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420 Upper thoracic scoliosis and the transverse process: A Clinico-pathological observation
109
Therapy - Combined Modality Therapy lobectomy - for 23.1%, after pneumonectomy - 10%. For surgically treated patients with adenocarcinoma 12 months survival after lobectomy - O%, after pneumonectomy - 100%. 24 months survival after pneumonectomy - 25%. Conclusions: Adjuvant therapy for operated patients with squamous cell carcinoma and adenocarcinoma in the clinical stadium of Tl-3 N2 MO is not always possible and further investigations and analysis should be carried out about the use of it in separate clinical groups. In cases when the complex therapy was possible, the results could be evaluated as satisfactory.
I420
Upper thoracic scoliosis and the transverse A Clinico-pathological observation
C. Natali, P. Cole, G. Askin. Australia
Princess
Alexandra
Hospital,
process:
Brisbane,
Study Design: Retrospective review of notes and radiographs of 16 patients undergoing en-bloc resection of pancoast tumour.. Objectives: To review the incidence of post-operative scoliosis, and the effect of the anatomical structures resected during surgery. Summary and Background Data: We observed the rapid onset of high thoracic scoliosis following en-bloc resection of pancoast tumour. However the magnitude of the scoliosis varied. We reviewed these patients to see whether there were any predictors for the subsequent development of scoliosis. Methods: Sixteen patients undergoing en-bloc resection for pancoast tumour were reviewed. The patients all had en-bloc tumour resection, but the number of upper ribs and transverse processes resected varied. The patient notes, operating records, pathology results and radiographs were reviewed. Results: Four patients (25%) had significant resection of the transverse processes of Tl to T3. All of these patients developed scoliosis of rapid onset, convex to the side of the resection. Of the remaining 12 patients either no scoliosis developed, (6 of 12) or scoliosis of less than 12 degrees, all cases convex to the side of the lesion.. These differences were statistically significant. In addition resection including the first rib was associated with a greater cobb angle. Conclusions: Our study suggests that preservation of the upper thoracic transverse processes protects against subsequent development of iatrogenic scoliosis. Removal of the first rib was also more likely to be associated with the development of scoliosis. This is discussed further.
I421 J. Jerman, Sloven/a
Is serum cholesterol cancer patients?
a prognostic
M. Sok. Dept. of Thor. Surg.,
factor in lung
Univ. Med. Center
Ljubljana,
In recent years some epidemiological and experimental studies confirm that serum lipoproteins especially serum cholesterol might have important role in cancer. The lower level of serum cholesterol at the time of cancer diagnosis was found in many studies, A term ‘tumor-associated hypocholesterolemia” (TAHC) was proposed and many authors believe this is a metabolic consequence of cancer. The negative relationship between serum cholesterol and death by cancer was also found in some series. Theaim of this retrospective study is to investigate the possible influence of pretreatment serum cholesterol (mean cholesterol = 5.027 mmol/l, SE = 0.0043) in patients with NSC lung cancer (n = 216; age 35-80; male = 178, female = 38) on survival after RO lung resection (stage I = 101, stage II = 35, stage81 = 71, stage IV = 9). Positive correlation was found between serum cholesterol level and two years postoperative survival (p = 0.019) for all patients. The same positive correlation was found when patients were divided in two different groups regarding stage (stage I and II - p = 0.024; stage III and IV-p = 0.284). This study shows, that patients with higher preoperative serum cholesterol level have longer survival. Pretreatment serum cholesterol might be important prognostic factor for operable lung cancer stage I and II.
Tuesday, 12 August 1997 POSTER
SESSION
Surgery I 422
The diagnosis with video-assisted thoracoscopy toward the indeterminate solitary pulmonary nodule
Masahide Murasugi, Takamasa Ohnuki, Masahiro Mae, Yasuyuki Sone, Sumio Nitta. Department of Surgery I, Tokyo Women’s Medical College, Tokyo, Japan From September 1992 to December 1996, 292 patients were performed video-assisted thoracoscopic surgery (VATS) in our department. We used VATS diagnosis for purpose of solitary pulmonary nodule. 80 cases were removed in these, there were 39 male and 41 female patients in this group. The age was from 23 to 83 years old (mean 59.1 years old). The size of nodule was 0.8 - 20 mm (73%). 77 wedge resections which contains a nodule and 3 needle biopsy were performed. An access thoracotomy had to be performed in 14 patients. 49 nodules were diagnosis as lung cancer (61%), there were 33 primaly lung cancer and 16 metastatic lung cancer (26 adenocarcinoma, 4 large cell carcinoma, 2 squamouscell carcinoma). Additionally 23 lobectomy by standard thracotomy were performed for treatment. Video-assisted thoracoscopy is an extremely useful procedure for the diagnosis and the treatment of the indeterminate solitary pulmonary nodule.
