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Thoracic and cardiovascular surgery in Japan in 2016

Annual report by The Japanese Association for Thoracic Surgery
  • Committee for Scientific Affairs, The Japanese Association for Thoracic Surgery
  • Hideyuki ShimizuEmail author
  • Shunsuke Endo
  • Shoji Natsugoe
  • Yuichiro Doki
  • Yasutaka Hirata
  • Junjiro Kobayashi
  • Noboru Motomura
  • Kiyoharu Nakano
  • Hiroshi Nishida
  • Morihito Okada
  • Yoshikatsu Saiki
  • Aya Saito
  • Yukio Sato
  • Kazuo Tanemoto
  • Yasushi Toh
  • Hiroyuki Tsukihara
  • Shinji Wakui
  • Hiroyasu Yokomise
  • Munetaka Masuda
  • Kohei Yokoi
  • Yutaka Okita
Open Access
Annual Report
  • 88 Downloads

The Japanese Association for Thoracic Surgery has conducted annual surveys of thoracic surgery throughout Japan since 1986 to establish the statistics for the number of procedures by operative category. The results from our annual survey of thoracic surgery performed in 2016 are summarized.

As has been done so far, 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 members’ continued professional support and contributions (Tables 1, 2).
Table 1

Number of institutions involved in the survey

 

Questionnaires

Sent out

Responded

Response rate (%)

(A) Cardiovascular surgery

(B) General thoracic Surgery

744

693

93.1

(C) Esophageal surgery

584

543

93.0

Table 2

Categories subclassified according to the number of operations performed

Number of operations performed

Category

General thoracic surgery

0

5

1–24

52

25–49

119

50–99

185

100–149

130

150–199

89

≥ 200

113

Total

693

Number of operations performed

Esophageal surgery

0

70

1–4

138

5–9

107

10–19

95

20–29

41

30–39

26

40–49

22

≥ 50

44

Total

543

The incidence of hospital mortality was added to the survey to clarify the situation nationwide, which has contributed to Japanese surgeons understanding the present status of thoracic surgery in Japan and to make progress to improve operative results by comparing their work with that of others. The Association was able to gain a better understanding of present problems, as well as future prospects, which has been reflected in its activities, 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 after the patient has been discharged from the hospital. Hospital mortality is defined as death within any time interval after an operation if the patient has not been discharged from the hospital.

Hospital-to-hospital transfer in the categories of esophageal surgery 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. On the other hand, hospital-to-hospital transfer 30 days after operation in the categories of cardiovascular surgery and general thoracic surgery is considered discharge because data of the national clinical database (NCD) 2016 were used in this category, and hospital-to-hospital transfer 30 days after operation is considered discharge in the NCD.

Abstract of the survey

All data regarding cardiovascular surgery and thoracic surgery were obtained from the NCD, whereas data regarding esophageal surgery were collected from a survey questionnaire by The Japanese Association for Thoracic Surgery forms because NCD of esophageal surgery does not include non-surgical cases (i.e. patients with adjuvant chemotherapy or radiation alone).

In association with the change in data collection of cardiovascular surgery from self-reports using questionnaire sheets in each participating institution until the report in 2014 to automatic package download from the JCVSD (Japanese Cardiovascular Surgery Database, a cardiovascular part of the NCD), the response rate is not available and is not indicated in the category of cardiovascular surgery (Table 1). Further, the number of institutions classified by operation number is also not calculated in the category of cardiovascular surgery (Table 2).

2016 Final report

(A) Cardiovascular surgery

First, we are very pleased with our colleagues’ (members’) cooperation with our survey of cardiovascular surgery, which definitely enhances the quality of this annual report. We are truly grateful again for the enormous effort put into completing the JCVSD/NCD at each participating institution.

Figure 1 shows the development of cardiovascular surgery in Japan over the last 30 years. Aneurysm surgery includes only operations for thoracic and thoracoabdominal aortic aneurysms. Extra-anatomic bypass surgery for thoracic aneurysms and pacemaker implantation were totally excluded from the survey since 2015. The number of assist device implantation operations is not included in the total number of surgical operations, while it remained in the survey.
Fig. 1

Cardiovascular surgery. IHD ischemic heart disease

A total of 67,867 cardiovascular operations, including 51 heart transplantations, were performed at 580 institutions in 2016, which increased by 6.8% from the survey in 2015 (n = 63,520). Considering the trend in 2016, the data of which were collected and aggregated in the same method as in 2015, the actual number of cardiovascular operations is still continuously increasing, although the apparent number decreased in 2015 probably due to a major change in data collection and aggregation.

When compared with the data of 2015 [1] and of 2006 [2], the number of operations in 2016 for congenital heart disease decreased by 3.4% (8744 vs. 9054) and 7.6%, respectively; that for valvular heart disease increased by 16.1% (23,012 vs. 19,820) and 52.5%, respectively; that for thoracic aortic aneurysm increased by 9.4% (19,078 vs. 17,444) and 104.6%, respectively; that for ischemic heart decreased by 1.5% (14,874 vs. 15,103) and 21.1%, respectively; that for other cardiovascular procedures decreased slightly by 1.1% (1874 vs. 1895) and increased by 64.1%, respectively. Data for individual categories are summarized in Tables 3, 4, 5, 6, 7, 8.
Table 3

Congenital (total; 8744)

(1) CPB (+) (total; 6462)

 

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

PDA

1

0

0

0

2

0

0

0

0

0

0

0

3

1 (33.3)

0

1 (33.3)

6

1 (16.7)

0

1 (16.7)

Coarctation (simple)

13

1 (7.7)

0

1 (7.7)

12

0

0

0

15

0

0

0

4

0

0

0

44

1 (2.3)

0

1 (2.3)

 + VSD

44

2 (4.5)

1 (2.3)

2 (4.5)

43

2 (4.7)

0

3 (7.0)

14

0

0

0

0

0

0

0

101

4 (4.0)

1 (1.0)

5 (5.0)

 + DORV

0

0

0

0

3

0

0

0

0

0

0

0

0

0

0

0

3

0

0

0

 + AVSD

0

0

0

0

1

0

0

0

0

0

0

0

0

0

0

0

1

0

0

0

 + TGA

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

 + SV

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

 + Others

10

0

0

0

9

0

0

1 (11.1)

3

0

0

0

1

0

0

0

23

0

0

1 (4.3)

Interrupt. of Ao (simple)

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

 + VSD

20

1 (5.0)

0

1 (5.0)

24

1 (4.2)

0

1 (4.2)

9

0

0

0

0

0

0

0

53

2 (3.8)

0

2 (3.8)

 + DORV

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

 + Truncus

6

1 (16.7)

0

1 (16.7)

5

0

0

0

0

0

0

0

0

0

0

0

11

1 (9.1)

0

1 (9.1)

 + TGA

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

 + Others

1

0

0

0

4

0

0

0

0

0

0

0

0

0

0

0

5

0

0

0

Vascular ring

0

0

0

0

1

0

0

0

0

0

0

0

0

0

0

0

1

0

0

0

PS

3

1 (33.3)

0

1 (33.3)

27

0

0

0

105

0

0

0

19

0

0

0

154

1 (0.6)

0

1 (0.6)

PA·IVS or critical PS

4

0

0

0

53

1 (1.9)

0

1 (1.9)

63

0

0

0

9

0

0

0

129

1 (0.8)

0

1 (0.8)

TAPVR

100

7 (7.0)

0

12 (12.0)

52

0

0

0

8

0

0

1 (12.5)

0

0

0

0

160

7 (4.4)

0

13 (8.1)

PAPVR ± ASD

0

0

0

0

5

0

0

0

50

0

0

0

13

0

0

0

68

0

0

0

ASD

1

0

0

0

51

0

0

0

608

0

0

0

372

0

2 (0.5)

1 (0.3)

1032

0

2 (0.2)

1 (0.1)

Cor triatriatum

1

0

0

0

6

0

0

0

8

0

0

0

0

0

0

0

15

0

0

0

AVSD (partial)

0

0

0

0

13

1 (7.7)

0

1 (7.7)

36

0

0

0

3

0

0

0

52

1 (1.9)

0

1 (1.9)

AVSD (complete)

4

1 (25.0)

0

1 (25.0)

107

2 (1.9)

0

3 (2.8)

94

1 (1.1)

0

1 (1.1)

2

0

0

0

207

4 (1.9)

0

5 (2.4)

 + TOF or DORV

1

0

0

0

7

1 (14.3)

0

2 (28.6)

12

0

0

1 (8.3)

0

0

0

0

20

1 (5.0)

0

3 (15.0)

 + Others

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

VSD (subarterial)

2

0

0

0

88

0

0

0

171

0

0

0

13

0

0

0

274

0

0

0

VSD (perimemb./muscular)

11

0

0

0

825

0

0

1 (0.1)

366

0

0

2 (0.5)

30

0

0

0

1232

0

0

3 (0.2)

VSD (type unknown)

0

0

0

0

0

0

0

0

0

0

0

0

48

0

0

1 (2.1)

48

0

0

1 (2.1)

VSD + PS

2

0

0

0

26

0

0

0

22

0

0

0

0

0

0

0

50

0

0

0

DCRV ± VSD

0

0

0

0

5

0

0

0

23

0

0

0

9

0

0

0

37

0

0

0

Aneurysm of sinus of Valsalva

0

0

0

0

0

0

0

0

0

0

0

0

5

0

0

0

5

0

0

0

TOF

14

0

0

0

162

1 (0.6)

0

2 (1.2)

174

2 (1.1)

0

3 (1.7)

25

0

0

1 (4.0)

375

3 (0.8)

0

6 (1.6)

PA + VSD

9

1 (11.1)

0

1 (11.1)

56

0

0

2 (3.6)

109

0

0

0

10

0

0

0

184

1 (0.5)

0

3 (1.6)

DORV

25

0

0

0

140

2 (1.4)

0

2 (1.4)

158

1 (0.6)

0

2 (1.3)

11

0

0

1 (9.1)

334

3 (0.9)

0

5 (1.5)

TGA (simple)

98

1 (1.0)

0

4 (4.1)

11

0

0

1 (9.1)

2

0

0

0

2

0

0

0

113

1 (0.9)

0

5 (4.4)

 + VSD

37

2 (5.4)

0

4 (10.8)

10

0

0

0

11

1 (9.1)

0

1 (9.1)

2

0

0

0

60

3 (5.0)

0

5 (8.3)

 VSD + PS

0

0

0

0

1

0

0

0

1

0

0

0

0

0

0

0

2

0

0

0

Corrected TGA

2

0

0

0

8

0

0

0

24

0

0

1 (4.2)

7

0

0

0

41

0

0

1 (2.4)

Truncus arteriosus

6

0

0

0

24

0

0

1 (4.2)

16

0

0

1 (6.3)

1

0

0

0

47

0

0

2 (4.3)

SV

24

2 (8.3)

0

6 (25.0)

181

3 (1.7)

0

7 (3.9)

199

3 (1.5)

0

6 (3.0)

28

2 (7.1)

0

3 (10.7)

432

10 (2.3)

0

22 (5.1)

TA

8

0

0

0

48

2 (4.2)

0

3 (6.3)

48

0

0

1 (2.1)

10

0

0

0

114

2 (1.8)

0

4 (3.5)

HLHS

28

2 (7.1)

0

5 (17.9)

124

3 (2.4)

0

9 (7.3)

74

1 (1.4)

0

3 (4.1)

0

0

0

0

226

6 (2.7)

0

17 (7.5)

Aortic valve lesion

10

1 (10.0)

0

1 (10.0)

22

1 (4.5)

0

4 (18.2)

110

0

0

0

36

2 (5.6)

0

4 (11.1)

178

4 (2.2)

0

9 (5.1)

Mitral valve lesion

1

0

0

1 (100.0)

37

0

0

0

62

0

0

0

11

1 (9.1)

0

1 (9.1)

111

1 (0.9)

0

2 (1.8)

Ebstein

9

1 (11.1)

0

1 (11.1)

15

0

0

0

26

0

0

0

10

0

0

0

60

1 (1.7)

