The 43rd Annual Meeting of the Japanese Association for Chest Surgery

With ongoing demographic shifts, regional disparities in population distribution are widening, and both the elderly population and the number of lung cancer surgeries are projected to reach their peak within the next decade. Advances in perioperative treatment, along with the widespread adoption of robotic-assisted and limited resection, are rapidly reshaping surgical indications and approaches.
Meanwhile, broader societal changes—including workstyle reform, growing awareness of diversity, and a shortage of surgeons—are driving the need for more efficient and sustainable high-level surgical care systems.
In light of these multifaceted structural changes, it is time to fundamentally re-evaluate the role and future direction of thoracic surgery. To ensure the field remains both viable and appealing in the decade to come, we must actively discuss next-generation surgical systems, including the potential for regional centralization.

Every thoracic surgeon has an “unforgettable case” — an operation that remains vividly etched in memory.
Whether it was the experience of overcoming a challenging procedure, confronting an unexpected complication, or even devising a new surgical technique, such moments serve as turning points in a surgeon’s growth and offer rich lessons for others.
We invite surgeons to share their most memorable case in video format, regardless of surgical type — including extended resection, limited resection, reconstructive surgery, minimally invasive procedures, or lung transplantation. Presentations should be delivered from the perspective of the operating surgeon, highlighting both the experience and the key takeaways. Each institution may submit one case. Presenters must be the primary surgeon.

The significance of lymph node dissection in lung cancer surgery remains a subject of ongoing debate. While some studies have reported that lymph node dissection is associated with better prognosis, others have shown no clear survival benefit. As such, definitive scientific evidence remains insufficient, and current guidelines recommend lymph node dissection primarily for the purpose of accurate pathological staging. Nevertheless, the essential role of surgery in lung cancer lies in local control, and preventing recurrence within the surgical field—including the mediastinum—can be considered a fundamental responsibility of thoracic surgeons.
Lymph node dissection involves en bloc removal of hilar and mediastinal lymph nodes along with surrounding adipose tissue, following meticulous dissection and exposure of adjacent vascular and neural structures. However, both the extent and technical precision of dissection tend to vary between institutions, potentially influencing the outcomes of clinical trials.
In this session, we invite speakers to share their institutional efforts and current standards for improving the quality and consistency of lymph node dissection, with the aim of fostering deeper discussion on enhancing its precision in lung cancer surgery.

The field of thoracic surgery has achieved remarkable advancements with the introduction of robotic-assisted procedures and sophisticated imaging technologies. Nevertheless, many unresolved clinical needs still remain. At the same time, numerous promising technological “seeds” remain underutilized, as they are not yet effectively aligned with real-world clinical demands.
In this session, we will share cutting-edge initiatives that aim to address challenges in thoracic surgery through innovative technologies. We hope to foster in-depth discussions on the future direction and potential of surgical innovation, and to promote meaningful connections between unmet needs and technological solutions.

The National Clinical Database (NCD) was established as a surgical case registry to support the board certification system in Japan. It serves as a world-leading big data platform, covering over 95% of all surgical procedures performed in Japan, with unmatched completeness and accuracy. In the field of general thoracic surgery, data collection began in 2014. Since then, the NCD has been utilized for a wide range of clinical research, including the implementation of a risk calculator function, and has also been applied to lung cancer registration.
In this session, speakers will present analyses of surgical trends based on real-world data from the NCD, as well as insights into how this data is being fed back into clinical practice. The impact of societal factors—such COVID-19 pandemic—on surgical care will also be discussed. Furthermore, the session will explore future directions and potential developments in NCD-based research.

This session is a video contest designed to enhance surgical techniques in right upper lobectomy and mediastinal lymph node dissection, which are considered standard procedures in thoracic surgery. Although these techniques represent the fundamentals of lung cancer surgery, their safe, curative, and aesthetically refined execution requires advanced skill and meticulous technique.
The contest invites submissions from young thoracic surgeons (aged 45 and under), showcasing procedures that demonstrate clear anatomical understanding, precise and safe operative maneuvers, oncologically sound and accurate lymph node dissection, and strong educational value. Through the sharing of outstanding surgical videos, this initiative aims to promote technical excellence among young surgeons and contribute to the continued advancement of thoracic surgery.
Submitted videos will be anonymized and evaluated by a panel of judges as well as session attendees. The top three entries will be recognized and awarded.

