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

6

0

0

0

22

0

0

1 (4.5)

21

1 (4.8)

0

1 (4.8)

5

0

0

0

54

1 (1.9)

0

2 (3.7)

Total

1051

15 (1.4)

0

28 (2.7)

973

9 (0.9)

0

16 (1.6)

285

3 (1.1)

0

6 (2.1)

66

0

0

0

2375

27 (1.1)

0

50 (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. interruption of aorta, 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

149

4 (2.7)

0

8 (5.4)

357

6 (1.7)

0

9 (2.5)

42

0

0

1 (2.4)

1

0

0

0

549

10 (1.8)

0

18 (3.3)

2

PAB

387

7 (1.8)

0

15 (3.9)

263

2 (0.8)

0

5 (1.9)

11

0

0

0

0

0

0

0

661

9 (1.4)

0

20 (3.0)

3

Bidirectional Glenn or hemi-Fontan ± α

1

0

0

0

240

2 (0.8)

0

2 (0.8)

106

1 (0.9)

0

1 (0.9)

4

0

0

0

351

3 (0.9)

0

3 (0.9)

4

Damus–Kaye–Stansel operation

2

0

0

0

36

1 (2.8)

0

1 (2.8)

15

0

0

0

3

0

0

1 (33.3)

56

1 (1.8)

0

2 (3.6)

5

PA reconstruction/repair (including redo)

16

0

0

1 (6.3)

106

2 (1.9)

0

3 (2.8)

140

0

0

2 (1.4)

25

0

0

0

287

2 (0.7)

0

6 (2.1)

6

RVOT reconstruction/repair

12

0

0

0

111

1 (0.9)

0

2 (1.8)

202

1 (0.5)

0

3 (1.5)

53

0

0

1 (1.9)

378

2 (0.5)

0

6 (1.6)

7

Rastelli procedure

9

0

0

0

39

0

0

1 (2.6)

94

0

0

2 (2.1)

11

0

0

0

153

0

0

3 (2.0)

8

Arterial switch procedure

134

9 (6.7)

1 (0.7)

9 (6.7)

40

1 (2.5)

0

1 (2.5)

2

1 (50.0)

0

2 (100.0)

0

0

0

0

176

11 (6.3)

1 (0.6)

12 (6.8)

9

Atrial switch procedure

2

1 (50.0)

0

1 (50.0)

4

0

0

0

1

0

0

0

0

0

0

0

7

1 (14.3)

0

1 (14.3)

10

Double switch procedure

0

0

0

0

0

0

0

0

15

0

0

0

0

0

0

0

15

0

0

0

11

Repair of anomalous origin of CA

1

0

0

0

4

0

0

0

8

0

0

0

4

0

0

0

17

0

0

0

12

Closure of coronary AV fistula

1

0

0

0

5

0

0

0

4

0

0

0

29

0

0

0

39

0

0

0

13

Fontan/TCPC

0

0

0

0

5

0

0

0

362

1 (0.3)

0

4 (1.1)

30

0

0

0

397

1 (0.3)

0

4 (1.0)

14

Norwood procedure

29

0

0

2 (6.9)

93

8 (8.6)

0

17 (18.3)

2

0

0

0

1

0

0

0

125

8 (6.4)

0

19 (15.2)

15

Ventricular septation

0

0

0

0

10

0

0

0

4

0

0

0

1

0

0

0

15

0

0

0

16

Left side AV valve repair (including Redo)

3

1 (33.3)

0

2 (66.7)

45

2 (4.4)

0

2 (4.4)

71

0

0

0

28

0

0

0

147

3 (2.0)

0

4 (2.7)

17

Left side AV valve replace (including Redo)

0

0

0

0

9

0

0

0

37

2 (5.4)

0

2 (5.4)

19

0

0

0

65

2 (3.1)

0

2 (3.1)

18

Right side AV valve repair (including Redo)

4

0

0

2 (50.0)

14

0

0

1 (7.1)

34

0

0

0

38

0

0

0

90

0

0

3 (3.3)

19

Right side AV valve replace (including Redo)

0

0

0

0

2

1 (50.0)

0

1 (50.0)

9

0

0

0

15

2 (13.3)

0

2 (13.3)

26

3 (11.5)

0

3 (11.5)

20

Common AV valve repair (including Redo)

2

0

0

0

33

1 (3.0)

0

3 (9.1)

34

2 (5.9)

0

2 (5.9)

1

0

0

0

70

3 (4.3)

0

5 (7.1)

21

Common AV valve replace (including Redo)

1

0

0

0

2

0

0

0

7

0

0

1 (14.3)

1

0

0

0

11

0

0

1 (9.1)

22

Repair of supra-aortic stenosis

3

0

0

0

9

0

0

0

15

0

0

0

2

0

0

0

29

0

0

0

23

Repair of subaortic stenosis (including Redo)

2

0

0

2 (100.0)

7

0

0

0

24

2 (8.3)

0

2 (8.3)

7

0

0

0

40

2 (5.0)

0

4 (10.0)

24

Aortic valve plasty ± VSD closure

4

0

0

0

8

0

0

0

31

0

0

0

2

0

0

0

45

0

0

0

25

Aortic valve replacement

0

0

0

0

0

0

0

0

19

0

0

0

23

0

0

0

42

0

0

0

26

AVR with annular enlargement

0

0

0

0

0

0

0

0

12

0

0

0

3

1 (33.3)

0

1 (33.3)

15

1 (6.7)

0

1 (6.7)

27

Aortic root replace (except Ross)

0

0

0

0

1

0

0

0

10

0

0

0

5

0

0

0

16

0

0

0

28

Ross procedure

0

0

0

0

0

0

0

0

11

1 (9.1)

0

1 (9.1)

2

0

0

0

13

1 (7.7)

0

1 (7.7)

Total

762

22 (2.9)

1 (0.1)

42 (5.5)

1443

27 (1.9)

0

48 (3.3)

1322

11 (0.8)

0

23 (1.7)

308

3 (1.0)

0

5 (1.6)

3835

63 (1.6)

1 (0.03)

118 (3.1)

Values in parenthesis represent mortality %

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

Table 4 Acquired (total, (1) + (2) + (4) + (5) + (6) + (7) + isolated ope. for arrhythmia in (3); 39,485

(1) Valvular heart disease (total; 21,939)

 

Valve

Cases

Operation

30-day mortality

Hospital mortality

Redo

Mechanical

Bioprosthesis

Ross procedure

Repair

With CABG

Hospital

After discharge

Cases

30-day mortality

Hospital mortality

Replace

Repair

Replace

Repair

Replace

Repair

Hospital

After discharge

Isolated

A

10,219

1884

8037

1

297

2298

156 (1.6)

5 (1.7)

3 (0.03)

0

238 (2.4)

9 (3.0)

371

20 (5.4)

0

35 (9.4)

M

4851

684

918

 

3249

716

56 (3.5)

16 (0.5)

2 (0.1)

0

95 (5.9)

35 (1.1)

344

10 (2.9)

0

27 (7.8)

T

253

10

68

 

175

25

5 (6.4)

5 (2.9)

0

0

9 (11.5)

7 (4.0)

48

3 (6.3)

0

6 (12.5)

P

13

2

9

 

2

0

0

0

0

0

0

0

4

0

0

0

A + M

A

1537

388

1085

0

55

238

75 (4.9)

0

112 (7.3)

91

13 (14.3)

0

16 (17.6)

M

275

422

0

832

A + T

A

448

96

339

1

6

63

11 (2.5)

0

23 (5.1)

42

2 (4.8)

0

4 (9.5)

T

3

5

0

435

M + T

M

3513

494

1044

 

1972

313

53 (1.5)

0

94 (2.7)

234

13 (5.6)

0

22 (9.4)

T

12

70

 

3424

A + M + T

A

1056

255

759

0

39

130

39 (3.7)

0

64 (6.1)

66

8 (12.1)

0

11 (16.7)

M

198

381

0

474

T

4

17

0

1032

Others

49

5

22

0

14

2

1 (2.0)

0

2 (0.2)

10

0

0

0

Total

21,939

4310

13,176

2

12,006

3785

422 (1.9)

5 (0.02)

688 (3.1)

1210

69 (5.7)

0

121 (10.0)

Number of redo cases is included in total case number of 21,939

Values in parenthesis represent mortality %

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

 

Cases

30-day mortality

Hospital mortality

Hospital

After discharge

TAVR

877

11

1

17

(2) Ischemic heart disease (total, (A) + (B) + (C); 15,629)

(A) Isolated CABG (total; (a)+(b); 14,454)

(a-1) on-pump arrest CABG (total; 3277)

 

Primary, elective

Primary, emergency

Redo, elective

Redo, emergency

Arterial graft only

Artery graft + SVG

SVG only

Others

Unclear

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

93

1 (1.1)

0

1 (1.1)

19

2 (10.5)

0

3 (15.8)

5

0

0

1 (20.0)

2

1 (50.0)

0

2 (100.0)

55

18

46

0

0

2VD

461

3 (0.7)

0

6 (1.3)

47

2 (4.3)

0

2 (4.3)

7

0

0

0

0

0

0

0

95

392

27

0

1

3VD

1512

10 (0.7)

0

12 (0.8)

161

15 (9.3)

0

19 (11.8)

15

1 (6.7)

0

2 (13.3)

1

1 (100.0)

0

1 (100.0)

92

1569

19

0

9

LMT

761

8 (1.1)

0

12 (1.6)

190

11 (5.8)

0

15 (7.9)

3

1 (33.3)

0

1 (33.3)

0

0

0

0

107

814

33

1

1

Total

2827

22 (0.8)

0

31 (1.1)

417

30 (7.2)

0

39 (9.4)

30

2 (6.7)

0

4 (13.3)

3

2 (66.7)

0

3 (100.0)

349

2793

125

1

11

Kawasaki

7

0

0

0

1

0

0

0

1

0

0

0

0

0

0

0

7

2

0

0

0

Hemodialysis

172

6 (3.5)