0

1 (1.7)

Coronary disease

4

2 (50.0)

0

2 (50.0)

7

1 (14.3)

0

2 (28.6)

18

1 (5.6)

0

1 (5.6)

2

0

0

0

31

4 (12.9)

0

5 (16.1)

Others

15

0

0

1 (6.7)

24

0

0

0

41

0

0

2 (4.9)

54

0

0

0

134

0

0

3 (2.2)

Conduit failure

0

0

0

0

5

0

0

1 (20.0)

37

0

0

0

12

0

0

0

54

0

0

1 (1.9)

Redo (excluding conduit failure)

5

0

0

0

63

2 (3.2)

0

4 (6.3)

104

1 (1.0)

0

4 (3.8)

63

1 (1.6)

0

1 (1.6)

235

4 (1.7)

0

9 (3.8)

Total

519

26 (5.0)

1 (0.2)

45 (8.7)

2307

23 (1.0)

0

51 (2.2)

2821

11 (0.4)

0

30 (1.1)

815

7 (0.9)

2 (0.2)

14 (1.7)

6462

67 (1.0)

3 (0.0)

140 (2.2)

(), % mortality

CPB cardiopulmonary bypass, PDA patent ductus arteriosus, VSD ventricular septal defect, DORV double outlet right ventricle, AVSD atrioventricular septal defect, TGA transposition of great arteries, SV single ventricle, Interrupt. 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; 2282)

 

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

After discharge

Hospital

After discharge

Hospital

After discharge

Hospital

After discharge

Hospital

After discharge

Hospital mortality

PDA

344

5 (1.5)

0

12 (3.5)

197

1 (0.5)

0

4 (2.0)

25

0

0

0

3

0

0

0

569

6 (1.1)

0

16 (2.8)

Coarctation (simple)

18

0

0

0

7

0

0

0

3

0

0

0

0

0

0

0

28

0

0

0

 + VSD

38

0

0

0

11

1 (9.1)

0

1 (9.1)

2

0

0

0

0

0

0

0

51

1 (2.0)

0

1 (2.0)

 + DORV

3

0

0

0

0

0

0

0

1

0

0

0

0

0

0

0

4

0

0

0

 + AVSD

2

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

2

0

0

0

 + TGA

1

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

1

0

0

0

 + SV

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

 + Others

12

0

0

0

5

0

0

0

1

0

0

0

0

0

0

0

18

0

0

0

Interrupt. of Ao (simple)

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

 + VSD

26

1 (3.8)

0

1 (3.8)

3

0

0

0

0

0

0

0

0

0

0

0

29

1 (3.4)

0

1 (3.4)

 + DORV

1

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

1

0

0

0

 + Truncus

7

2 (28.6)

0

2 (28.6)

3

0

0

0

0

0

0

0

0

0

0

0

10

2 (20.0)

0

2 (20.0)

 + TGA

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

 + Others

1

0

0

0

2

0

0

0

0

0

0

0

0

0

0

0

3

0

0

0

Vascular ring

3

0

0

0

12

0

0

0

8

0

0

0

0

0

0

0

23

0

0

0

PS

5

0

0

0

9

0

0

0

1

0

0

0

1

0

0

0

16

0

0

0

PA·IVS or critical PS

27

1 (3.7)

0

1 (3.7)

34

1 (2.9)

0

1 (2.9)

6

0

0

0

1

0

0

0

68

2 (2.9)

0

2 (2.9)

TAPVR

13

1 (7.7)

0

1 (7.7)

2

0

0

0

0

0

0

0

0

0

0

0

15

1 (6.7)

0

1 (6.7)

PAPVR ± ASD

0

0

0

0

2

0

0

0

1

0

0

0

0

0

0

0

3

0

0

0

ASD

0

0

0

0

2

0

0

0

4

0

0

0

2

0

0

0

8

0

0

0

Cor triatriatum

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

AVSD (partial)

1

0

0

0

0

0

0

0

2

0

0

0

0

0

0

0

3

0

0

0

AVSD (complete)

50

0

0

1 (2.0)

82

0

1 (1.2)

1 (1.2)

7

0

0

0

0

0

0

0

139

0

1 (0.7)

2 (1.4)

 + TOF or DORV

0

0

0

0

5

0

0

0

2

0

0

0

0

0

0

0

7

0

0

0

 + Others

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

VSD (subarterial)

4

0

0

0

6

0

0

0

0

0

0

0

0

0

0

0

10

0

0

0

VSD (perimemb./muscular)

47

0

0

1 (2.1)

111

1 (0.9)

0

1 (0.9)

5

0

0

0

1

0

0

0

164

1 (0.6)

0

2 (1.2)

VSD + PS

0

0

0

0

2

0

0

0

0

0

0

0

0

0

0

0

2

0

0

0

DCRV ± VSD

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

Aneurysm of sinus of Valsalva

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

TOF

16

1 (6.3)

0

1 (6.3)

84

1 (1.2)

0

1 (1.2)

12

0

0

0

3

0

0

0

115

2 (1.7)

0

2 (1.7)

PA + VSD

20

0

0

0

54

0

0

1 (1.9)

25

1 (4.0)

0

3 (12.0)

1

0

0

0

100

1 (1.0)

0

4 (4.0)

DORV

50

0

0

0

83

0

0

0

16

0

0

0

0

0

0

0

149

0

0

0

TGA (simple)

5

0

0

0

3

0

0

0

0

0

0

0

2

0

0

0

10

0

0

0

 + VSD

9

0

0

0

4

0

0

0

1

0

0

0

1

0

0

0

15

0

0

0

 VSD + PS

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

Corrected TGA

4

0

0

0

8

0

0

0

14

0

0

0

4

0

0

0

30

0

0

0

Truncus arteriosus

24

0

0

1 (4.2)

7

0

0

0

2

0

0

0

0

0

0

0

33

0

0

1 (3.0)

SV

68

3 (4.4)

1 (1.5)

6 (8.8)

51

1 (2.0)

0

3 (5.9)

19

0

0

0

2

0

0

0

140

4 (2.9)

1 (0.7)

9 (6.4)

TA

20

0

0

1 (5.0)

21

1 (4.8)

0

1 (4.8)

3

0

0

0

3

0

0

0

47

1 (2.1)

0

2 (4.3)

HLHS

77

2 (2.6)

0

4 (5.2)

25

0

0

0

15

0

0

0

0

0

0

0

117

2 (1.7)

0

4 (3.4)

Aortic valve lesion

6

0

1 (16.7)

2 (33.3)

2

0

0

0

1

0

0

0

0

0

0

0

9

0

1 (11.1)

2 (22.2)

Mitral valve lesion

1

1 (100.0)

0

1 (100.0)

2

0

0

0

4

0

0

0

1

0

0

0

8

1 (12.5)

0

1 (12.5)

Ebstein

6

1 (16.7)

0

1 (16.7)

3

0

0

0

1

0

0

0

0

0

0

0

10

1 (10.0)

0

1 (10.0)

Coronary disease

5

0

0

0

3

0

0

0

1

0

0

0

2

0

0

0

11

0

0

0

Others

10

0

0

0

16

0

0

2 (12.5)

13

3 (23.1)

0

3 (23.1)

5

0

0

0

44

3 (6.8)

0

5 (11.4)

Conduit failure

0

0

0

0

0

0

0

0

0

0

0

0

1

0

0

0

1

0

0

0

Redo (excluding conduit failure)

7

0

0

0

106

0

0

1 (0.9)

126

1 (0.8)

0

1 (0.8)

30

0

0

0

269

1 (0.4)

0

2 (0.7)

Total

931

18 (1.9)

2 (0.2)

36 (3.9)

967

7 (0.7)

1 (0.1)

17 (1.8)

321

5 (1.6)

0

7 (2.2)

63

0

0

0

2282

30 (1.3)

3 (0.13)

60 (2.6)

(), % mortality

CPB cardiopulmonary bypass, PDA patent ductus arteriosus, VSD ventricular septal defect, DORV double outlet right ventricle, AVSD atrioventricular septal defect, TGA transposition of the great arteries, SV single ventricle, Interrupt. 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

162

4 (2.5)

1 (0.6)

7 (4.3)

431

5 (1.2)

0

8 (1.9)

49

0

0

1 (2.0)

0

0

0

0

642

9 (1.4)

1 (0.2)

16 (2.5)

2

PAB

270

5 (1.9)

1 (0.4)

11 (4.1)

284

2 (0.7)

1 (0.4)

5 (1.8)

16

0

0

0

0

0

0

0

570

7 (1.2)

2 (0.4)

16 (2.8)

3

Bidirectional Glenn or hemi-Fontan ± α

0

0

0

0

285

2 (0.7)

0

5 (1.8)

114

0

0

1 (0.9)

6

0

0

0

405

2 (0.5)

0

6 (1.5)

4

Damus–Kaye–Stansel operation

3

0

0

0

31

3 (9.7)

0

5 (16.1)

13

0

0

1 (7.7)

1

0

0

0

48

3 (6.3)

0

6 (12.5)

5

PA reconstruction/repair (including redo)

16

0

0

0

138

3 (2.2)

0

4 (2.9)

200

1 (0.5)

0

2 (1.0)

14

0

0

0

368

4 (1.1)

0

6 (1.6)

6

RVOT reconstruction/repair

6

0

0

0

186

0

0

2 (1.1)

303

2 (0.7)

0

3 (1.0)

44

0

0

2 (4.5)

539

2 (0.4)

0

7 (1.3)

7

Rastelli procedure

1

0

0

0

27

0

0

1 (3.7)

106

0

0

0

9

0

0

0

143

0

0

1 (0.7)

8

Arterial switch procedure

138

3 (2.2)

0

7`(5.1)

26

2 (7.7)

0

2 (7.7)

6

1 (16.7)

0

1 (16.7)

1

0

0

0

171

6 (3.5)

0

10 (5.8)

9

Atrial switch procedure

1

0

0

0

2

0

0

1 (50.0)

7

0

0

1 (14.3)

1

0

0

0

11

0

0

2 (18.2)

10

Double switch procedure

0

0

0

0

0

0

0

0

7

0

0

0

0

0

0

0

7

0

0

0

11

Repair of anomalous origin of CA

3

1 (33.3)

0

1 (33.3)

4

0

0

1 (25.0)

2

0

0

0

1

0

0

0

10

1 (10.0)

0

2 (20.0)

12

Closure of coronary AV fistula

1

0

0

0

4

0

0

0

5

0

0

0

0

0

0

0

10

0

0

0

13

Fontan/TCPC

1

0

0

0

3

0

0

0

364

2 (0.5)

0

7 (1.9)

42

2 (4.8)

0

2 (4.8)

410

4 (1.0)

0

9 (2.2)

14

Norwood procedure

0

0

0

0

18

1 (5.6)

0

3 (16.7)

2

0

0

0

0

0

0

0

20

1 (5.0)

0

3 (15.0)

15

Ventricular septation

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

16

Left side AV valve repair (including Redo)

2

0

0

0

43

0

0

0

67

0

0

1 (1.5)

13

0

0

0

125

0

0

1 (0.8)

17

Left side AV valve replace (including Redo)

0

0

0

0

15

0

0

0

37

0

0

1 (2.7)

11

1 (9.1)

0

1 (9.1)

63

1 (1.6)

0

2 (3.2)

18

Right side AV valve repair (including Redo)

15

2 (13.3)

0

2 (13.3)

71

0

0

0

85

1 (1.2)

0

3 (3.5)

57

0

0

0

228

3 (1.3)

0

5 (2.2)

19

Right side AV valve replace (including Redo)

0

0

0

0

1

0

0

0

9

0

0

0

25

1 (4.0)

0

1 (4.0)

35

1 (2.9)

0

1 (2.9)

20

Common AV valve repair (including Redo)

8

3 (37.5)

0

6 (75.0)

19

1 (5.3)

0

3 (15.8)

10

1 (10.0)

0

1 (10.0)

1

0

0

0

38

5 (13.2)

0

10 (26.3)

21

Common AV valve replace (including Redo)

1

0

0

1 (100.0)

