- Email: [email protected]
P-894 Bronchomyoplasty in lung cancer surgery
S 354
Posters t Surgery
gas was used from the beginning in 2 patients. The ponod of maintenance with SFG gas was ,5 to 6 months However. with the use of C~Fu gas. it was possible to mal~e the maintenance twice as long Besides. the amount of C3Fu gas needed was about half the amount of SFe gas Conclusions: Thus. the use of C~Fu gas made it possible to achieve longer maintenance with loss amount of gas as compared with SFe gas Therefore. as a gas for thoracic cavity volume control. C3F a gas was considered more effective than SFB gas
Temporary aorto-aortal by-pass during extended pneumonectomy J Klein. P Names. T Bchanos. M Szkorupa. D Horak University Hospital
Olornouc, Olornouc, Czech Republic Background: Involvement of the aortic arch or descending aorta is net unoommon for left sided tumors. Direct involvement of the aortic well is generally considered to be a contraindication of lung resection However. there are limited reports of full thiclmess resaotions of aorta in lung cancer surgery They may be accomplished as a partial resection using patch or as a total tubular r o s e , o n with reconstTuction by a graft To prevent spinal cord ischemia. the cardiepulmonary by~ass is usually recommended Method: The authors present a case report of full-ti'tckness resection of the descendent aorta during pneumonectomy for centrally located carcinoma A direct invasion to descendent aorta was confirmed dunng the procedure and the cardiopulmonary bypass has not been available at the moment. Alter tumor dissection, two aortal cannulas were inserted into the aorta, the first one into the aortic arch over the loft subclavian artery, the second one into the descendent aorta over the claphragm and then they were bypassed without any pump. The descendent aorta was oross~lamped by the outcome of the left subclavian artery and c~or the distal cannula. The invaded aortic tube was rosected and replaced by Dacron graft Result: No early complications were observed The patient has survived with no sign of relapse for twelve months alter the surgery Conduslon: In "1-4tumors with an involvement of the aorta, a surgical resection can be easily performed in highly selected cases even without any special equipment for cardiepulmonary by~ass
Conclusions: There was no current evidence that VATS was particularly effective in acute prevention oflP However. the incidence of aoute e~aoerbation of IP seamed to be minimal in VATS compared to that in PLT or MST. hence further investigation is required
[P~
surgical treatment of multiple lung cancer
K K urewski. B Andrzej. R W~eld. M Ewa. G Artur. L Robert. M Meja. J Jacek Medical University or Gdatlsk, Gdat~sk, Poland Objective: Multiple primary lung cancer (MPLC) is not an uncommon event and several authors report an incidence of 0 2 20% The purpose oftPds paper is to present our own e~perienca in the surgical tTeatment of MPLC Metedal and methods: Nineteen patients have been tTeated with surgical resection for MPLC between 1990 and 2000. with synchronous and metachronous MPLC. respectively. 18 males (95%) and 1 female (5%) in moan age of 57.2 years (43 to 71) have been included into the analysis. MaITInl and Melamed's cnterla for diagnosis were applied: different histology (n = 9); or the same histology, but disease flee interval of at least 2 years (n = 10). or origin from carOnoma in s~u. All patients were staged accorclng to the now Intemational Classlficahon System revised in 1997 by Mountain. The first resection was: Ioboctomy in 15 patients (80%). a bilobectomy in 2 (10%). a segmentectomy in 1 (5%) and wedge resection in 1 (5%) The second operation was: Iobectomy in 7 patients (37%). a segmentaotomy in 4 (21%). wedge resection in 7 (37%) and completion pneumonectomy in 1 (5%) There were 12 (64%) squamous cell carcinomas. 