Remembrance: Tsuguo Naruke, MD, 1934-2006

On May 20, 2006, Tsuguo Naruke died of a myocardial infarction at the Kodokan gymnasium (a Mecca of Judo) during his practice of Judo. He complained of very bad feelings in his chest, and soon lost consciousness. Although he was sent to the nearby Tokyo University Hospital by ambulance, he already passed away. He was 74. Until the end, he was truly a Samurai, a master of Judo, and of course, an active thoracic surgeon.

Tsuguo Naruke was born in Tokyo in 1934. He received his baccalaureate, medical degree, and the Doctor of Medical Science degree from Keio University, Tokyo. After finishing residency of surgery and pathology, including a training at Hahnemann University in Philadelphia, he held a staff appointment in the Division of Thoracic Surgery of the National Cancer Center (NCC) Hospital, Tokyo under the oversight of Dr. Shichiro Ishikawa and Dr. Keiichi Suemasu. He was promoted to the Division Head in 1974, Chief of the Department of Surgery in 1989, and the Deputy-director of the Hospital in 1994. Even after the retirement from the NCC in 1999, he continued his career as a consultant surgeon at the Saiseikai Central Hospital, Tokyo, until his death.

Throughout his professional life, Dr. Naruke was an active academic surgeon in all aspects - clinical surgery and practice, education, and research. His great contributions as an academic surgeon were as follows: the establishment of the lymph node map and the evaluation of prognostic significance of systematic lymph node dissection in lung cancer [1,2], the technical refinement of bronchoplastic procedures [3], the development of the screening system in lung cancer, and the technical development of thoracoscopic surgery (VATS) [4], Among these, the promulgation of the lymph node map had the significant impact on the surgeons: the concept to classify the lymph node stations in the hilum and mediastinum according to the anatomical landmarks was not only quite unique and novel, but also practically convenient in describing the exact location of metastatic lymph nodes during the surgery for lung cancer. Owing to this map, the route of lymphatic spread as well as the prognostic significance of the metastasis at the specific mediastinal sites in lung cancer was being elucidated. Nowadays, although the ATS map is being used in many countries, the concept dividing mediastinal sites into 9 stations by a single-digit number and hilar/interlobar/pulmonary stations into 5 stations by a two-digit number was took taken over even in the ATS map. There has been still some controversy in the anatomical definition of lymph node stations, and the establishment and evolution of the new map has become an important task of the next generations. That must be our job.

Even after his retirement from the NCC, he maintained the discipline as a surgeon, seeking for more sophisticated VATS lobectomy with complete lymph node dissection. In Japan, Dr. Naruke became a pioneer in VATS procedure despite his senior appointment in the early 1990s. This energy might be based on his profound belief that the less invasive surgery is the greatest merit to the patients from his wide experience. Also, he must have seen the future way in thoracic surgery through VATS to truly robotic, technologically advanced surgery.

He had a firm belief that the sound mind as a surgeon is in a sound body. So, he had never quit his practice of Judo even in the latter part of his life. He never told us how often and when he went to the Kodokan gymnasium for practice, but it must have been in the early morning or in the late evening, I guess. In judo he was ranked at 8-dan (the 3rd highest ranking black belt), and nominated as a Master. Also, his practice in surgery was based on the Bushido spirit (the Samurai’s discipline and way of life), in which the courage, benevolence, politeness, sincerity, honor, loyalty, and modesty have been highly appreciated. I hear that he must have read a book entitled "Bushido: the soul of Japan," which was written by Inazo Nitobe about 100 years ago and translated into many languages (first edition was published in 1900 by The Leeds & Biddle Co., Philadelphia). In the resident education of surgery, he talked only a little bit during the operations, but all of a sudden, the residents were told "you are to try this case!" He really took the "readiness" seriously, as the old Samurais did so.

The death during the surgery or that on the "Tatami (Judo mat)" of Judo gymnasium might have been what the death was supposed to be for him. But, he was too young to go. Maybe only one consolation of his wife, Shinako, and himself might be the growth of their son, Dr. Masao Naruke, as a thoracic surgeon. Dr. Naruke’s spirit must have been succeeded in his son, I believe. It is altogether fitting that Tsuguo Naruke be recognized again for his important, great contributions to the thoracic surgical community and that we pay tribute to a true Samurai of Japan.

Hisao Asamura, MD
Chief, Division of Thoracic Surgery
National Cancer Center Hospital, Tokyo
Japan
 

References

1. Naruke T, Suemasu K, Ishikawa S. Lymph node mapping and curability at various levels of metastasis in resected lung cancer. J Thorac Cardiovasc Surg 1978;76:832-9.

2. Naruke T, Tsuchiya R, Kondo H, Nakayama H, Asamura H. Lymph node sampling in lung cancer: how should it be done? Eur J Cardio-thorac Surg 1999;16(suppl):s17-s24.

3. Naruke T, Yoneyama T, Ogata T, Suemasu, K. Bronchoplastic procedures for lung cancer. J Thorac Cardiovasc Surg 1977;73:927-35.

4. Naruke T, Tsuchiya R, Kondo H, Nakayama H, Asamura H. VATS lobectomy for lung cancer. Asian J Surg 1999;22:33-40.