Purpose: Most postoperative recurrences of non-small cell lung cancer (NSCLC) develop within 5 years after curative resection, with ultra-late recurrences developing over 10 years after the resection being rare. This study aimed to analyze the features of ultra-late recurrence in cases with NSCLC who had undergone curative resection. Patients and methods: Among 1458 consecutive cases with NSCLC who underwent curative resection with systematic lymph node dissection during 1990–2006, 12 cases developed recurrence over 10 years after the resection. We defined the recurrence developing over 10 years after the resection as ultra-late recurrence and analyzed the factors related to it. Results: Among the 1458 cases, recurrence developed in 476 (32.6%) cases. Of them, ultra-late recurrence developed in 12 (2.5%) cases. The ultra-late recurrence was histopathologically classified as adenocarcinoma in 11 cases and atypical carcinoid in 1 case. All cases were of invasive carcinoma. We compared ultra-late recurrence cases with non-recurrence cases and showed that none of the examined factors significantly influenced ultra-late recurrence; however, lymphatic invasion was close to significantly influencing it. There were two cases in which recurrence developed over 15 years after the resection; both cases were of adenocarcinoma with anaplastic lymphoma kinase (ALK) rearrangement. Conclusion: There is a possibility of ultra-late recurrence developing over 10 years after the resection of any invasive NSCLC. Lymphatic invasion is close to significantly influencing ultra-late recurrence. Furthermore, a long follow-up period may be required in cases with adenocarcinoma with ALK rearrangement because it has the possibility of recurrence over 15 years after the resection.

Background: The prognosis of postoperative recurrence in patients with non‐small cell lung cancer (NSCLC) is poor. However, depending on the recurrence patterns and treatment options, some patients can achieve long‐term survival following recurrence. In this study, we investigated the clinicopathological characteristics of NSCLC patients with curable disease who developed postoperative recurrence.Methods: This retrospective study enrolled 535 patients who had developed recurrence from among 1760 consecutive patients with NSCLC who underwent curative resection from 1990 to 2008.Post‐recurrence cure was defined as being cancer‐free for at least five years after treatment for recurrence in patients who had undergone radical local treatment or chemotherapy. The clinicopathological characteristics associated with post‐recurrence cure were analyzed.Results: Among 535 patients who developed recurrence, 24 (4.5%) achieved post‐recurrence cure. The median post‐recurrence follow‐up duration was 151 (85–275) months for those who achieved post‐recurrence cure. The solitary recurrent lesions and local treatment for the initial recurrence site were significantly more for patients who could be cured after they developed recurrence. All patients with post‐recurrence cure received only radical local treatment for the recurrent lesions.Conclusions: Some patients with solitary recurrent NSCLC lesions can be cured with only radical local treatment.Key points: Significant findings of the studyThe post‐recurrence cure patients maintained a cancer‐free status for five years after treatment for recurrence without a second recurrence. All patients with post‐recurrence cure received only radical local treatment for recurrence and had significantly higher number of solitary recurrent lesions.What this study addsSome patients with solitary recurrent NSCLC lesions after resection can be cured with only radical local treatment.

Mediastinal hematoma is usually caused by thoracic trauma or a ruptured aortic aneurysm. Spontaneous non-traumatic mediastinal hematomas are rare but potentially life-threatening conditions that can occur in patients taking anticoagulants. We report a case of 72-year-old man with a massive mediastinal hematoma associated with anticoagulant therapy. He had complained of acute chest discomfort and subsequent tarry diarrhea. Because he had been taking warfarin for paroxysmal atrial fibrillation, an upper gastrointestinal hemorrhage was initially suspected, but no bleeding was detected by upper endoscopy. A computed tomography scan revealed a massive posterior mediastinal hematoma and markedly compressed surrounding structures. The compression of the left atrium caused a congested lung and exacerbated respiratory and hemodynamic status despite conservative therapy. Therefore, we surgically removed the hematoma. Immediately after removal, the respiratory and hemodynamic conditions improved, and the postoperative course was uneventful. Spontaneous mediastinal hematoma is rare but can occur in patients who are administered anticoagulants regardless of the therapeutic level of anticoagulation. Although conservative therapy is commonly effective, active surgical intervention should be considered for cases in which the hematoma is symptomatic or conservative therapy is ineffective. To facilitate prompt and proper management, clinicians should be aware of this condition as a potential complication of anticoagulant therapy.

Background: The effectiveness of local therapy has been reported in patients with oligo‐recurrence of non‐small cell lung cancer (NSCLC), a metachronous recurrence with a limited number of recurrences, which can be treated with local therapy. Conversely, remarkable progress has been made in systemic therapy for NSCLC with the advent of molecular targeted therapy. In particular, epidermal growth factor receptor (EGFR)‐tyrosine kinase inhibitors (TKIs) are very effective in the treatment of EGFR‐mutated NSCLC. There is currently no consensus on treatment for oligo‐recurrence of EGFR‐mutated NSCLC.Methods: From 2004 to 2014, 811 patients underwent complete resection for NSCLC at Kitasato University Hospital and, of these, 244 patients developed recurrence. Oligo‐recurrence was defined as the presence of two or less recurrent lesions, and 34 patients presented with EGFR‐mutated oligo‐recurrence.Results: We retrospectively examined and compared the effects of EGFR‐TKIs with those of radical local therapy in patients with oligo‐recurrent EGFR‐mutated NSCLC. The five‐year post‐recurrence survival (PRS) rates of patients with EGFR‐mutated oligo‐recurrence who received radical local therapy (n = 23) and those who did not (n = 11) were 59.4 and 45.5%, respectively (p = 0.777). Multivariate analysis revealed no favorable prognostic factors associated with prolonged PRS, and radical local therapies did not improve PRS in patients with oligo‐recurrence (p = 0.551).Conclusion: Radical local therapy did not affect PRS in patients with oligo‐recurrent EGFR‐mutated NSCLC. Even in cases of oligo‐recurrence, the administration of local therapy in patients with EGFR‐mutated NSCLC might be carefully considered.