4

0

0

0

6

0

0

0

3

0

0

1 (33.3)

14

0

0

2 (14.3)

22

Repair of supra-aortic stenosis

2

1 (50.0)

0

1 (50.0)

2

0

0

0

8

0

0

0

1

0

0

0

13

1 (7.7)

0

1 (7.7)

23

Repair of subaortic stenosis (including Redo)

1

0

0

0

11

0

0

0

33

0

0

0

7

0

0

0

52

0

0

0

24

Aortic valve plasty ± VSD Closure

8

1 (12.5)

0

1 (12.5)

10

0

0

2 (20.0)

28

0

0

0

5

0

0

0

51

1 (2.0)

0

3 (5.9)

25

Aortic valve replacement

0

0

0

0

2

0

0

0

35

0

0

0

29

2 (6.9)

0

4 (13.8)

66

2 (3.0)

0

4 (6.1)

26

AVR with annular enlargement

0

0

0

0

0

0

0

0

10

0

0

0

0

0

0

0

10

0

0

0

27

Aortic root replace (except Ross)

0

0

0

0

0

0

0

0

7

0

0

0

10

0

0

0

17

0

0

0

28

Ross procedure

1

0

0

0

4

0

0

0

13

0

0

0

    

18

0

0

0

29

Bilateral pulmonary artery banding

156

4 (2.6)

1 (0.6)

8 (5.1)

19

1 (5.3)

0

2 (10.5)

0

0

0

0

0

0

0

0

175

5 (2.9)

1 (0.6)

10 (5.7)

Total

796

24 (3.0)

3 (0.4)

45 (5.7)

1640

20 (1.2)

1 (0.1)

44 (2.7)

1542

8 (0.5)

0

23 (1.5)

281

6 (2.1)

0

11 (3.9)

4259

58 (1.4)

4 (0.09)

123 (2.9)

(), % 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 operations for arrhythmia in (3); 40,152

(1) Valvular heart disease (total; 23,254)

 

Valve

Cases

Operation

30-Day mortality

Hospital mortality

Redo

Mechanical

Bioprosthesis

Ross Procedure

Repair

Unknown

With CABG

Hospital

After discharge

Cases

30-Day mortality

Hospital mortality

Replace

Repair

Replace

Repair

Replace

Repair

Hospital

After discharge

Isolated

A

9472

1574

7626

0

272

0

2508

176 (1.9)

4 (1.5)

1 (0.01)

0

283 (3.1)

9 (3.3)

522

26 (5.0)

0

37 (7.1)

M

4576

539

785

 

3252

0

827

56 (4.2)

34 (1.0)

0

0

83 (6.3)

48 (1.5)

473

25 (5.3)

0

39 (8.2)

T

303

10

53

 

240

0

37

3 (4.8)

7 (2.9)

0

0

4 (6.3)

11 (4.6)

83

5 (6.0)

0

7 (8.4)

P

10

0

7

 

3

0

0

1 (14.3)

0

0

0

1 (14.3)

0

6

1 (16.7)

0

1 (16.7)

A + M

A

1352

279

952

0

49

72

247

62

(4.6)

0

 

104

(7.7)

153

8 (5.2)

0

16 (10.5)

     

0

M

183

377

 

792

0

A + T

A

500

90

370

0

8

32

83

25

(5.0)

1

(0.2)

35

(7.0)

59

7 (11.9)

0

9 (15.3)

     

0

T

1

5

 

494

0

M + T

M

3663

453

967

 

2176

67

402

70

(1.9)

0

 

119

(3.2)

400

14 (3.5)

0

22 (5.5)

      

0

 

T

1

39

 

3623

0

A + M + T

A

1046

192

745

0

38

71

119

41

(3.9)

0

 

69

(6.6)

118

8 (6.8)

0

10 (8.5)

M

157

370

 

491

28

T

0

3

 

1043

0

Others

 

2332

2

22

0

28

2280

45

17

(0.7)

1

(0.0)

34

(3.3)

220

2 (0.9)

0

6

Total

 

23,254

     

4268

496

(2.1)

3

(0.01)

800

(3.4)

2034

96 (4.7)

0

147 (7.2)

(), % mortality

Number of redo cases is included in total case number of 23,254

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

TAVR

Cases

30-Day mortality

Hospital mortality

Hospital

After discharge

 

2250

15 (0.7)

1 (0.0)

30 (1.3)

(2) Ischemic heart disease (total, (A) + (B); 14,874)

(A) Isolated CABG (total; (a) + (b); 13,654)

(a-1) On-pump arrest CABG (total; 3023)

 

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

53

2 (3.8)

0

2 (3.8)

17

1 (5.9)

0

2 (11.8)

2

0

0

0

0

0

0

0

23

25

24

0

0

2VD

343

5 (1.5)

0

8 (2.3)

54

4 (7.4)

0

4 (7.4)

4

0

0

0

0

0

0

0

68

299

30

1

3

3VD

1140

9 (0.8)

1 (0.1)

16 (1.4)

164

10 (6.1)

0

12 (7.3)

9

0

0

0

1

0

0

0

87

1193

27

5

2

LMT

969

17 (1.8)

0

25 (2.6)

256

13 (5.1)

0

20 (7.8)

8

0

0

1 (12.5)

3

0

0

0

113

1064

40

10

9

Total

2505

33 (1.3)

1 (0.0)

51 (2.0)

491

28 (5.7)

0

38 (7.7)

23

0

0

1 (4.3)

4

0

0

0

291

2581

121

16

14

Kawasaki

9

0

0

0

2

0

0

0

0

0

0

0

0

0

0

0

5

4

2

0

0

Hemodialysis

244

14 (5.7)

0

18 (7.4)

48

6 (12.5)

0

6 (12.5)

6

0

0

0

1

0

0

0

18

257

19

3

2

(), % 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; 2077)

 

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

30

0

0

0

10

1 (10.0)

0

1 (10.0)

2

0

0

0

0

0

0

0

9

24

9

0

0

2VD

164

2 (1.2)

0

3 (1.8)

44

2 (4.5)

0

3 (6.8)

2

0

0

0

1

0

0

0

46

146

18

0

1

3VD

672

10 (1.5)

1 (0.1)

18 (2.7)

180

13 (7.2)

0

27 (15.0)

15

0

0

0

1

0

0

0

109

711

39

4

5

LMT

597

10 (1.7)

0

18 (3.0)

332

22 (6.6)

0

29 (8.7)

23

2 (8.7)

0

2 (8.7)

4

2 (50.0)

0

2 (50.0)

139

756

54

1

6

Total

1463

22 (1.5)

1 (0.1)

39 (2.7)

566

38 (6.7)

0

60 (10.6)

42

2 (4.8)

0

2 (4.8)

6

2 (33.3)

0

2 (33.3)

303

1637

120

5

12

Kawasaki

1

0

0

0

1

0

0

0

0

0

0

0

0

0

0

0

0

2

0

0

0

Hemodialysis

211

8 (3.8)

0

17 (8.1)

77

8 (10.4)

0

12 (15.6)

8

0

0

0

1

0

0

0

30

243

21

1

2

(), % 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 LMT alone or LMT with other branch diseases

(b) Off-pump CABG (total; 8554)

(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

439

2 (0.5)

0

2 (0.5)

50

0

0

0

9

1 (11.1)

0

1 (11.1)

6

3 (50.0)

0

4 (66.7)

360

103

36

3

2

2VD

1222

9 (0.7)

0

16 (1.3)

136

4 (2.9)

0

6 (4.4)

17

0

0

0

3

1 (33.3)

0

1 (33.3)

510

808

40

5

15

3VD

2721

15 (0.6)

0

34 (1.2)

360

10 (2.8)

0

15 (4.2)

28

0

0

0

5

1 (20.0)

0

1 (20.0)

662

2359

56

15

22

LMT

2804

17 (0.6)

0

35 (1.2)

715

25 (3.5)

0

42 (5.9)

31

2 (6.5)

0

2 (6.5)

8

0

0

0

977

2438

95

15

33

Total

7186

43 (0.6)

0

87 (1.2)

1261

39 (3.1)

0

63 (5.0)

85

3 (3.5)

0

3 (3.5)

22

5 (22.7)

0

6 (27.3)

2509

5708

227

38

72

Kawasaki

14

0

0

0

3

1 (33.3)

0

1 (33.3)

0

0

0

0

0

0

0

0

12

4

0

1

0

Hemodialysis

818

20 (2.4)

0

38 (4.6)

139

4 (2.9)

0

10 (7.2)

11

0

0

0

3

1 (33.3)

0

1 (33.3)

229

688

46

2

6

(), % 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) Conversion from off-pump CABG to on-pump CABG or on- pump beating-heart CABG during surgery (total; 233)

 

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

After discharge

Hospital

After discharge

Hospital

After discharge

Hospital

After discharge

Hospital mortality

Conversion to on-pump CABG arrest heart

28

1 (3.6)

0

1 (3.6)

9

0

0

0

1

1 (100.0)

0

1 (100.0)

2

1 (50.0)

0

1 (50.0)

Conversion to on-pump beating-heart CABG

148

6 (4.1)

0

12 (8.1)

41

4 (9.8)

0

6 (14.6)

3

1 (33.3)

0

1 (33.3)

1

1 (100.0)

0

1 (100.0)

Total

176

7 (4.0)

0

13 (7.4)

50

4 (8.0)

0

6 (12.0)

4

2 (50.0)

0

2 (50.0)

3

2 (66.7)

0

2 (66.7)

Hemodialysis

35

3 (8.6)

0

6 (17.1)

6

0

0

0

0

0

0

0

1

1 (100.0)

0

1 (100.0)

(), % mortality

CABG coronary artery bypass grafting

(B) Operation for complications of MI (total; 1220)

 

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

145

4 (2.8)

0

11 (7.6)

16

5 (31.3)

0

5 (31.3)

90

43

17

VSP closure

45

5 (11.1)

0

5 (11.1)

222

71 (32.0)

1 (0.5)

89 (40.1)

81

0

2

Cardiac rupture

35

6 (17.1)

1 (2.9)

8 (22.9)

212

79 (37.3)

0

88 (41.5)

43

0

4

Mitral regurgitation

 (1) Papillary muscle rupture

16

2 (12.5)

0

3 (18.8)

33

7 (21.2)

0

9 (27.3)

19

6

43

 (2) Ischemic

309

19 (6.1)

0

32 (10.4)

37

7 (18.9)

0

11 (29.7)

254

229

117

Others

73

5 (6.8)

0

6 (8.2)

77

26 (33.8)

0

34 (44.2)

59

9

7

Total

623

41 (6.6)

1 (0.2)

65 (10.4)

597

195 (32.7)

1 (0.2)

236 (39.5)

546

287

190

(), % 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

(3) Operation for arrhythmia (total; 7168)

 

Cases

30-Day mortality

Hospital mortality

Concomitant operation

Isolated

Congenital

Valve

IHD

Others

Multiple combination

Hospital

After discharge

2 categories

3 categories

Maze

3974

82 (2.1)

0

138 (3.5)

136

168

3459

665

288

712

42

For WPW

1

0

0

0

0

0

0

1

0

0

0

For ventricular tachyarrhythmia

34

1 (2.9)

0

1 (2.9)

4

1

17

18

4

10

1

Others

3159

59 (1.9)

1 (0.03)

104 (3.3)

199

116

2478

671

306

572

48

Total

7168

142 (2.0)

1 (0.01)

243 (3.4)

339

285

5954

1355

598

1294

91

(),  % mortality

Except for 339 isolated cases, all remaining 6829 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; 172)

 

CPB (+)

CPB (−)

Cases

30-Day mortality

Hospital mortality

Cases

30-Day mortality

Hospital mortality

Hospital

After discharge

Hospital

After discharge

Total

81

11 (13.6)

0

15 (18.5)

91

7 (7.7)

0

10 (11.0)

(), % mortality

CPB cardiopulmonary bypass

(5) Cardiac tumor (total; 535)

 

Cases

30-Day mortality

Hospital mortality

Concomitant operation

Hospital

After discharge

AVR

MVR

CABG

Others

Benign tumor

462

2 (0.4)