5 (26%) adencoarcinomas and 2 (10%) other tumour types Results The mean interval between the rrst and the second operation was 64 g months (23 to 148 months) There was no penoperatlve mortality Four patients (21%) had postoperative corn plications. The 5year survival of patients with metachronous turnours undergoing standard surgical procedures was 20% Conclusion: Surgical treatment of multiple squamous cell caranoma is justified and limited operation using brenchoplastic techniques provides satisfactory results. Careful Ibllow up is rooommended in all patients Ibllowlng curative pulmonary resection to allow for early detection of a subsequent cancer at a curable stage
P[P-892~Surgical treatment of lung cancer combined wRh Interstitial
pneumonia -especially on surgical approach and postoperative acute exacerbation K Koizumi. T Hirata. K Hiraj. S Yamagishi. D Okada. T Kawasi'tma. H. Kinosilta. Y. Enometo. Y. Naka]ima. K. Shimr,,o. Nippon MeCtcal School,
Tokyo, Japan Barkground: Postoperative acute exacerbation of inters~ial pneumonia (IP) is Imown to be serious complication in the surgical treatment far primary lung cancer combined with interstitial pneumonia This retrospective study was aimed to investigate influence on cifferent three approaches to the thorax as for postoperative acute e~acarbation of IP with lung cancer Patients and Methods: Between 1982 and 2004. 1180 patients underwent pulmonary resection for lung cancer at the Nippon Medical School hospital. Among them. fifty four patients had IP. The average ago was 71 years old (ranging from ,57-86) and the sex ratio was 42 to ,5. Among them. approaches to the thorax consisted of postorelatoral thoracotomy (n= 15). muscl~sparlng thoracotomy (n= 1,5). and video assisted thoraclo surgery (VATS) (n=24). Preoperative conditions, surgically related factors, and survival rate were evaluated The clagnosis of acute e0cacarbation of IP was based on the following oriteda. 1) intensified dyspnea. 2) increase in the inters~ial shadow on chest X-ray. 3) increase in fine crackling rales on auscultation. 4) elevation of serum lactate dchydmgenase (LDEI). 5) decrease in PaO2 of more than 10 mmHg under similar condition: all of 1). 2). 3) plus at least either of 4) or 5) are necessary for diagnosis Clinical outcome within 30 days postoperation was compared between patients with and without acute e~acerbation Statistical analyses wore camod out using the software package of Stat View 5.0. Results: Elderly and male patients with severe smoking index was dominant. Histopathologically. squamous cell ca~noma was dominant. Classification of IP consists of UIP 50 and NSIP. 3. Acute exacerbation of IP was not shown in 3 patients with NSII~ Seven of 54 suffered from acute e~acerbation of II~ Acute e~acerbation occurred at the 11th postoperative day on average (ranging 3-20 postoperative day). Even though, the significant difference of an incidence of aoute e~acerbation oflP was not ~und between three approaches. in the patients who underwent PLT there were 2 cases, in MST there were 4 and 1 in VATS Single vadable analysis suggested that e0certion dyspnea (Hegh-Jonos classification) t grade II (p < 0 01) . serum C-rea~ve protein (CRP) t2 0mg/dl (p 0 01). serum LDH t4001U//(p 0 01). and% total lung capacity (%TLC) 9,5% (p 0 01) was considered to be preoperative risk factors of acute e0cacerbation A higher incidence of severe postoperative complications ooourred in patients with acute e~acerbation of IP compared to those in patients without acute e~acarbation (p<0.01). As for the VATS patient, there was a little frequency of postoperative complicati on in comparison with two approaches. Hc~evor the significant difference was not shown on an incldence of acute exacerbation between the three approaches.
