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460 Endobronchial electrocautery is an alternative for Nd-YAG laser for clearing intraluminal lung tumors
118 458 El
Therapy - Combined Modality Bronchial, tracheal and bronchovascular resections
A. Giingor, 0. bzdemir, E. Dikmen, U. GBnOllij, of Ankara Universit): Ankara, Turkey
sleeve
j. &ten.
Medical
School
Background:
Sleeve resections spare the larger volume of healthy tissue in comparison with the surgical resections performed in both malignant and benign lesions of the lung. The most important problem in the surgical treatment of the lung cancer is difficulty to provide complete resection. Methods: Twenty-one patients with nonsmall cell lung cancer who cannot undergo either simple lobectomy or pneumonectomy were selected for the sleeve resections. Bronchial sleeve lobectomy was carried out in 14 of the patients, 5 bronchovascular lobectomy, 1 bronchovascular bilobectomy superior, and 1 tracheal sleeve pneumonectomy were performed in the remaining patients. Results: There was neither operative nor hospital mortality. Mean intensive care unit and hospital stays were 2.5 and 11 days, respectively. Bronchial anastomotic leakage which leading empyema was occurred in one patient. That complication was resolved by performing pleural drainage through 23 days. Three patients were died separately because of the radiation pneumonitis with fibrosis, local recurrence and extensive disease with distant metastasis between 6 and 7 months postoperatively. Eighteen patients are still alive, 2 of them have been receiving adjuvant chemoradiotherapy. Asymptomatic autopneumonectomy was developed in one patient with bronchovascular sleeve left upper lobectomy due to late arterial occlusion at anastomotic line. Conclusions: Bronchial and bronchovascular sleeve resections are alternative methods for other resection procedures in patients who are not suitable for complete removal of tumor by simple resections and/or patients with limited pulmonary reserve. These procedures have similar risk and benefit as in other methods.
I
459
En-block resection
in thoracic outlet tumors
A. GOngor, 0. Ozdemir, A. Nadir, H. Deda, U. Gdntillii. Ankara Universit,! Ankara, Turkey
Medical
School
of
Background: Superior sulcus tumors and nonpulmonary tumors which invade thoracic outlet have different clinical features, surgical indications, surgical technics, and postoperative prognosis in comparison with bronchial tumors. Methods: We carried out en-block resection in 8 patients with tumors which invaded or were localized in thoracic outlet. One of the cases had vertebral body tumor, one had low-grade fibrosarcoma and remaining six patients had lung cancers. Size of the tumors was varied from 5 cm to 28 centimeters. We performed colourimetric vertebral artery doppler ultrasonography in patients with the suspicion of vertebral artery invasion besides routine screening tools such as CT, MRI. Subclavian artery resection and reconstruction were performed in two cases, plexus branchialis dissection and partial excision were done in three cases. We dissected whole brachial plexus which was invaded by fibrosarcoma in one patient. We reconstructed the thoracic wall by using methyl methacrylate sandwich grafts in six patients. Unilateral phrenic nerve palsy was developed in two patients as a surgical complication. One patient had local causalgia which lasted 5 months, and in another patient local recurrence occurred in the 7’” month and was died in the llth month postoperatively. Conclusions: We think that the surgical indications in tumors originated from thoracic outlet or invaded this site should be revisited.
460 El
Endobronchial electrocautery is an alternative for Nd-YAG laser for clearing intraluminal lung tumors
T.J. van Boxem, B.J. Venmans, G. Sutedja, Hospital Amsterdam, the Netherlands
P.E. Postmus.
Free University
Nd-YAG laser is the most popular instrument to treat patients with intraluminal tumor in the major airways. It is usually performed under general anesthesia. Fiberoptic bronchoscopic electrocautery (FBE) under local anesthesia (FBE) was used successfully to provide rapid palliation [Sutedja et al. Thorax 1994; 49: 72431 FBE may be equally useful in patients who are Nd-YAG laser candidates for clearance of intraluminal tumor. Patients with visible intraluminal tumor in the large airways were treated with FBE instead of Nd-YAG laser. Nd-YAG laser equipment was kept
Therapy
ready for use during FBE sessions. Treatment session was terminated when significant tumor clearance had been achieved, or in cases with extraluminal tumor compression. Fifty-six patients, 11 females, median age 64 years (range 2C-90) were treated and 82 FBE sessions were completed. Thirty-seven patients (86%) had intraluminal non small cell cancer. The remaining patients had typical carcinoid and miscellaneous tumors. Significant tumor clearance was documented in 39 patients (70%). The remaining patients proved to have extraluminal tumor. Ten sessions (12%) were completed under general anesthesia, among them were 9 patients with typical bronchial carcinoid. No conversion to Nd-YAG laser treatment was necessary, but additional Nd-YAG treatment was given to obtain in depth necrosis in one patient. A switch to rigid bronchoscopy was successful to control bleeding in one patient. In this phase II feasibility study, FBE achieved the treatment objectives in the majority of patients who were considered Nd-YAG laser candidates. Our findings seem to confirm that FBE is competitive to Nd-YAG laser. A randomized phase III study is underway.
