Stent implantation in poststenotic retention pneumonia due to inoperable bronchial carcinoma

140 Ammu~ H, Nmke T, Tsuchiya R, Goye T, Kcmdo H, Suemesu K. Divirion of ?lwracic Surgmy, National &nar Center H#NI. S-I-I Tsmktji, clkuo-ku. To&olO4. JTbomccudiov~~Surg 1992;104: 145664. Dtige28-yearperiod, 52 bm&opleunl fistuksdeveloped nfterpulmoolry~anof49primryMdthreeItEUrrClltlUDg~ attbcNatirmlcIocarccaterHaspital,Tokyo.~rbe~prial there wea? 2359 pukmamy reeectione for primary lung aear; the pnvJance0~macbopburslfirtulswP2.1Ib.MvltiwiDtesDnlysisoo 15 variables in the most rexeN 1360 resections revealed signilicant risk factors for bronchopleunl fistula: wider resection such a.s pneumonecNmy. raiduai avcitm~tot~ tinsue at the bmncbial eNmp, preope&ve irradiation, and diebe&. Univarkte analysis tiuiber t’ecogmiizd P risk in pteapentive bmttcbiel arterial infusion and the ~oetsurgial stage of lung cancer. Six patients were not treated. Apart fromche-sttubediainageinmvmPdkate,argicalrqeirweseuempted in 39, direct teeutureof the stump in 16, WRppiag in 23, thoncopleay in 3 1, compk.tion pneumonectomy in 6, nnd other treatmeats. Despite vprious treatmats. 37 p&ate (71.2% mortality) died fmm f&dar&ted anplicatious (such es re@rgiNtion of infected pleural fluid throuOhthefishrle~d~y/~ncicbl~iog).Eveaforprtients whose fisNla.s were cured and who were discbarged, the aveNge hospital stay was 169days. Ftuiherittvcstigatian isnecesssry to answer wbetber pNveution by Rep cave&e is of any benefit. Second primary lung m after bronchial sleeve cpssti~t: Treatment and results in eleven patienk Van Schil PEY, De la Rivkre AB, Kneepen PJ, Van Swieten HA, Defauw JJ, Van dea Bosch JMM. Gerard VanLaethtmlaan3, B-2650 E&gem. J Thorns Cardiovasc Surg 1992;104:1451-5. Duringtheyeatx1%0&1989,145patientstmderwentsleeve lohectomy or sleeve resection of a meim bmnchus. Follow-up WLS completeenfeptforoaepnti~t,w&w~wlongerevil~leforfollowup4yearssfteropention. Ekwapltien(s(7,6%)hPdesecoadprirrmry cancer in the lung; 10 of thea patimts (90.9%) were men. Mean ageat sleeve operntion was 61.2 * 11.6 year& Mean inte~al be&veea sleeve operetion and developmeat of second primary CPDCBT wee 53.8 months (range. 6 to 197 months). All second primary cancers occuned cm the contrakternl side. In five cases there was squamous cell carcioome, in mocarcieoma. in one there was adenosquamous twotberewasad c~i~rns,intwothete-snnllccllcsn~orm,nndinooe~ent~ definitehistologic typecould beestablished. Fivepatients bad different histologic type from the initial, resected primary Nna. Seven pieats (64%) wereopented on: five uulenveat lobectomy nod two underwent segmentectomy. lnonepatieat theNmorwesjudgedtobeeuareseetsble. Chemotherapy wee given to the two P&us with smell cell carcinoma andradiotherapywasgiventoonepatientwithbonemekstas@. Followup was complete for these II patients. Date were calculated from detection of second primary cancer. There was one postoperative death from myocardixl mf&tion. Eight other patientsdiedduring follow-up: five died of recumnt tumor or mstssllses, two diedof acutecardiac failure, and one died of a perforated ulcer. ‘Ibe I- end 4-y-r actuarial survivals were 41% and 3046, respectively. For the patients operated on, I- and 4-y= survivals were 57% end 43R, respectively. There were no survivors at 5 years. Sleeve resection is e valuable me&xl of preserving functional lung tissue. It offers P cbanca of subsequent resection in patients who have stxood primary cancer, with acceptable resldts.

