- Email: [email protected]
441 Surgical resection for lung cancer patients with idiopathic interstitial pneumonia
Therapy - Combined Modality thoracoscopic mediastinal nodal sampling as an alternative, adjunctive diagnostic procedure for lymph node of mediastinum. Between January 1993 and October 1996, at the National Cancer institute of Milan 25 patients with bronchogenic carcinoma underwent thoracoscopic exploration with mediastinal nodal sampling or lymphadenectomy. Fifteen patients had preoperative confirmation of NSCLC with bronchoscopy, sputum cytology or CT-directed percutaneous lung biopsy. Seven patients had a pulmonary parenchymal lesion with mediastinum not staged. The remaining three patients had mediastinal adenopathies without parenchymal lesions. All patients had a CT-scan evidence of enlarged (1.5 cm diameter) lymph nodes of the aortic window (11 cases), of the ascending aorta (7 cases), of the sub-carinal location (5 cases), and paraesophageal nodes below the carina (2 cases). In 3 patients the diagnosis was not provided by mediastinoscopy and VATS was successfully performed. In 3 patients more than one mediastinal lymph nodal location was sampled. In 1 patient we observed a pleural metastatic involvement. We performed 20 ipsilateral biopsies and 5 contralateral to the tumor. Neither morbidity nor mortality were observed in our series. Five patients with pathologically benign sample by frozen-section analysis underwent thoracotomy: one was found to have pathologic stage I bronchogenic carcinoma and the other four patients had a stage II disease. Eleven patients had mediastinal metastatic disease too advanced for resection. Eight patients after induction therapy underwent exploratory thoracotomy while seven patients had a radical resection. Cervical mediastinoscopy remain our primary surgical approach for the paratracheal nodal sites but we generally prefer the thoracoscopic approach to the Chamberlain procedure. VATS provides a safe and effective procedure in dissection and sampling of lymph nodes and other pathological lesions of the mediastinum.
438 Surgical treatment of lung cancer with subclinical L-2 carcinomatous pleurisy found at thoracotomy and its prognostic
factors
M. Shiba, T. Fujisawa, Y. Saitoh, T. lizasa, K. Shibuya, T. Yasukawa, K. Yasuhuku. Y. Yamaguchi. Chiba Univ. Chiba, Japan Operative indication for the lung cancer patients with malignant pleural effusion that could not be detected preoperatively is still controversial. We analyzed surgical outcome of these patients and their prognostic factors. Fifty-five patients with subclinical malignant pleural effusion (n = 25) or pleural dissemination (n = 30) found at thoracothomy has been underwent lobectomy plus partial pleurectomy with lymph node dissection. All these patients has been underwent pleural lavage by anticancer drug at the end of the operation and the drug was instillated through chest drainage tube after the operation. Postoperative survival rate was compared with clinicopathological factors. Postoperative five year survival rate was 26.9% in all the patients. Statistical difference of survival rate between DO cases that had malignant cells only in the effusion and Dl cases that had macroscopic pleural dissemination, was not demonstrated. Visceral pleural invasion did not show any significant correlation with survival. But statistical significant difference was demonstrated between female and male, negative and positive nodal status, less than 3 cm and more than 3 cm in tumor diameter, and low and high labeling index group of Ki-67 antigen expression in the resected tumor tissue. (p < 0.05) Multivariate analysis according to the Cox proportional hazards regression model was performed by using the above four significant factors demonstrated that lymph nodal involvement and Ki-67 labeling index were independent prognostic factors. (p < 0.05) These results indicate that surgical treatment for lung cancer patients with subclinical malignant pleural effusion or dissemination should be underwent especially in NO cases or low Ki-67 labeled tumor cases.
I439
The influence of autologous blood transfusion surgery for patients with stage I bronchogenic carcinoma
in
K. Kikuchi’, M. Gika’, M. Kohno’, Y. lzumi ‘, K. Kobayashi ‘, M. Handaz, Y. lkeda 3. ’ Departmenf of Surgery; ‘The Blood Center; 3Department of Medicine, School of Medicine, Keio University, Tokyo, Japan Autologous transfusions in surgery for patients with stage I bronchogenic carcinoma have been performed to prevent the side effects of homologous transfusions.
