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409 Surgery for N.S.C.L.C. in a defined Italian geographical area: Five and ten years survival
Therapy - Combined Modality
106
neoadjuvant chemotherapy (DINC) for tracheobronchoplasty (Plasty) in advanced or intractable lung cancer. Patients and Methods: Induction chemotherapy was performed in 80 patients with MVP and G-CSF from Nov. 1989 to Dec. 1996. Twenty-six of the patients underwent DING before Plasty. Eight patients dropped out from DING entity because of adverse effects or disease progression after first chemotherapy. The age of remaining 18 cases was from 44 to 76 years. There were 12 males and 6 females. Fifteen patients had non small cell lung cancer (NSCLC) and 3 had small cell lung cancer (SCLC). Definition of DING was as follows: the regimen consisted of CDDP 80 mg/m2, VDS 3 mg/me, MMC 8 mg/m2 and with or without G-CSF; and chemotherapy was performed in at least 2 cycles with intervals of less than 3 weeks, Indication criteria for DING were as follows: stage llla or far advanced disease in 15 patients, synchronous double primary disease in 2, low pulmonary function in 4 and/or SCLC in 3 cases. Results: Nine patients had complete or partial tumor remission (50.0%) on image and pathological examination, Ten had withdrawal of cancer as seen on bronchofiberscopy just before operation (55.6%) and 6 of these showed histological disappearance at the same level on resected sample (33.3%). Four patients had sleeve or wedge pneumonectomy, 13 had sleeve or wedge lobectomy and remaining 1 had sleeve lobectomy combined with wedge segmentectomy. Fifteen patients were free of cancer at surgical margines (83.3%) 2 had residual cancer on tracheobronchial stump, and 1 had residual cancer on chest wall. Two patients died within 30 days after operation (11 .l%) and 3 had anastomotic complications relating to Plasty (16.6%). The actuarial survival rate at 5 years after Plasty was 46.6%. The survival rate for NSCLC was 49.6%. The survival rate for SCLC was not evaluable because of small numbers, but one patient with T4N3 is cancer free after 6 years. Conclusions: DING is effective for cancer regression of tracheobronchial tree and for enhancement of resectability by Plasty. The resection range of airway by Plasty should depend on the primary cancer location of the tracheobronchial tree.
I
409
F. Santobuono,
A. Buonsanto.
I 411
Graft insertion technique: A new simple procedure of SVC reconstruction for SVC invasive T4 lung cancer resection
K. Mitsui, M. Onizuka, S. Ishikawa, Y. Inage, K. Mase, Y. Minami, E. Akaogi, T. Mitsui, T. Ogata. Univ. of Tsukuba, Japan Procedure: A PTFE ring graft of the wall or the stump of the This procedure was used lung cancer invaded to SVC. thrombus was observed in 3
is inserted into SVC lumen through incision vein, and fixed with silk knot outside. for resection of 7 patients with advanced Postoperatively, occlusion of the graft with patients, but this operative technique is a