0

8 (4.7)

28

3 (10.7)

0

5 (17.9)

1

0

0

1 (100.0)

0

0

0

0

10

173

10

0

8

Values in parenthesis represent mortality %

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, LMT includes LMT alone or LMT with other branch diseases

(a-2) on-pump beating CABG (total; 2171)

 

Primary, elective

Primary, emergency

Redo, elective

Redo, emergency

Arterial graft only

Artery graft + SVG

SVG only

Others

Unclear

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

35

2 (5.7)

0

2 (5.7)

31

2 (6.5)

0

5 (16.1)

4

0

0

1 (25.0)

3

1 (33.3)

0

1 (33.3)

40

6

25

0

2

2VD

255

4 (1.6)

0

6 (2.4)

51

4 (7.8)

0

6 (11.8)

11

1 (9.1)

0

1 (9.1)

6

2 (33.3)

0

4 (66.7)

74

224

18

0

7

3VD

894

15 (1.7)

0

28 (3.1)

170

15 (8.8)

0

18 (10.6)

7

0

0

0

1

1 (100.0)

0

1 (100.0)

118

918

24

0

12

LMT

479

6 (1.3)

0

8 (1.7)

216

24 (11.1)

0

33 (15.3)

6

0

0

0

2

1 (50.0)

0

1 (50.0)

103

564

31

0

5

Total

1663

27 (1.6)

0

44 (2.6)

468

45 (9.6)

0

62 (13.2)

28

1 (3.6)

0

2 (7.1)

12

5 (41.7)

0

7 (58.3)

335

1712

98

0

26

Kawasaki

2

0

0

0

1

1 (100.0)

0

1 (100.0)

0

0

0

0

1

0

0

0

1

1

0

0

2

Hemodialysis

139

4 (2.9)

0

11 (7.9)

30

3 (10.0)

0

4 (13.3)

6

0

0

0

2

0

0

1 (50.0)

17

142

10

0

8

Values in parenthesis represent mortality %

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, LMT includes LMT alone or LMT with other branch diseases

(b) off-pump CABG (total; 9006)

(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

Unclear

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

556

3 (0.5)

0

6 (1.1)

70

4 (5.7)

0

5 (7.1)

27

1 (3.7)

0

2 (7.4)

2

1 (50.0)

0

1 (50.0)

531

36

64

0

24

2VD

1446

10 (0.7)

1 (0.07)

13 (0.9)

144

8 (5.6)

0

9 (6.3)

12

0

0

0

2

0

0

0

521

977

56

0

50

3VD

3679

27 (0.7)

0

43 (1.2)

386

13 (3.4)

0

16 (4.1)

22

0

0

0

3

0

0

0

708

3237

41

0

104

LMT

2164

14 (0.6)

0

23 (1.1)

474

18 (3.8)

0

23 (4.9)

14

0

0

0

5

0

0

0

654

1934

45

0

24

Total

7845

54 (0.7)

1 (0.01)

85 (1.1)

1074

43 (4.0)

0

53 (4.9)

75

1 (1.3)

0

2 (2.7)

12

1 (8.3)

0

1 (8.3)

2414

6184

206

0

202

Kawasaki

16

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

13

2

1

0

0

Hemodialysis

524

4 (0.8)

0

9 (1.7)

79

4 (5.1)

0

4 (5.1)

7

0

0

0

1

0

0

0

99

453

13

0

46

Values in parenthesis represent mortality %

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, LMT includes LMT alone or LMT with other branch diseases

(c) Includes cases of conversion, during surgery, from off-pump CABG to on-pump CABG or on-pump beating-heart CABG (total; 156)

 

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

27

1 (3.7)

0

0

3

0

0

0

0

0

0

0

0

0

0

0

A conversion to on-pump beating-heart CABG

100

4 (4.0)

0

4 (4.0)

26

3 (11.5)

0

3 (11.5)

0

0

0

0

0

0

0

0

Total

127

5 (3.9)

0

4 (3.1)

29

3 (10.3)

0

3 (10.3)

0

0

0

0

0

0

0

0

Hemodialysis

15

1 (6.7)

0

1 (6.7)

1

0

0

0

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; 1175)

 

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

257

6 (2.3)

0

13 (5.1)

38

6 (15.8)

0

7 (18.4)

164

59

19

VSP closure

51

4 (7.8)

0

5 (9.8)

245

70 (28.6)

0

82 (33.5)

77

1

7

Cardiac rupture

21

1 (4.8)

0

5 (23.8)

199

73 (36.7)

0

78 (39.2)

23

1

1

Mitral regurgitation

 1) Papillary muscle rupture

10

1 (10.0)

0

1 (10.0)

46

10 (21.7)

1 (2.2)

12 (26.1)

18

11

46

 2) Ischemic

251

7 (2.8)

0

17 (6.8)

27

7 (25.9)

0

7 (25.9)

221

174

53

Others

19

0

0

0

11

1 (9.1)

0

3 (27.3)

3

4

0

Total

609

19 (3.1)

0

41 (6.7)

566

167 (29.5)

1 (0.2)

189 (33.4)

506

250

126

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; 0)

 

Cases

30-day mortality

Hospital mortality

Hospital

After discharge

Isolated

0

0

0

0

With CABG

0

0

0

0

Total

0

0

0

0

TMLR transmyocardial laser revascularization

(3) Operation for arrhythmia (total; 3855)

 

Cases

30-day mortality

Hospital mortality

Concomitant operation

Isolated

Congenital

Valve

IHD

Others

Multiple combination

Hospital

After discharge

2 categories

3 categories

Maze

3486

34 (1.0)

0

55 (1.6)

15

127

3,162

375

216

440

32

For WPW

2

0

0

0

0

1

1

0

0

0

0

For ventricular tachyarrhythmia

35

2 (5.7)

0

3 (8.6)

2

3

14

13

5

2

0

Others

332

3 (0.9)

0

4 (1.2)

89

7

193

57

25

34

3

Total

3855

39 (1.0)

0

62 (1.6)

106

138

3370

445

246

476

35

Values in parenthesis represent mortality %. Except for 106 isolated cases, all remaining 3749 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; 178)

 

CPB (+)

CPB (−)

Cases

30-day mortality

Hospital mortality

Cases

30-day mortality

Hospital mortality

Hospital

After discharge

Hospital

After discharge

Total

102

12 (11.8)

0

15 (14.7)

76

0

0

5 (6.6)

Values in parenthesis represent mortality %

CPB cardiopulmonary bypass

(5) Cardiac tumor (total; 602)

 

Cases

30-day mortality

Hospital mortality

Concomitant operation

Hospital

After discharge

AVR

MVR

CABG

Others

Benign tumor

530

4 (0.8)

0

7 (1.3)

10

11

25

70

 Cardiac myxoma

419

2 (0.5)

0

2 (0.5)

4

8

20

59

 Papillary fibroelastoma

46

0

0

2 (4.3)

4

2

1

7

 Rhabdomyoma

4

1 (25.0)

0

1 (25.0)

0

0

0

0

 Others

61

1 (1.6)

0

2 (3.3)

2

1

4

4

Malignant tumor

72

4 (5.6)

1 (1.4)

11 (15.3)

2

3

2

11

 Primary

45

2 (4.4)

0

3 (6.7)

2

3

1

7

 Metastatic

27

2 (7.4)

1 (3.7)

8 (29.6)

0

0

1

4

Values in parenthesis represent mortality %

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

(6) HOCM and DCM (total; 211)

 

Cases

30-day mortality

Hospital mortality

Concomitant operation

Hospital

After discharge

AVR

MVR

MVP

CABG

Myectomy

171

5 (2.9)

0

8 (4.7)

110

19

23

13

Myotomy

5

0

0

0

1

2

0

0

No-resection

14

1 (7.1)

0

1 (7.1)

2

5

16

0

Volume reduction surgery of the left ventricle

21

3 (14.3)

0

4 (19.0)

0

6

6

4

Total

211

9 (4.3)

0

13 (6.2)

113

32

45

17

Values in parenthesis represent mortality %

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

(7) Other open-heart operation (total; 820)

 

Cases

30-day mortality

Hospital mortality

Hospital

After discharge

Total

820

36 (4.4)

0

42 (5.1)

Values in parenthesis represent mortality %

Table 5 Thoracic aortic aneurysm (total; 17,498)

(1) Dissection (total; 7733)

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.

2787

220 (7.9)

1 (0.04)

267 (9.6)

1

0

0

0

234

7 (3.0)

0

13 (5.6)

7

2 (28.6)

0

2 (28.6)

182

143

5

7

137

71

10 (14.1)

0

14 (19.7)

2. Aortic root

197

42 (21.3)

0

48 (24.4)

1

0

0

0

60

5 (8.3)

0

8 (13.3)

1

0

0

0

39

181

3

2

52

34

6 (17.6)

0

8 (23.5)

3. Ascending Ao. + Arch

1525

129 (8.5)

0

156 (10.2)

41

5 (12.2)

0

8 (19.5)

295

3 (1.0)

0

10 (3.4)

109

2 (1.8)

0

5 (4.6)

104

52

10

2

75

76

5 (6.6)

0

8 (10.5)

4. Arch + descending Ao.

57

2 (3.5)

0

5 (8.8)

16

5 (31.3)

0

6 (37.5)

24

1 (4.2)

0

2 (8.3)

62

5 (8.1)

0

7 (11.3)

0

0

0

0

5

19

1 (5.3)

0

2 (10.5)

5. Aortic root + Asc. Ao. + Arch

129

21 (16.3)

0

23 (17.8)

0

0

0

0

29

3 (10.3)

0

8 (27.6)

5

0

0

0

24

109

1

1

28

17

1 (5.9)

0

1 (5.9)

6. Descending Ao.

16

1 (6.3)

0

1 (6.3)

41

4 (9.8)

0

7 (17.1)

63

2 (3.2)