Bronchornyoplasty In lung cancer surgery E Levchenko A Trishin. V Shutev. M Cloel'~oy. A Rybas Regions/C,/inica/
Cancer Center, Stavropo/, Russia Background: to study the effectiveness of primary (PBMP) and secondary (SBMP) bmnchomyoplasty in prevention and tTeatment the bmnchopleural fistula (BPF) in lung cancer surgery Methods: From 1998 to 2004. surgical operation was performed in 48.2 NSCLC patients: Iohectomy - 179. bilohectomy - 28.. pneumonectomy - 275 Vioryl 3/0 was used for suture in interbmnchial (26) and tracheobronohial (31) anastomosis, in wedge rase~on of cadna (8.) and bronchus (21) Bronchial stump was closed by stapling devise (408). We stucled results of lung cancer surgery in 253 patients from 1998 to 2002 cenb-ol groqo (CG). From 2002 latissimus dorsl (43). serratus antonor (25) or intercostal muscle (2) flap was used for prevontwo purpose in patients with high rlsk of BPF in basic groqo (BG) (229 persons). Results: Postoperative complications in BG and CG were registered in 22.15% vs. 20.6% Co= 0609). 3(Tday mortal~ was 5.2% vs. 4.35% (p = 0.815) accordingly BPF was observed in 9(3 56%) patients in CG vs 7(3 1%) patients in BG (p 0959) Expected BPF was assumed in 6 of 7 cases (they underwent PBMP) All these patients were underwent conservative Izeatmont. Impormcabillty of tracheobrenchial anastomosis was reached to 2 nd. 3r~ and 7TM day Right main bronchial stump insufficiency was dosed to L~~ and 8TM day and 12TM week. Three patients were underwent rethoracotomy and SBMP immediately after discovery this complication (1 in BG and 2 in CG). Impermeabil~y in these cases was reached to 11 t~. 7t~ and 50th day accordingly. Empyema was observed in 2 patients with BPF alter PBMP and in 2 patients after SBMI~ Conclusions: PBMP is not doorease the rate ofBPF (p = 0.959). but It permit to liquidate this life threatening complication more faster (in 71.4% cases without ampyoma). SBMP at first hours after ciscovery BPF permit to reach good results. [P~
Modified rnusde sparing rnlnl-t~oracotorny as a standard
approach for rase=tlon of NSCLC C. Liu. Koo FozmCat/on Sun Yat~en C a n e r Center, China
Background: To report our experience in perfarming modified vertical mirtthoracotomy as a standard approach for NSCLC. Methods: From Feb 2000 to Sop 2064. total 153 patients (total 158 operations. bilateral in 2. sequential thoracotamy in 3) received surgical resection for their primary non small cell lung cancer in our hospital. Except for early 5 patients.
Posters t Surgery
gas was used from the beginning in 2 patients. The ponod of maintenance with SFG gas was ,5 to 6 months However. with the use of C~Fu gas. it was possible to mal~e the maintenance twice as long Besides. the amount of C3Fu gas needed was about half the amount of SFe gas Conclusions: Thus. the use of C~Fu gas made it possible to achieve longer maintenance with loss amount of gas as compared with SFe gas Therefore. as a gas for thoracic cavity volume control. C3F a gas was considered more effective than SFB gas
Temporary aorto-aortal by-pass during extended pneumonectomy J Klein. P Names. T Bchanos. M Szkorupa. D Horak University Hospital
Olornouc, Olornouc, Czech Republic Background: Involvement of the aortic arch or descending aorta is net unoommon for left sided tumors. Direct involvement of the aortic well is generally considered to be a contraindication of lung resection However. there are limited reports of full thiclmess resaotions of aorta in lung cancer surgery They may be accomplished as a partial resection using patch or as a total tubular r o s e , o n with reconstTuction by a graft To prevent spinal cord ischemia. the cardiepulmonary by~ass is usually recommended Method: The authors present a case report of full-ti'tckness resection of the descendent aorta during pneumonectomy for centrally located carcinoma A direct invasion to descendent aorta was confirmed dunng the procedure and the cardiopulmonary bypass has not been available at the moment. Alter tumor dissection, two aortal cannulas were inserted into the aorta, the first one into the aortic arch over the loft subclavian artery, the second one into the descendent aorta over the claphragm and then they were bypassed without any pump. The descendent aorta was oross~lamped by the outcome of the left subclavian artery and c~or the distal cannula. The invaded aortic tube was rosected and replaced by Dacron graft Result: No early complications were observed The patient has survived with no sign of relapse for twelve months alter the surgery Conduslon: In "1-4tumors with an involvement of the aorta, a surgical resection can be easily performed in highly selected cases even without any special equipment for cardiepulmonary by~ass