0

3 (0.6)

15

12

38

111

 (Cardiac myxoma)

353

2 (0.6)

0

3 (0.8)

4

7

23

84

Malignant tumor

73

4 (5.5)

0

8 (11.0)

2

1

3

12

 (Primary)

12

0

0

1 (8.3)

0

0

1

2

(),  % mortality

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

(6) HOCM and DCM (total; 310)

 

Cases

30-Day mortality

Hospital mortality

Concomitant operation

Hospital

After discharge

AVR

MVR

MVP

CABG

Myectomy

120

1 (0.8)

0

2 (1.7)

65

16

17

14

Myotomy

10

0

0

1 (10.0)

4

0

1

1

No-resection

168

8 (4.8)

0

15 (8.9)

33

88

80

21

Volume reduction surgery of the left ventricle

12

1 (8.3)

0

1 (8.3)

0

2

6

4

Total

310

10 (3.2)

0

19 (6.1)

102

106

104

40

(), % 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; 668)

 

Cases

30-Day mortality

Hospital mortality

Hospital

After discharge

Open-heart operation

383

40 (10.4)

1 (0.3)

54 (14.1)

Non-open-heart operation

285

43 (15.1)

0

53 (18.6)

Total

668

83 (12.4)

1 (0.1)

107 (16.0)

(), % mortality

Table 5

Thoracic aortic aneurysm (total; 19,078)

(1) Dissection (total; 9441)

(1) Dissection (total; 9441)

Stanford type

Acute

Chronic

Concomitant operation

Redo

A

B

A

B

Replaced site

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

Others

Cases

30-Day mortality

Hospital mortality

Hospital

After discharge

Hospital

After discharge

Hospital

After discharge

Hospital

After discharge

Hospital

After discharge

1. Ascending Ao.

2738

241 (8.8)

0

286 (10.4)

3

0

0

0

299

13 (4.3)

0

20 (6.7)

7

0

0

0

128

162

19

14

162

74

109

16 (14.7)

0

18 (16.5)

2. Aortic Root

190

38 (20.0)

0

42 (22.1)

0

0

0

0

58

5 (8.6)

0

7 (12.1)

3

0

0

0

31

159

4

0

68

15

34

6 (17.6)

0

7 (20.6)

3. Arch

1426

128 (9.0)

1 (0.07)

161 (11.3)

34

2 (5.9)

0

2 (5.9)

296

6 (2.0)

0

10 (3.4)

205

10 (4.9)

0

17 (8.3)

55

65

4

1

87

38

125

12 (9.6)

0

15 (12.0)

4. Aortic root + Asc.Ao. + arch

180

28 (15.6)

0

32 (17.8)

0

0

0

0

51

2 (3.9)

0

3 (5.9)

7

1 (14.3)

0

1 (14.3)

24

111

3

1

42

10

26

5 (19.2)

0

6 (23.1)

5. Descending Ao.

64

2 (3.1)

0

4 (6.3)

29

1 (3.4)

0

5 (17.2)

67

0

0

0

254

7 (2.8)

0

15 (5.9)

8

6

0

0

4

4

118

4 (3.4)

0

10 (8.5)

6. Thoracoabdominal Ao.

12

0

0

0

15

2 (13.3)

0

2 (13.3)

29

1 (3.4)

0

1 (3.4)

187

11 (5.9)

0

14 (7.5)

0

0

0

0

1

0

102

6 (5.9)

0

8 (7.8)

7. Stent graft*a

851

79 (9.3)

0

93 (10.9)

469

33 (7.0)

0

46 (9.8)

461

5 (1.1)

0

13 (2.8)

1506

22 (1.5)

1 (0.1)

36 (2.4)

31

90

2

4

92

28

683

20 (2.9)

0

31 (4.5)

 1) TEVAR l*b

85

13 (15.3)

0

15 (17.6)

418

27 (6.5)

0

40 (9.6)

287

2 (0.7)

0

5 (1.7)

1262

15 (1.2)

1 (0.1)

26 (2.1)

0

2

0

0

0

9

553

13 (2.4)

0

22 (4.0)

 2) Open stent

766

66 (8.6)

0

78 (10.2)

51

6 (11.8)

0

6 (11.8)

174

3 (1.7)

0

8 (4.6)

244

7 (2.9)

0

10 (4.1)

31

88

2

4

92

19

130

7 (5.4)

0

9 (6.9)

  a) With total arch*c

756

64 (8.5)

0

76 (10.1)

40

3 (7.5)

0

3 (7.5)

164

3 (1.8)

0

8 (4.9)

195

6 (3.1)

0

8 (4.1)

31

86

2

4

89

19

112

6 (5.4)

0

8 (7.1)

  b) without total arch*d

10

2 (20.0)

0

2 (20.0)

11

3 (27.3)

0

3 (27.3)

10

0

0

0

49

1 (2.0)

0

2 (4.1)

0

2

0

0

3

0

18

1 (5.6)

0

1 (5.6)

Total

5461

516 (9.4)

1 (0.02)

618 (11.3)

550

38 (6.9)

0

55 (10.0)

1261

32 (2.5)

0

54 (4.3)

2169

51 (2.4)

1 (0.0)

83 (3.8)

277

593

32

20

456

169

1197

69 (5.8)

0

95 (7.9)

(), % mortality

Acute, within 2 weeks from the onset

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

(2) Non-dissection (total; 9637)

Replaced site

Unruptured

Ruptured

Concomitant operation

Redo

Cases

30-Day mortality

Hospital mortality

Cases

30-Day mortality

Hospital mortality

AVP

AVR

MVP

MVR

CABG

Others

Cases

30-Day mortality

Hospital mortality

Hospital

After discharge

Hospital

After discharge

Hospital

After discharge

1. Ascending Ao.

1528

30 (2.0)

0

45 (2.9)

53

5 (9.4)

0

9 (17.0)

85

1048

89

50

201

240

196

12 (6.1)

0

23 (11.7)

2. Aortic Root

864

25 (2.9)

0

31 (3.6)

52

8 (15.4)

0

10 (19.2)

193

593

62

20

126

133

152

17 (11.2)

0

20 (13.2)

3. Arch

1729

46 (2.7)

1 (0.06)

83 (4.8)

130

13 (10.0)

0

22 (16.9)

42

276

16

9

295

112

185

10 (5.4)

0

20 (10.8)

4. Aortic Root + Asc.Ao. + Arch

254

11 (4.3)

0

14 (5.5)

8

3 (37.5)

0

4 (50.0)

55

161

17

7

40

38

43

8 (18.6)

0

10 (23.3)

5. Descending Ao.

307

7 (2.3)

0

15 (4.9)

64

15 (23.4)

0

19 (29.7)

2

13

0

0

29

5

75

5 (6.7)

0

10 (13.3)

6. Thoracoabdominal Ao.

349

16 (4.6)

0

24 (6.9)

42

7 (16.7)

0

12 (28.6)

0

1

0

0

7

1

88

9 (10.2)

0

13 (14.8)

7. Stent graft*a

3837

97 (2.5)

1 (0.03)

170 (4.4)

420

66 (15.7)

3 (0.71)

87 (20.7)

22

108

22

3

212

74

830

42 (5.1)

1 (0.1)

65 (7.8)

 1) TEVARl*b

2727

59 (2.2)

1 (0.04)

102 (3.7)

336

55 (16.4)

3 (0.89)

72 (21.4)

0

4

0

0

16

24

713

31 (4.3)

1 (0.1)

49 (6.9)

 2) Open stent

1110

38 (3.4)

0

68 (6.1)

84

11 (13.1)

0

15 (17.9)

22

104

22

3

196

50

117

11 (9.4)

0

16 (13.7)

  a) with total arch*c

983

34 (3.5)

0

62 (6.3)

65

9 (13.8)

0

12 (18.5)

21

99

22

3

186

47

93

9 (9.7)

0

13 (14.0)

  b) without total arch*d

127

4 (3.1)

0

6 (4.7)

19

2 (10.5)

0

3 (15.8)

1

5

0

0

10

3

24

2 (8.3)

0

3 (12.5)

Total

8868

232 (2.6)

2 (0.02)

382 (4.3)

769

117 (15.2)

3 (0.39)

163 (21.2)

399

2200

206

89

910

603

1569

103 (6.6)

1 (0.1)

161 (10.3)

(), % 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

Table 6

Pulmonary thromboembolism (total; 138)

 

Cases

30-Day mortality

Hospital mortality

Hospital

After discharge

Acute

90

10 (11.1)

 

11

Chronic

48

2 (4.2)

 

3

Total

138

12 (8.7)

0

14 (10.1)

(), % mortality

Table 7

Implantation of VAD (total; 164)

 

Cases

30-Day mortality

Hospital mortality

Hospital

After discharge

Implantation of VAD

164

3 (1.8)

3 (1.8)

31 (18.9)

(), % mortality

VAD ventricular assist devise

Table 8

Heart transplantation (total; 51)

 

Cases

30-Day mortality

Hospital mortality

Hospital

After discharge

Heart transplantation

51

1 (2.0)

0

2 (3.9)

Heart and lung transplantation

0

0

0

0

Total

51

1 (2.0)

0

2 (3.9)

(), % mortality

In 2016, of 8744 operations for congenital heart disease, 6462 open-heart surgeries were performed with overall hospital mortality of 2.2%. The number of operations decreased gradually throughout these 10 years (maximum 7386 cases in 2006), and overall hospital mortality showed a plateau at around 3.0%. In detail, the most common disease was ventricular septal defect (VSD) (perimembranous/muscular) (1232 cases), as in 2015 when VSD became the most common disease for the first time since the inauguration of this survey. Atrial septal defect (ASD) was the “second” most common one (1032 cases) in 2016. It was mainly due to the development and increasing use of commercially available catheter devices for ASD closure. In the last 10 years, hospital mortality for complex congenital heart disease was as follows (2006 [2], 2011 [3], and 2016), complete atrio-septal defect (4.5%, 4.7%, and 3.5%), tetralogy of Fallot (1.9%, 0.7%, and 1.6%), transposition of the great arteries with intact septum (4.4%, 2.5%, and 4.4%) and with ventricular septal defect (9.1%, 3.6%, and 8.3%), single ventricle (6.7%, 4.4%, and 5.1%), and hypoplastic left heart syndrome (16.6%, 14.3%, and 7.5%). Right heart bypass surgery is now commonly performed (405 bidirectional Glenn procedures excluding 48 Damus–Kaye–Stansel procedures and 410 Fontan-type procedures including total cavo-pulmonary connection) with acceptable hospital mortality (1.5% and 2.2%, respectively). The Norwood type I procedure was performed in 20 cases, with a relatively low hospital mortality rate of 15%.

The total number of operations for valvular heart disease is increasing, although the apparent number dropped in the survey in 2015, probably because of a major change in the process of data collection. The number of isolated aortic valve replacements/repairs with/without CABG (n = 9472) increased by 9.5% from the previous year (8651) and by 10.3% from 5 years ago (n = 8589), although trans-catheter aortic valve replacement (TAVR or TAVI) was introduced in 2013 and is rapidly spreading.

The hospital mortality of single valve placement was 3.1% and 6.3% for the aortic and mitral positions, while that for mitral valve repair was only 1.5%. The hospital mortality for redo valve surgery was 7.1% in the aortic and 8.2% in the mitral positions, respectively. Finally, overall hospital mortality did not show a dramatic improvement over the last 10 years (4.0% in 2006 [2], 3.4% in 2011 [3], and 3.5% in 2016), which might be partially due to the recent increasing age of the patients. Repair of the valve became a common procedure (367 cases of aortic, 6711 cases of mitral, and 5400 cases tricuspid), and mitral valve repair constituted 29.2% of all valvular operations and 64.4% of all mitral valve procedures, which are similar to those of the last 5 years. Aortic and mitral valve replacements with bioprostheses were performed in 9693 cases and 2499 cases, respectively. The ratio of bioprostheses was 81.9% in the aortic and 65.2% in the mitral positions. This ratio of using bioprostheses increased dramatically from 30 to 40% in the early 2000s [4, 5]. CABG was performed as a concomitant procedure in 18.5% of all valvular operations (15.1% in 2006 [2] and 17.5% in 2011 [3]).