0

3 (4.8)

208

11 (5.3)

0

14 (6.7)

0

1

0

0

1

24

4 (16.7)

0

6 (25.0)

7. Thoracoabdominal Ao.

2

0

0

1 (50.0)

11

3 (27.3)

0

4 (36.4)

27

2 (7.4)

0

3 (11.1)

138

7 (5.1)

0

12 (8.7)

0

0

0

0

1

31

4 (12.9)

0

5 (16.1)

8. Extra-anatomical bypass

7

1 (14.3)

0

1 (14.3)

8

0

0

0

3

0

0

0

4

0

0

0

0

0

0

0

0

0

0

0

0

9. Stent graft*a

233

18 (7.7)

0

25 (10.7)

277

11 (4.0)

0

16 (5.8)

232

4 (1.7)

0

8 (3.4)

883

18 (2.0)

1 (0.1)

26 (2.9)

8

5

3

0

7

94

4 (4.3)

0

4 (4.3)

 1) TEVARl*b

105

8 (7.6)

0

11 (10.5)

272

11 (4.0)

0

15 (5.5)

170

1 (0.6)

0

3 (1.8)

835

16 (1.9)

1 (0.1)

24 (2.9)

0

0

0

0

0

77

2 (2.6)

0

2 (2.6)

 2) Open stent

128

10 (7.8)

0

14 (10.9)

5

0

0

1 (20.0)

62

3 (4.8)

0

5 (8.1)

48

2 (4.2)

0

2 (4.2)

8

5

3

0

7

17

2 (11.8)

0

2 (11.8)

  a) With total arch*c

127

10 (7.9)

0

14 (11.0)

4

0

0

1 (25.0)

54

3 (5.6)

0

5 (9.3)

43

2 (4.7)

0

2 (4.7)

8

5

3

0

7

16

2 (12.5)

0

2 (12.5)

  b) Without total arch*d

1

0

0

0

1

0

0

0

8

0

0

0

5

0

0

0

0

0

0

0

0

1

0

0

0

 3) Unspecified

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

Total

4953

434 (8.8)

1 (0.02)

527 (10.6)

396

28 (7.1)

0

41 (10.4)

967

27 (2.8)

0

55 (5.7)

1,417

45 (3.2)

1 (0.1)

66 (4.7)

357

491

22

12

306

366

35 (9.6)

0

48 (13.1)

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

Acute, within 2 weeks from the onset

*a = *b + *c + *d + unspecified

(2) Non-dissection (total; 9765)

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.

1369

24 (1.8)

0

38 (2.8)

36

4 (11.1)

0

7 (19.4)

82

872

67

50

171

122

5 (4.1)

0

9 (7.4)

2. Aortic root

1022

27 (2.6)

0

32 (3.1)

35

8 (22.9)

0

10 (28.6)

250

698

71

19

121

129

17 (13.2)

0

22 (17.1)

3. Ascending Ao. + Arch

2139

43 (2.0)

0

75 (3.5)

162

29 (17.9)

4 (2.5)

38 (23.5)

44

181

21

8

351

90

5 (5.6)

0

6 (6.7)

4. Arch + descending Ao.

137

10 (7.3)

0

14 (10.2)

22

2 (9.1)

0

4 (18.2)

0

11

0

0

9

7

1 (14.3)

0

2 (28.6)

5. Aortic root + Asc. Ao. + Arch

120

2 (1.7)

0

3 (2.5)

2

0

0

0

26

90

3

1

12

10

0

0

1 (10.0)

6. Descending Ao.

255

8 (3.1)

0

12 (4.7)

64

11 (17.2)

0

17 (26.6)

0

0

0

0

5

16

4 (25.0)

0

6 (37.5)

8

1 (12.5)

0

1 (12.5)

7. Thoracoabdominal Ao.

390

21 (5.4)

0

28 (7.2)

65

14 (21.5)

0

20 (30.8)

0

0

0

0

0

24

3 (12.5)

0

4 (16.7)

9

0

0

0

8. Extra-anatomical bypass

25

0

1 (4.0)

0

0

0

0

0

0

1

0

0

2

3

0

0

1 (33.3)

10

0

0

1 (10.0)

9. Stent graft*a

3528

55 (1.6)

3 (0.1)

95 (2.7)

394

46 (11.7)

0

69 (17.5)

12

14

2

1

50

159

11 (6.9)

0

25 (15.7)

1100

23 (2.1)

1 (0.1)

35 (3.2)

 1) TEVAR*b

3158

43 (1.4)

3 (0.1)

75 (2.4)

363

42 (11.6)

0

62 (17.1)

6

1

1

0

11

148

8 (5.4)

0

22 (14.9)

1100

23 (2.1)

1 (0.1)

35 (3.2)

 2) Open stent

370

12 (3.2)

0

20 (5.4)

31

4 (12.9)

0

7 (22.6)

6

13

1

1

39

11

3 (27.3)

0

3 (27.3)

  a) With total arch*c

285

8 (2.8)

0

16 (5.6)

23

1 (4.3)

0

4 (17.4)

6

13

1

1

35

8

2 (25.0)

0

2 (25.0)

  b) Without total arch*d

85

4 (4.7)

0

4 (4.7)

8

3 (37.5)

0

3 (37.5)

0

0

0

0

4

3

1 (33.3)

0

1 (33.3)

 3) Unspecified

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

Total

8985

190 (2.1)

4 (0.04)

297 (3.3)

780

114 (14.6)

4 (0.5)

165 (21.2)

414

1867

164

79

721

560

46 (8.2)

76 (13.6)

1,127

24 (2.1)

1 (0.1)

37 (3.3)

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 6 Pulmonary thromboembolism (total; 171)

 

Cases

30-day mortality

Hospital mortality

Hospital

After discharge

Acute

110

15 (13.6)

6 (5.5)

19 (17.3)

Chronic

61

6 (9.8)

0

6 (9.8)

Total

171

21 (12.3)

6 (3.5)

25 (14.6)

Values in parenthesis represent mortality %

Table 7 Assisted circulation (total; 1679)

Sites

VAD

Heart–lung assist

Device

Results

Method

Results

Centrifugal

VAS (extra)

VAS (implant)

Not weaned

Weaned

PCPS

Others

Not weaned

Weaned

On going

Death

Transplant

Alive

Deaths

Transplant

Deaths

Transplant

Deaths

Alive

Post cardiotomy

 Left

23

5

5

5

13 (39.4)

0

12

3 (9.1)

0

      

 Right

2

0

0

0

1 (50.0)

0

1

0

0

      

 Biventricle

  Right

8

0

0

0

6 (75.0)

0

2

1 (12.5)

0

432

78

259 (50.8)

0

79 (15.5)

157

  Left

7

3

0

Congestive heart failure

 Left

52

41

99

101

56 (29.2)

6

18

7 (3.6)

1

      

 Right

6

1

0

0

2 (28.6)

0

3

2 (28.6)

0

      

 Biventricle

  Right

24

6

0

3

16 (53.3)

0

8

2 (6.7)

1

676

61

332 (45.0)

1

111 (15.1)

281

  Left

10

16

4

Respiratory failure

         

80

40

35 (29.2)

0

15 (12.5)

70

Total

132

72

108

109

94 (30.1)

6

44

15 (4.8)

2

1188

179

626 (45.8)

1

205 (15.0)

508

Values in parenthesis represent mortality %

VAD ventricular assist devise, VAS ventricular assist system, extra Extracorporeal VAS, implant Implantable VAS, PCPS percutaneous cardiopulmonary support

Table 8 Heart transplantation (total; 30)

 

Cases

30-day mortality

Hospital mortality

Hospital

After discharge

Heart transplantation

30

1 (3.3)

0

2 (6.7)

Heart and lung transplantation

0

0

0

0

Total

30

1 (3.3)

0

2 (6.7)

Values in parenthesis represent mortality %

Table 9 Pacemaker + ICD (total; 4923)

 

Pacemaker

ICD

V

A-V

CRT

CRTD

ICD

Initial

570

1,971

94

245

383

Exchange

454

807

29

116

254

Unclear

0

0

0

0

0

Total

1024

2778

123

361

637

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

In 2014, 6894 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 3.9 % in 2004. In detail, the most common disease was atrial septal defect (1,248 cases); however, its number deceased to 64.3 % of that in 2004, which might be partially due to the recent development of catheter closure of atrial septal defect in Japan. In the last 10 years, hospital mortality for complex congenital heart disease improved in some anomalies such as, complete atrioventricular septal defect (5.4–1.7 %), tetralogy of Fallot (2.5–1.1 %), transposition of the great arteries with and without ventricular septal defect (9.8–3.9 and 7.1–6.6 %, respectively), single ventricle (8.5–4.3 %), and hypoplastic left heart syndrome (27.7–9.8 %). Right heart bypass surgery is now commonly performed (351 bidirectional Glenn procedures excluding 56 Damus–Kaye–Stansel procedures and 397 Fontan-type procedures including total cavopulmonary connection) with acceptable hospital mortality (1.2 and 1.0 %). Norwood type I procedure was performed in 125 cases with relatively low hospital mortality rate of 15.2 %.

As previously mentioned, the number of operations for valvular heart disease increased by 73.8 % in the last 10 years, and the hospital mortality associated with primary single valve replacement was 2.4 and 5.9 % for the aortic and the mitral position, while that for primary mitral valve repair was 1.1 %. However, hospital mortality rate for redo valve surgery was still high and was 9.4 and 7.8 % for aortic and mitral procedure, respectively. Finally, overall hospital mortality did not show dramatic improvement during the last 10 years (3.8 % in 2004 and 3.1 % in 2014), which might be partially due to the recent progression of age of the patients. Repair of the valve became popular procedure (397 cases in the aortic, 6527 cases in the mitral, and 5066 cases in the tricuspid), and mitral valve repair constituted 29.8 % of all valvular heart disease operation and 59.6 % of all mitral valve procedure (10,957 procedures), which are similar to those of the last 5 years and increased compared with those of 2004 (23.6 and 42.8 %, respectively). Aortic and mitral valve replacements with bioprosthesis were performed in 10,220 cases and 2,765 cases, respectively, with the number consistently increasing in the aortic position. The ratio of prostheses changed dramatically during the last 10 years and the usage of bioprosthesis is 77.5 % at the aortic position (36.7 % in 2004) and 25.2 % at the mitral position (14.8 % in 2004). CABG as a concomitant procedure performed in 17.3 % of operations for all valvular heart disease (13.3 % in 2004).