423
El
Surgical treatment of patients with lung cancer and cardiopulmonary disorder
S. Nitta. T. Ohnuki, J. Kei, Y. Sone, M. Murasugi, Women’s Medical College, Tokyo
H. Kaneyasu.
Tokyo
Surgical treatment for patients with lung cancer (LC) and ischemic heart diseases (IHD) is controversial. We applied forced expiratory volume one second more than 800 ml/m’, or total pulmonary vascular resistance index of contra-lateral lung less than 800 dyne see-s cm m2, to clear patients with LC and cardiopulmonary disorder for lung resection, resulting in perioperative mortality less than 3% (N = 544) during the past ten years. In these, 14 had previous PTCA, 8, previous CABG, IO, simultaneous surgery (10 lung resections followed by CABG with or without extracorporeal circulation and one lobectomy followed by aneurysmectomy) and 1, post-operative CA BG, resulting in no peri-operative mortality and favorable prognosis compared to that of LC patients with normal function. Simultaneous surgery was performed to cover restricted cardiopulmonary function after surgery in 5 patients and to prevent prioperative risk in 4. In ptients (N = 27) with Stage I, NSCLC and IHD (coronary artery stenosis ~75%) 14 with coronary intervention for concomitant IHD resulted in better prognosis, compared to other 13. To offer feasible quality of post-operative life in patients with LC) and concomitant cardio-pulmonary disorder, it is of importance prospectively to estimate their post-operative cardio-pulmonary function. and to perform adequate intervention of IHD preoperatively, or simultaneously, or in two stages based upon their diseases.
I
424
Trachea-bronchial carcinoma
resection for bronchogenic
M. Sarto. H. Kato, K. Furukawa. N. Ikeda, H. Nakamura, C. Konaka. Department of Surgery, Tokyo Medical College, 6-7- 1 Nishishinjuku, Shinjuku-ku, Tokyo 160, Japan The results of 44 trachea-bronchial resecrions from 1976 to 1994 were reviewed. Thirty three cases were male and 11 cases were female with a mean age of 59.3. Most were squamous cell carcinoma (30 cases) followed by adenocarcinoma (8 cases including 2 cases of thyroid cancer invading the trachea), adenoid cystic carcinoma (4 cases), carcinoid (1 case) and mucoepidermoid carcinoma (1 case). The post-surgical T factor was Tl in 9 cases, T2 in 14 cases, T3 in 8 cases and T4 in 8 cases. There were 16
Therapy - Combined Modality Therapy lobectomy - for 23.1%, after pneumonectomy - 10%. For surgically treated patients with adenocarcinoma 12 months survival after lobectomy - O%, after pneumonectomy - 100%. 24 months survival after pneumonectomy - 25%. Conclusions: Adjuvant therapy for operated patients with squamous cell carcinoma and adenocarcinoma in the clinical stadium of Tl-3 N2 MO is not always possible and further investigations and analysis should be carried out about the use of it in separate clinical groups. In cases when the complex therapy was possible, the results could be evaluated as satisfactory.
I420
Upper thoracic scoliosis and the transverse A Clinico-pathological observation
C. Natali, P. Cole, G. Askin. Australia
Princess
Alexandra
Hospital,
process:
Brisbane,
Study Design: Retrospective review of notes and radiographs of 16 patients undergoing en-bloc resection of pancoast tumour.. Objectives: To review the incidence of post-operative scoliosis, and the effect of the anatomical structures resected during surgery. Summary and Background Data: We observed the rapid onset of high thoracic scoliosis following en-bloc resection of pancoast tumour. However the magnitude of the scoliosis varied. We reviewed these patients to see whether there were any predictors for the subsequent development of scoliosis. Methods: Sixteen patients undergoing en-bloc resection for pancoast tumour were reviewed. The patients all had en-bloc tumour resection, but the number of upper ribs and transverse processes resected varied. The patient notes, operating records, pathology results and radiographs were reviewed. Results: Four patients (25%) had significant resection of the transverse processes of Tl to T3. All of these patients developed scoliosis of rapid onset, convex to the side of the resection. Of the remaining 12 patients either no scoliosis developed, (6 of 12) or scoliosis of less than 12 degrees, all cases convex to the side of the lesion.. These differences were statistically significant. In addition resection including the first rib was associated with a greater cobb angle. Conclusions: Our study suggests that preservation of the upper thoracic transverse processes protects against subsequent development of iatrogenic scoliosis. Removal of the first rib was also more likely to be associated with the development of scoliosis. This is discussed further.