Isolated CABG was performed in 13,654 cases, only 76.1% of that 10 years ago (n = 17,941) [2]. Among these, off-pump CABG was intended in 8554 cases (62.6%), with a success rate of 97.3%, so that the final success rate of off-pump CABG was 60.9%. The percentage of intended off-pump CABG reached 60.3% in 2004 [4], and it was then kept at over 60% until now. In 13,654 isolated CABG patients, 13,029 patients (95.4%) received at least one arterial graft, while all-arterial-graft CABG was performed in only 3103 patients or 22.7% of them. The operative and hospital mortality rates associated with primary elective CABG procedures in 11,154 cases were 0.9% and 1.6%, respectively. A similar data analysis of CABG including primary/redo and elective/emergency data was begun in 2003 [5], and the operative and hospital mortality rates associated with primary elective CABG procedures in 2003 were 1.0% and 1.5%, respectively, so that the operative results of primary CABG have been stable. Hospital mortality of primary emergency CABG in 2318 cases was still high, at 6.9%. The conversion from off-pump CABG rate was 2.7%, with hospital mortality of 9.9%. A total of 1220 patients underwent surgery for complications of myocardial infarction, including 675 operations for left ventricular aneurysm, ventricular septal perforation, or cardiac rupture and 395 operations for ischemic mitral regurgitation. In this report, the number of concomitant coronary artery bypass grafting (CABG) procedures with other major procedures is not included in the category of ischemic heart disease but in other categories such as valvular heart disease and thoracic aneurysm; then, the overall number of CABG procedure including concomitant CABG with other major procedures still remained at over 20,000 cases per year (20,589 cases) in 2016.

Operations for arrhythmia were performed mainly as a concomitant procedure in 7168 cases, with a 24.3% increase compared with that of 2015. Implantations of pacemakers and ICDs are not included in this category. The hospital mortality of arrhythmia surgery including 3974 MAZE procedures was 3.4%. The MAZE procedure has become a quite common procedure (2944 cases in 2006 [2], and 3771 cases in 2011 [3]).

In 2016, 19,078 operations were performed for diseases of the thoracic and thoracoabdominal aortae: 9441 for aortic dissection and 9637 for non-dissection. The number of operations for aortic dissection increased by 10.5% this year compared with the previous year (n = 8547). The hospital mortality of operations for 5461 Stanford type A acute aortic dissections remained as high as 11.3%. The number of operations for non-dissected aneurysm increased by 8.3%, with overall hospital mortality of 5.7% (4.3% and 21.2% for unruptured and ruptured aneurysms, respectively).

The number of stent graft procedures has recently increased remarkably. Most importantly, the number of open stent grafts with total arch replacement strikingly increased 5 times (228–1155) and 3.4 times (308–1048) in dissecting and non-dissecting aortic aneurysms, respectively. This must be associated with the commercial availability of special designed device for open stent grafting since 2014.

A total of 3287 patients with aortic dissection underwent stent graft placement: 2052 thoracic endovascular aortic repair (TEVAR) and 1235 open stent grafting. The number of TEVAR procedures for type B chronic aortic dissections increased by 41.4% from 1065 cases in 2015 to 1506 cases in 2016. The hospital mortality rates associated with TEVAR for type B aortic dissection were 9.6% and 2.1% in acute and chronic cases, respectively.

A total of 4257 patients with non-dissected aortic aneurysms underwent stent graft placement, consisting of 3063 TEVAR [5.2% increase compared with 2015 (n = 2912)] and 1194 open stent grafts [27.4% increase compared with 2015 (n = 937)]. The hospital mortality rates for TEVAR and open stenting were as follows: TEVAR, 3.7% for unruptured and 21.4% for ruptured aneurysms; open stent grafting, 6.1% for unruptured and 17.9% for ruptured aneurysms.

(B) General thoracic surgery

The 2016 survey of general thoracic surgery comprised 693 surgical units, and most data were submitted through the web-based collection system of the national clinical database (NCD) [6]. In total, 82,193 operations were reported by general thoracic surgery departments in 2016, 1.9 times the number of operations in 2001 and 2418 more operations than in 2015, while the number of surgical units submitting reports to this survey decreased by 43 due to conversion of the data collection system since 2014 (Fig. 2).
Fig. 2

General thoracic surgery

In 2016, 42,107 operations for primary lung cancer were performed (Table 9), and the number has increased every year. The 2016 value is 2.2 times that of 2001. Operations for lung cancer accounted for 51.2% of all procedures in general thoracic surgery.
Table 9

Total cases of general thoracic surgery during 2016

 

Cases

%

Benign pulmonary tumor

2124

2.6

Primary lung cancer

42,107

51.2

Other primary malignant pulmonary tumor

375

0.5

Metastatic pulmonary tumor

8497

10.3

Tracheal tumor

122

0.1

Mesothelioma

634

0.8

Chest wall tumor

664

0.8

Mediastinal tumor

5026

6.1

Thymectomy for MG without thymoma

145

0.2

Inflammatory pulmonary disease

2142

2.6

Empyema

2833

3.4

Bullous disease excluding pneumothorax

436

0.5

Pneumothorax

14,867

18.1

Chest wall deformity

189

0.2

Diaphragmatic hernia including traumatic

37

0.0

Chest trauma excluding diaphragmatic hernia

426

0.5

Lung transplantation

75

0.1

Others

1494

1.8

Total

82,193

100.0

The number of video-assisted thoracic surgery (VATS) operations, defined as a surgical procedure using a skin incision longer than 8 cm and/or a minithoracotomy (hybrid) approach, has been described since the Annual Report 2015. The number of VATS operations for benign pulmonary tumor, primary lung cancer, and the total number of VATS operations in 2016 are shown in Tables 10, 11, 13, 16, 17, 18, 19, 20, 21, 22, 23, 25, 26, 27, and 29, respectively.
Table 10

Benign pulmonary tumor

 

Cases

30-Day mortality

Hospital mortality

by VATS

Hospital

after discharge

Benign pulmonary tumor

Hamartoma

442

0

0

1 (0.2)

423

Sclerosing hemangioma

96

0

0

0

94

Papilloma

17

0

0

0

16

Mucous gland adenoma bronchial

6

0

0

0

5

Fibroma

118

0

1 (0.8)

0

110

Lipoma

10

0

0

0

7

Neurogenic tumor

15

0

0

0

13

Clear cell tumor

5

0

0

0

5

Leiomyoma

15

0

0

0

14

Chondroma

7

0

0

0

6

Inflammatory myofibroblastic tumor

2

0

0

0

2

Pseudolymphoma

39

0

0

0

37

Histiocytosis

9

0

0

0

8

Teratoma

6

0

0

0

5

Others

1337

0

0

1 (0.1)

1270

Total

2124

0

1 (0.05)

2 (0.1)

2015

(), Mortality %

Table 11

Primary malignant pulmonary tumor

 

Cases

30-Day mortality

Hospital mortality

VATS

Hospital

After discharge

Primary malignant pulmonary tumor

42,482

118 (0.3)

52 (0.1)

242 (0.6)

28,568

 Lung cancer

42,107

115 (0.3)

52 (0.1)

237 (0.6)

28,568

  Adenocarcinoma

29,607

53 (0.2)

24 (0.1)

96 (0.3)

 

  Squamous cell carcinoma

7877

40 (0.5)

17 (0.2)

102 (1.3)

 

  Large cell carcinoma

791

1 (0.1)

4 (0.5)

5 (0.6)

 

 (LCNEC)

480

0

2 (0.4)

2 (0.4)

 

  Small cell carcinoma

755

6 (0.8)

2 (0.3)

10 (1.3)

 

  Adenosquamous carcinoma

574

6 (1.0)

1 (0.2)

8 (1.4)

 

  Carcinoma with pleomorphic, sarcomatoid or sarcomatous elements

468

4 (0.9)

1 (0.2)

7 (1.5)

 

  Carcinoid

251

0

1 (0.4)

0

 

  Carcinomas of salivary-gland type

33

0

0

0

 

  Unclassified

59

0

0

0

 

  Multiple lung cancer

1327

3 (0.2)

1 (0.1)

7 (0.5)

 

  Others

365

2 (0.5)

1 (0.3)

2 (0.5)

 

  Wedge resection

6275

8 (0.1)

9 (0.1)

19 (0.3)

5395

  Segmental excision

4391

8 (0.18)

1 (0.0)

13 (0.3)

3265

   (Sleeve segmental excision)

16

0

0

0

5

  Lobectomy

30,597

86 (0.3)

37 (0.1)

176 (0.6)

19,697

   (Sleeve lobectomy)

481

3 (0.6)

1 (0.2)

7 (1.5)

92

  Pneumonectomy

477

8 (1.7)

3 (0.6)

22 (4.6)

39

   (Sleeve pneumonectomy)

15

1 (6.7)

0

5 (33.3)

2

  Other bronchoplasty

48

1 (2.1)

0

1 (2.1)

0

  Pleuropneumonectomy

3

1 (33.3)

0

1 (33.3)

0

  Others

316

3 (0.9)

2 (0.6)

5 (1.6)

172

  Unknown

0

0

0

0

 

 Sarcoma

49

1 (2.0)

0

2 (4.1)

 

 AAH

131

0

0

0

 

 Others

195

2 (1.0)

0

3 (1.5)

 

(), Mortality %

There were 2124 operations for benign pulmonary tumors in 2016, similar to the number in 2015 (Table 10). Hamartoma was the most frequent diagnosis in operations for benign pulmonary tumors. VATS was performed in 2015 patients (94.7%).

Additional information on primary malignant pulmonary tumors is shown in Tables 11 and 12. With regard to lung cancer subtype, adenocarcinoma was by far the most frequent diagnosis (70.3% of all lung cancer operations), followed by squamous cell carcinoma (18.7%). Sublobar resection was performed in 10,666 lung cancer cases (25.1% of all cases), and lobectomy was performed in 30,597 cases (72.0% of all cases). Sleeve lobectomy was performed in 481 cases, and pneumonectomy was required in 477 cases (1.1% of all cases). VATS lobectomy for lung cancer was performed in 19,697 cases (64.3% of all lobectomy cases). The number of VATS procedures for primary lung cancer was slightly higher than in 2015. The number of patients aged 80 years or older who underwent lung cancer surgery was 5279 (12.5%). In total, 115 patients died before hospital discharge within 30 days after surgery, and 52 patients died after discharge within 30 days after surgery. Therefore, 167 patients died within 30 days after surgery (30-day mortality rate, 0.4%). In total, 237 patients died before discharge (hospital mortality rate, 0.6%), and the 30-day mortality rate, by procedure, was 0.3% for segmentectomy, 0.6% for lobectomy, and 4.6% for pneumonectomy. Interstitial pneumonia was the leading cause of death after lung cancer surgery, followed by pneumonia, cardiovascular events, and respiratory failure. The risk calculators for mortality and morbidity, such as broncho-pleural fistula and respiratory failure, after lung cancer surgery based on the NCD are now available [7, 8].
Table 12

Details of lung cancer operations

TNM

c-Stage

Cases

Ia

25,963

Ib

7947

IIa

3149

IIb

1796

IIIa

2459

IIIb

175

IV

441

NA

177

Total

42,107

Sex

Cases

Male

25,716

Female

16,391

NA

0

Total

42,107

Cause of death

Cases

Cardiovascular

32

Pneumonia

42

Pyothorax

3

Bronchopleural fistula

18

Respiratory failure

29

Pulmonary embolism

2

Interstitial pneumonia

84

Brain infarction or bleeding

6

Others

62

Unknown

11

Total

289

p-Stage

Cases

0 (pCR)

634

Ia

22,249

Ib

8334

IIa

3354

IIb

2131

IIIa

4029

IIIb

180

IV

1013

NA

183

Total

42,107

Age (years)