Isolated CABG was performed in 14,454 cases which were only 72.5 % of that of 10 years ago (2004). Among these 14,454 cases, off-pump CABG was intended in 9,006 cases (62.3 %) with a success rate of 98.3 %, so final success rate of off-pump CABG was 61.2 %. The percentage of intended off-pump CABG reached 60.3 % in 2004, and then was kept over 60 % until now. In 14,454 isolated CABG patients, 95.4 % of them received at least one arterial graft, while all arterial graft CABG was performed only 21.4 % of them.

The operative and hospital mortality rates associated with primary elective CABG procedures in 12335 cases were 0.8 and 1.3 %, 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 has been stable, while hospital mortality of primary emergency CABG in 1,959 cases was still high and was 7.9 %. During these 10 years, the results of conversion from off-pump CABG improved both in conversion rate (3.1–1.7 %) and in hospital mortality (10.4–4.5 %).

A total of 1175 patients underwent surgery for complications of myocardial infarction, including 329 operations for a left ventricular aneurysm or ventricular septal perforation or cardiac rupture and 261 operations for ischemic mitral regurgitation.

Operations for arrhythmia were performed mainly as a concomitant procedure in 3855 cases with satisfactory mortality (1.6 % hospital mortality) including 3,486 MAZE procedures. MAZE procedure has become quite popular procedure when compared with that in 2004 (1837 cases).

Operations for thoracic aortic dissection were performed in 7733 cases. For 4953 Stanford type A acute aortic dissections, hospital mortality remained high and was 10.6 %. Operations for a non-dissected thoracic aneurysm were carried out in 9765 cases, with overall hospital mortality of 4.7 %. The hospital mortality associated with unruptured aneurysm was 3.3 %, and that of ruptured aneurysm was 21.2 %, which remains markedly high.

The number of stent graft procedures remarkably increased recently. A total of 1,625 patients with aortic dissection underwent stent graft placement: thoracic endovascular aortic repair (TEVAR) in 1,382 cases and open stent grafting in 243 cases. The number of TEVAR for type B chronic aortic dissections increased from 69 cases in 2004 to 835 cases in 2014. The hospital mortality rates associated with TEVAR for type B aortic dissection were 5.5 % in acute cases and 2.9 % for chronic cases, respectively.

A total of 3922 patients with non-dissected aortic aneurysm underwent stent graft placement; TEVAR in 3521 cases (12.4 % increase compared with that in 2013) and open stent grafting in 401 cases (145 % increase compared with that in 2013). The reason of dramatic increase in open stent grafting might be due to commercially availability since 2014. The hospital mortality rates for TEVAR were 2.4 and 17.1 % for non-ruptured and ruptured aneurysm, respectively.

In summary, the total cardiovascular operations increased during 2014 by 1141 cases with steadily improving results in almost all categories throughout these 10 years.

(B) General thoracic surgery

The total number of operations reported in 2014 in general thoracic surgery has reached 77070, which means 1.74-fold of that in 2001, and increased by 1764 cases compared with that in 2013 (Fig. 2, Table 10).
Fig. 2

General thoracic surgery

Table 10 Total entry cases of general thoracic surgery during 2014

 

Cases

%

Benign pulmonary tumor

2171

2.8

Primary lung cancer

38,085

49.4

Other primary malignant pulmonary tumor

359

0.5

Metastatic pulmonary tumor

8057

10.5

Tracheal tumor

118

0.2

Mesothelioma

673

0.9

Chest wall tumor

698

0.9

Mediastinal tumor

4685

6.1

Thymectomy for MG without thymoma

188

0.2

Inflammatory pulmonary disease

2287

3.0

Empyema

2608

3.4

Bullous disease excluding pneumothorax

415

0.5

Pneumothorax

14,572

18.9

Chest wall deformity

217

0.3

Diaphragmatic hernia including traumatic

55

0.1

Chest trauma excluding diaphragmatic hernia

394

0.5

Lung transplantation

60

0.1

Others

1428

1.9

Total

77,070

100.0

The number of operations for primary lung cancer was 38085 in 2014 (Table 10), showing the steady increase (31,301; 2009, 32,801; 2010, 33,878; 2011, 35,667; 2012, 37,008; 2013), and 1.95-fold of the number of operations in 2001. Surgery for lung cancer consists 49.4 % of all the general thoracic surgery.

Surgery for benign pulmonary tumor was 2171 in 2014 (Table 11).

Table 11

1. Benign pulmonary tumor

 

Cases

30-day mortality

Hospital mortality

Hospital

After discharge

Hamartoma

481

0

0

0

Sclerosing hemangioma

103

0

0

0

Papilloma

18

0

0

0

Mucous gland adenoma bronchial

7

0

0

0

Fibroma

129

0

0

0

Lipoma

6

0

0

0

Neurogenic tumor

17

0

0

0

Clear cell tumor

2

0

0

0

Leiomyoma

19

0

0

0

Chondroma

5

0

0

0

Inflammatory myofibroblastic tumor

1

0

0

0

Pseudolymphoma

32

0

0

0

Histiocytosis

23

0

0

0

Teratoma

0

0

0

0

Others

1328

2 (0.2)

1 (0.1)

6 (0.5)

Total

2171

2 (0.1)

1 (0.05)

6 (0.3)

Values in parenthesis represent mortality %

Further information of primary malignant pulmonary tumors is shown in Tables 12 and 13. Among lung cancer subtypes, adenocarcinoma comprises an overwhelming percentage of 69.2 % of the total lung cancer surgery, followed by squamous cell carcinoma of 19.3 %. Limited resection by wedge resection or segmentectomy was performed in 9581 lung cancer patients, which is 25.2 % of the entire cases. Lobectomy was performed in 27,584 patients, which is 72.4 % of the entire cases. Sleeve lobectomy was done in 471 patients. Pneumonectomy was done in 521 patients which is 1.4 % of the entire cases.

Table 12

2. Primary malignant pulmonary tumor

 

Cases

30-day mortality

Hospital mortality

Hospital

After discharge

2. Primary malignant pulmonary tumor

38,444

104 (0.3)

59 (0.2)

269 (0.7)

Lung cancer

38,085

103 (0.3)

59 (0.2)

266 (0.7)

 Adenocarcinoma

26,338

33 (0.1)

23 (0.1)

82 (0.3)

 Squamous cell carcinoma

7367

46 (0.6)

22 (0.3)

127 (1.7)

 Large cell carcinoma

835

5 (0.6)

6 (0.7)

10 (1.2)

 (LCNEC)

462

4 (0.9)

1 (0.2)

8 (1.7)

 Small cell carcinoma

601

1 (0.2)

1 (0.2)

9 (1.5)

 Adenosquamous carcinoma

548

7 (1.3)

0

14 (2.6)

 Carcinoma with pleomorphic, sarcomatoid or sarcomatous elements

528

6 (1.1)

2 (0.4)

12 (2.3)

 Carcinoid

198

0

0

0

 Carcinomas of salivary-gland type

45

0

0

0

 Unclassified

55

2 (3.6)

0

4 (7.3)

 Multiple lung cancer

1227

1 (0.1)

3 (0.2)

6 (0.5)

 Others

343

2 (0.6)

2 (0.6)

2 (0.6)

 Wedge resection

5438

4 (0.1)

4 (0.1)

20 (0.4)

 Segmental excision

4143

2 (0.05)

3 (0.1)

13 (0.3)

 (Sleeve segmental excision)

16

0

0

0

 Lobectomy

27,584

82 (0.3)

51 (0.2)

198 (0.7)

 (Sleeve lobectomy)

471

5 (1.1)

7 (1.5)

10 (2.1)

 Pneumonectomy

521

8 (1.5)

0

20 (3.8)

 (Sleeve pneumonectomy)

13

0

0

1 (7.7)

 Other bronchoplasty

46

2 (4.3)

0

2 (4.3)

 Pleuropneumonectomy

1

0

0

0

Others

343

5 (1.5)

1 (0.3)

10 (2.9)

Sarcoma

40

0

0

0

AAH

126

0

0

0

Others

193

1 (0.5)

0

3 (1.6)

Values in parenthesis represent mortality %

Table 13 Details of lung cancer operation

 

Cases

c-Stage (TNM)

 Ia

22,809

 Ib

7213

 IIa

2982

 IIb

1780

 IIIa

2505

 IIIb

204

 IV

481

 NA

111

 Total

38,085

Sex

 Male

23,540

 Female

14,516

 NA

29

 Total

38,085

Cause of death

 Cardiovascular

23

 Pneumonia

47

 Pyothorax

4

 Bronchopleural fistula

16

 Respiratory failure

41

 Pulmonary embolism

11

 Interstitial pneumonia

78

 Brain infarction or bleeding

14

 Others

80

 Unknown

11

 Total

325

p-Stage

 0 (pCR)

295

 Ia

19,666

 Ib

7601

 IIa

3213

 IIb

2087

 IIIa

3761

 IIIb

179

 IV

1072

 NA

211

 Total

38,085

Age

 <20

85

 20–29

33

 30–39

219

 40–49

1009

 50–59

3646

 60–69

12,731

 70–79

15,765

 80–89

4532

 ≥90

58

 NA

7

 Total

38,085

There were 103 patients who died without discharge within 30 days after lung cancer surgery, and 59 patients who were discharged from hospital but died within 30 days after lung cancer surgery, indicating that 162 patients died within 30 days after lung cancer surgery (30-day mortality rate; 0.42 %). There were 266 patients died without discharge (hospital mortality rate; 0.70 %). 30-day mortality rate in regard to procedures is 0.12 % in segmentectomy, 0.48 % in lobectomy, and 1.53 % in pneumonectomy. Interstitial pneumonia was the leading cause of death after lung cancer surgery, followed by pneumonia, respiratory failure, cardiovascular event, and bronchopleural fistula.

