Meeting the Editorial Board Member of CCTS: Dr. Toyofumi Fengshi Chen-Yoshikawa

Posted On 2024-10-16 11:34:05


Toyofumi Fengshi Chen-Yoshikawa1, Jin Ye Yeo2

1Department of Thoracic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan; 2CCTS AME Publishing Company

Correspondence to: Jin Ye Yeo. CCTS Editorial Office, AME Publishing Company. Email: ccts@amegroups.com

Expert introduction

Dr. Toyofumi Fengshi Chen-Yoshikawa (Figure 1) is a Professor in Thoracic Surgery at Nagoya University Hospital, Nagoya University Graduate School of Medicine. He graduated Kyoto University, Faculty of Medicine in 1997, and obtained Japanese medical license in 1997. He completed his surgical residency training in Kyoto University Hospital and related hospitals (Kochi Municipal Hospital and Shizuoka City Hospital) from 1997 to 2003. After obtaining PhD in Kyoto University Graduate School of Medicine in 2007, he joined the faculty of General Thoracic Surgery at Kyoto University. He also underwent clinical fellowship in lung transplantation at Toronto General Hospital from 2008 to 2009. Between 2009 and 2019, he worked in Kyoto University with Professor Hiroshi Date. Since September in 2019, he has been working as a Professor and Director in Thoracic Surgery at Nagoya University Hospital, Nagoya University Graduate School of Medicine.

He is an active member of American Association for Thoracic Surgeons (AATS), European Society of Thoracic Surgeons (ESTS), International Society for Heart and Lung Transplantation (ISHLT), Japanese Association of Chest Surgeons (JACS) and other thoracic and transplantation societies. He is on the editorial board of J Thorac Cardiovasc Surg. His main research and interests are: lung cancer, lung transplantation (lung preservation, ischemia-reperfusion injury, surgical technique, living-donor lobar lung transplantation, and chronic lung allograft dysfunction), minimally invasive thoracic surgery, regenerative medicine, and surgical simulation and training. He has authored or co-authored a number of articles in the general thoracic surgical fields and has published over 430 peer-reviewed manuscripts in English.

Figure 1 Dr. Toyofumi Fengshi Chen-Yoshikawa


Interview

CCTS: What initially inspired you to pursue a career in thoracic surgery and lung transplantation? 

Dr. Chen-Yoshikawa: Seeing patients suffering from illnesses and experiencing their improvement or being cured by treatment is what motivates me today. This experience has truly inspired me to pursue my career in thoracic surgery and lung transplantation. I believe that behind every study and paper of mine hides daily clinical experience.

CCTS: Could you share some recent studies in lung transplantation that you deem the most impactful? What potential impacts do these studies have on the field?

Dr. Chen-Yoshikawa: In lung transplantation, ex vivo lung perfusion (EVLP) is the most impactful study these days. It was developed and clinically applied in the 2000s (1-3), and since the beginning of the 2020s, it has been widely used in routine medical practice in Europe and the United States (4). In terms of lung preservation and evaluation of marginal donor lungs, I believe this has contributed to an increase in the number of lung transplants worldwide, as previously unused lungs can now be used with not only objective data but also confidence. More recently, further progress is being made in lung preservation, as preservation at 10 degrees has proven to be more practical and effective (5).

CCTS: What are the current challenges in addressing ischemia-reperfusion injury following lung transplantation, and what breakthroughs do you hope to achieve through your research?

Dr. Chen-Yoshikawa: One of the current major challenges in ischemia-reperfusion injury is the further pursuit of lung preservation methods that minimize ischemia-reperfusion injury. One possible and promising method is the establishment of a lung preservation method using the airway pathway. We have already conducted several researches on lung preservation methods using the airway pathway, such as inhalation of isoflurane, salmeterol, human atrial natriuretic peptide (hANP), and milrinone (6-9). Another possible method is conditions of lung preservation. As I wrote before, preservation at 10 degrees has proven to be more practical and effective (5). We have demonstrated that hydrogen gas could alleviate ischemia-reperfusion injury in lung transplantation (10).

CCTS: What emerging trends or technologies in minimally invasive thoracic surgery excite you the most, and how do you see these developments impacting patient outcomes?