Therapy
113
From Nov. 1988 to Oct. 1996, adequate patients for surgery due to bronchogenic carcinoma were selected. Patients with hemoglobin levels higher than 11 .O g/dl were indicated for this study. According to the patients’ body weight 200 or 400 ml of blood on one to three times was taken from 3 weeks to 5 days prior to the surgery. Autologous blood transfusion was collected preoperatively from 85 patients. The total volume of blood ranged from 200 to 1,000 ml, mean volume of 527 ml. 96 percent of all patients avoided homologous transfusion (20.0 percent no blood transfusion, 76 percent only an autologous transfusion). Only one patient who had autologous transfusion had chill and fever. Postoperative 5 years survival rate was 90.5 percent in autologous transfusion group but 80.0 percent in no transfusion group. We consider autologous transfusions in surgery for patients with stage I bronchogenic carcinoma is very useful not only to prevent the side effect of the homologous transfusion but also to improve the postoperative survival rate of stage I lung cancer patients.
I
440
Surgical treatment for the patient with suspected recurrent lung cancer
M. Gika, M. Kohno. Y. Izumi, K. Kikuchi, Medicine, Keio UniversitL: Tokyo, Japan
K. Kobayashi.
School
of
We studied the significance of second operation for the patient with suspected recurrent lung cancer. From January 1991 through December 1996, 17 patients with suspected recurrent lung cancer were operated at Keio University Hospital. There were 9 men and 8 women. The mean age was 88 years with a range of 51 to 84 years. Their clinical characteristics were as follows; 1. pathological stage; stage I in 12, stage II in 2, stage IIIA in 2, stage IIIB in 1, 2. histological type; adenocarcinoma in 12, squamous cell carcinoma in 3, large cell carcinoma in 1, small cell carcinoma in 1. 3. surgical procedure; lobectomy in 14, bilobectomy in 2, partial resection in 1. 4. procedure of the second operation; ipsilateral in 9 (lobectomy in 1, segmentectomy in 2, partial resection in I), contralateral in 8 (lobectomy in 2, segmentectomy in 4, subsegmentectomy in 1, partial resection in 1). In 4 of 17 patients pathological examination of second operation was different from the one of primary operation. Three of them died from recurrence of lung cancer, and 2 patients died of another disease. Other 12 patients have been alive for I month to 5 years and 8 months. Generally, in patients with history of previous operations for lung cancer, second operation for new coin lesion(s) has not been indicated as it was considered as recurrent lung cancer. We performed, however, operations on selected patients in whom tumor(s) were limited at most in one lobe and postoperative lung function would be preserved. In summary, we consider that second operation may be valuable in patients with suspected recurrent lung cancer provided that lesions are limited in only one lobe.
441
El
Surgical resection for lung cancer patients with idiopathic interstitial pneumonia
Y. Izumi, M. Gika, M. Kohno, K. Kikuchi, Medicine, Keio Univ., Tokyo, Japan
Objective:
K. Kobayashi.
School
of
The postoperative morbidities and prognoses were studied with idiopathic interstitial pneumonia (IIP) undergoing surgical for lung cancer. Materials and Methods: From April 1985 to October 1996, out of 616 surgical resections for lung cancer performed at our institution 12 (1.9%) who had IIP were included in the study. Age ranged from 63 to 77 years (average 67), 11 were males and one female. As predicative indices of postoperative morbidity, preoperative chest x-ray findings, chest Garium scans, serum lactate dehydrogenase (LDH) and C-reactive protein (CRP) levels, respiratory functions, smoking index, anesthesia and operation time, intraoperative bleeding and intraoperative fraction of inspired oxygen (FlO*) were studied. Results: Postoperative exacerbations of IIP were seen in 7 patients and of these patients 6 died of respiratory failure. The other causes of deaths were lung cancer in 3 and esophageal cancer in 1. Two are still alive. The longest survival was 35 months. Acute exacerbations of IIP considered to be directly related to operations were seen in 4 patients. They all died due to respiratory failure. In these 4 patients significant differences compared with the others were seen concerning preoperative serum CRP level, in patients resections
114
Therapy - Combined Modality
vital capacity, anesthesia and operation time, and intraoperative bleeding. Discussion: As a whole, the prognoses of lung cancer patients with IIP were poor. Postoperative exacerbation of IIP lead to death from respiratory failure in 6 out of 7 patients. Increased preoperative serum CRP and decreased vital capacity may become predictors of outcome. Also, it is imperative to reduce anesthesia and operation time with minimal bleeding.