Surgery for metastatic pulmonary tumors is denoted in Table 14. The number of patients undergoing operations for metastatic pulmonary tumor was 8057 in 2014 with steady increase similarly to lung cancer surgery (6248; 2009, 6748: 2010, 7210; 2011, 7403; 2012, 7829; 2013). Colorectal cancer was by far the leading primary malignancy indicated for resection of metastatic tumors, which comprises 48.4 % of the entire cases.

Table 14

3. Metastatic pulmonary tumor

 

Cases

30-day mortality

Hospital mortality

Hospital

After discharge

3. Metastatic pulmonary tumor

8057

17 (0.2)

8 (0.1)

30 (0.4)

 Colo-rectal

3902

2 (0.1)

0

5 (0.1)

 Hepatobiliary/pancreatic

388

2 (0.5)

0

2 (0.5)

 Uterine

387

0

0

0

 Mammary

445

0

0

0

 Ovarian

56

0

0

0

 Testicular

84

0

0

0

 Renal

618

3 (0.5)

2 (0.3)

3 (0.5)

 Skeletal

148

0

1 (0.7)

0

 Soft tissue

235

0

1 (0.4)

2 (0.9)

 Otorhinolaryngological

422

2 (0.5)

1 (0.2)

2 (0.5)

 Pulmonary

497

8 (1.6)

1 (0.2)

11 (2.2)

 Others

875

0

2 (0.2)

5 (0.6)

Values in parenthesis represent mortality %

118 tracheal tumors were operated in 2014 (Table 15). Squamous cell carcinoma and adenoid cystic carcinoma were frequent primary tracheal tumor.

Table 15

4. Tracheal tumor

 

Cases

30-day mortality

Hospital mortality

Hospital

After discharge

4. Tracheal tumor

118

4 (3.4)

1 (0.8)

10 (8.5)

(A) Primary malignant tumor (histological classification)

 Squamous cell carcinoma

15

0

0

1 (6.7)

 Adenoid cystic carcinoma

9

0

0

0

 Mucoepidermoid carcinoma

2

0

0

0

 Others

10

0

0

0

 Total

36

0

0

1 (2.8)

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

48

4 (8.3)

1 (2.1)

9 (18.8)

(C) Benign tracheal tumor (histological classification)

 Papilloma

0

0

0

0

 Adenoma

3

0

0

0

 Neurofibroma

1

0

0

0

 Chondroma

0

0

0

0

 Leiomyoma

3

0

0

0

 Others

27

0

0

0

 Histology unknown

0

0

0

0

 Total

34

0

0

0

Operation

 Sleeve resection with reconstruction

13

0

0

1 (7.7)

 Wedge with simple closure

0

0

0

0

 Wedge with patch closure

0

0

0

0

 Total laryngectomy with tracheostomy

0

0

0

0

 Others

29

0

0

0

 Unknown

0

0

0

0

 Total

42

0

0

1 (2.4)

Values in parenthesis represent mortality %

673 tumors of the pleural origin were operated in 2014 (Table 16). Diffuse malignant pleural mesothelioma was the most frequent histology. Total pleurectomy was performed in 73 patents and surpassed extrapleural pneumonectomy which was the most frequently chosen operative method in 2013. Hospital mortality rate was 4.1 % after total pleurectomy and 4.3 % after extrapleural pneumonectomy in 2014.

Table 16

5. Tumor of pleural origin

 

Cases

30-day mortality

Hospital mortality

Hospital

After discharge

Histological classification

 Solitary fibrous tumor

122

0

0

0

 Diffuse malignant pleural mesothelioma

283

3 (1.1)

0

10 (3.5)

 Localized malignant pleural mesothelioma

26

0

0

1 (3.8)

 Others

242

3 (1.2)

2 (0.8)

9 (3.7)

 Total

673

6 (0.9)

2 (0.3)

20 (3.0)

Operative procedure

 Extrapleural pneumonectomy

70

1 (1.4)

0

3 (4.3)

 Total pleurectomy

73

1 (1.4)

0

3 (4.1)

 Others

140

1 (0.7)

0

4 (2.9)

 Total

283

3 (1.1)

0

10 (3.5)

Values in parenthesis represent mortality %

698 chest wall tumors were resected in 2014 (Table 17). 362 cases (51.9 %) were benign. Among 336 malignant chest wall tumors, 208 cases (61.9 %) were metastatic tumors.

Table 17

6. Chest wall tumor

 

Cases

30-day mortality

Hospital mortality

Hospital

After discharge

Primary malignant tumor

128

1 (0.8)

0

5 (3.9)

Metastatic malignant tumor

208

0

1 (0.5)

3 (1.4)

Benign tumor

362

0

0

0

Total

698

1 (0.1)

1 (0.1)

8 (1.1)

Values in parenthesis represent mortality %

Table 18 denotes surgery for mediastinal tumors. 4685 mediastinal tumors were operated in 2014. There were 2104 thymic epithelial tumors (1773 thymomas, 296 thymic carcinomas, and 35 thymic neuroendocrine carcinoma including carcinoid), followed by 932 congenital cysts, 481 neurogenic tumors, 214 lymphatic tumors, and 122 germ cell tumors.

Table 18

7. Mediastinal tumor

 

Cases

30-day mortality

Hospital mortality

Hospital

After discharge

7. Mediastinal tumor

4685

5 (0.1)

2 (0.04)

17 (0.4)

 Thymoma*

1773

5 (0.3)

0

9 (0.5)

 Thymic cancer

296

0

0

1 (0.3)

 Thymus carcinoid

35

0

0

0

 Germ cell tumor

122

0

0

0

  Benign

87

0

0

0

  Malignant

35

0

0

0

 Neurogenic tumor

481

0

0

0

 Congenital cyst

932

0

1 (0.1)

5 (0.5)

 Goiter

75

0

0

1 (1.3)

 Lymphatic tumor

214

0

0

0

 Excision of pleural recurrence of thymoma

43

0

0

0

 Thymolipoma

14

0

0

0

 Others

700

0

1 (0.1)

1 (0.1)

Values in parenthesis represent mortality %

* Includes those with myasthenia gravis

Thymectomy for myasthenia gravis was done in 495 patients (Table 19). Among them, 307 patients were associated with thymoma, and the remaining 188 patients were not associated with thymoma.

Table 19

8. Thymectomy for myasthenia gravis

 

Cases

30-day mortality

Hospital mortality

Hospital

After discharge

8. Thymectomy for myasthenia gravis

495

1 (0.2)

0

1 (0.2)

 With thymoma

307

1 (0.3)

0

1 (0.3)

Values in parenthesis represent mortality %

Lung resection for inflammatory lung diseases were done in 2287 patients in 2014 (Table 20). Inflammatory pseudotumor comprised 24.7 % of the entire cases, followed by atypical mycobacterium infection (21.9 %) and fungal infections (15.1 %).

Table 20

9. Operation for non-neoplastic disease

(A) Inflammatory pulmonary disease

 

Cases

30-day mortality

Hospital mortality

Hospital

After discharge

9. Operation for non-neoplastic disease

21,976

197 (0.9)

14 (0.1)

425 (1.9)

(A) Inflammatory pulmonary disease

2287

6 (0.3)

2 (0.1)

17 (0.7)

 Tuberculous infection

73

0

0

0

 Mycobacterial infection

501

1 (0.2)

1 (0.2)

3 (0.6)

 Fungal infection

345

1 (0.3)

1 (0.3)

6 (1.7)

 Bronchiectasis

67

0

0

1 (1.5)

  Tuberculous nodule

133

0

0

0

  Inflammatory pseudo tumor

566

0

0

0

  Interpulmonary lymph node

63

0

0

0

 Others

539

4 (0.7)

0

7 (1.3)

Values in parenthesis represent mortality %

2,608 operations for empyema were reported in 2014 (Table 21). There were 1911 patients (73.3 %) with acute empyema and 698 patients with chronic empyema. Bronchopleural fistula was associated in 469 patients (24.5 %) with acute empyema and 345 patients (49.5 %) with chronic empyema. It should be noted that hospital mortality was as high as 15.1 % in patients of acute empyema with fistula.

Table 21

9. Operation for non-neoplastic disease

(B) Empyema

 

Cases

30-day mortality

Hospital mortality

Hospital

After discharge

Acute empyema

1911

52 (2.7)

3 (0.2)

126 (6.6)

 With fistula

469

28 (6.0)

1 (0.2)

71 (15.1)

 Without fistula

1425

23 (1.6)

2 (0.1)

52 (3.6)

 Unknown

17

1 (5.9)

0

3 (17.6)

Chronic empyema

697

14 (2.0)

1 (0.1)

38 (5.5)

 With fistula

345

12 (3.5)

1 (0.3)

27 (7.8)

 Without fistula

328

2 (0.6)

0

10 (3.0)

 Unknown

24

0

0

1 (4.2)

Total

2608

66 (2.5)

4 (0.2)

164 (6.3)

Values in parenthesis represent mortality %

Operation for descending necrotizing mediastinitis was done in 103 patients in 2014 (Table 22). Hospital mortality rate was 8.7 %.

Operation for bullous diseases was done in 415 patients in 2014 (Table 23). Lung volume reduction surgery was done in only 28 patients, while emphysematous bulla was the principal target of operation.