Surgical cancer
K. Kawahara, Japan
management
T. Shiraishi,
of small
K. Okabayashi,
peripheral
T. Shirakusa.
type
lung
Univ. of Fukuoka,
Between January 1984 and August 1996, 117 patients with small peripheral type lung cancer (less than 2.0 cm in diameter) underwent surgical resection. Six (5.0%) of the patients had a tumor less than 1 .O cm in diameter. There were 70 males and 47 females and 22 (18.0%) were aged 60 or less, 53 (45.3%) were in the six decadesand 42 (35.9%) were 70 or more. Histologic type of cancer was squamous cell carcinoma in 21 (17.9%) patients adenocarcinoma in 80 (68.4%), small cell carcinoma in 7 (6.0%) large cell carcinoma in 3 (2.6%) adenosquamous cell carcinoma in 2 (1.7%) and sarcoma in one. Lymph node metastasis was confirmed histologically in 36 (30.6%) patients, while 81 (69.2%) patients were node negative. TNM stages were stage I in 79 patients (67.5%) stage II in 2 (6.0%), stage IIIA in 26 (22.2%), stage IIIB in one (0.97%) and stage IV in 4 (3.4%). The surgical procedures were pneumonectomy in 4 (3.4%) patients, lobectomy in 14 (12.0%). segmentectomy in 5 (4.3%) and partial wedge resection in 14 (12.0%). Thoracoscopic approach was performed in 34 (29.1%) patients. Mediastinal dissection was performed in 97 (94.8%) patients with pneumonectomy or lobectomy. None of the patients underwent preoperative chemotherapy or radiotherapy. Postoperative chemotherapy consisting of CDDP, VP-16 or VDS was performed in 14 of the 36 patients (38.9%) with node positive disease. Eleven (14.3%) of the 77 patients with node negative stage I non-small cell lung cancer were orally administered 5-FU or UFT postoperatively. There were no surgical deaths within 30 days after surgery. The 3- and 5-year survival rates were 73% and 69% in patients with stage I disease, 60% and 55% in stage II, and 40% and 26% in stage IIIA. There were no patients with stage IIIB or IV disease surviving for more than 3 years. Histologic types of cancer measuring 1 cm or less in diameter were adenocarcinoma in 5 (83.3%) patients and squamous cell carcinoma in 1 (16.7%). Three patients underwent lobectomy with mediastinal dissection and 3, partial resection. There were no regional node metastasis in any of the patients. One patient died from coronary heart disease 28 months after surgery, while five patients are alive and free from disease between 6 and 116 months after surgery. Surgical resection should be chosen first of all in patients with stage I or II lung cancer. In most of the patients with small peripheral type lung cancer, radical resection can be accomplished. Especially, in tumor measuring 1 cm or less in diameter, lymph node metastasis is unlikely, so even partial resection without mediastinal dissection is feasible as a curative treatment.
Dept. of Surgery,
Our department is located in central Italy, near the east coast, and patients referring come from southern adriatic regions, which are mainly agricultural. Up to december 1996 1403 patients, selected from a total of 3596 observed cases, underwent surgery for lung cancer: 1070 N.S.C.L.C. and 59 S.C.L.C. were resected. There were 318 pneumonectomies and 885 lobectomies and minor resections; the number of explorations was 30 per cent before 1981, 21 per cent from 1982 to 1986, 7 per cent from 1987 to 1990 and less than 3 per cent from 1991. Mortality rate was 5.9 per cent; 11 patients were lost to follow-up. Long-term survival was considered for N.S.C.L.C. operated upon within 1986 and 1991. More than 67 per cent of those with Tl NO disease fared well after 5 years; the figure was 47 per cent after 10 years. Survival with T2 NO disease was respectively 50 and 26 per cent; T3 NO patients survived to 5 years in 30 per cent of cases, but after 10 years only 16 per cent of them survived. A high percentage of the late deaths (around 50 per cent) was related to the development of metastases. Local recurrences were not frequent; a second primary carcinoma was observed in twenty cases and the new resections were 12. The late results of surgical therapy could improve in coming years, due to the increasing number of patients prepared by neoadjuvant therapy.
I 410
simple and useful procedure for SVC reconstruction in extended resection of SVC invasive T4 lung cancer patients. To get longer survivors, extended operation for SVC invasive T4 lung cancer, should be restricted to the patients with squamous cell carcinoma, NO-1 disease, and no other T4 disease.
Surgery for N.S.C.L.C. in a defined Italian geographical area: Five and ten years survival
V. Beltrami, E. Mascitelli, Unit! of Chieti, /ta/y
Therapy
I
412 t
Analysis grouping
of survival classification
according of lung
to the new cancer
1997
stage
R. Rami-Porta. Bronchogenic Carcinoma Cooperative Group of the Spanish Society of Pneumology and Thoracic Surgery; Section of Thoracic Surgery Hospital Mutua de Terrassa, Tertassa, Barcelona, Spain Objective: To validate the prognostic value of the new 1997 stage grouping classification of lung cancer. Material and Method: From Oct’93 to Sept’96, the Bronchogenic Carcinoma Cooperative Group of the Spanish Society of Pneumology and Thoracic Surgery has prospectively collected, in a homogeneous way (Arch Bronconeumol 1995; 31: 303-309) epidemiological, clinical, biological, clinical and pathological staging, and follow-up data on over 2.000 consecutive patients who underwent thoracotomy for bronchogenic carcinoma in 20 Spanish hospitals. This survival analysis is based on the 728 patients registered in the first year of the study (Oct’93-Sep’94). Patients with operative, 30-day mortality (53) or lost to follow-up (29) were excluded. Follow-up information between 12 and 24 months after surgery was available for the remaining 646 patients.