Conclusions: There was no current evidence that VATS was particularly effective in acute prevention oflP However. the incidence of aoute e~aoerbation of IP seamed to be minimal in VATS compared to that in PLT or MST. hence further investigation is required
[P~
surgical treatment of multiple lung cancer
K K urewski. B Andrzej. R W~eld. M Ewa. G Artur. L Robert. M Meja. J Jacek Medical University or Gdatlsk, Gdat~sk, Poland Objective: Multiple primary lung cancer (MPLC) is not an uncommon event and several authors report an incidence of 0 2 20% The purpose oftPds paper is to present our own e~perienca in the surgical tTeatment of MPLC Metedal and methods: Nineteen patients have been tTeated with surgical resection for MPLC between 1990 and 2000. with synchronous and metachronous MPLC. respectively. 18 males (95%) and 1 female (5%) in moan age of 57.2 years (43 to 71) have been included into the analysis. MaITInl and Melamed's cnterla for diagnosis were applied: different histology (n = 9); or the same histology, but disease flee interval of at least 2 years (n = 10). or origin from carOnoma in s~u. All patients were staged accorclng to the now Intemational Classlficahon System revised in 1997 by Mountain. The first resection was: Ioboctomy in 15 patients (80%). a bilobectomy in 2 (10%). a segmentectomy in 1 (5%) and wedge resection in 1 (5%) The second operation was: Iobectomy in 7 patients (37%). a segmentaotomy in 4 (21%). wedge resection in 7 (37%) and completion pneumonectomy in 1 (5%) There were 12 (64%) squamous cell carcinomas. 5 (26%) adencoarcinomas and 2 (10%) other tumour types Results The mean interval between the rrst and the second operation was 64 g months (23 to 148 months) There was no penoperatlve mortality Four patients (21%) had postoperative corn plications. The 5year survival of patients with metachronous turnours undergoing standard surgical procedures was 20% Conclusion: Surgical treatment of multiple squamous cell caranoma is justified and limited operation using brenchoplastic techniques provides satisfactory results. Careful Ibllow up is rooommended in all patients Ibllowlng curative pulmonary resection to allow for early detection of a subsequent cancer at a curable stage
P[P-892~Surgical treatment of lung cancer combined wRh Interstitial
pneumonia -especially on surgical approach and postoperative acute exacerbation K Koizumi. T Hirata. K Hiraj. S Yamagishi. D Okada. T Kawasi'tma. H. Kinosilta. Y. Enometo. Y. Naka]ima. K. Shimr,,o. Nippon MeCtcal School,
Tokyo, Japan Barkground: Postoperative acute exacerbation of inters~ial pneumonia (IP) is Imown to be serious complication in the surgical treatment far primary lung cancer combined with interstitial pneumonia This retrospective study was aimed to investigate influence on cifferent three approaches to the thorax as for postoperative acute e~acarbation of IP with lung cancer Patients and Methods: Between 1982 and 2004. 1180 patients underwent pulmonary resection for lung cancer at the Nippon Medical School hospital. Among them. fifty four patients had IP. The average ago was 71 years old (ranging from ,57-86) and the sex ratio was 42 to ,5. Among them. approaches to the thorax consisted of postorelatoral thoracotomy (n= 15). muscl~sparlng thoracotomy (n= 1,5). and video assisted thoraclo surgery (VATS) (n=24). Preoperative conditions, surgically related factors, and survival rate were evaluated The clagnosis of acute e0cacarbation of IP was based on the following oriteda. 1) intensified dyspnea. 2) increase in the inters~ial shadow on chest X-ray. 3) increase in fine crackling rales on auscultation. 