Locally advanced lung cancsr (stage Ilk, IUb) in which the primary tumor is proximal (T3) or has invaded adjecat struchrrs (T3) or 0’0~“s (T4) or in which medrastinal lymph nodea are involved (N2. N3) woreuu the progo& significantly. However:ia eta@ Ilk (T.3or N2), when surgical bxwtmeat results Lo total renmwal of the p_rY ~mor end involved lymph nodes, them still is P masoneblle chance for

Abstracts/Lung

Cancer

IO (1993)

123-150

UltimaN cut& Go the other band, total excision CM be very rarely ~~iaT4~N3tuwns.Thaefas,this~(~ge~)ususlly indicatmIrarescotabtity.DiitedllmgcPaosrwitbdieteN~ (@age IV) is still cwsiderw ‘to be incurable. Neverthekes, solid met~tatic sitea (Ml) eapecielly brain, have been -011 ocsosion by resec(iott of the printuy tumor and maoval of the solitary meulNas. ibis w to impmw nwdiiet eutvivel end doss yield S-year suvivel issl~potioara.Tbsrrsulbafterangiul~tin~pPtients with higher stage lung repot&l over the IaEt 10 years are reviti. Meld stunts ia the atlascop& trenhnent of malignant bron&ial tImNuN SchmitzE,H~~T,BobndwfK,OuntberRW.~P.Malirinirahc Klinik I, KrmkenhausBahmia. Buhaeienw. 21, W-Ul3OMoen 1. Dtscb Med Wochemchr1992;117:1663-8. sdf-expandiig mete1 statswe* implanted in the tmchee or main bnmchus in 12 patients (ekVe#l men, one women; uwan age 60 i. 8 years) with ntable bmnchiel cucinome (n = II) or tmcheal metasksis of P hypenwphroma (II = 1). They al1 bad pulmonary compliwtioa caused by tumcur stewsa (group I: aovere dyspaoea [II -61, gmupll: re&NionpnwmotiIn = 4]orltmgabxese[n = 21&r ensucceaful~dibiotictreatacat). ne procedure was umlerkkea after local pnsaflhesia with P flexible broncbaqe (in the 6nt three erses still with e rigid brcw&xqe lm&rgenemlaaaesthcljB)~ fluoroscqic control. Immediate reduction in dyspnoea occurred in five of the six patienk in group I. IO five of the six patients in gmup U antibiotics cured the infection atlea slat pIpcement. The tbempeutic effectwolimtnedinNescvercdyspDoeosDd~~tionofsecNetions.Tbe clinical improvementlasted longer inpatientswitbabsceasand rstention pneumonia than those with dyspnoea (41 f 16 vs. 26 * IO days). - If strict indications ere olwewed in cases with malignant bmnchitd sten~s,implratati~ofselfixpandingsteatspmvidesrapidlyeffsctive, well-NINeted palliatioo. hdicafion for stqery in small41 ca&xm~ oftbelung Kaiser D, Fritz&e A, Matthiareo W. Abteiirrng Tboratchirurgie, Lungenklinik Heckshorn, Kndmhaur i!d~lmdolf. Zum Heckmhom 33, D-I&W Berlin 39. Tl~orac Crudiovasc Surg 1992;40:185-9. While the development of cbemothempeutic agents bas lead to progluw in the treatment of small-cell carcinomas of the llmg, the number of local recuxaces still remains high. Surgery in tumors stage 1 md U followed by postqemtive chemotbempy is the treatment of choice and bas been accepted worldwide. la tumors stageiIIa, apeaally in Tl-3 N2 we ohtaieed good resultsin tbe projected 3-year survival using P multimodality thenpeutic regime consisting of neoadjuvrat cbemotb~py(3cyclespreopmtive)andsurgeryns~llaspostope~tive chemotbenpy and irradiation of the mediastinum. Projected 3-year survival wps 67% io stage 1 Nmrs, 42% in stage U and with our multimodality thempeutlc regime 38% UI stage Ilk Nmors. Stent lmplantatiw in paststem& retention pneumonia due to impersbkbmwhial uucinoma Issperseo D. HammarC-H, Watek J. MditiUdzeKiinikIl, SmdtiischrJ KlinlkwnFuCia, 6.

PanUiaNac4-6,64aDFul&z

F’neumob~e 1592;46:484-

old patient referred to in thisreport hrsbeen squemoes cell cnrcinoma of the ri.&t superior lobe of the lung for the lmt two years. AtIer therapeutic irradiation the disease subsided tempamrily. Subsque~Uly the patient became severely ill and was refined to hospital with high fever and of the right refractory pneumonl‘8. X-my film revealed atela&s superior and central lobeg and e pneumonic intiltmtion of the right inferior lobe. Bronchoscopy &owed complete Nmour stenoses of the superior plld central lobes. The lower lobe of the lung was visualised as subtotally stenosed and obstructal by pus. Despite pathogen-directed antibiosis the poststeuotlc mtentlon pneumonia did not heal. Atier laser recanalisetioo of the rightinferior lobe we implanted en eodobrmcbial stent.Sub~~tly,~epneumcmiilnesdzd~theprtientsurvivedfor five months relrtively free from mmplaiets. The 65 year

suffering fromaminoperable