Dr. Chen-Yoshikawa: I am interested in the precise less invasive surgery for small lung cancers. Several recent prospective clinical trials have demonstrated the benefit of sublobar resection for small non-small cell lung cancer, and therefore sublobar resection, such as wedge resection and segmentectomy, has recently been performed worldwide. The next step is to perform accurate identification of that small lung cancer. It is necessary to identify the location of the tumor, including tumors that are not lung cancers. The lungs are soft, deformable organs, and their preoperative computed tomography (CT) and intraoperative deflated forms are quite different. Therefore, we have developed an algorithm, the Resection Process Map (RPM), for inflation/deflation deformation and surgical deformation, and are exploring its use in surgical simulation (11). The use of this technology may reduce the use of medical resources, such as eliminating the need for preoperative and intraoperative marking using CT and bronchoscopy, and may allow for more accurate and safer surgery.

CCTS: How has your team contributed to advancing minimally invasive thoracic surgery techniques, and what outcomes have you observed?

Dr. Chen-Yoshikawa: We have developed an algorithm called RPM. We have applied RPM clinically using several backward and prospective studies (12, 13).

CCTS: Could you share insights on how surgical simulation has changed training for thoracic surgeons? What other innovations do you believe will shape the future of surgical education?

Dr. Chen-Yoshikawa: It is important to create and pre-simulate an individual patient's virtual deformable image using software such as RPM before surgery. This means that tomorrow's surgery will be performed preoperatively using the actual patient's CT. Thereafter, performing the surgery on the actual patient would provide the most preliminary training. Of course, postoperative review is also possible. It is important to increase the use of such off-the-job training. This is like a flight simulator for airplanes.

CCTS: How has your experience been as an Editorial Board Member of CCTS?

Dr. Chen-Yoshikawa: It is a good opportunity for us to learn about trends in medicine in general by doing our own research and writing papers so far, as well as actively reviewing papers, including those in other fields. In addition, by doing this kind of work, I am also organizing my own knowledge.By regularly reviewing submitted papers to CCTS, we often read several papers related to the submitted paper, which helps us to regularly learn about trends in the broader field and also to organize our knowledge.


Reference

  1. Steen S, Sjoberg T, Pieere L, et al. Transplantation of lungs from a non-heart-beating donor. Lancet 2001; 17: 825-9.
  2. Cypel M, Yeung JC, Liu M, et al. Normothermic ex vivo lung perfusion in clinical lung transplantation. N Engl J Med 2011; 364: 1431-40.
  3. Warnecke G, Van Raemdonck D, Smith MA, et al. Normothermic ex-vivo preservation with the portable Organ Care System Lung device for bilateral lung transplantation (INSPIRE): a randomised, open-label, non-inferiority, phase 3 study. Lancet Respir Med 2018; 6: 357-67.
  4. Chen-Yoshikawa TF. Ischemia-reperfusion injury in lung transplantation. Cells 2021; 10: 1333.
  5. Ali A, Wang A, Ribeiro RVP, et al. Static lung storage at 10 degree maintains mitochondrial health and preserves donor organ function. Sci Transl Med 2021; 13: eabf7601.
  6. Fujinaga T, Nakamura T, Fukuse T, et al. Isoflurane inhalation after circulatory arrest protects against warm ischemia reperfusion injury of the lungs. Transplantation 2006; 82: 1168-72.
  7. Chen F, Nakamura T, Fujinaga T, et al. Protective effect of a nebulized β2-adrenoreceptor agonist in warm ischemic–reperfused rat lungs. Ann Thorac Surg 2006; 82: 465-71.
  8. Aoyama A, ChenF, FujinagaT, et al. Post-ischemic infusion of atrial natriuretic peptide attenuates warm ischemia-reperfusion injury in rat lung. J Heart Lung Transplant 2009;  28: 628-34.
  9. Zhang J, ChenF, Zhao X, et al. Nebulized phosphodiesterase III inhibitor during warm ischemia attenuates pulmonary ischemia-reperfusion injury. J Heart Lung Transplant 2009; 28: 79-84.
  10. Kayawake H, Chen-Yoshikawa TF, Saito M, et al. Protective Effects of a Hydrogen-Rich Preservation Solution in a Canine Lung Transplantation Model. Ann Thorac Surg. 2021; 111: 246-52.
  11. Tokuno J, Chen-Yoshikawa TF, Nakao M, Matsuda T, Date H. Resection Process Map: A novel dynamic simulation system for pulmonary resection. J Thorac Cardiovasc Surg. 2020; 159: 1130-8.
  12. Tokuno J, Chen-Yoshikawa TF, Nakao M, et al. Creation of a video library for education and virtual simulation of anatomical lung resection. Interact Thorac Cardiovasc Surg 2022; 34: 808-13.
  13. Kadomatsu Y, Nakao M, Ueno H, et al. Clinical application of Resection Process Map as a novel surgical guide in thoracic surgery. Interdiscip Cardiovasc Thorac Surg 2023; ivad059.