Cases

< 20

32

20–29

45

30–39

233

40–49

1154

50–59

3710

60–69

14,181

70–79

17,491

80–89

5187

≥ 90

74

NA

0

Total

42,107

Operations for metastatic pulmonary tumors are shown in Table 13; 8497 operations were performed in 2016. Colorectal cancer was the most frequent diagnosis (47.7% of all cases).
Table 13

Metastatic pulmonary tumor

 

Cases

30-Day mortality

Hospital mortality

VATS

Hospital

After discharge

Metastatic pulmonary tumor

8497

11 (0.1)

9 (0.1)

20 (0.2)

7909

 Colorectal

4052

4 (0.1)

3 (0.1)

8 (0.2)

3766

 Hepatobiliary/pancreatic

400

1 (0.3)

0

1 (0.3)

381

 Uterine

431

1 (0.2)

0

1 (0.2)

410

 Mammary

472

0

1 (0.2)

0

444

 Ovarian

69

0

0

0

64

 Testicular

61

0

0

0

57

 Renal

724

0

0

1 (0.1)

688

 Skeletal

140

0

0

0

130

 Soft tissue

213

0

0

0

192

 Otorhinolaryngological

459

2 (0.4)

1 (0.2)

2 (0.4)

430

 Pulmonary

549

1 (0.2)

2 (0.4)

3 (0.5)

471

 Others

927

2 (0.2)

2 (0.2)

4 (0.4)

876

(), Mortality %

There were 122 operations for malignant tracheal tumor in 2016, but only 29 patients were treated with curative intent (Table 14).
Table 14

Tracheal tumor

 

Cases

30-Day mortality

 

Hospital

After discharge

Hospital mortality

Tracheal tumor

122

4 (3.3)

0

5 (4.1)

A. Primary malignant tumor

    

Histological classification

 Squamous cell carcinoma

15

0

0

1 (6.7)

 Adenoid cystic carcinoma

20

1 (5.0)

0

1 (5.0)

 Mucoepidermoid carcinoma

0

0

0

0

 Others

11

0

0

0

 Total

46

1 (2.2)

0

2 (4.3)

B. Metastatic/invasive malignant tumor

 e.g. invasion of thyroid cancer

36

3 (8.3)

0

3 (8.3)

C. Benign tracheal tumor

Histological classification

 Papilloma

6

0

0

0

 Adenoma

2

0

0

0

 Neurofibroma

0

0

0

0

 Chondroma

0

0

0

0

 Leiomyoma

4

0

0

0

 Others

28

0

0

0

 Histology unknown

0

0

0

0

 Total

40

0

0

0

Operation

 Sleeve resection with reconstruction

27

0

0

0

 Wedge with simple closure

0

0

0

0

 Wedge with patch closure

1

0

0

0

 Total laryngectomy with tracheostomy

1

0

0

0

 Others

4

1 (25.0)

0

1 (25.0)

 Unknown

0

0

0

0

 Total

33

1 (3.0)

0

1 (3.0)

(), Mortality %

There were 634 pleural tumors in 2016 (Table 15). Diffuse malignant pleural mesothelioma was the most frequent histologic diagnosis. Total pleurectomy was performed in 73 cases, and extrapleural pneumonectomy was performed in 64 cases. The hospital mortality rate was 0% after total pleurectomy and 1.6% after extrapleural pneumonectomy, which were better than the previous outcomes.
Table 15

Tumor of pleural origin

Histological classification

Cases

30-Day mortality

Hospital mortality

Hospital

After discharge

Tumor of pleural origin

Solitary fibrous tumor

122

0

0

0

Diffuse malignant pleural mesothelioma

247

1 (0.4)

0

2 (0.8)

Localized malignant pleural mesothelioma

42

0

0

0

Others

223

4 (1.8)

1 (0.4)

8 (3.6)

Total

634

5 (0.8)

1 (0.2)

10 (1.6)

Operative procedure

Cases

30-Day mortality

Hospital mortality

Hospital

After discharge

Extrapleural pneumonectomy

64

0

0

1 (1.6)

Total pleurectomy

73

0

0

0

Others

110

1 (0.9)

0

1 (0.9)

Total

247

1 (0.4)

0

2 (0.8)

(), Mortality %

In total, 664 chest wall tumors were resected in 2016 (Table 16), of which 346 (52.1%) were benign. Among the 318 malignant chest wall tumors, 207 (65.1%) were metastatic tumors.
Table 16

Chest wall tumor

 

Cases

30-Day mortality

Hospital mortality

VATS

Hospital

After discharge

Chest wall tumor

Primary malignant tumor

111

0

0

0

54

Metastatic malignant tumor

207

1 (0.5)

0

2 (1.0)

93

Benign tumor

346

0

0

0

267

Total

664

1 (0.2)

0

2 (0.3)

414

(), Mortality %

Mediastinal tumors were resected in 5026 patients, a slight increase from the previous year (Table 17). Thymic epithelial tumor, including 1986 thymomas, 314 thymic carcinomas, and 40 thymic carcinoids, was the most frequent mediastinal tumor type in 2016.
Table 17

Mediastinal tumor

 

Cases

30-Day mortality

Hospital mortality

By VATS

Hospital

After discharge

Mediastinal tumor

5026

6 (0.1)

3 (0.06)

9 (0.2)

3636

 Thymoma

1986

2 (0.1)

2 (0.1)

2 (0.1)

1218

 Thymic cancer

314

2 (0.6)

1 (0.3)

2 (0.6)

164

 Thymus carcinoid

40

0

0

0

20

 Germ cell tumor

84

0

0

0

47

  Benign

56

0

0

0

34

  Malignant

28

0

0

0

13

 Neurogenic tumor

447

0

0

0

419

 Congenital cyst

1111

0

0

0

993

 Goiter

81

0

0

1 (1.2)

31

 Lymphatic tumor

182

2 (1.1)

0

2 (1.1)

136

 Excision of pleural recurrence of thymoma

31

0

0

0

27

 Thymolipoma

22

0

0

0

17

 Others

728

0

0

2 (0.3)

564

(), Mortality %

Thymectomy for myasthenia gravis was performed in 478 patients (Table 18); 333 operations were associated with thymoma, and the remaining were not associated with thymoma.
Table 18

Thymectomy for myasthenia gravis

 

Cases

30-Day mortality

Hospital mortality

by VATS

Hospital

After discharge

Thymectomy for myasthenia gravis

478

2 (0.4)

1 (0.2)

2 (0.4)

276

 With thymoma

333

2 (0.6)

1 (0.3)

2 (0.6)

189

(), Mortality %

Operations for non-neoplastic disease were performed in 22,424 patients. There were 2142 cases of lung resection for inflammatory lung diseases (Table 19); 21.7% of the cases were associated with atypical mycobacterium infections, and 15.2% were fungal infections. An operation for inflammatory nodules was performed because lung cancer was suspected before surgery in 913 cases (42.6%)
Table 19

Operations for non-neoplastic diseases

 

Cases

30-Day mortality

Hospital mortality

Hospital

After discharge

Operations for non-neoplastic diseases

22,424

195 (0.9)

20 (0.1)

466 (2.1)

 

Cases

30-Day mortality

Hospital mortality

VATS

Hospital

After discharge

A. Inflammatory pulmonary disease

2142

6 (0.3)

1 (0.0)

16 (0.7)

1948

 Tuberculous infection

41

0

0

0

38

 Mycobacterial infection

464

0

0

3 (0.6)

423

 Fungal infection

326

1 (0.3)

1 (0.3)

4 (1.2)

255

 Bronchiectasis

58

0

0

0

47

 Tuberculous nodule

88

0

0

0

83

 Inflammatory pseudotumor

774

3 (0.4)

0

4 (0.5)

751

 Interpulmonary lymph node

51

0

0

0

50

 Others

340

2 (0.6)

0

5 (1.5)

301

(), Mortality %

The 2833 operations for empyema (Table 20) included 2085 cases (73.6%) of acute empyema and 748 cases of chronic empyema. A bronchopleural fistula was reported in 470 patients with acute empyema and 359 patients with chronic empyema. The hospital mortality rate was 18.3% in patients with acute empyema with fistula.
Table 20

B. Empyema

 

Cases

30-Day mortality

Hospital mortality

by VATS

Hospital

After discharge

Acute empyema

2085

50 (2.4)

5 (0.2)

150 (7.2)

1758

 With fistula

470

24 (5.1)

1 (0.2)

86 (18.3)

272

 Without fistula

1596

26 (1.6)

4 (0.3)

63 (3.9)

1469

 Unknown

19

0

0

1 (5.3)

17

Chronic empyema

748

19 (2.5)

2 (0.3)

45 (6.0)

442

 With fistula

359

15 (4.2)

2 (0.6)

26 (7.2)

160

 Without fistula

355

4 (1.1)

0

16 (4.5)

257

 Unknown

34

0

0

3 (8.8)

25

Total

2833

69 (2.4)

7 (0.2)

195 (6.9)

2200

(), Mortality %

There were 100 operations for descending necrotizing mediastinitis (Table 21). The hospital mortality rate was 14.0%.
Table 21

C. Descending necrotizing mediastinitis

 

Cases

30-Day mortality

Hospital mortality

VATS

Hospital

After discharge

C. Descending necrotizing mediastinitis

100

7 (7.0)

0

14 (14.0)

71

(), Mortality %

There were 436 operations for bullous diseases (Table 22). Lung volume reduction surgery was performed in only 18 patients.
Table 22

D. Bullous diseases

 

Cases

30-Day mortality

Hospital mortality

VATS

Hospital

After discharge

D. Bullous diseases

436

2 (0.5)

0

3 (0.7)

405

Emphysematous bulla

354

0

0

1 (0.3)

331

Bronchogenic cyst

15

0

0

0

14

Emphysema with LVRS

18

0

0

0

17

Others

49

2 (4.1)

0

2 (4.1)

43

(), Mortality %

LVRS lung volume reduction surgery

A total of 14,867 operations were performed for spontaneous pneumothorax (Table 23). The 11,835 operations for primary pneumothorax included 3028 patients (25.6%) who underwent bullectomy only and 7966 patients (67.3%) who underwent an additional procedure. There were 3032 operations for secondary pneumothorax. COPD was by far the most prevalent associated disease (70.7%). The hospital mortality rate for secondary pneumothorax associated with COPD was 2.8%.
Table 23

E. Pneumothorax

Cases

30-Day mortality

Hospital mortality

Hospital

After discharge

14,867

57 (0.4)

11 (0.1)

129 (0.9)

Spontaneous pneumothorax

Operative procedure

Cases

30-Day mortality

Hospital mortality

VATS

Hospital

After discharge

Bullectomy

3028

2 (0.1)

1 (0.0)

8 (0.3)

2986

Bullectomy with additional procedure

7966

9 (0.11)

0

12 (0.2)

7860

 Coverage with artificial material

7564

7 (0.09)

0

9 (0.1)

7461

 Parietal pleurectomy

53

1 (1.9)

0

1 (1.9)

52

 Coverage and parietal pleurectomy

73

1 (1.4)

0

1 (1.4)

73

 Others

276

0

0

1 (0.4)

274

Others

836

6 (0.7)

1 (0.1)

11 (1.3)

771

Unknown

5

0

0

0

5

Total

11,835

17 (0.1)

2 (0.02)

31 (0.3)

11,622

Secondary pneumothorax

Associated disease

Cases

30-Day mortality

Hospital mortality

VATS

Hospital

After discharge

COPD

2145

20 (0.9)

5 (0.2)

59 (2.8)

2068

Tumorous disease

124

8 (6.5)

2 (1.6)

15 (12.1)

114

Catamenial

166

0

0

0

166

LAM

38

0

0

0

38

Others (excluding pneumothorax by trauma)

559

12 (2.1)

2 (0.4)

24 (4.3)

520

Unknown

0

0

0

0

0

Operative procedure

Cases

30 Day mortality

Hospital mortality

VATS

Hospital

After discharge

Bullectomy

433

4 (0.9)

1 (0.2)

8 (1.8)

417

Bullectomy with additional procedure

1828

17 (0.9)

4 (0.2)

42 (2.3)

1779

 Coverage with artificial material

1736

16 (0.9)