Surgeons often tend to focus primarily on perioperative outcomes and long-term survival; however, postoperative quality of life (QOL) is undoubtedly a critical surgical outcome as well. In recent years, patient-reported outcome (PRO) measures—though subjective in nature—have been reported to correlate with postoperative complications and survival, leading to increasing recognition of their clinical significance.
In this session, we will present the latest developments in QOL and PRO research in general thoracic surgery, including the results of an international joint survey conducted by the Japanese Association for Chest Surgery (JACS) and the European Society of Thoracic Surgeons (ESTS) regarding the current use of QOL/PRO measures. We look forward to active discussion on their utility, clinical applicability, and future prospects.

In recent years, work style reform has progressed across the medical field, and thoracic surgery is likewise expected to address long working hours and strengthen team-based care. It is also urgent to build an environment where professionals of diverse backgrounds—across gender, age, and career stage—can thrive. To foster surgical skills and expertise, ensuring time for self-development and research, along with fair compensation and adequate private time, are essential.
This theme calls for initiatives and proposals on reducing surgical burden, task shifting, active participation of female and young surgeons, support for balancing work with family responsibilities, and interprofessional collaboration, as well as improvements in remuneration systems and working-hour management. Through such efforts, we aim to keep thoracic surgery an attractive specialty that inspires the next generation of young physicians to confidently pursue this field.

Thoracic surgery is undergoing rapid transformation due to innovations in technology, evolution in perioperative care, and the challenges posed by aging populations. In this joint session, thoracic surgeons from Vietnam, Taiwan, and Japan—three key regions in East Asia—will gather to exchange perspectives on current challenges, emerging practices, and shared visions for the future.
Topics such as robotic surgery, minimally invasive approaches, surgical education, centralization of care, and opportunities for international collaboration will be explored. Through this dialogue, we aim to “design the future” of thoracic surgery together, fostering stronger partnerships and advancing the field across the region.

The Japanese Association for Chest Surgery (JACS), with a history spanning over 30 years, has made significant contributions to the advancement of thoracic surgery through the unwavering efforts of its pioneers, including the establishment of a formal board certification system.
Today, the field of thoracic surgery is undergoing a major transformation, driven by demographic shifts, advancements in perioperative care, and the widespread adoption of robotic surgery. In navigating this era of change, it is essential that we faithfully inherit the wisdom and techniques built by our predecessors while embracing innovation to pursue even greater heights.

In the surgical treatment of thoracic advanced malignancies, extended resections involving major blood vessels are unavoidable in pursuit of a cure. However, resection and reconstruction of major vessels require advanced surgical skills, as well as sophisticated perioperative management techniques such as ECMO or temporary bypass. This session aims to specifically discuss each institution’s unique innovations and novel technical approaches to safely perform these complex procedures, and by sharing multi-institutional experiences, strives to further standardize the surgical methods and expand their indications.

With minimally invasive surgery now becoming the standard approach, it is increasingly challenging for surgeons to acquire operative skills in the current era. Thoracoscopic and robotic procedures, in particular, demand a high level of technical expertise, and the surgeon’s experience directly influences the safety and precision of surgery. As such, the importance of structured training programs continues to grow.
This session will focus on off-the-job training (Off-JT) for young thoracic surgeons, regardless of whether it is implemented at the departmental or individual level. Presentations will highlight actual case studies and the educational effectiveness of such training methods. Through these initiatives, we aim to facilitate a multifaceted discussion on the challenges and future prospects of standardizing and disseminating Off-JT in surgical education.

