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Extended operations for T4 primary lung cancer
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Operative indication of small primary lesion with advanced disease Junzo Shimizu, Makoto Oda, Yoshinobu Hayashi and Yoh Watanabe Department of Surgery, Kanasawa University School of Medicine, 13-1 Takara-machi, Kanazawa 920, Japan Results of surgical treatment obtained in cases of small primary lesion with advanced lung cancer were reviewed with following conclusion. 1) In TlN2 cases the 3-year and 5-year survival rates were both 30.6%. The 5-year survival rate was 37.0% for cases after curative operation and 0% for cases after non-curative operation, showing better prognosis for cases after curative operation. It is considered that extended resection of lymph node is required even in cases of small primary lesion with advanced lung cancer. Almost all the long-term survivor had metastatic node confined within one level involving the lower mediastinal node. 2) In TlMl cases we usually conduct resection only when PM is detected intraoperatively. Relatively long survival time can be obtained by combined use of systemic immunochemotherapy after the operation. 3) In cases diagnosed as T4 because of pleural dissemination despite of small diameter of the primary lesion, we carried out resection of primary lesion and the parietal pleurectomy for the purpose of prevention of reduction in quality of life. A present, 3 out of 4 patients undergone resection by this method are still alive (for 20 months at the longest).
263 Surgical treatment of primary lung cancer under 40 years old T.Shimono. H.Kusagawa, T.Mizumoto, S.Namikawa. and M,Kusagawa Dept. of Thorac. Surg. Mie Univ., Tsu, Japan Between 1965 and 1990, 837 patients were treated for lung cancer at our hospital. Among them, 24 (2.9%) were aged 33 to 39 years. The male to female rate of the younger patients was 2.4 : 1 although that of the patients older than 40 years was 3.6 : 1. They consisted of 16 patients (67%) with adenocarcinoma, 7 (29%) with squamous cell carcinoma and 1(4%) with large cell carcinoma. At the time of diagnosis, the disease was diagnosed as Stage 1 in 6 patients (24%). Stage 2 in 5 (21%), Stage 3 in 8 (34%) and Stage 4 in 5 (21%). All patients underwent thoracotomy. The procedure was curative in 11 (46%) and palliative in 5 (21%) ;in 8(33X), the lesion was unresectable. In these patients, the 5year survival rate being similar was 36%. to that in the general population of patients. However, the 5-year survival rate for the patients in Stage 3 was 47%, being higher than that in the general population. The younger patients group was characterized by advanced stage of disease but an aggressive surgical approach may prolong survival.
Results of Surgical Treatment for T4 Lung Cancer Makoto Oda, Yoh Watanabe, Junso Shin&u, Yoshinobu Hayashi, Yasuhiko Ohta First Department of Surgery, Kanazawa University, Ishikawa, Japan Results of surgical treatment obtained in 75 cases of T4 lung cancer at our department were reviewed. The cumulative l-, 3- and 5-year survival rates after resection were 39.3X, 14.6% and 10.5% respectively for all cases of T4 lesions. The most significant prognostic factor was the N-factor. The 5-year survival rates were 38.2%. 6.3X, 3.5% and nil for T4N0, T4N1, T4N2 and T4N3 respectively. Significant difference in survival rate was seen between T4NO and T4N2 (PcO.05). There were 6 patients who survived 3 years or longer. They showed direct invasion to the single organ : left atrium, carina, superior vena cava and intrapericardial pulmonary artery. None of the cases with malignant pleural effusion survived more than 30 months. It is possible that agressive surgical treatment may yield long survival in T4 cases having invasion to single structure such as left atrium and carlna. However, it seems that operative indication for cases with malignant pleural effusion should be decided carefully.
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Extended Operations for T4 Primary Lung Cancer H. Ayabe, Y.Tagawa, K.Kawahara, M.Tomita First Department of Surgery, Nagasaki University School of Medicine, Nagasaki, Japan. Surgery for advanced lung cancer is controversial. We reviewed the results of extended operations for T4 lung cancer. From 1955 to April 1991, 780 patients underwent pulmonary resectdon for primary lung cancer in our department. Thirty-eight of them(5%) had extended operations for T4 lung cancer. T4 organs were SVC(9), left atrium (7), esophagus(b), carina(6), thoracic vertebrum(3), carcinomatous pleuritis(3), aorta(Z), esophagus and left atrium(l) and aorta and SVC(1). Operative procedures performed were as gallows: SVC resection and replacement with PTFE graft(7), lateral wall resection of SVC(3), partial resection of left atrium(a), partial resection of esophageal muscular layer(b), thoracic esophagectomy and reconstruction(l), sleeve pneumonec& tomy(4), carinal resection with right upper lebectomy, (2), partial resection of thoracic vertebrum(3), aortic resection and replacement with Dacron graft(3) and pleura-pneumonectomy(3). Five patients(l3%) died within 30 days after operation. The rates of postoperative complications were high in the patients with resection of esophagus or aorta. Twenty-eight patients died(2-28 mo.) and 10 are alive(l-16 mo.). One year survival rate was 53% and 2 years was only 16%. Survival of the patients with T4 lung cancer was not good except for SVC and carina. Extended operations for T4 lung cancer should be restricted for selected patients.
