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A new technique of bronchial suture after pneumonectomy
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invasion. Intra-pericardial organs could be resected using a simple clamping technique in most cases. However, for the cases that more than two mediastinal organs were invaded at a time the use of cardio-pulmonary bypass enable to resect the invaded organs. We also mention about the values of angiography and CT-scan as preoperative evaluation for extended surgery. A New Technique of Bronchial Suture After Pneumonectomy. Pastorino, U., Valente, M., Muscolino, G., , Cataldo, I., Preda, F., Bedini, A., Ravasi, G. ist. Naz. Tumori, Milano, Italy. Broncho-pleural fistula after pneumonectomy for lung cancer still remains a serious problem in thoracic surgery. Even if linear staplers have reduced the occurrence of this complication in comparison with traditional interrupter suture, the incidence of broncho-pleural fistula, with or without subsequent empyema, remains as high as 15%, and mortality of patients suffering from this untoward event is about 50%. Main factors involved in the etiology of fistula are infection and devitalization or lack of vascular supply of the bronchus after radical peribronchial gland dissection. As far as our experience is concerned, mechanical stapling may result in microscopic fissuration of the pars membranacea, Particularly when anterior thoracotomy is used. Starting from Jan. 84 we have used a new technical procedure consisting in stapling the main bronchus over a thin shield of prosthetic material (namely Teflon or Goretex) by a Premium TA-4.8. Out of 24 pneumonectomies performed by this way we observed only 3 cases of dealyed microfistula (12.5%). All of them healed spontaneously after rib resection, with no related mortality. Even if results are still preliminary, such a procedure seems to offer some advantages over standard stapling for cancer pneumonectomy, particularly by the anterior approach. ~L3nagement of Secondary and New Primary Lung Cancer: The Role of Resection Volume. Valente, M., Pastorino, U., Ongari, M., Ravasi, G. ist Naz. Tumori, Milan, Italy. Surgical resection of pulmonary lesions in patients with previous cancer treatment is actually considered a routine procedure, provided that no residual tumor is left at the site of primary or in any other extrathoracic organ. Lung sparing procedures are used, to cope with multiple resections, either synchronous or metachronous, or with impaired lung function in elder or previously resected patients. Sublobar resections appear optimal for childhood
tumors
(Wilms, Ewing) or for bone and soft tissue sarcomas, but questionable in case of suspected new primary or carcinomas with high chance of nodal metastases. A common procedure is to perform sublobar resection for periferal lesions and lobectomy for centrally located tumors. In order to establish the role of resection volume on the final effectiveness of treatment, in term of survival and modality of recurrence, we have evaluated 120 consecutive patients who underwent pulmonary resections after previous primary cancer treatment. 88 (73%) had a previous diagnosis of carcinoma or melanoma, 18 of them (20%) showing nodal metastases (NI). The overall survival at 5 and 8 years was 35% and 33% for NO patients and 31% and 19% for NI. According to the extent of resection (lobar versus sublobar) no significant differences were evident in overall and relapse-free survival nor in frequency and modality of relapse; more detailed analyses will be discussed. Inte~Inittent C.P.A.P. (Continuous Positive Airw a y Pressure)by Mask to Prevent Atelectasis After Pulmonary Surgery. Bedini, A.V., Ammatuna, M., Genitoni, V., Valente, M., Ravasi, G.L. Istituto Nazionale Tumori, Milan, Italy. The overall incidence of postoperative pulmonary complications after pulmonary surgery, especially atelectasis, is quite high. Recently some reports pointed out the effectiveness of C.P.A.P. in the treatment and/or prophylaxis of atelectasis after upper abdominal operations. With the aim of testing the impact of C.P.A.P. on the postoperative occurrence of atelectasis, we started a perspective study. After pulmonary surgical procedure, but pneumonectomy, 44 patients were enrolled in two groups. The first received intermittent C.P.A.P. by mask, with a level of P.E.E.P. (Positive End Expiratory Pressure) of cm 5 of water, at a Fi02 (Fraction of inspired Oxigen) of 0.33,1 hour every 6, for a total of 8 administrations. The control group was submitted at the same intervals to the same Fi02. The groups were comparable according to preoperative and postextubations blood gases values. All the patients received thoracic physiotherapy. During the first 72 postoperative hours, vital signs and blood gases were monitored. Roentgenograms of the chest were taken daily, so as the survey of air loss from the thoracic drains. At the end of observation period 45.4% of the patients of the control and 9% of C.P.A.P. group developed atelectasis (p/0.05). Oxigenation of controls was lower of a mean of mm i0 Hg at the same time. The duration of air loss was not influenced by the treatment. We conclude that C.P.A.P. can improve postoperative outcome. Median Survival: A n Original Approach for Long T e r m Survival in Lung Cancer Patients.