Table 22

9. Operation for non-neoplastic disease

(C) Descending necrotizing mediastinitis

 

Cases

30-day mortality

Hospital mortality

Hospital

After discharge

(C) Descending necrotizing mediastinitis

103

6 (5.8)

0

9 (8.7)

Values in parenthesis represent mortality %

Table 23

9. Operation for non-neoplastic disease

(D) Bullous disease

 

Cases

30-day mortality

Hospital mortality

Hospital

After discharge

(D) Bullous disease

415

1 (0.2)

0

1 (0.2)

 Emphysematous bulla

322

1 (0.3)

0

1 (0.3)

 Bronchogenic cyst

18

0

0

0

 Emphysema with volume reduction surgery

28

0

0

0

 Others

47

0

0

0

Values in parenthesis represent mortality %

LVRS lung volume reduction surgery

14,572 operations for pneumothorax were reported in 2014 (Table 24).

Table 24

9. Operation for non-neoplastic disease

(E) Pneumothorax

 

Cases

30-day mortality

Hospital mortality

Hospital

After discharge

(E) Pneumothorax

14,572

60 (0.4)

8 (0.1)

133 (0.9)

Spontaneous pneumothorax

 Operative procedure

  Bullectomy

3410

3 (0.1)

0

12 (0.4)

  Bullectomy with additional procedure

7625

2 (0.03)

1 (0.01)

7 (0.1)

  Coverage with artificial material

7241

2 (0.03)

0

6 (0.1)

  Parietal pleurectomy

51

0

0

1 (2.0)

  Coverage and parietal pleurectomy

92

0

0

0

  Others

241

0

1 (0.4)

0

Others

905

8 (0.9)

0

12 (1.3)

Unknown

8

0

0

0

Total

11,948

13 (0.1)

1 (0.01)

31 (0.3)

Secondary pneumothorax

 Associated disease

  COPD

1763

18 (1.0)

2 (0.1)

51 (2.9)

  Tumorous disease

84

7 (8.3)

3 (3.6)

14 (16.7)

  Catamenial

148

0

0

0

  LAM

47

0

0

0

  Others (excluding pneumothorax by trauma)

582

22 (3.8)

2 (0.3)

37 (6.4)

  Unknown

    

 Operative procedure

  Bullectomy

372

2 (0.5)

1 (0.3)

3 (0.8)

  Bullectomy with additional procedure

1509

16 (1.1)

2 (0.1)

37 (2.5)

   Coverage with artificial material

1423

16 (1.1)

2 (0.1)

37 (2.6)

   Parietal pleurectomy

9

0

0

0

   Coverage and parietal pleurectomy

18

0

0

0

   Others

59

0

0

0

  Others

735

29 (3.9)

4 (0.5)

62 (8.4)

  Unknown

8

0

0

0

  Total

2624

47 (1.8)

7 (0.3)

102 (3.9)

Values in parenthesis represent mortality %

The number of operations for spontaneous pneumothorax was 11,948. Among them, 3410 patients (28.5 %) underwent bullectomy alone, while additional procedure was performed in 7625 patients (63.8 %).

The number of operations for secondary pneumothorax was 2624. COPD was by far the most prevalent associated disease (67.2 %). It should be noted that hospital mortality rate of operation for pneumothorax associated with tumorous disease was as high as 16.7 %.

217 cases of surgery for chest wall deformity were reported in 2014 survey (Table 25). This number might be underestimated compared with the real number of operations, because chest wall deformity is more likely to be treated in the institutes which are not associated with JATS.

Table 25

9. Operation for non-neoplastic disease

(F) Chest wall deformity

 

Cases

30-day mortality

Hospital mortality

Hospital

After discharge

(F) Chest wall deformity

217

0

0

0

 Funnel chest

209

0

0

0

 Others

8

0

0

0

Diaphragmatic hernia was treated by surgery in 55 patients in 2014 (Table 26).

Table 26

9. Operation for non-neoplastic disease

(G) Diaphragmatic hernia

 

Cases

30-day mortality

Hospital mortality

Hospital

After discharge

(G) Diaphragmatic hernia

55

1 (1.8)

0

1 (1.8)

 Congenital

22

0

0

0

 Traumatic

9

0

0

0

 Others

24

1 (4.2)

0

1 (4.2)

Values in parenthesis represent mortality %

Chest trauma was treated by surgery in 394 patients in 2014 (Table 27).

Table 27

9. Operation for non-neoplastic disease

(H) Chest trauma

 

Cases

30-day mortality

Hospital mortality

Hospital

After discharge

(H) Chest trauma

394

29 (7.4)

0

36 (9.1)

Values in parenthesis represent mortality %

Table 28 denotes operations for other diseases, including 77 arteriovenous malformations and 104 pulmonary sequestrations.

Table 28

9. Operation for non-neoplastic disease

(I) Other respiratory surgery

 

Cases

30-day mortality

Hospital mortality

Hospital

After discharge

(I) Other respiratory surgery

1325

28 (2.1)

0

64 (4.8)

 Arteriovenous malformation*

77

0

0

0

 Pulmonary sequestration

104

0

0

0

 Postoperative bleeding air leakage

386

11 (2.8)

0

30 (7.8)

 Chylothorax

65

1 (1.5)

0

2 (3.1)

 Others

693

16 (2.3)

0

32 (4.6)

Values in parenthesis represent mortality %

Table 29 denotes lung transplantation in 2014. A total of 60 lung transplantations were performed in 2014. The number of patients undergoing lung transplantation from brain-dead donors and living-related donors was 40 and 20, respectively. The number of lung transplantation is almost constant these several years, and lung transplantation is still dependent on living-related donors in Japan.

Table 29

10. Lung transplantation

 

Cases

30-day mortality

Hospital mortality

Hospital

After discharge

Single lung transplantation from brain dead donor

23

0

0

0

Bilateral lung transplantation from brain dead donor

17

0

0

0

Lung transplantation from living donor

20

0

0

2 (10.0)

Total of lung transplantation

60

0

0

2 (3.3)

Donor of living donor lung transplantation

37

0

0

0

Values in parenthesis represent mortality %

Details of tracheabronchoplasty, pediatric surgery, and combined resection of neighboring organs are denoted in Tables 30, 31, 32, and 33.

Table 30

11. Tracheobronchoplasty

 

Cases

30-day mortality

Hospital mortality

Hospital

After discharge

11. Tracheobronchoplasty

649

9 (1.4)

7 (1.1)

16 (2.5)

Trachea

27

0

0

1 (3.7)

 Sleeve resection with reconstruction

20

0

0

1 (5.0)

 Wedge with simple closure

0

0

0

0

 Wedge with patch closure

0

0

0

0

 Total laryngectomy with tracheostomy

0

0

0

0

 Others

7

0

0

0

Carinal reconstruction

28

2 (7.1)

0

2 (7.1)

Sleeve pneumonectomy

15

0

0

1 (6.7)

Sleeve lobectomy

476

5 (1.1)

7 (1.5)

10 (2.1)

Sleeve segmental excision

22

0

0

0

Bronchoplasty without lung resection

13

1 (7.7)

0

1 (7.7)

Others

68

1 (1.5)

0

1 (1.5)

Values in parenthesis represent mortality %

Table 31

12. Pediatric surgery

 

Cases

30-day mortality

Hospital mortality

Hospital

After discharge

12. Pediatric surgery

580

3 (0.5)

0

7 (1.2)

Values in parenthesis represent mortality %

Table 32

13. Combined resection of neighboring organ(s)

Organ resected

Cases

30-day mortality

Hospital mortality

Hospital

After discharge

13. Combined resection of neighboring organ(s)

1408

7 (0.5)

3 (0.2)

25 (1.8)

(A) Primary lung cancer (organ resected)

 Aorta

16

0

0

1 (6.3)

 Superior vena cava

26

0

0

2 (7.7)

 Brachiocephalic vein

13

1 (7.7)

0

1 (7.7)

 Pericardium

143

1 (0.7)

1 (0.7)

4 (2.8)

 Pulmonary artery

158

1 (0.6)

0

2 (1.3)

 Left atrium

30

0

0

0

 Diaphragm

51

0

0

0

 Chest wall (including ribs)

360

3 (0.8)

2 (0.6)

17 (4.7)

 Vertebra

16

1 (6.3)

0

2 (12.5)

 Esophagus

9

0

0

0

 Total

822

7 (0.9)

3 (0.4)

29 (3.5)

(B) Mediastinal tumor (organ resected)

 Aorta

2

0

0

1 (50.0)

 Superior vena cava

59

0

0

1 (1.7)

 Brachiocephalic vein

89

0

0

0

 Pericardium

340

2 (0.6)

0

3 (0.9)

 Pulmonary artery

3

0

0

0

 Left atrium

0

0

0

0

 Diaphragm

34

0

0

1 (2.9)

 Chest wall (including ribs)

9

0

0

0

 Vertebra

13

0

0

0

 Esophagus

4

0

0

0

 Lung

461

0

0

0

 Total

1014

2 (0.2)

0

6 (0.6)

Values in parenthesis represent mortality %

Table 33

14. Operation of lung cancer invading the chest wall of the apex

 

Cases

30-day mortality

Hospital mortality

Hospital

After discharge

14. Operation of lung cancer invading the chest wall of the apex

737

2 (0.3)

5 (0.7)

15 (2.0)

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)

Committee for Scientific Affairs in JATS changed the method of surveying general thoracic surgery in 2014. JATS had investigated the number of diseases and operative procedures based on questionnaires until 2013 surveys, but JATS started to collect the number of procedures in general thoracic surgery using the database in National Clinical Database (NCD) registry. There were some differences in definition in VATS procedure between surveys by JATS before 2013 and that using NCD after 2014. While the length of skin incision in definition of VATS procedure had been less than 8 cm by JATS survey before 2013 following Swanson et al’s proposal [1], NCD registry did not limit the length of skin incision in VATS procedures. On the other hand, NCD required the surgeons to choose the approach among complete VATS procedure without thoracotomy, the procedure using both thoracotomy and VATS which includes hybrid approach, and conventional thoracotomy without VATS procedure. It is presumed that hybrid approach was included in VATS procedure as far as the skin incision was shorter than 8 cm in JATS survey before 2013, but this does not seem to apply to survey in 2014 based on NCD registry, suggesting possible inconsistency in comparison between JATS survey before 2013 and NCD 2014 registry. In this report, therefore, analysis with regard to VATS procedure was not conducted.