Wednesday, 13 August 1997 POSTER
SESSION
Surgery
I442
Analysis of the patients who had double or triple primary cancers included primary lung cancer
T. Tokui, K. Adachi, Unk!, Tsu, Japan
M. Takao, T. Shimono,
S. Namikawa,
the left main pulmonary artery and extended into the left side wall of pulmonary trunk. The portion of tumor located in the left main pulmonary artery and pulmonary trunk was excised intact including the left side wall of the trunk. Histologically, the tumor was a leiomyosarcoma. The patient had an uncomplicated postoperative course and was discharged without additional chemotherapy or radiotherapy. She is doing well 14 months after the operation. Patient 2. A 37 year old man was referred to Mie university hospital for evaluation and treatment of presumed left atrial tumor. Angiogram revealed large filling defect in the left atrium and a total lack of filling of left pulmonary veins. CT scan demonstrated large mass in the left atrium that extended into left lower pulmonary vein. Left postero-lateral thoracotomy was performed and CPB was applied. After obtaining cardiac arrest, incision into the left atrium was performed and entire tumor in the left atrium was excised including half part of left atrial wall. Thereafter, left pneumonectomy was done and CPB was completed. Histologically, the tumor was a leiomyosarcoma that was originated in the left lower pulmonary vein. The patient had left hemiplegia but was discharged without additional chemotherapy or radiotherapy. He is doing well 5 months after the operation. The methods of resections of pulmonary leiomyosarcoma that involved left atrium or pulmonary trunk will be discussed.
I. Yada. Mie
Purpose and Method: We examined the patients who had double or triple primary cancers included primary lung cancer for family history, habits, hereditary factor etc. We have diagnosed multiple primary cancers according to Warren and Gates and excluded multiple lung cancers from this series. Results and Conclusions: Until 1996, we surgically treated 43 double primary cancer patients and 9 triple primary cancer patients. In double primary cancer patients, 31 were men and 12 were women, a mean age of 63.8 years. In triple primary cancer patients, all were men, a mean age of 71 .O years. There was no relation of multiple primary cancers to family history. But smoking habit was very important factor of multiple primary cancers. In 25 patients who had double primary cancers, Brinkman index (B.I.) was over 600. In 8 patients who had triple primary cancers, 6.1. was over 1000. We examined 10 double primary cancer patients and 5 triple primary cancer patients for germ-line p53 mutations. All of cases were wild type, Germ-line p53 mutation was uncommon in patients with multiple primary cancers. In most of multiple primary cancer cases, the interval between primary lung cancer and another cancer was within 5 years, but in some of them, it was over 10 years. 20 of 30 patients (66.7%) followed until death died of lung cancer. This result suggested that prognosis of multiple primary cancer patient depends on the prognosis of primary lung cancer. The median survival of multiple primary cancer patients with metachronous presentation (36 month) was significantly higher in patients with synchronous presentation (16 month).