106
neoadjuvant chemotherapy (DINC) for tracheobronchoplasty (Plasty) in advanced or intractable lung cancer. Patients and Methods: Induction chemotherapy was performed in 80 patients with MVP and G-CSF from Nov. 1989 to Dec. 1996. Twenty-six of the patients underwent DING before Plasty. Eight patients dropped out from DING entity because of adverse effects or disease progression after first chemotherapy. The age of remaining 18 cases was from 44 to 76 years. There were 12 males and 6 females. Fifteen patients had non small cell lung cancer (NSCLC) and 3 had small cell lung cancer (SCLC). Definition of DING was as follows: the regimen consisted of CDDP 80 mg/m2, VDS 3 mg/me, MMC 8 mg/m2 and with or without G-CSF; and chemotherapy was performed in at least 2 cycles with intervals of less than 3 weeks, Indication criteria for DING were as follows: stage llla or far advanced disease in 15 patients, synchronous double primary disease in 2, low pulmonary function in 4 and/or SCLC in 3 cases. Results: Nine patients had complete or partial tumor remission (50.0%) on image and pathological examination, Ten had withdrawal of cancer as seen on bronchofiberscopy just before operation (55.6%) and 6 of these showed histological disappearance at the same level on resected sample (33.3%). Four patients had sleeve or wedge pneumonectomy, 13 had sleeve or wedge lobectomy and remaining 1 had sleeve lobectomy combined with wedge segmentectomy. Fifteen patients were free of cancer at surgical margines (83.3%) 2 had residual cancer on tracheobronchial stump, and 1 had residual cancer on chest wall. Two patients died within 30 days after operation (11 .l%) and 3 had anastomotic complications relating to Plasty (16.6%). The actuarial survival rate at 5 years after Plasty was 46.6%. The survival rate for NSCLC was 49.6%. The survival rate for SCLC was not evaluable because of small numbers, but one patient with T4N3 is cancer free after 6 years. Conclusions: DING is effective for cancer regression of tracheobronchial tree and for enhancement of resectability by Plasty. The resection range of airway by Plasty should depend on the primary cancer location of the tracheobronchial tree.
I
409
F. Santobuono,
A. Buonsanto.
I 411
Graft insertion technique: A new simple procedure of SVC reconstruction for SVC invasive T4 lung cancer resection
K. Mitsui, M. Onizuka, S. Ishikawa, Y. Inage, K. Mase, Y. Minami, E. Akaogi, T. Mitsui, T. Ogata. Univ. of Tsukuba, Japan Procedure: A PTFE ring graft of the wall or the stump of the This procedure was used lung cancer invaded to SVC. thrombus was observed in 3
is inserted into SVC lumen through incision vein, and fixed with silk knot outside. for resection of 7 patients with advanced Postoperatively, occlusion of the graft with patients, but this operative technique is a