(C) Esophageal surgery

During 2014 alone, a total of 13,958 patients with esophageal diseases were registered from 601 institutions (response rate: 96.0 %) which affiliated to the Japanese Association for Thoracic Surgery and/or to the Japan Esophageal Society. Among these institutions, those where 20 or more patients underwent esophageal surgeries within the year of 2014 were 133 institutions (22.1 %), which shows no definite shift of esophageal operations to high volume institutions when compared to the data of 2013 (33.3 %) (Table 34) Of 3,956 patients with a benign esophageal disease, 1660 (42.0 %) patients underwent surgery, and 57 (1.4 %) patients underwent endoscopic resection, while 2239 (56.6 %) patients did not undergo any surgical treatment. (Table 35) Of 10,638 patients with a malignant esophageal tumor, 8135 (76.5 %) patients underwent resection, esophagectomy for 6247 (59.0 %) and endoscopic mucosal resection (EMR) or endoscopic submucosal dissection (ESD) for 1851 (17.5 %), while 2492 (23.5 %) patients did not undergo any resection. (Tables 36, 37) The patients registered, particularly those undergoing ESD or EMR for a malignant esophageal disease, have been increasing since 1990 (Fig. 3).

Table 34 Distribution of number of esophageal operations in 2014 in each institution

Esophageal surgery

Number of operations in 2014

Benign esophageal diseases

Malignant esophageal disease

Benign + malignant

0

289

136

98

1–4

245

148

145

5–9

45

120

117

10–19

17

81

108

20–29

3

36

39

30–39

1

23

27

40–49

0

20

25

≧50

1

37

42

Total

601

601

601

Table 35 Benign esophageal diseases

 

Operation (+)

Endoscopic resection

Operation (−)

Total

Number of patients

Hospital mortality

Total

Open

T/L*3

Open Surgery

T/L*3

Total

~30 days

31–90 days

Total (including after 91 days mortality)

~30 days

31–90 days

Total (including after 91 days mortality)

1. Achalasia

338

179

159

1 (0.6)

0

1 (0.6)

0

0

0

1 (0.3)

 

52

390

2. Benign tumor

111

73

38

0

0

0

0

0

0

0

43

18

172

 (1) Leiomyoma

70

43

27

0

0

0

0

0

0

0

17

9

96

 (2) Cyst

12

7

5

0

0

0

0

0

0

0

0

0

12

 (3) Others

29

23

6

0

0

0

0

0

0

0

26

6

61

 (4) Not specified

0

0

0

0

0

0

0

0

0

0

0

3

3

3. Diverticulum

55

39

16

0

0

0

0

0

0

0

 

17

72

4. Hiatal hernia

739

423

316

2 (0.5)

2 (0.5)

4 (0.9)

1 (0.3)

1 (0.3)

2 (0.6)

6 (0.8)

 

193

932

5. Spontaneous rupture of the esophagus

95

87

8

4 (4.6)

1 (1.1)

5 (5.7)

0

0

0

5 (5.3)

 

13

108

6. Esophagotracheal fistula

18

17

1

0

0

0

0

0

0

0

 

12

30

7. Congenital esophageal atresia

51

47

4

0

1 (2.1)

1 (2.1)

0

0

0

1 (2.0)

 

1

52

8. Congenital esophageal stenosis

10

9

1

0

0

0

0

0

0

0

 

4

14

9. Corrosive stricture of the esophagus

11

8

3

0

0

0

0

0

0

0

 

10

21

10. Esophagitis, esophageal ulcer

87

61

26

0

0

0

0

0

0

0

 

1199

1286

11. Esophageal varices

70

67

3

2 (3.0)

0

2 (3.0)

0

0

0

2 (2.9)

 

685

755

 (1) Laparotomy

9

6

3

0

0

0

0

0

0

0

  

9

 (2) Sclerotherapy

           

201

201

 (3) EVL

           

344

344

12. Others

75

62

13

5 (8.1)

0

5 (8.1)

0

0

0

5 (6.7)

14

35

124

Total

1660

1072

588

14 (1.3)

4 (0.4)

18 (1.7)

1 (0.2)

1 (0.2)

2 (0.3)

20 (1.2)

57

2239

3956

Values in parenthesis represent mortality %

T/L thoracoscopic and/or laparoscopic

Table 36 Malignant esophageal diseases (histologic classification)

 

Resection (+)

Resection (−)

Total

Carcinomas

8100

2495

10,595

 1. Squamous cell carcinoma

7233

2355

9588

 2. Basaloid (-squamous) carcinoma

79

2

81

 3. Carcinosarcoma

43

3

46

 4. Adenocarcinoma in the Barrett’s esophagus

319

21

340

 5. Other adenocarcinoma

350

67

417

 6. Adenosquamous carcinoma

22

5

27

 7. Mucoepidermoid carcinoma

2

0

2

 8. Adenoid cystic carcinoma

1

1

2

 9. Endcrine cell carcinoma

34

24

58

 10. Undifferentiated carcinoma

7

4

11

 11. Others

10

13

23

Other malignancies

35

8

43

 1. Malignant non-epithelial tumors

8

2

10

 2. Malignant melanoma

20

5

25

 3. Other malignant tumors

7

1

8

Not specified

0

0

0

Total

8135

2503

10,638

Resection: including endoscopic resection

Table 37 Malignant esophageal disease (clinical characteristics)

 

Operation (+)

EMR or ESD

Operation (−)

Total

Cases

Hospital mortality

~30 days

31–90 days

Total (including after 91 days mortality)

1. Esophageal cancer

6247

47 (0.8)

46 (0.7)

128 (2.0)

1851

2492

10,584

Location

 (1) Cervical esophagus

258

0

1 (0.4)

3 (1.2)

76

178

512

 (2) Thoracic esophagus

5041

45 (0.9)

39 (0.8)

112 (2.2)

1501

2133

8675

 (3) Abdominal esophagus

644

2 (0.3)

3 (0.5)

7 (1.1)

100

117

861

 (4) Multiple cancers

301

0

3 (1.0)

6 (2.0)

174

61

536

 (5) Others/not described

3

0

0

0

0

3

0

Tumor depth

 (A) Superficial cancer (T1)

1892

9 (0.5)

9 (0.5)

22 (1.2)

1848

210

3950

  Mucosal cancer (T1a)

415

0

2 (0.5)

2 (0.5)

1514

49

1978

 (B) Advanced cancer (T2–T4)

4344

37 (0.9)

37 (0.9)

105 (2.4)

2

2282

6628

 (C) Not specified

11

1 (9.1)

0

1 (9.1)

1

0

12

2. Multiple primary cancers

1050

7 (0.7)

7 (0.7)

21 (2.0)

520

338

1908

1) Synchronous

587

4 (0.7)

2 (0.3)

10 (1.7)

210

185

982

 (1) Head and neck

184

0

0

1 (0.5)

84

59

327

 (2) Stomach

226

2 (0.9)

0

4 (1.8)

72

65

363

 (3) Others

144

1 (0.7)

2 (1.4)

4 (2.8)

41

42

227

 (4) Triple cancers

33

1 (3.0)

0

1 (3.0)

13

19

65

 (5) Unknown

0

0

0

0

0

0

0

2) Metachronous

463

3 (0.6)

5 (1.1)

11 (2.4)

310

153

926

 (1) Head and neck

102

0

1 (1.0)

2 (2.0)

107

38

247

 (2) Stomach

114

2 (1.8)

1 (0.9)

3 (2.6)

75

36

225

 (3) Others

221

1 (0.5)

2 (0.9)

5 (2.3)

86

60

367

 (4) Triple cancers

26

0

1 (3.8)

1 (3.8)

42

19

87

 (5) Unknown

0

0

0

0

0

0

0

Unknown

0

0

0

0

0

0

0

Values in parenthesis represent mortality %

EMR endoscopic mucosal resection (including endoscopic submucosal dissection)

Fig. 3

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

Among benign esophageal diseases (Table 35), hiatal hernia, esophageal varices, esophagitis (including reflux esophagitis) and achalasia 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 as well as the above-mentioned diseases. 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 1072 patients with a benign esophageal disease, with 30-day mortality in 14 (1.3 %), while thoracoscopic and/or laparoscopic surgery was performed for 588 patients, with 1(0.2 %) of the 30-day mortality The difference in these death rates between open and scopic surgery seems to be related the conditions requiring open surgery.

The majority of malignant diseases were carcinomas (Table 36). Among esophageal carcinomas, the incidence of squamous cell carcinoma was 90.5 %, while that of adenocarcinomas including Barrett cancer was 7.1 %. The resection rate for patients with a squamous cell carcinoma was 76.4 %, while that for patients with an adenocarcinoma was 88.3 %.

According to location, cancer in the thoracic esophagus was the most common (Table 37). Of the 3950 patients (37.3 % of total esophageal malignancies) having superficial esophageal cancers within mucosal and submucosal layers, 1892 (47.9 %) patients underwent esophagectomy, while 1848 (46.8 %) patients underwent EMR or ESD. The 30-day mortality rate and hospital mortality rate after esophagectomy for patients with a superficial cancer were 0.5 and 1.2 % respectively. Advanced esophageal cancer invading deeper than the submucosal layer was observed in 6628 (62.6 %) patients. Of the 6628 patients with advanced esophageal cancer, 4344 (65.5 %) underwent esophagectomy, with 0.9 % of the 30-day mortality rate, and with 2.4 % of the hospital mortality rate.

Multiple primary cancers were observed in 1908 (18.0 %) of all the 10,584 patients with esophageal cancer. Synchronous cancer was found in 982 (51.5 %) patients, while metachronous cancer (found before esophageal cancer) was observed in 926 (48.5 %) patients. The stomach is the commonest site for both synchronous and metachronous malignancy followed by head and neck cancer (Table 37).