I443
Therapy
Primary pulmonary leiomyosarcoma involving left atrium or pulmonary trunk: Methods of resections with cardiopulmonary bypass
T. Shimono, Lt. Yuasa, F. Yasuda, K. Adachi, T. Tokui, M. Takao, S. Namikawa, H. Yuasa, I. Yada. Mie Univ., Tsu, Japan
K. Tani,
Primary pulmonary leiomyosarcoma is rare tumor and very few cases have been treated surgically for this tumor, because of its invasion into the heart and/or great vessels, and massive intra-pulmonary metastasis. In our institute, two cases of pulmonary leiomyosarcoma that involved left atrium or pulmonary trunk successfully underwent surgical resections using cardiopulmonary bypass (CPB). We wish to report these cases. Patient 1. A 72 year old woman was referred to Mie university hospital for evaluation and treatment of presumed pulmonary thromboembolism. Angiogram revealed filling defects in the pulmonary trunk, a total lack of filling of left main pulmonary artery and diminution of filling of arteries of the left lung. Physicians performed a biopsy of a tumor, which was presumed sarcoma. CT scan disclosed occlusion of the left main pulmonary artery by mass and dense filling of pulmonary artery branches with tumors. Median sternotomy was performed and CPB was applied. The patient underwent left pneumonectomy and incision from left main pulmonary artery into the pulmonary trunk under CPB. A large tumor completely filled
The role of limited operation for primary lung cancer 0 444 M. Takao, A. Shimamoto, K. Adachi, T. Tokui, K. Tani, T. Shimono, S. Namikawa, I. Yada. Mie Univ., Tsu, Japan Although the significance of limited operation for primary lung cancer has been controversial, it could be a beneficial therapeutic modality for some selected patients. We have done limited operation: partial resection or segmentectomy for cases defined by so-called 3R “Radlcallty, Risk and Reduction”. We reviewed these surgical results to investigate the role of limited operation for primary lung cancer, Methods: We performed limited operation for 75 cases (6.5%) out of 1214 cases treated surgically for primary lung cancer between 1957 and 1996. In Radicality group, twenty four cases (32%) with stage I underwent limited operation for peripheral small tumor. In Risk group, thirty three cases (44%); 26, 1 and 6 with stage I, II and III/IV; with preoperative risks such as age over 80 years old, cardiopulmonary diseases and major organ dysfunction underwent relative noncurative operation. In Reduction group, twenty two cases (29%); 2, 1 and 19 with stage I, II and III/IV; underwent absolute noncurative operation to make tumor volume reduce. Results: Five-year survival rate was 60%, 69% and 16% in Radicality, Risk and Reduction group, while it was 65% in cases with stage I who underwent lobectomy and R2 lymphnodal dissection. In Radicality group, four cases with adenocarcinoma died at 25 to 72 months postoperatively due to local recurrence. So that, we have changed operative procedure from simple partial resection without lymphnodal dissection to segmentectomy with mediastinal lymphnodal dissection since 1992. In Risk group, the operative mortality was nil and postoperative QOL was not impaired. However, there were 4 cancer death and 4 non-cancer death within 26 months postoperatively. Conclusion: The surgical results of limited operation in Radicality and Risk group was comparable to that of standard operation for the stage I lung cancer. Of particular, Risk group may be the best indication for limited surgery. In Radicality group, careful patient selection and theoretical operative procedure should be important. In Reduction group, further efforts such as multimodality treatment should be needed to improve the long term result.
445
Carcinoid
tumors in the chest
El A. Shimamoto, M. Takao, S. Namikawa, I. Yada. Department & Cardiovascular Surgery, Mie University School of Medicine, Japan
of Thoracic Tsu, M/e,
Bronchial carcinoids were found in eight of 1528 patients with primary lung tumors (0.52%) and thymic carcinoids in three of 138 patients with tumors of the thymus (2.2%). Five of the bronchial carcinoids were in central sites and three were in peripheral sites. Seven of the bronchial carcinoids were removed by lobectomy and one by partial resection. There were no recurrences or metastases. Because
438 Surgical treatment of lung cancer with subclinical L-2 carcinomatous pleurisy found at thoracotomy and its prognostic
factors
M. Shiba, T. Fujisawa, Y. Saitoh, T. lizasa, K. Shibuya, T. Yasukawa, K. Yasuhuku. Y. Yamaguchi. Chiba Univ. Chiba, Japan Operative indication for the lung cancer patients with malignant pleural effusion that could not be detected preoperatively is still controversial. We analyzed surgical outcome of these patients and their prognostic factors. Fifty-five patients with subclinical malignant pleural effusion (n = 25) or pleural dissemination (n = 30) found at thoracothomy has been underwent lobectomy plus partial pleurectomy with lymph node dissection. All these patients has been underwent pleural lavage by anticancer drug at the end of the operation and the drug was instillated through chest drainage tube after the operation. Postoperative survival rate was compared with clinicopathological factors. Postoperative five year survival rate was 26.9% in all the patients. Statistical difference of survival rate between DO cases that had malignant cells only in the effusion and Dl cases that had macroscopic pleural dissemination, was not demonstrated. Visceral pleural invasion did not show any significant correlation with survival. But statistical significant difference was demonstrated between female and male, negative and positive nodal status, less than 3 cm and more than 3 cm in tumor diameter, and low and high labeling index group of Ki-67 antigen expression in the resected tumor tissue. (p < 0.05) Multivariate analysis according to the Cox proportional hazards regression model was performed by using the above four significant factors demonstrated that lymph nodal involvement and Ki-67 labeling index were independent prognostic factors. (p < 0.05) These results indicate that surgical treatment for lung cancer patients with subclinical malignant pleural effusion or dissemination should be underwent especially in NO cases or low Ki-67 labeled tumor cases.