262
Operative indication of small primary lesion with advanced disease Junzo Shimizu, Makoto Oda, Yoshinobu Hayashi and Yoh Watanabe Department of Surgery, Kanasawa University School of Medicine, 13-1 Takara-machi, Kanazawa 920, Japan Results of surgical treatment obtained in cases of small primary lesion with advanced lung cancer were reviewed with following conclusion. 1) In TlN2 cases the 3-year and 5-year survival rates were both 30.6%. The 5-year survival rate was 37.0% for cases after curative operation and 0% for cases after non-curative operation, showing better prognosis for cases after curative operation. It is considered that extended resection of lymph node is required even in cases of small primary lesion with advanced lung cancer. Almost all the long-term survivor had metastatic node confined within one level involving the lower mediastinal node. 2) In TlMl cases we usually conduct resection only when PM is detected intraoperatively. Relatively long survival time can be obtained by combined use of systemic immunochemotherapy after the operation. 3) In cases diagnosed as T4 because of pleural dissemination despite of small diameter of the primary lesion, we carried out resection of primary lesion and the parietal pleurectomy for the purpose of prevention of reduction in quality of life. A present, 3 out of 4 patients undergone resection by this method are still alive (for 20 months at the longest).
263 Surgical treatment of primary lung cancer under 40 years old T.Shimono. H.Kusagawa, T.Mizumoto, S.Namikawa. and M,Kusagawa Dept. of Thorac. Surg. Mie Univ., Tsu, Japan Between 1965 and 1990, 837 patients were treated for lung cancer at our hospital. Among them, 24 (2.9%) were aged 33 to 39 years. The male to female rate of the younger patients was 2.4 : 1 although that of the patients older than 40 years was 3.6 : 1. They consisted of 16 patients (67%) with adenocarcinoma, 7 (29%) with squamous cell carcinoma and 1(4%) with large cell carcinoma. At the time of diagnosis, the disease was diagnosed as Stage 1 in 6 patients (24%). Stage 2 in 5 (21%), Stage 3 in 8 (34%) and Stage 4 in 5 (21%). All patients underwent thoracotomy. The procedure was curative in 11 (46%) and palliative in 5 (21%) ;in 8(33X), the lesion was unresectable. In these patients, the 5year survival rate being similar was 36%. to that in the general population of patients. However, the 5-year survival rate for the patients in Stage 3 was 47%, being higher than that in the general population. The younger patients group was characterized by advanced stage of disease but an aggressive surgical approach may prolong survival.
Results of Surgical Treatment for T4 Lung Cancer Makoto Oda, Yoh Watanabe, Junso Shin&u, Yoshinobu Hayashi, Yasuhiko Ohta First Department of Surgery, Kanazawa University, Ishikawa, Japan Results of surgical treatment obtained in 75 cases of T4 lung cancer at our department were reviewed. The cumulative l-, 3- and 5-year survival rates after resection were 39.3X, 14.6% and 10.5% respectively for all cases of T4 lesions. The most significant prognostic factor was the N-factor. The 5-year survival rates were 38.2%. 6.3X, 3.5% and nil for T4N0, T4N1, T4N2 and T4N3 respectively. Significant difference in survival rate was seen between T4NO and T4N2 (PcO.05). There were 6 patients who survived 3 years or longer. They showed direct invasion to the single organ : left atrium, carina, superior vena cava and intrapericardial pulmonary artery. None of the cases with malignant pleural effusion survived more than 30 months. It is possible that agressive surgical treatment may yield long survival in T4 cases having invasion to single structure such as left atrium and carlna. However, it seems that operative indication for cases with malignant pleural effusion should be decided carefully.
264
Extended Operations for T4 Primary Lung Cancer H. Ayabe, Y.Tagawa, K.Kawahara, M.Tomita First Department of Surgery, Nagasaki University School of Medicine, Nagasaki, Japan. Surgery for advanced lung cancer is controversial. We reviewed the results of extended operations for T4 lung cancer. From 1955 to April 1991, 780 patients underwent pulmonary resectdon for primary lung cancer in our department. Thirty-eight of them(5%) had extended operations for T4 lung cancer. T4 organs were SVC(9), left atrium (7), esophagus(b), carina(6), thoracic vertebrum(3), carcinomatous pleuritis(3), aorta(Z), esophagus and left atrium(l) and aorta and SVC(1). Operative procedures performed were as gallows: SVC resection and replacement with PTFE graft(7), lateral wall resection of SVC(3), partial resection of left atrium(a), partial resection of esophageal muscular layer(b), thoracic esophagectomy and reconstruction(l), sleeve pneumonec& tomy(4), carinal resection with right upper lebectomy, (2), partial resection of thoracic vertebrum(3), aortic resection and replacement with Dacron graft(3) and pleura-pneumonectomy(3). Five patients(l3%) died within 30 days after operation. The rates of postoperative complications were high in the patients with resection of esophagus or aorta. Twenty-eight patients died(2-28 mo.) and 10 are alive(l-16 mo.). One year survival rate was 53% and 2 years was only 16%. Survival of the patients with T4 lung cancer was not good except for SVC and carina. Extended operations for T4 lung cancer should be restricted for selected patients.