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 38). Transhiatal esophagectomy commonly performed in Western countries was adopted in only 2.8 % of patients having a superficial cancer who underwent esophagectomy and in 1.6 % of those having an advanced cancer in Japan. The thoracoscopic and/or laparoscopic esophagectomy were adopted for 1134 patients (59.9 %) with a superficial cancer, and for 1666 patients (38.3 %) 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. 4).

Table 38 Malignant esophageal disease (surgical procedures)

 

Operation (+)

Thoracoscopic and/or laparscopic procedure

EMR or ESD

Cases

Hospital mortality

Cases

Hospital mortality

~30 days

31–90 days

Total (including after 91 days mortality)

~30 days

31–90 days

Total (including after 91 days mortality)

Superficial cancer (T1)

1892

9 (0.5)

9 (0.5)

22 (1.2)

1134

3 (0.3)

7 (0.6)

14 (1.2)

1848

 Mucosal cancer (T1a)

415

0

2 (0.5)

2 (0.5)

223

0

0

0

1514

Esophagectomy

1892

9 (0.5)

9 (0.5)

22 (1.2)

1134

3 (0.3)

7 (0.6)

14 (1.2)

1848

 (1) Transhiatal esophagectomy

53

1 (1.9)

1 (1.9)

2 (3.8)

4

0

0

0

 

 (2) Transthoracic (rt.) esophagectomy and reconstruction

1579

5 (0.3)

8 (0.5)

17 (1.1)

1037

2 (0.2)

7 (0.7)

13 (1.3)

 

 (3) Transthoracic (lt.) esophagectomy and reconstruction

43

0

0

0

7

0

0

0

 

 (4) Cervical esophageal resection and reconstruction

35

0

0

0

16

0

0

0

 

 (5) Two-stage operation

27

0

0

0

13

0

0

0

 

 (6) Others

155

3 (1.9)

0

3 (1.9)

57

1 (1.8)

0

1 (1.8)

 

 (7) Not specified

0

0

0

0

0

0

0

0

 

Advanced cancer (T2–T4)

Esophagectomy

4344

37 (0.9)

37 (0.9)

105 (2.4)

1666

11 (0.7)

11 (0.7)

32 (1.9)

2

 (1) Transhiatal esophagectomy

68

0

1 (1.5)

1 (1.5)

7

0

0

0

 

 (2) Transthoracic (rt.) esophagectomy and reconstruction

3661

31 (0.8)

26 (0.7)

78 (2.1)

1522

9 (0.6)

10 (0.7)

27 (1.8)

 

 (3) Transthoracic (lt.) esophagectomy and reconstruction

137

1 (0.7)

2 (1.5)

3 (2.2)

14

0

0

0

 

 (4) Cervical esophageal resection and reconstruction

171

1 (0.6)

2 (1.2)

8 (4.7)

35

1 (2.9)

0

2 (5.7)

 

 (5) Two-stage operation

84

1 (1.2)

1 (1.2)

4 (4.8)

25

0

0

0

 

 (6) Others/not specified

223

3 (1.3)

5 (2.2)

11 (4.9)

63

1 (1.6)

1 (1.6)

3 (4.8)

 

 (7) Not specified

0

0

0

0

0

0

0

0

 

(Depth not specified)

11

1 (9.1)

0

1 (9.1)

0

0

0

0

1

Combined resection of other organs

330

6 (1.8)

4 (1.2)

13 (3.9)

     

 (1) Aorta

2

0

0

0

     

 (2) Trachea, bronchus

24

0

0

1 (4.2)

     

 (3) Lung

77

3 (3.9)

2 (2.6)

6 (7.8)

     

 (4) Others

227

3 (1.3)

2 (0.9)

6 (2.6)

     

Unknown

0

0

0

0

     

Salvage surgery

262

4 (1.5)

4 (1.5)

10 (3.8)

55

0

2 (3.6)

2 (3.6)

26

Values in parenthesis represent mortality %

Fig. 4

Annual trend of video-assisted esophagectomy for esophageal malignancy

Combined resection of the neighboring organs during resection of an esophageal cancer was performed in 330 patients (Tables 38, 39). Resection of the aorta together with the esophagectomy was performed in 2 cases. Tracheal and/or bronchial resection combined with esophagectomy was performed in 24 patients, with the 30-day mortality rate at 0 % and the hospital mortality rate at 4.2 %. Lung resection combined with esophagectomy was performed in 77 patients, with the 30-day mortality rate at 3.9 % and the hospital mortality rate at 7.8 %.

Table 39

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

4194

120

2.86

7

3

42.86

24

0

0.00

50

2

4.00

78

4

5.13

1997

4441

127

2.86

1

0

0.00

34

5

14.71

56

1

1.79

94

3

3.19

1998

4878

136

2.79

4

0

0.00

29

0

0.00

74

1

1.35

128

2

1.56

1999

5015

116

2.31

5

0

0.00

23

2

8.70

68

0

0.00

122

1

0.82

2000

5350

81

1.51

2

0

0.00

23

2

8.70

69

0

0.00

96

1

1.04

2001

5521

110

1.99

1

0

0.00

26

1

3.85

83

3

3.61

99

2

2.02

2002

4904

66

1.35

3

1

33.33

20

2

10.00

63

0

0.00

63

1

1.59

2003

4639

45

0.97

0

0

0.00

24

2

8.33

58

0

0.00

88

1

1.14

2004

4739

64

1.35

2

0

0.00

17

0

0.00

59

5

8.47

119

2

1.68

2005

5163

52

1.01

1

0

0.00

11

1

9.09

67

1

1.49

73

1

1.37

2006

5236

63

1.20

0

0

0.00

17

0

0.00

62

2

3.23

122

3

2.46

2007

4990

60

1.20

0

0

0.00

25

1

4.00

44

1

2.27

138

2

1.45

2008

5124

63

1.23

0

0

0.00

17

1

5.88

48

1

2.08

185

0

0.00

2009

5260

63

1.20

0

0

0.00

19

2

10.53

58

2

3.45

211

3

1.42

2010

5180

45

0.87

2

0

0.00

33

0

0.00

58

0

0.00

245

5

2.04

2011

5430

38

0.70

4

0

0.00

26

0

0.00

41

0

0.00

179

5

2.79

2012

6055

47

0.78

2

0

0.00

23

1

4.35

69

0

0.00

240

1

0.42

2013

5824

41

0.70

2

0

0.00

44

0

0.00

77

1

1.30

156

3

1.92

2014

6247

47

0.75

2

0

0.00

24

0

0.00

77

3

3.90

227

3

1.32

Total

98,190

1384

1.41

38

4

10.53

273

20

7.33

1181

23

1.95

2663

43

1.61

a The 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

Salvage surgery after definitive (chemo-) radiotherapy was performed in 262 patients, with the 30-day mortality rate at 1.5 % and with the hospital mortality rate at 3.8 % (Table 38).

Last, 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.

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. We greatly acknowledge Dr. T. Koyama for his help of data analysis.

Reference

  1. 1.
    Swanson SJ, Herndon II JE, D’Amico TA, et al. Video-assisted thoracic surgery lobectomy: report of CALGB 39802—a prospective, multi-institution feasibility study. J Clin Oncol. 2007;25:4993–7.CrossRefPubMedGoogle Scholar

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Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made.

Authors and Affiliations

  • Committee for Scientific Affairs, The Japanese Association for Thoracic Surgery
    • 1
  • Munetaka Masuda
    • 2
    Email author
  • Meinoshin Okumura
    • 3
  • Yuichiro Doki
    • 4
  • Shunsuke Endo
    • 5
  • Yasutaka Hirata
    • 6
  • Junjiro Kobayashi
    • 7
  • Hiroyuki Kuwano
    • 8
  • Noboru Motomura
    • 9
  • Hiroshi Nishida
    • 10
  • Yoshikatsu Saiki
    • 11
  • Aya Saito
    • 9
  • Hideyuki Shimizu
    • 12
  • Fumihiro Tanaka
    • 13
  • Kazuo Tanemoto
    • 14
  • Yasushi Toh
    • 15
  • Hiroyuki Tsukihara
    • 16
  • Shinji Wakui
    • 17
  • Hiroyasu Yokomise
    • 18
  1. 1.TokyoJapan
  2. 2.Department of SurgeryYokohama City UniversityYokohamaJapan
  3. 3.Department of General Thoracic SurgeryOsaka University Graduate School of MedicineOsakaJapan
  4. 4.Department of Gastroenterological SurgeryOsaka University Graduate School of MedicineOsakaJapan
  5. 5.Department of Thoracic SurgeryJichi Medical UniversityTochigiJapan
  6. 6.Department of Cardiac SurgeryThe University of Tokyo HospitalTokyoJapan
  7. 7.Department of Cardiovascular SurgeryNational Cerebral and Cardiovascular CenterOsakaJapan
  8. 8.Department of General Surgical Science Graduate School of MedicineGunma UniversityGunmaJapan
  9. 9.Department of Cardiovascular Surgery, Sakura Medical CenterToho UniversityChibaJapan
  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.Department of Cardiovascular SurgeryKeio UniversityTokyoJapan
  13. 13.Second Department of SurgeryUniversity of Occupational and Environmental HealthFukuokaJapan
  14. 14.Department of Cardiovascular SurgeryKawasaki Medical SchoolOkayamaJapan
  15. 15.Department of Gastroenterological SurgeryNational Kyushu Cancer CenterFukuokaJapan
  16. 16.Department of Cardiothoracic Surgery, Graduate School of MedicineThe University of TokyoTokyoJapan
  17. 17.Department of Cardiovascular SurgeryNihon University HospitalTokyoJapan
  18. 18.Department of General Thoracic Surgery, Faculty of MedicineKagawa UniversityKagawaJapan

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