4 (0.2)

38 (2.2)

1689

 Parietal pleurectomy

6

0

0

0

5

 Coverage and parietal pleurectomy

23

0

0

2 (8.7)

23

 Others

63

1 (1.6)

0

2 (3.2)

62

Others

768

19 (2.5)

4 (0.5)

48 (6.3)

707

Unknown

3

0

0

0

3

Total

3032

40 (1.3)

9 (0.3)

98 (3.2)

2906

(), Mortality %

The 2016 survey reported 181 operations for chest wall deformity (Table 24). However, this might be an underestimate, because the Nuss procedure for pectus excavatum was more likely to have been performed in pediatric surgery centers not associated with JATS.
Table 24

F. Chest wall deformity

 

Cases

30-Day mortality

Hospital mortality

Hospital

After discharge

F. Chest wall deformity

181

0

0

0

 Funnel chest

8

0

0

0

 Others

7

0

0

0

(), Mortality %

Diaphragmatic hernia was treated surgically in 37 patients (Table 25). This figure might be an underestimate, since some procedures might have been classified as gastrointestinal surgery.
Table 25

G. Diaphragmatic hernia

 

Cases

30-Day mortality

Hospital mortality

VATS

Hospital

After discharge

G. Diaphragmatic hernia

37

0

0

0

19

 Congenital

9

0

0

0

8

 Traumatic

13

0

0

0

6

 Others

15

0

0

0

5

(), Mortality %

The survey reported 426 procedures for chest trauma excluding iatrogenic injuries (Table 26). The hospital mortality rate was 7.3%.
Table 26

H. Chest trauma

 

Cases

30-Day mortality

Hospital mortality

VATS

Hospital

After discharge

H. Chest trauma

426

26 (6.1)

0

31 (7.3)

277

(), Mortality %

Table 27 shows operations for other diseases, including 81 cases of arteriovenous malformation and 113 cases of pulmonary sequestration.
Table 27

I. Other respiratory surgery

 

Cases

30-Day mortality

Hospital mortality

VATS

Hospital

After discharge

I. Other respiratory surgery

1394

28 (2.0)

1 (0.1)

78 (5.6)

1008

 Arteriovenous malformation

81

0

0

1 (1.2)

78

 Pulmonary sequestration

113

0

0

0

95

 Postoperative bleeding · air leakage

428

15 (3.5)

1 (0.2)

40 (9.3)

292

 Chylothorax

67

1 (1.5)

0

2 (3.0)

55

 Others

705

12 (1.7)

0

35 (5.0)

488

(), Mortality %

A total of 75 lung transplantations were performed in 2016 (Table 28): 58 patients received lung transplants from brain-dead donors and 17 received transplants from living-related donors. The number of lung transplantation procedures has increased slightly.
Table 28

Lung transplantation

 

Cases

30-Day mortality

Hospital mortality

Hospital

After discharge

Single lung transplantation from brain-dead donor

29

0

0

1 (3.4)

Bilateral lung transplantation from brain-dead donor

29

0

0

2 (6.9)

Lung transplantation from living donor

17

1 (5.9)

0

2 (11.8)

Total lung transplantation

75

1 (1.3)

0

5 (6.7)

Donor of living donor lung transplantation

33

0

0

0

(), Mortality %

The number of VATS procedures has increased annually, reaching 64,036 (77.9% of all general thoracic surgeries) in 2016 (Table 29).
Table 29

Video-assisted thoracic surgery

 

Cases

30-Day mortality

Hospital mortality

Hospital

After discharge

Video-assisted thoracic surgery

64,036

191 (0.3)

58 (0.09)

424 (0.7)

(), Mortality %

(including thoracic sympathectomy 160)

The details of tracheobronchoplasty, pediatric surgery, and combined resection of neighboring organs are shown in Tables 30, 31, and 32, 33.
Table 30

Tracheobronchoplasty

 

Cases

30-Day mortality

Hospital mortality

Hospital

After discharge

Tracheobronchoplasty

790

11 (1.4)

1 (0.1)

26 (3.3)

 Trachea

41

1 (2.4)

0

1 (2.4)

  Sleeve resection with reconstruction

32

0

0

0

  Wedge with simple closure

2

0

0

0

  Wedge with patch closure

1

0

0

0

  Total laryngectomy with tracheostomy

1

0

0

0

  Others

5

1 (20.0)

0

1 (20.0)

Carinal reconstruction

22

1 (4.5)

0

1 (4.5)

Sleeve pneumonectomy

17

1 (5.9)

0

5 (29.4)

Sleeve lobectomy

483

2 (0.4)

1 (0.2)

7 (1.4)

Sleeve segmental excision

17

0

0

0

Bronchoplasty without lung resection

26

1 (3.8)

0

3 (11.5)

Others

184

5 (2.7)

0

9 (4.9)

(), Mortality %

Table 31

Pediatric surgery

 

Cases

30-Day mortality

Hospital mortality

Hospital

After discharge

Pediatric surgery

353

2 (0.6)

0

3 (0.8)

(), Mortality %

Table 32

Combined resection of neighboring organ(s)

 

Cases

30-Day mortality

Hospital mortality

Hospital

After discharge

Combined resection of neighboring organ(s)

1396

5 (0.4)

6 (0.4)

20 (1.4)

Organ resected

Cases

30-Day mortality

Hospital mortality

Hospital

After discharge

A. Primary lung cancer

 Aorta

12

0

0

0

 Superior vena cava

29

1 (3.4)

0

2 (6.9)

 Brachiocephalic vein

7

0

0

0

 Pericardium

102

2 (2.0)

1 (1.0)

3 (2.9)

 Pulmonary artery

103

0

0

3 (2.9)

 Left atrium

17

0

0

2 (11.8)

 Diaphragm

62

1 (1.6)

1 (1.6)

4 (6.5)

 Chest wall (including ribs)

347

1 (0.3)

2 (0.6)

4 (1.2)

 Vertebra

16

0

0

1 (6.3)

 Esophagus

4

0

0

0

 Total

699

5 (0.7)

4 (0.6)

19 (2.7)

B. Mediastinal tumor

Aorta

6

0

0

0

Superior vena cava

68

0

0

0

Brachiocephalic vein

122

1 (0.8)

1 (0.8)

1 (0.8)

Pericardium

358

1 (0.3)

1 (0.3)

2 (0.6)

Pulmonary artery

5

0

0

0

Left atrium

0

0

0

0

Diaphragm

47

0

1 (2.1)

0

Chest wall (including ribs)

8

0

0

0

Vertebra

4

0

0

0

Esophagus

8

0

0

0

Lung

524

1 (0.2)

2 (0.4)

2 (0.4)

Total

1150

3 (0.3)

5 (0.4)

5 (0.4)

(), Mortality %

Table 33

Operation of lung cancer invading the chest wall of the apex

 

Cases

30-Day mortality

Hospital mortality

Hospital

After discharge

Operation of lung cancer invading the chest wall of the apex

754

3 (0.4)

2 (0.3)

7 (0.9)

(), 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 2016 alone, a total of 12,753 patients with esophageal diseases were registered from 543 institutions (response rate: 93.0%) 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 2016 were 133 institutions (24.5%), which shows no definite shift of esophageal operations to high-volume institutions when compared to the data of 2015 (23.8%) (Table 34). Of 2418 patients with a benign esophageal disease, 1525 (63.1%) patients underwent surgery, and 73 (3.0%) patients underwent endoscopic resection, while 820 (33.9%) patients did not undergo any surgical treatment (Table 35). Of 10,830 patients with a malignant esophageal tumor, 8296 (76.6%) patients underwent resection, with esophagectomy for 6158 (56.9%) and endoscopic mucosal resection (EMR) or endoscopic submucosal dissection (ESD) for 2138 (19.7%), while 2534 (23.4%) patients did not undergo any resection (Tables 36, 37). The annual trend of registered in-patients with esophageal diseases has not changed in the last decades (Fig. 3).
Table 34

Distribution of number of esophageal operations in 2016 in each institution

Esophageal surgery

Number of operations in 2016

Benign esophageal diseases

Malignant esophageal disease

Benign + malignant

0

241

107

70

1-4

244

138

138

5–9

42

98

107

10–19

9

85

95

20–29

2

34

41

30–39

3

28

26

40–49

1

16

22

≥ 50

1

37

44

Total

543

543

543

Table 35

Benign esophageal diseases

 

Operation(+)

Endoscopic resection

Operation (–)

Total

Number of patients

Hospital mortality

T/L*3

Total

Total

Open

T/L*3

Open surgery

≤ 30 days

31–90 days

Total (including after 91 days mortality)

≤ 30 days

31–90 days

Total (including after 91 days mortality)

1. Achalasia

211

119

92

0

0

0

0

0

0

0

 

36

247

2. Benign tumor

133

80

53

0

0

0

0

0

0

0

51

60

244

 (1) Leiomyoma

77

47

30

0

0

0

0

0

0

0

25

12

114

 (2) Cyst

18

9

9

0

0

0

0

0

0

0

0

0

18

 (3) Others

38

24

14

0

0

0

0

0

0

0

26

48

112

 (4) Not specified

0

0

0

0

0

0

0

0

0

0

0

0

0

3. Diverticulum

34

24

10

0

0

0

0

0

0

0

 

6

40

4. Hiatal hernia

680

395

285

2 (0.5)

1 (0.3)

4 (1.0)

0

1 (0.4)

2 (0.7)

6 (0.9)

 

136

816

5. Spontaneous rupture of the esophagus

104

92

12

1 (1.1)

4 (4.3)

6 (6.5)

0

0

0

6 (5.8)

 

8

112

6. Esophago-tracheal fistula

25

22

3

1 (4.5)

1 (4.5)

2 (9.1)

0

0

0

2 (8.0)

 

11

36

7. Congenital esophageal atresia

52

46

6

0

0

0

0

0

0

0

 

4

56

8. Congenital esophageal stenosis

7

6

1

0

0

0

0

0

0

0

 

5

12

9. Corrosive stricture of the esophagus

12

7

5

0

1 (14.3)

1 (14.3)

0

0

0

1 (8.3)

 

2

14

10. Esophagitis, Esophageal ulcer

57

44

13

0

0

0

0

0

0

0

  

57

11. Esophageal varices

123

121

2

1 (0.8)

0

1 (0.8)

0

0

0

1 (0.8)

 

531

654

 (1) Laparotomy

28

26

2

0

0

0

0

0

0

0

  

28

 (2) Sclerotherapy

           

168

168

 (3) EVL

           

303

303

12. Others

87

74

13

1 (1.4)

3 (4.1)

6 (8.1)

0

0

0

6 (6.9)

22

21

130

Total

1525

1030

495

6 (0.6)

10 (1.0)

20 (1.9)

0

1 (0.2)

2 (0.4)

22 (1.4)

73

820

2418

(), Mortality %

T/L thoracoscopic and/or laparoscopic

Table 36

Malignant esophageal diseases (histologic classification)

 

Resection (+)

Resection (−)

Total

Carcinomas

8240

2534

10,774

 1

Squamous cell carcinoma

7273

2381

9654

 2

Basaloid(-squamous)carcinoma

65

8

73

 3

Carcinosarcoma

35

2

37

 4

Adenocarcinoma in the Barrett’s esophagus

414

36

450

 5

Other adenocarcinoma

343

51

394

 6

Adenosquamous carcinoma

26

5

31

 7

Mucoepidermoid carcinoma

4

1

5

 8

Adenoid cystic carcinoma

0

0

0

 9.

