Cytological examination of intraoperative pleural lavage in primary lung cancer patients

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CYTOLOGICAL EXAMINATION OF INTRAOPERATIVE PLEURAL LAVAGE IN PRIMARY LUNG CANCER PATIENTS Satoh,T. ,Tsukamoto,T., Ablko,M. ,Yamada,K., and Nagasawa,M. Departments of Surgery and Internal Medicine, Yamagata Prefectural Central Hospital, Ymagata 990, Japan We performed cytological examination of pleural lavage fluid obtained during thoracotomy for lung cancer where pleural dissemlnatlon or malignant pleural effusmns were not noted at surgery. Based on these examinations, we attempted to determine recurrence pattern and prognostic factors. 144 patients underwent resection for lung cancer at our hospital from January 1989 to December 1992. Patients with definite pleural dlssemlnation, malignant pleural effusion or severe adhesion were excluded, and the remainmg 119 patients were studied. Cytology was performed twice: firstly Immediately after the opening of the chest and secondary at the end of the operation. Those patients who indicated negative results on both occasions were defined as belonging to the negatwe group, and those who indicated posltwe on either or both occasions were defined as belonging to the positive group. Twelve patients (10.1%) were found to belong to the positwe group. Their histological types were as follows: adenocarcinoma in six patients, squamous cell carcinoma in three. large cell carcinoma in three, large cell carcinoma IFI two, and adenosquamous cell carcinoma in one. Recurrence with pleurltls carcinomatosa was observed in four of these 12 patients. Eight died, three of plewitis carcinomatosa. When cumulative surwval rates were compared between the two groups. 3-year survival in the positive group was 30%. and l&year survival in the negative group was 66%. This indicated that prognosis was significantly poorer in the positive group.

SELF-EXPANDABLE FOR MALIGNANT Mitsuru

Koike*,

YBTALIC STENTS TRACHEOBQONCHIAL

M. Ishida*,Y.

T. Ishikawa**.

H.Osada

Radiology

?? *, Surgery III***,

Kanagawa

Japan.

Purpose:To

evaluate

steots(EMS)

for

improvemeot

of quality

Materials ia 3 and

right

imminent

asphyxia.

we

used

under

are

clinical

encountered.

placement,

in 3 and repeated respiratory

placed

until

metallic by

mean

advanced

cancer

patients

for

obstructive type.

The

of

disease.

in 3, left main

inidicationa

died

position were

and 7. bronchus

treatment

are

pneumonia.

EMS

EMS

and

were

placed

after

in 4 were terminal

increase

No complication

treatmentwas

secretion

15 days

immediate

satisfactory.

endoscopic

of bronchial

their

4 lung

Modified

in ideal

lasertreatment

status

of Medicine,

control.

improvement

was

with

of trachea

In 3 out of 5. multiple

1 patient

School

stenosis

aad repeated and

I *,

Medicine

self-expandable

patients

in 3. The

endoscopic

increase

and

ot

include

the stenosis

original

were

and

for remarkable

materials

bronchus

and/or

stents

in the airway

in the

breathlessness

Giaoturco

University

usefuloesa

of life

H. Niimi”.

of Internal

tracheobroacbial

with

main

tluoroscopic

Results:All was

clinical malignant

carcinoma

S. Koooo**.

Department

St.Mariaona

and Methods:The

esophageal

Nakajima**,

***.

PLACEMENT STENOSIS

in a week setting.

performed

stage

required after

Radiation and

EMS therapy

achieved

in 3 to 4 months

good after

stating. Conclusion:EMS promising repeated satisfactory

for malignant

forimmediate laser

dilatation,

treatment

long term

and/or

tracheobronchial but

stenosis

additional

irradiation

are

treatments required

is safe such

nod as

to achieve

results.

602

603

USE OF CARCINOEMBRYONIC ANTIGEN RATIO IN PLEURAL WASHINGS FROM PRIMARY LUNG CANCER PATIENTS AS A PARAMETER FOR PLEURAL INVASION Tanaka, S. Asao, T. Kato, Ft. Shimizu, Y. Nagamachi, Y. Department of Surgery, Gunma University School of Medicine, Maebashi, 371 Japan

A CLINICAL ANALYSIS OF SURSICAL CASES OF LUNG CANCER COMPLICATED WITH IDIOPATHIC P LMONARY FIBROSIS. Tanimura, S.l), Tomoyasu, H.'Y , Banba, J.'), Masaki, M.l), Matsushita, H.*) Dept. of Thoracic Surgeryl) and Dept. of Pathology'), Toranomon Hospital, Tokyo, Japan. As the prognosis of lung cancer associated with idiopathic pulmonary fibrosis (IPF) is very poor, previous reported studies were mainly performed on nonsurgical or postmortem cases. We investigated the clinicopathological features and the problems of intraoperative and postoperative management in 13 cases with lung cancer complicating IPF. The average age of the patients was 63 years, and all of them were males and heavy smokers (average 6.1: 1160). Four had squamous cell carcinoma, five had adenocarcinoma, two had small cell carcinoma, and one had large cell carcinoma, and all tumors were located in the peripheral regions of the lung. Concerning the prognosis, five patients are alive and eight patients are dead. Six died due to recurrence of lung cancer or new cancer of other organ, while two died of exacerbation of IPF. Because excessive oxygenation during surgery might exacerbate IPF, we tried to keep the Pa02 less than 100 Torr during or after surgery. This was effective in protecting against the exacerbation of IPF, as no relapse was observed in controlled nine cases.

The ratio of carcinoembryonic antigen (CEA) levels in pleural washings to serum levels were determined. The pleural washings were obtained at the time of thoracotomy from 66 patients with primary lung cancer, 5 with metastatic lung cancer and 12 with benign lung disease. Elevated values (>lOO ml/g protein) were observed in 15 of 66 (22.7 %) patients with primary lung cancer, in 1 of 5 (20%) patients with metastatic lung cancer

, whereas in no

patient with benign lung disease. Among the patients with primary lung cancer, positive rate of elevated CEA ratio in patients with pleural tumor invasion was significantly when compared

higher, 44 % (11/25),

with 9.6 % (4/41) in patients without pleural

invasion.Four patientswho developed pleuraldisseminationhad positiveCEA ratio at the time of surgery. Positive cytology was

obtained from only 4 patients, and all of them had elevated CEA ratio. In conclusion, we have found that the CEA ratio could be a sensitive detector of pleural invasion and micro dissemination.