I439
The influence of autologous blood transfusion surgery for patients with stage I bronchogenic carcinoma
in
K. Kikuchi’, M. Gika’, M. Kohno’, Y. lzumi ‘, K. Kobayashi ‘, M. Handaz, Y. lkeda 3. ’ Departmenf of Surgery; ‘The Blood Center; 3Department of Medicine, School of Medicine, Keio University, Tokyo, Japan Autologous transfusions in surgery for patients with stage I bronchogenic carcinoma have been performed to prevent the side effects of homologous transfusions.
Therapy
113
From Nov. 1988 to Oct. 1996, adequate patients for surgery due to bronchogenic carcinoma were selected. Patients with hemoglobin levels higher than 11 .O g/dl were indicated for this study. According to the patients’ body weight 200 or 400 ml of blood on one to three times was taken from 3 weeks to 5 days prior to the surgery. Autologous blood transfusion was collected preoperatively from 85 patients. The total volume of blood ranged from 200 to 1,000 ml, mean volume of 527 ml. 96 percent of all patients avoided homologous transfusion (20.0 percent no blood transfusion, 76 percent only an autologous transfusion). Only one patient who had autologous transfusion had chill and fever. Postoperative 5 years survival rate was 90.5 percent in autologous transfusion group but 80.0 percent in no transfusion group. We consider autologous transfusions in surgery for patients with stage I bronchogenic carcinoma is very useful not only to prevent the side effect of the homologous transfusion but also to improve the postoperative survival rate of stage I lung cancer patients.
I
440
Surgical treatment for the patient with suspected recurrent lung cancer
M. Gika, M. Kohno. Y. Izumi, K. Kikuchi, Medicine, Keio UniversitL: Tokyo, Japan
K. Kobayashi.
School
of
We studied the significance of second operation for the patient with suspected recurrent lung cancer. From January 1991 through December 1996, 17 patients with suspected recurrent lung cancer were operated at Keio University Hospital. There were 9 men and 8 women. The mean age was 88 years with a range of 51 to 84 years. Their clinical characteristics were as follows; 1. pathological stage; stage I in 12, stage II in 2, stage IIIA in 2, stage IIIB in 1, 2. histological type; adenocarcinoma in 12, squamous cell carcinoma in 3, large cell carcinoma in 1, small cell carcinoma in 1. 3. surgical procedure; lobectomy in 14, bilobectomy in 2, partial resection in 1. 4. procedure of the second operation; ipsilateral in 9 (lobectomy in 1, segmentectomy in 2, partial resection in I), contralateral in 8 (lobectomy in 2, segmentectomy in 4, subsegmentectomy in 1, partial resection in 1). In 4 of 17 patients pathological examination of second operation was different from the one of primary operation. Three of them died from recurrence of lung cancer, and 2 patients died of another disease. Other 12 patients have been alive for I month to 5 years and 8 months. Generally, in patients with history of previous operations for lung cancer, second operation for new coin lesion(s) has not been indicated as it was considered as recurrent lung cancer. We performed, however, operations on selected patients in whom tumor(s) were limited at most in one lobe and postoperative lung function would be preserved. In summary, we consider that second operation may be valuable in patients with suspected recurrent lung cancer provided that lesions are limited in only one lobe.