With advancements in minimally invasive techniques, the surgical approaches to total thymectomy have become increasingly diverse. The benefit of avoiding a median sternotomy is widely acknowledged. However, when median sternotomy is omitted, the operative field within the anterior mediastinum becomes more restricted, inevitably limiting both visualization and maneuverability.
This raises an important question: do these minimally invasive approaches maintain the same level of surgical precision as the traditional sternotomy, or is there a trade-off in accuracy in favor of less invasiveness? This issue remains open to debate.
In this session, expert surgeons will present operative videos to highlight the technical challenges, key procedural tips, and safety considerations specific to each approach. We aim to foster discussion on the current challenges and future prospects in the pursuit of minimally invasive thymic surgery.

Robot-assisted surgery in the field of general thoracic surgery has undergone remarkable advancement over the past decade, with the annual number of procedures now over 9,000 in Japan. In recent years, multiple robotic platforms have been introduced, offering the promise of improved functionality and reduced costs. Each system has its own distinct characteristics—ranging from operability and haptic feedback to running costs.
As case volumes increase, more institutions are implementing multiple robotic systems, prompting comprehensive evaluations of their utility. In this session, experienced surgeons who are proficient in different robotic platforms will present actual surgical videos and discuss the advantages, limitations, and practical adaptations unique to each system. Technical tips and strategic insights will also be explored.
Through these presentations, we aim to provide a practical and forward-looking discussion on the current state and future direction of robotic thoracic surgery.

Following the results of large-scale clinical trials, opportunities for performing intentional limited resection have been increasing. In the JCOG0802 trial, segmentectomy demonstrated favorable overall survival compared to lobectomy; however, the rate of local recurrence was doubled, indicating that further improvement in local control remains a critical issue.
With regard to surgical indications, more detailed evaluation of biological malignancy factors—such as age, sex, tumor solidity, pleural invasion, and high SUV on PET—is warranted. From a technical perspective, achieving a surgical margin greater than the tumor diameter is recommended. This often necessitates more complex procedures, such as resection involving adjacent segments or subsegments.
This session aims to discuss, in a practical and detailed manner, how institutions determine indications and implement intraoperative strategies to minimize local recurrence.

Perioperative treatment for non-small cell lung cancer (NSCLC) is undergoing a major transformation with the advent of immune checkpoint inhibitors and molecular targeted therapies. In addition to traditional stage-based treatment strategies, the clinical application of biomarkers has progressed, further highlighting the importance of personalized medicine.
In this session, we aim to comprehensively share the latest evidence and clinical experiences related to perioperative treatment—ranging from treatment selection based on stage and biomarkers to the implementation of novel therapies in real-world practice. We invite discussion on the challenges and strategies involved in determining surgical indications and treatment planning, as well as pitfalls encountered in preoperative and postoperative therapies, with the goal of optimizing perioperative treatment for NSCLC.

Lung transplantation in Japan is currently performed at 11 centers nationwide, with the number of procedures increasing steadily each year. As the number of patients seeking transplantation also continues to grow, further expansion is anticipated in the future.
Although the number of procedures per center remains relatively low compared to other countries, Japan has achieved favorable clinical outcomes. Nevertheless, challenges persist, such as balancing transplant responsibilities with other clinical duties, and adapting to ongoing healthcare workstyle reforms.
Through discussions with experts from transplant centers in Western countries, where centralization of transplant care has progressed, this session aims to explore and envision the future structure of lung transplantation in Japan.

In recent years, the widespread use of immunotherapy for unresectable lung cancer and the advances in perioperative immunotherapy for advanced cases have led to an increasing number of opportunities to perform surgery following immunotherapy. However, treatment-related tissue reactions and adhesions often raise the technical difficulty of surgery, frequently requiring central vascular manipulation and resulting in a higher rate of thoracotomy conversion. In addition, unexpected complications such as immune-related adverse events (irAEs) may arise in the preoperative or postoperative period, sometimes leading to loss of surgical opportunity or necessitating special perioperative management strategies.
This session will focus on sharing practical tips and highlighting potential pitfalls in surgery after immunotherapy, as well as perioperative management, with the aim of improving surgical feasibility and outcomes.