Surgical cancer
K. Kawahara, Japan
management
T. Shiraishi,
of small
K. Okabayashi,
peripheral
T. Shirakusa.
type
lung
Univ. of Fukuoka,
Between January 1984 and August 1996, 117 patients with small peripheral type lung cancer (less than 2.0 cm in diameter) underwent surgical resection. Six (5.0%) of the patients had a tumor less than 1 .O cm in diameter. There were 70 males and 47 females and 22 (18.0%) were aged 60 or less, 53 (45.3%) were in the six decadesand 42 (35.9%) were 70 or more. Histologic type of cancer was squamous cell carcinoma in 21 (17.9%) patients adenocarcinoma in 80 (68.4%), small cell carcinoma in 7 (6.0%) large cell carcinoma in 3 (2.6%) adenosquamous cell carcinoma in 2 (1.7%) and sarcoma in one. Lymph node metastasis was confirmed histologically in 36 (30.6%) patients, while 81 (69.2%) patients were node negative. TNM stages were stage I in 79 patients (67.5%) stage II in 2 (6.0%), stage IIIA in 26 (22.2%), stage IIIB in one (0.97%) and stage IV in 4 (3.4%). The surgical procedures were pneumonectomy in 4 (3.4%) patients, lobectomy in 14 (12.0%). segmentectomy in 5 (4.3%) and partial wedge resection in 14 (12.0%). Thoracoscopic approach was performed in 34 (29.1%) patients. Mediastinal dissection was performed in 97 (94.8%) patients with pneumonectomy or lobectomy. None of the patients underwent preoperative chemotherapy or radiotherapy. Postoperative chemotherapy consisting of CDDP, VP-16 or VDS was performed in 14 of the 36 patients (38.9%) with node positive disease. Eleven (14.3%) of the 77 patients with node negative stage I non-small cell lung cancer were orally administered 5-FU or UFT postoperatively. There were no surgical deaths within 30 days after surgery. The 3- and 5-year survival rates were 73% and 69% in patients with stage I disease, 60% and 55% in stage II, and 40% and 26% in stage IIIA. There were no patients with stage IIIB or IV disease surviving for more than 3 years. Histologic types of cancer measuring 1 cm or less in diameter were adenocarcinoma in 5 (83.3%) patients and squamous cell carcinoma in 1 (16.7%). Three patients underwent lobectomy with mediastinal dissection and 3, partial resection. There were no regional node metastasis in any of the patients. One patient died from coronary heart disease 28 months after surgery, while five patients are alive and free from disease between 6 and 116 months after surgery. Surgical resection should be chosen first of all in patients with stage I or II lung cancer. In most of the patients with small peripheral type lung cancer, radical resection can be accomplished. Especially, in tumor measuring 1 cm or less in diameter, lymph node metastasis is unlikely, so even partial resection without mediastinal dissection is feasible as a curative treatment.
Dept. of Surgery,
Our department is located in central Italy, near the east coast, and patients referring come from southern adriatic regions, which are mainly agricultural. Up to december 1996 1403 patients, selected from a total of 3596 observed cases, underwent surgery for lung cancer: 1070 N.S.C.L.C. and 59 S.C.L.C. were resected. There were 318 pneumonectomies and 885 lobectomies and minor resections; the number of explorations was 30 per cent before 1981, 21 per cent from 1982 to 1986, 7 per cent from 1987 to 1990 and less than 3 per cent from 1991. Mortality rate was 5.9 per cent; 11 patients were lost to follow-up. Long-term survival was considered for N.S.C.L.C. operated upon within 1986 and 1991. More than 67 per cent of those with Tl NO disease fared well after 5 years; the figure was 47 per cent after 10 years. Survival with T2 NO disease was respectively 50 and 26 per cent; T3 NO patients survived to 5 years in 30 per cent of cases, but after 10 years only 16 per cent of them survived. A high percentage of the late deaths (around 50 per cent) was related to the development of metastases. Local recurrences were not frequent; a second primary carcinoma was observed in twenty cases and the new resections were 12. The late results of surgical therapy could improve in coming years, due to the increasing number of patients prepared by neoadjuvant therapy.
I 410
simple and useful procedure for SVC reconstruction in extended resection of SVC invasive T4 lung cancer patients. To get longer survivors, extended operation for SVC invasive T4 lung cancer, should be restricted to the patients with squamous cell carcinoma, NO-1 disease, and no other T4 disease.
Surgery for N.S.C.L.C. in a defined Italian geographical area: Five and ten years survival
V. Beltrami, E. Mascitelli, Unit! of Chieti, /ta/y
Therapy
I
412 t
Analysis grouping
of survival classification
according of lung
to the new cancer
1997
stage
R. Rami-Porta. Bronchogenic Carcinoma Cooperative Group of the Spanish Society of Pneumology and Thoracic Surgery; Section of Thoracic Surgery Hospital Mutua de Terrassa, Tertassa, Barcelona, Spain Objective: To validate the prognostic value of the new 1997 stage grouping classification of lung cancer. Material and Method: From Oct’93 to Sept’96, the Bronchogenic Carcinoma Cooperative Group of the Spanish Society of Pneumology and Thoracic Surgery has prospectively collected, in a homogeneous way (Arch Bronconeumol 1995; 31: 303-309) epidemiological, clinical, biological, clinical and pathological staging, and follow-up data on over 2.000 consecutive patients who underwent thoracotomy for bronchogenic carcinoma in 20 Spanish hospitals. This survival analysis is based on the 728 patients registered in the first year of the study (Oct’93-Sep’94). Patients with operative, 30-day mortality (53) or lost to follow-up (29) were excluded. Follow-up information between 12 and 24 months after surgery was available for the remaining 646 patients.