441
El
Surgical resection for lung cancer patients with idiopathic interstitial pneumonia
Y. Izumi, M. Gika, M. Kohno, K. Kikuchi, Medicine, Keio Univ., Tokyo, Japan
Objective:
K. Kobayashi.
School
of
The postoperative morbidities and prognoses were studied with idiopathic interstitial pneumonia (IIP) undergoing surgical for lung cancer. Materials and Methods: From April 1985 to October 1996, out of 616 surgical resections for lung cancer performed at our institution 12 (1.9%) who had IIP were included in the study. Age ranged from 63 to 77 years (average 67), 11 were males and one female. As predicative indices of postoperative morbidity, preoperative chest x-ray findings, chest Garium scans, serum lactate dehydrogenase (LDH) and C-reactive protein (CRP) levels, respiratory functions, smoking index, anesthesia and operation time, intraoperative bleeding and intraoperative fraction of inspired oxygen (FlO*) were studied. Results: Postoperative exacerbations of IIP were seen in 7 patients and of these patients 6 died of respiratory failure. The other causes of deaths were lung cancer in 3 and esophageal cancer in 1. Two are still alive. The longest survival was 35 months. Acute exacerbations of IIP considered to be directly related to operations were seen in 4 patients. They all died due to respiratory failure. In these 4 patients significant differences compared with the others were seen concerning preoperative serum CRP level, in patients resections
114
Therapy - Combined Modality
vital capacity, anesthesia and operation time, and intraoperative bleeding. Discussion: As a whole, the prognoses of lung cancer patients with IIP were poor. Postoperative exacerbation of IIP lead to death from respiratory failure in 6 out of 7 patients. Increased preoperative serum CRP and decreased vital capacity may become predictors of outcome. Also, it is imperative to reduce anesthesia and operation time with minimal bleeding.
Wednesday, 13 August 1997 POSTER
SESSION
Surgery
I442
Analysis of the patients who had double or triple primary cancers included primary lung cancer
T. Tokui, K. Adachi, Unk!, Tsu, Japan
M. Takao, T. Shimono,
S. Namikawa,
the left main pulmonary artery and extended into the left side wall of pulmonary trunk. The portion of tumor located in the left main pulmonary artery and pulmonary trunk was excised intact including the left side wall of the trunk. Histologically, the tumor was a leiomyosarcoma. The patient had an uncomplicated postoperative course and was discharged without additional chemotherapy or radiotherapy. She is doing well 14 months after the operation. Patient 2. A 37 year old man was referred to Mie university hospital for evaluation and treatment of presumed left atrial tumor. Angiogram revealed large filling defect in the left atrium and a total lack of filling of left pulmonary veins. CT scan demonstrated large mass in the left atrium that extended into left lower pulmonary vein. Left postero-lateral thoracotomy was performed and CPB was applied. After obtaining cardiac arrest, incision into the left atrium was performed and entire tumor in the left atrium was excised including half part of left atrial wall. Thereafter, left pneumonectomy was done and CPB was completed. Histologically, the tumor was a leiomyosarcoma that was originated in the left lower pulmonary vein. The patient had left hemiplegia but was discharged without additional chemotherapy or radiotherapy. He is doing well 5 months after the operation. The methods of resections of pulmonary leiomyosarcoma that involved left atrium or pulmonary trunk will be discussed.
I. Yada. Mie
Purpose and Method: We examined the patients who had double or triple primary cancers included primary lung cancer for family history, habits, hereditary factor etc. We have diagnosed multiple primary cancers according to Warren and Gates and excluded multiple lung cancers from this series. Results and Conclusions: Until 1996, we surgically treated 43 double primary cancer patients and 9 triple primary cancer patients. In double primary cancer patients, 31 were men and 12 were women, a mean age of 63.8 years. In triple primary cancer patients, all were men, a mean age of 71 .O years. There was no relation of multiple primary cancers to family history. But smoking habit was very important factor of multiple primary cancers. In 25 patients who had double primary cancers, Brinkman index (B.I.) was over 600. In 8 patients who had triple primary cancers, 6.1. was over 1000. We examined 10 double primary cancer patients and 5 triple primary cancer patients for germ-line p53 mutations. All of cases were wild type, Germ-line p53 mutation was uncommon in patients with multiple primary cancers. In most of multiple primary cancer cases, the interval between primary lung cancer and another cancer was within 5 years, but in some of them, it was over 10 years. 20 of 30 patients (66.7%) followed until death died of lung cancer. This result suggested that prognosis of multiple primary cancer patient depends on the prognosis of primary lung cancer. The median survival of multiple primary cancer patients with metachronous presentation (36 month) was significantly higher in patients with synchronous presentation (16 month).