4) elevation of serum lactate dchydmgenase (LDEI). 5) decrease in PaO2 of more than 10 mmHg under similar condition: all of 1). 2). 3) plus at least either of 4) or 5) are necessary for diagnosis Clinical outcome within 30 days postoperation was compared between patients with and without acute e~acerbation Statistical analyses wore camod out using the software package of Stat View 5.0. Results: Elderly and male patients with severe smoking index was dominant. Histopathologically. squamous cell ca~noma was dominant. Classification of IP consists of UIP 50 and NSIP. 3. Acute exacerbation of IP was not shown in 3 patients with NSII~ Seven of 54 suffered from acute e~acerbation of II~ Acute e~acerbation occurred at the 11th postoperative day on average (ranging 3-20 postoperative day). Even though, the significant difference of an incidence of aoute e~acerbation oflP was not ~und between three approaches. in the patients who underwent PLT there were 2 cases, in MST there were 4 and 1 in VATS Single vadable analysis suggested that e0certion dyspnea (Hegh-Jonos classification) t grade II (p < 0 01) . serum C-rea~ve protein (CRP) t2 0mg/dl (p 0 01). serum LDH t4001U//(p 0 01). and% total lung capacity (%TLC) 9,5% (p 0 01) was considered to be preoperative risk factors of acute e0cacerbation A higher incidence of severe postoperative complications ooourred in patients with acute e~acerbation of IP compared to those in patients without acute e~acarbation (p<0.01). As for the VATS patient, there was a little frequency of postoperative complicati on in comparison with two approaches. Hc~evor the significant difference was not shown on an incldence of acute exacerbation between the three approaches.
Bronchornyoplasty In lung cancer surgery E Levchenko A Trishin. V Shutev. M Cloel'~oy. A Rybas Regions/C,/inica/
Cancer Center, Stavropo/, Russia Background: to study the effectiveness of primary (PBMP) and secondary (SBMP) bmnchomyoplasty in prevention and tTeatment the bmnchopleural fistula (BPF) in lung cancer surgery Methods: From 1998 to 2004. surgical operation was performed in 48.2 NSCLC patients: Iohectomy - 179. bilohectomy - 28.. pneumonectomy - 275 Vioryl 3/0 was used for suture in interbmnchial (26) and tracheobronohial (31) anastomosis, in wedge rase~on of cadna (8.) and bronchus (21) Bronchial stump was closed by stapling devise (408). We stucled results of lung cancer surgery in 253 patients from 1998 to 2002 cenb-ol groqo (CG). From 2002 latissimus dorsl (43). serratus antonor (25) or intercostal muscle (2) flap was used for prevontwo purpose in patients with high rlsk of BPF in basic groqo (BG) (229 persons). Results: Postoperative complications in BG and CG were registered in 22.15% vs. 20.6% Co= 0609). 3(Tday mortal~ was 5.2% vs. 4.35% (p = 0.815) accordingly BPF was observed in 9(3 56%) patients in CG vs 7(3 1%) patients in BG (p 0959) Expected BPF was assumed in 6 of 7 cases (they underwent PBMP) All these patients were underwent conservative Izeatmont. Impormcabillty of tracheobrenchial anastomosis was reached to 2 nd. 3r~ and 7TM day Right main bronchial stump insufficiency was dosed to L~~ and 8TM day and 12TM week. Three patients were underwent rethoracotomy and SBMP immediately after discovery this complication (1 in BG and 2 in CG). Impermeabil~y in these cases was reached to 11 t~. 7t~ and 50th day accordingly. Empyema was observed in 2 patients with BPF alter PBMP and in 2 patients after SBMI~ Conclusions: PBMP is not doorease the rate ofBPF (p = 0.959). but It permit to liquidate this life threatening complication more faster (in 71.4% cases without ampyoma). SBMP at first hours after ciscovery BPF permit to reach good results. [P~
Modified rnusde sparing rnlnl-t~oracotorny as a standard
approach for rase=tlon of NSCLC C. Liu. Koo FozmCat/on Sun Yat~en C a n e r Center, China
Background: To report our experience in perfarming modified vertical mirtthoracotomy as a standard approach for NSCLC. Methods: From Feb 2000 to Sop 2064. total 153 patients (total 158 operations. bilateral in 2. sequential thoracotamy in 3) received surgical resection for their primary non small cell lung cancer in our hospital. Except for early 5 patients.