I461
Roentgenologically occult lung cancer treated with fiberoptic bronchoscopic electrocautery: A pilot study-of a simple and cheap technique.
T.J. van Boxem, B.J. Venmans, G. Sutedja, Hospital Amsterdam, the Netherlands
P.E. Postmus.
Free University
The curative potential of photodynamic therapy (PDT) and brachytherapy for the treatment of roentgenologically occult lung cancer (ROLC) has been demonstrated earlier. Bronchoscopic electrocautery (BE) is currently feasible using an insulated flexible bronchoscope to coagulate and vaporize tumor tissue. ROLC is usually small and superficial, so, BE may be able to eradicate ROLC completely. In a prospective study, thirteen patients with 15 ROLCs have been treated with BE. Follow-up has been ?I 6 months. Median age was 69 years (range 48-79 years). Fiberoptic bronchoscope and monopolar electrical probe were used under local anesthesia to coagulate ROLCs. Energy applied was f 30 Watts. There was no complication during BE. Ten patients with 12 lesions reached a complete response (CR rate = 80%; 95% Cl: 52-96%). Median follow-up has been 22 months (range 16-43 months). BE was unsuccessful in 3 patients, but PDT also failed to obtain a CR. Two patients underwent radical resection and the tumors were shown histologically to be locally invasive. One patient received external radiotherapy. Three patients with a CR have died, two because of myocardial infarction and apoplexia, and one because of metastasis from his previously resected T3Nl large cell primary. Current data suggest that BE is an effective treatment modality and is potentially curative in patients with ROLC. It is a cost-effective alternative for photodynamic therapy.
Thursday, POSTER
14 August
1997
SESSION
Surgery
I462
Prognosis
O.M. Kshivets.
Omsk
of lung cancer Cancer
Centec
Omsk,
Russia
The aim of study is to prognosis of lung cancer (LC) using biometrics, statistic and newest approaches (theory of artificial intelligence and optimal solutions, combinatorial optimization, complex system analysis, simulation modeling in terms of synergetics, prognostics, expert and discovery system technology, etc.) oriented to computers. The basis of this research is the data of 452 LC patients (LCP) of the II-IV stages operated and been under control in clinic during 1976-1990. 230 patients having the II-IV stages of LC were included into the group to be studied. 156 oncopatients with the
Therapy - Combined Modality Bronchial, tracheal and bronchovascular resections
A. Giingor, 0. bzdemir, E. Dikmen, U. GBnOllij, of Ankara Universit): Ankara, Turkey
sleeve
j. &ten.
Medical
School
Background:
Sleeve resections spare the larger volume of healthy tissue in comparison with the surgical resections performed in both malignant and benign lesions of the lung. The most important problem in the surgical treatment of the lung cancer is difficulty to provide complete resection. Methods: Twenty-one patients with nonsmall cell lung cancer who cannot undergo either simple lobectomy or pneumonectomy were selected for the sleeve resections. Bronchial sleeve lobectomy was carried out in 14 of the patients, 5 bronchovascular lobectomy, 1 bronchovascular bilobectomy superior, and 1 tracheal sleeve pneumonectomy were performed in the remaining patients. Results: There was neither operative nor hospital mortality. Mean intensive care unit and hospital stays were 2.5 and 11 days, respectively. Bronchial anastomotic leakage which leading empyema was occurred in one patient. That complication was resolved by performing pleural drainage through 23 days. Three patients were died separately because of the radiation pneumonitis with fibrosis, local recurrence and extensive disease with distant metastasis between 6 and 7 months postoperatively. Eighteen patients are still alive, 2 of them have been receiving adjuvant chemoradiotherapy. Asymptomatic autopneumonectomy was developed in one patient with bronchovascular sleeve left upper lobectomy due to late arterial occlusion at anastomotic line. Conclusions: Bronchial and bronchovascular sleeve resections are alternative methods for other resection procedures in patients who are not suitable for complete removal of tumor by simple resections and/or patients with limited pulmonary reserve. These procedures have similar risk and benefit as in other methods.