I443
Therapy
Primary pulmonary leiomyosarcoma involving left atrium or pulmonary trunk: Methods of resections with cardiopulmonary bypass
T. Shimono, Lt. Yuasa, F. Yasuda, K. Adachi, T. Tokui, M. Takao, S. Namikawa, H. Yuasa, I. Yada. Mie Univ., Tsu, Japan
K. Tani,
Primary pulmonary leiomyosarcoma is rare tumor and very few cases have been treated surgically for this tumor, because of its invasion into the heart and/or great vessels, and massive intra-pulmonary metastasis. In our institute, two cases of pulmonary leiomyosarcoma that involved left atrium or pulmonary trunk successfully underwent surgical resections using cardiopulmonary bypass (CPB). We wish to report these cases. Patient 1. A 72 year old woman was referred to Mie university hospital for evaluation and treatment of presumed pulmonary thromboembolism. Angiogram revealed filling defects in the pulmonary trunk, a total lack of filling of left main pulmonary artery and diminution of filling of arteries of the left lung. Physicians performed a biopsy of a tumor, which was presumed sarcoma. CT scan disclosed occlusion of the left main pulmonary artery by mass and dense filling of pulmonary artery branches with tumors. Median sternotomy was performed and CPB was applied. The patient underwent left pneumonectomy and incision from left main pulmonary artery into the pulmonary trunk under CPB. A large tumor completely filled
The role of limited operation for primary lung cancer 0 444 M. Takao, A. Shimamoto, K. Adachi, T. Tokui, K. Tani, T. Shimono, S. Namikawa, I. Yada. Mie Univ., Tsu, Japan Although the significance of limited operation for primary lung cancer has been controversial, it could be a beneficial therapeutic modality for some selected patients. We have done limited operation: partial resection or segmentectomy for cases defined by so-called 3R “Radlcallty, Risk and Reduction”. We reviewed these surgical results to investigate the role of limited operation for primary lung cancer, Methods: We performed limited operation for 75 cases (6.5%) out of 1214 cases treated surgically for primary lung cancer between 1957 and 1996. In Radicality group, twenty four cases (32%) with stage I underwent limited operation for peripheral small tumor. In Risk group, thirty three cases (44%); 26, 1 and 6 with stage I, II and III/IV; with preoperative risks such as age over 80 years old, cardiopulmonary diseases and major organ dysfunction underwent relative noncurative operation. In Reduction group, twenty two cases (29%); 2, 1 and 19 with stage I, II and III/IV; underwent absolute noncurative operation to make tumor volume reduce. Results: Five-year survival rate was 60%, 69% and 16% in Radicality, Risk and Reduction group, while it was 65% in cases with stage I who underwent lobectomy and R2 lymphnodal dissection. In Radicality group, four cases with adenocarcinoma died at 25 to 72 months postoperatively due to local recurrence. So that, we have changed operative procedure from simple partial resection without lymphnodal dissection to segmentectomy with mediastinal lymphnodal dissection since 1992. In Risk group, the operative mortality was nil and postoperative QOL was not impaired. However, there were 4 cancer death and 4 non-cancer death within 26 months postoperatively. Conclusion: The surgical results of limited operation in Radicality and Risk group was comparable to that of standard operation for the stage I lung cancer. Of particular, Risk group may be the best indication for limited surgery. In Radicality group, careful patient selection and theoretical operative procedure should be important. In Reduction group, further efforts such as multimodality treatment should be needed to improve the long term result.
445
Carcinoid
tumors in the chest
El A. Shimamoto, M. Takao, S. Namikawa, I. Yada. Department & Cardiovascular Surgery, Mie University School of Medicine, Japan
of Thoracic Tsu, M/e,
Bronchial carcinoids were found in eight of 1528 patients with primary lung tumors (0.52%) and thymic carcinoids in three of 138 patients with tumors of the thymus (2.2%). Five of the bronchial carcinoids were in central sites and three were in peripheral sites. Seven of the bronchial carcinoids were removed by lobectomy and one by partial resection. There were no recurrences or metastases. Because