I421 J. Jerman, Sloven/a
Is serum cholesterol cancer patients?
a prognostic
M. Sok. Dept. of Thor. Surg.,
factor in lung
Univ. Med. Center
Ljubljana,
In recent years some epidemiological and experimental studies confirm that serum lipoproteins especially serum cholesterol might have important role in cancer. The lower level of serum cholesterol at the time of cancer diagnosis was found in many studies, A term ‘tumor-associated hypocholesterolemia” (TAHC) was proposed and many authors believe this is a metabolic consequence of cancer. The negative relationship between serum cholesterol and death by cancer was also found in some series. Theaim of this retrospective study is to investigate the possible influence of pretreatment serum cholesterol (mean cholesterol = 5.027 mmol/l, SE = 0.0043) in patients with NSC lung cancer (n = 216; age 35-80; male = 178, female = 38) on survival after RO lung resection (stage I = 101, stage II = 35, stage81 = 71, stage IV = 9). Positive correlation was found between serum cholesterol level and two years postoperative survival (p = 0.019) for all patients. The same positive correlation was found when patients were divided in two different groups regarding stage (stage I and II - p = 0.024; stage III and IV-p = 0.284). This study shows, that patients with higher preoperative serum cholesterol level have longer survival. Pretreatment serum cholesterol might be important prognostic factor for operable lung cancer stage I and II.
Tuesday, 12 August 1997 POSTER
SESSION
Surgery I 422
The diagnosis with video-assisted thoracoscopy toward the indeterminate solitary pulmonary nodule
Masahide Murasugi, Takamasa Ohnuki, Masahiro Mae, Yasuyuki Sone, Sumio Nitta. Department of Surgery I, Tokyo Women’s Medical College, Tokyo, Japan From September 1992 to December 1996, 292 patients were performed video-assisted thoracoscopic surgery (VATS) in our department. We used VATS diagnosis for purpose of solitary pulmonary nodule. 80 cases were removed in these, there were 39 male and 41 female patients in this group. The age was from 23 to 83 years old (mean 59.1 years old). The size of nodule was 0.8 - 20 mm (73%). 77 wedge resections which contains a nodule and 3 needle biopsy were performed. An access thoracotomy had to be performed in 14 patients. 49 nodules were diagnosis as lung cancer (61%), there were 33 primaly lung cancer and 16 metastatic lung cancer (26 adenocarcinoma, 4 large cell carcinoma, 2 squamouscell carcinoma). Additionally 23 lobectomy by standard thracotomy were performed for treatment. Video-assisted thoracoscopy is an extremely useful procedure for the diagnosis and the treatment of the indeterminate solitary pulmonary nodule.
423
El
Surgical treatment of patients with lung cancer and cardiopulmonary disorder
S. Nitta. T. Ohnuki, J. Kei, Y. Sone, M. Murasugi, Women’s Medical College, Tokyo
H. Kaneyasu.
Tokyo
Surgical treatment for patients with lung cancer (LC) and ischemic heart diseases (IHD) is controversial. We applied forced expiratory volume one second more than 800 ml/m’, or total pulmonary vascular resistance index of contra-lateral lung less than 800 dyne see-s cm m2, to clear patients with LC and cardiopulmonary disorder for lung resection, resulting in perioperative mortality less than 3% (N = 544) during the past ten years. In these, 14 had previous PTCA, 8, previous CABG, IO, simultaneous surgery (10 lung resections followed by CABG with or without extracorporeal circulation and one lobectomy followed by aneurysmectomy) and 1, post-operative CA BG, resulting in no peri-operative mortality and favorable prognosis compared to that of LC patients with normal function. Simultaneous surgery was performed to cover restricted cardiopulmonary function after surgery in 5 patients and to prevent prioperative risk in 4. In ptients (N = 27) with Stage I, NSCLC and IHD (coronary artery stenosis ~75%) 14 with coronary intervention for concomitant IHD resulted in better prognosis, compared to other 13. To offer feasible quality of post-operative life in patients with LC) and concomitant cardio-pulmonary disorder, it is of importance prospectively to estimate their post-operative cardio-pulmonary function. and to perform adequate intervention of IHD preoperatively, or simultaneously, or in two stages based upon their diseases.
I
424
Trachea-bronchial carcinoma
resection for bronchogenic
M. Sarto. H. Kato, K. Furukawa. N. Ikeda, H. Nakamura, C. Konaka. Department of Surgery, Tokyo Medical College, 6-7- 1 Nishishinjuku, Shinjuku-ku, Tokyo 160, Japan The results of 44 trachea-bronchial resecrions from 1976 to 1994 were reviewed. Thirty three cases were male and 11 cases were female with a mean age of 59.3. Most were squamous cell carcinoma (30 cases) followed by adenocarcinoma (8 cases including 2 cases of thyroid cancer invading the trachea), adenoid cystic carcinoma (4 cases), carcinoid (1 case) and mucoepidermoid carcinoma (1 case). The post-surgical T factor was Tl in 9 cases, T2 in 14 cases, T3 in 8 cases and T4 in 8 cases. There were 16