Segmentectomy of small peripheral lung cancers smaller than 2 cm is becoming established as a standard therapy as well as lobectomy. With the rapid spread of surgical-assist robots in Japan in recent years, not only the conventional VATS and open chest segmentectomy but also RATS segmentectomy is now widely performed.
Both VATS and RATS have their advantages and disadvantages in various aspects such as operability, emergency response, margin acquisition, cost, and education, although there is almost no difference in the cure and safety. Open chest surgery is also a viable option in cases of adhesions or complex surgeries, and small open chest surgery is a sufficiently minimally invasive surgery.
In this workshop, We would like to invite each institution to present and share their own originality and ingenuity in surgery, taking advantage of the characteristics of each approach.

Although giant tumors without distant metastasis are relatively uncommon, they remain important surgical targets with the potential for radical resection. However, in conventional thoracotomy, it is often difficult to secure sufficient working space within the thoracic cavity, and modifications or alternative approaches are frequently required.
When adjacent organ invasion is present, complete resection may necessitate combined organ resection, chest wall or great vessel reconstruction, and, in some cases, the use of cardiopulmonary support. Each case thus demands not only advanced techniques but also flexible ideas and bold execution beyond standardized procedures.
In this session, we aim to share the unique ingenuity and accumulated experiences of each institution, and to discuss the challenges and innovations involved in surgery for giant tumors.

Superior sulcus tumors (SST) are characterized by unique anatomical features that demand highly sophisticated multidisciplinary strategies for both diagnosis and treatment. In addition to the traditional approach of preoperative chemoradiotherapy, perioperative treatments incorporating immune checkpoint inhibitors have recently been introduced, offering new prospects for improved curability and long-term outcomes.
In this session, we aim to deepen discussions from a broad perspective on the latest perioperative treatments for SST—including chemoradiotherapy and immunotherapy—as well as innovations in surgical approaches, reconstruction techniques, and actual postoperative management. We also encourage presentations sharing valuable insights and experiences from daily practice, such as treatment strategies for complex cases, preoperative assessments, and initiatives in multidisciplinary team care.

Segmentectomy for lung cancer has been increasingly performed in recent years due to its minimally invasive nature and potential for preserving pulmonary function, with the results of the JCOG0802 trial further supporting this trend. However, a certain proportion of patients still experience postoperative recurrence, among which local recurrence accounts for a significant fraction. Accurate diagnosis of recurrence and appropriate decision-making regarding treatment strategies are therefore of paramount importance.
In this workshop, experts will share their insights on the practical evaluation of recurrence, including imaging and pathological diagnosis, as well as diverse treatment options such as reoperation, systemic therapy, and radiotherapy. Through these multidisciplinary perspectives, we aim to discuss and define optimal strategies for managing recurrence after segmentectomy.

In recent years, pulmonary air leaks have increasingly been encountered in patients with interstitial pneumonia, pulmonary emphysema, or those treated with immune checkpoint inhibitors and chemotherapy. In many such cases, chest tube drainage alone proves insufficient, and treatment options are often limited by comorbidities and the patient’s overall condition. However, standardized treatment strategies have yet to be established, and various methods have been reported, including pleurodesis, muscle flap or free fat tissue techniques, bronchial occlusion, and air leak detection via thoracography. In this session, we aim to share our experiences regarding the selection and technical aspects of these treatments, discuss treatment outcomes, and explore future directions for management.

For thoracic surgeons, the risk of pulmonary artery bleeding is inescapable. In other words, it would not be an exaggeration to say that only those who can manage pulmonary artery bleeding can continue as thoracic surgeons. As minimally invasive approaches diversify, there are both common and approach-specific aspects when discussing the key points and pitfalls of managing such bleeding. In recent years, the number of minimally invasive procedures—where emergency management is technically more demanding—has been increasing, and the accumulation of diverse strategies for controlling pulmonary artery bleeding is crucial for the safe dissemination of these techniques. Furthermore, we hope that each presenter will also share preventive measures, derived from their own experience, to avoid pulmonary artery bleeding in the first place.