I
459
En-block resection
in thoracic outlet tumors
A. GOngor, 0. Ozdemir, A. Nadir, H. Deda, U. Gdntillii. Ankara Universit,! Ankara, Turkey
Medical
School
of
Background: Superior sulcus tumors and nonpulmonary tumors which invade thoracic outlet have different clinical features, surgical indications, surgical technics, and postoperative prognosis in comparison with bronchial tumors. Methods: We carried out en-block resection in 8 patients with tumors which invaded or were localized in thoracic outlet. One of the cases had vertebral body tumor, one had low-grade fibrosarcoma and remaining six patients had lung cancers. Size of the tumors was varied from 5 cm to 28 centimeters. We performed colourimetric vertebral artery doppler ultrasonography in patients with the suspicion of vertebral artery invasion besides routine screening tools such as CT, MRI. Subclavian artery resection and reconstruction were performed in two cases, plexus branchialis dissection and partial excision were done in three cases. We dissected whole brachial plexus which was invaded by fibrosarcoma in one patient. We reconstructed the thoracic wall by using methyl methacrylate sandwich grafts in six patients. Unilateral phrenic nerve palsy was developed in two patients as a surgical complication. One patient had local causalgia which lasted 5 months, and in another patient local recurrence occurred in the 7’” month and was died in the llth month postoperatively. Conclusions: We think that the surgical indications in tumors originated from thoracic outlet or invaded this site should be revisited.
460 El
Endobronchial electrocautery is an alternative for Nd-YAG laser for clearing intraluminal lung tumors
T.J. van Boxem, B.J. Venmans, G. Sutedja, Hospital Amsterdam, the Netherlands
P.E. Postmus.
Free University
Nd-YAG laser is the most popular instrument to treat patients with intraluminal tumor in the major airways. It is usually performed under general anesthesia. Fiberoptic bronchoscopic electrocautery (FBE) under local anesthesia (FBE) was used successfully to provide rapid palliation [Sutedja et al. Thorax 1994; 49: 72431 FBE may be equally useful in patients who are Nd-YAG laser candidates for clearance of intraluminal tumor. Patients with visible intraluminal tumor in the large airways were treated with FBE instead of Nd-YAG laser. Nd-YAG laser equipment was kept
Therapy
ready for use during FBE sessions. Treatment session was terminated when significant tumor clearance had been achieved, or in cases with extraluminal tumor compression. Fifty-six patients, 11 females, median age 64 years (range 2C-90) were treated and 82 FBE sessions were completed. Thirty-seven patients (86%) had intraluminal non small cell cancer. The remaining patients had typical carcinoid and miscellaneous tumors. Significant tumor clearance was documented in 39 patients (70%). The remaining patients proved to have extraluminal tumor. Ten sessions (12%) were completed under general anesthesia, among them were 9 patients with typical bronchial carcinoid. No conversion to Nd-YAG laser treatment was necessary, but additional Nd-YAG treatment was given to obtain in depth necrosis in one patient. A switch to rigid bronchoscopy was successful to control bleeding in one patient. In this phase II feasibility study, FBE achieved the treatment objectives in the majority of patients who were considered Nd-YAG laser candidates. Our findings seem to confirm that FBE is competitive to Nd-YAG laser. A randomized phase III study is underway.
I461
Roentgenologically occult lung cancer treated with fiberoptic bronchoscopic electrocautery: A pilot study-of a simple and cheap technique.
T.J. van Boxem, B.J. Venmans, G. Sutedja, Hospital Amsterdam, the Netherlands
P.E. Postmus.
Free University
The curative potential of photodynamic therapy (PDT) and brachytherapy for the treatment of roentgenologically occult lung cancer (ROLC) has been demonstrated earlier. Bronchoscopic electrocautery (BE) is currently feasible using an insulated flexible bronchoscope to coagulate and vaporize tumor tissue. ROLC is usually small and superficial, so, BE may be able to eradicate ROLC completely. In a prospective study, thirteen patients with 15 ROLCs have been treated with BE. Follow-up has been ?I 6 months. Median age was 69 years (range 48-79 years). Fiberoptic bronchoscope and monopolar electrical probe were used under local anesthesia to coagulate ROLCs. Energy applied was f 30 Watts. There was no complication during BE. Ten patients with 12 lesions reached a complete response (CR rate = 80%; 95% Cl: 52-96%). Median follow-up has been 22 months (range 16-43 months). BE was unsuccessful in 3 patients, but PDT also failed to obtain a CR. Two patients underwent radical resection and the tumors were shown histologically to be locally invasive. One patient received external radiotherapy. Three patients with a CR have died, two because of myocardial infarction and apoplexia, and one because of metastasis from his previously resected T3Nl large cell primary. Current data suggest that BE is an effective treatment modality and is potentially curative in patients with ROLC. It is a cost-effective alternative for photodynamic therapy.
Thursday, POSTER
14 August
1997
SESSION
Surgery
I462
Prognosis
O.M. Kshivets.
Omsk
of lung cancer Cancer
Centec
Omsk,
Russia
The aim of study is to prognosis of lung cancer (LC) using biometrics, statistic and newest approaches (theory of artificial intelligence and optimal solutions, combinatorial optimization, complex system analysis, simulation modeling in terms of synergetics, prognostics, expert and discovery system technology, etc.) oriented to computers. The basis of this research is the data of 452 LC patients (LCP) of the II-IV stages operated and been under control in clinic during 1976-1990. 230 patients having the II-IV stages of LC were included into the group to be studied. 156 oncopatients with the