Endocrine cell carcinoma

53

25

78

 10

Undifferentiated carcinoma

8

6

14

 11

Others

19

19

38

Other malignancies

43

6

49

 1

Malignant non-epithelial tumors

16

0

16

 2

Malignant melanoma

23

6

29

 3

Other malignant tumors

4

0

4

Not specified

56

0

56

Total

8339

2540

10,879

Resection: including endoscopic resection

Table 37

Malignant esophageal diseases (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

6158

40 (0.6)

41 (0.7)

101 (1.6)

2138

2534

10,830

Location

 (1) Cervical esophagus

251

1 (0.4)

5 (2.0)

9 (3.6)

100

214

565

 (2) Thoracic esophagus

4958

31 (0.6)

33 (0.7)

81 (1.6)

1711

2067

8736

 (3) Abdominal esophagus

697

7 (1.0)

1 (0.1)

8 (1.1)

126

125

948

 (4) Multiple cancers

251

1 (0.4)

1 (0.4)

2 (0.8)

186

56

493

 (5) Others/not described

1

0

1 (100.0)

1

15

72

88

Tumor depth

 (A) Superficial cancer(T1)

1913

8 (0.4)

5 (0.3)

15 (0.8)

2124

268

4305

  Mucosal cancer (T1a)

361

0

0

0

1857

47

2265

 (B) Advanced cancer (T2–T4)

4240

32 (0.8)

36 (0.8)

86 (2.0)

11

2264

6515

 (C) Not specified

5

0

0

0

3

2

10

2. Multiple primary cancers

1076

5 (0.5)

11 (1.0)

23 (2.1)

556

436

2068

 1) Synchronous

589

1 (0.2)

7 (1.2)

14 (2.4)

210

209

1008

  (1) Head and neck

197

0

4 (2.0)

4 (2.0)

82

65

344

  (2) Stomach

199

1 (0.5)

1 (0.5)

3 (1.5)

62

57

318

  (3) Colorectum

64

0

1 (1.6)

4 (6.3)

20

22

106

  (4) Lung

47

0

0

1 (2.1)

13

13

73

  (5) Pancreas

4

0

0

0

0

2

6

  (6) Liver

5

0

0

1 (20.0)

3

8

16

  (7) Others

35

0

0

0

11

24

70

  (8) Triple cancers

38

0

1 (2.6)

1 (2.6)

18

18

74

  (9) Unknown

0

0

0

0

1

0

1

 2) Metachronous

487

4 (0.8)

4 (0.8)

9 (1.8)

346

227

1060

  (1) Head and neck

104

1 (1.0)

0

1 (1.0)

130

36

270

  (2) Stomach

104

2 (1.9)

3 (2.9)

5 (4.8)

83

53

240

  (3) Colorectum

71

1 (1.4)

0

1 (1.4)

24

26

121

  (4) Lung

32

0

0

0

13

23

68

  (5) Pancreas

0

0

0

0

0

3

3

  (6) Liver

3

0

0

0

3

7

13

  (7) Others

136

0

1 (0.7)

1 (0.7)

49

52

237

  (8) Triple cancers

37

0

0

1 (2.7)

41

27

105

  (9) Unknown

0

0

0

0

3

0

3

Unknown

0

0

0

0

0

0

0

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, achalasia, esophageal varices, and esophagitis (including reflux esophagitis) were the most common conditions in Japan. On the other hand, benign esophageal tumors, spontaneous rupture of the esophagus, and congenital esophageal atresia were common diseases that were surgically treated, as well as the above-mentioned diseases. Open surgery was performed in 1030 (67.5%) patients with a benign esophageal disease, with 30-day mortality in 6 (0.6%), while thoracoscopic and/or laparoscopic surgery was performed for 495 (32.5%) patients, with no 30-day mortality. The difference in these death rates between open and endoscopic 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 89.6%, while that of adenocarcinomas including Barrett’s cancer was 7.8%. The resection rate for patients with a squamous cell carcinoma was 75.3%, while that for patients with an adenocarcinoma was 89.7%.

According to location, cancer in the thoracic esophagus was the most common (Table 37). Of the 4305 patients (40.0% of all esophageal malignancies) having superficial esophageal cancers within mucosal and submucosal layers, 6158 (56.9%) patients underwent esophagectomy, while 2138 (19.7%) patients underwent EMR or ESD. The 30-day mortality rate and hospital mortality rate after esophagectomy for patients with a superficial cancer were 0.4% and 0.8%, respectively.

Multiple primary cancers were observed in 2068 (19.1%) of the 10,830 patients with esophageal cancer. Synchronous cancer was found in 1008 (9.3%) patients, while metachronous cancer was observed in 1060 (9.8%) patients. The stomach, and head and neck region are the common sites for both synchronous and metachronous malignancies (Table 37).

Among esophagectomy procedures, transthoracic esophagectomy through right thoracotomy was the most commonly performed 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 performed in only 5.8% of patients having a superficial cancer and advanced cancer who underwent esophagectomy in Japan. Thoracoscopic and/or laparoscopic esophagectomy was performed for 1296 patients (67.7%) with a superficial cancer and for 2060 patients (48.6%) with an advanced cancer. The number of cases of thoracoscopic and/or laparoscopic surgery for superficial or advanced cancer has been increasing for several years (Fig. 4).
Table 38

Malignant Esophageal diseases (surgical procedures)

 

Operation (+)

Thoracoscopic and/or laparoscopic 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)

1913

8 (0.4)

5 (0.3)

15 (0.8)

1296

3 (0.2)

4 (0.3)

8 (0.6)

2124

 Mucosal cancer (T1a)

361

0

0

0

224

0

0

0

1857

Esophagectomy

1913

8 (0.4)

5 (0.3)

15 (0.8)

1296

3 (0.2)

4 (0.3)

8 (0.6)

2124

 (1) Transhiatal esophagectomy

110

3 (2.7)

0

3 (2.7)

14

0

0

0

 

 (2) Transthoracic (rt.) esophagectomy and reconstruction

1645

5 (0.3)

4 (0.2)

11 (0.7)

1229

3 (0.2)

4 (0.3)

8 (0.7)

 

 (3) Transthoracic (lt.) esophagectomy and reconstruction

24

0

1 (4.2)

1 (4.2)

0

0

0

0

 

 (4) Cervical esophageal resection and reconstruction

47

0

0

0

31

0

0

0

 

 (5) Others

15

0

0

0

5

0

0

0

 

 (6) Esophagectomy without reconstruction

59

0

0

0

17

0

0

0

 

 (7) not specified

13

0

0

0

0

0

0

0

 

Advanced cancer (T2–T4)

Esophagectomy

4240

32 (0.8)

36 (0.8)

86 (2.0)

2060

15 (0.7)

19 (0.9)

38 (1.8)

11

 (1) Transhiatal esophagectomy

244

3 (1.2)

2 (0.8)

5 (2.0)

33

1 (3.0)

0

1 (3.0)

 

 (2) Transthoracic (rt.) esophagectomy and reconstruction

3638

26 (0.7)

30 (0.8)

68 (1.9)

1986

13 (0.7)

18 (0.9)

35 (1.8)

 

 (3) Transthoracic (lt.) esophagectomy and reconstruction

110

1 (0.9)

0

1 (0.9)

3

0

0

0

 

 (4) Cervical esophageal resection and reconstruction

133

0

0

2 (1.5)

11

0

0

0

 

 (5) Others

38

1 (2.6)

1 (2.6)

3 (7.9)

7

0

0

0

 

 (6) Esophagectomy without reconstruction

77

1 (1.3)

2 (2.6)

6 (7.8)

20

1 (5.0)

1 (5.0)

2 (10.0)

 

 (7) not specified

0

0

1

1

0

0

0

0

 

(Depth not specified)

5

0

0

0

0

0

0

0

0

Combined resection of other organs

226

1 (0.4)

4 (1.8)

8 (3.5)

     

 (1) Aorta

3

0

0

0

     

 (2) Trachea, Bronchus

12

0

0

1 (8.3)

     

 (3) Lung

56

0

2 (3.6)

2 (3.6)

     

 (4) Others

155

1 (0.6)

2 (1.3)

5 (3.2)

     

Unknown

0

0

0

0

     

Salvage surgery

250

4 (1.6)

8 (3.2)

15 (6.0)

69

2 (2.9)

3 (4.3)

5 (7.2)

26

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 226 patients (Tables 38, 39). Resection of the aorta together with esophagectomy was performed in 3 cases. Tracheal and/or bronchial resection combined with esophagectomy was performed in 12 patients, with both 30-day mortality and hospital mortality of 0%. Lung resection combined with esophagectomy was performed in 56 patients, with 30-day mortality of 0% and hospital mortality of 3.6%.
Table 39

Mortality after combined resection of the neighbouring organs

Year

Esophagectomy

Combined resection

a

b

c (%)

Aorta

Tracheobronchus

Lung

Others

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

6244

47

0.75

2

0

0.00

24

0

0.00

77

3

3.90

227

3

1.32

2015

6151

39

0.63

3

0

0.00

15

0

0.00

67

3

4.48

266

4

1.50

2016

6158

40

0.65

3

0

0.00

12

0

0.00

56

0

0.00

155

1

0.65

Total

1,10,496

1463

1.32

44

4

9.09

486

20

4.12

1304

26

1.99

3084

48

1.56

aNumber of patients who underwent the operation

bNumber of patients who 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 250 patients, with 30-day mortality of 1.6% and hospital mortality of 6.0% (Table 38).

Lastly, we should continue our efforts for complete surveys through more active collaboration with the Japan Esophageal Society and other related societies.

Notes

Acknowledgements

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.

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© The Author(s) 2019

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
  • Hideyuki Shimizu
    • 2
    Email author
  • Shunsuke Endo
    • 3
  • Shoji Natsugoe
    • 4
  • Yuichiro Doki
    • 5
  • Yasutaka Hirata
    • 6
  • Junjiro Kobayashi
    • 7
  • Noboru Motomura
    • 8
  • Kiyoharu Nakano
    • 9
  • Hiroshi Nishida
    • 10
  • Morihito Okada
    • 11
  • Yoshikatsu Saiki
    • 12
  • Aya Saito
    • 8
  • Yukio Sato
    • 13
  • Kazuo Tanemoto
    • 14
  • Yasushi Toh
    • 15
  • Hiroyuki Tsukihara
    • 16
  • Shinji Wakui
    • 17
  • Hiroyasu Yokomise
    • 18
  • Munetaka Masuda
    • 19
  • Kohei Yokoi
    • 20
  • Yutaka Okita
    • 21
  1. 1.Committee for Scientific Affairs, The Japanese Association for Thoracic SurgeryTokyoJapan
  2. 2.Department of Cardiovascular SurgeryKeio UniversityTokyoJapan
  3. 3.Department of Thoracic SurgeryJichi Medical UniversityShimotsukeJapan
  4. 4.Department of Digestive Surgery and Breast and Thyroid SurgeryKagoshima UniversityKagoshimaJapan
  5. 5.Department of Gastroenterological SurgeryOsaka University Graduate School of MedicineSuitaJapan
  6. 6.Department of Cardiac SurgeryThe University of Tokyo HospitalTokyoJapan
  7. 7.Department of Cardiovascular SurgeryNational Cerebral and Cardiovascular CenterSuitaJapan
  8. 8.Department of Cardiovascular SurgeryToho University, Sakura Medical CenterSakuraJapan
  9. 9.Harajuku Rehabilitation HospitalTokyoJapan
  10. 10.RehabilitationTokyo Shinagawa HospitalTokyoJapan
  11. 11.Department of Surgical OncologyHiroshima UniversityHigashihiroshimaJapan
  12. 12.Division of Cardiovascular SurgeryTohoku University Graduate School of MedicineSendaiJapan
  13. 13.Department of Thoracic surgeryUniversity of TsukubaTsukubaJapan
  14. 14.Department of Cardiovascular SurgeryKawasaki Medical SchoolKurashikiJapan
  15. 15.Department of Gastroenterological SurgeryNational Kyushu Cancer CenterFukuokaJapan
  16. 16.Department of Cardiothoracic Surgery, Graduate School of MedicineThe University of TokyoTokyoJapan
  17. 17.Cardiovascular SurgeryNihon University HospitalTokyoJapan
  18. 18.Department of General Thoracic Surgery, Faculty of MedicineKagawa UniversityKagawaJapan
  19. 19.Department of SurgeryYokohama City UniversityYokohamaJapan
  20. 20.Department of Thoracic SurgeryNagoya University Graduate School of MedicineNagoyaJapan
  21. 21.Cardio-aortic CenterTakatsuki General HospitalTakatsukiJapan

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