invasion. Intra-pericardial organs could be resected using a simple clamping technique in most cases. However, for the cases that more than two mediastinal organs were invaded at a time the use of cardio-pulmonary bypass enable to resect the invaded organs. We also mention about the values of angiography and CT-scan as preoperative evaluation for extended surgery. A New Technique of Bronchial Suture After Pneumonectomy. Pastorino, U., Valente, M., Muscolino, G., , Cataldo, I., Preda, F., Bedini, A., Ravasi, G. ist. Naz. Tumori, Milano, Italy. Broncho-pleural fistula after pneumonectomy for lung cancer still remains a serious problem in thoracic surgery. Even if linear staplers have reduced the occurrence of this complication in comparison with traditional interrupter suture, the incidence of broncho-pleural fistula, with or without subsequent empyema, remains as high as 15%, and mortality of patients suffering from this untoward event is about 50%. Main factors involved in the etiology of fistula are infection and devitalization or lack of vascular supply of the bronchus after radical peribronchial gland dissection. As far as our experience is concerned, mechanical stapling may result in microscopic fissuration of the pars membranacea, Particularly when anterior thoracotomy is used. Starting from Jan. 84 we have used a new technical procedure consisting in stapling the main bronchus over a thin shield of prosthetic material (namely Teflon or Goretex) by a Premium TA-4.8. Out of 24 pneumonectomies performed by this way we observed only 3 cases of dealyed microfistula (12.5%). All of them healed spontaneously after rib resection, with no related mortality. Even if results are still preliminary, such a procedure seems to offer some advantages over standard stapling for cancer pneumonectomy, particularly by the anterior approach. ~L3nagement of Secondary and New Primary Lung Cancer: The Role of Resection Volume. Valente, M., Pastorino, U., Ongari, M., Ravasi, G. ist Naz. Tumori, Milan, Italy. Surgical resection of pulmonary lesions in patients with previous cancer treatment is actually considered a routine procedure, provided that no residual tumor is left at the site of primary or in any other extrathoracic organ. Lung sparing procedures are used, to cope with multiple resections, either synchronous or metachronous, or with impaired lung function in elder or previously resected patients. Sublobar resections appear optimal for childhood
tumors
(Wilms, Ewing) or for bone and soft tissue sarcomas, but questionable in case of suspected new primary or carcinomas with high chance of nodal metastases. A common procedure is to perform sublobar resection for periferal lesions and lobectomy for centrally located tumors. In order to establish the role of resection volume on the final effectiveness of treatment, in term of survival and modality of recurrence, we have evaluated 120 consecutive patients who underwent pulmonary resections after previous primary cancer treatment. 88 (73%) had a previous diagnosis of carcinoma or melanoma, 18 of them (20%) showing nodal metastases (NI). The overall survival at 5 and 8 years was 35% and 33% for NO patients and 31% and 19% for NI. According to the extent of resection (lobar versus sublobar) no significant differences were evident in overall and relapse-free survival nor in frequency and modality of relapse; more detailed analyses will be discussed. Inte~Inittent C.P.A.P. (Continuous Positive Airw a y Pressure)by Mask to Prevent Atelectasis After Pulmonary Surgery. Bedini, A.V., Ammatuna, M., Genitoni, V., Valente, M., Ravasi, G.L. Istituto Nazionale Tumori, Milan, Italy. The overall incidence of postoperative pulmonary complications after pulmonary surgery, especially atelectasis, is quite high. Recently some reports pointed out the effectiveness of C.P.A.P. in the treatment and/or prophylaxis of atelectasis after upper abdominal operations. With the aim of testing the impact of C.P.A.P. on the postoperative occurrence of atelectasis, we started a perspective study. After pulmonary surgical procedure, but pneumonectomy, 44 patients were enrolled in two groups. The first received intermittent C.P.A.P. by mask, with a level of P.E.E.P. (Positive End Expiratory Pressure) of cm 5 of water, at a Fi02 (Fraction of inspired Oxigen) of 0.33,1 hour every 6, for a total of 8 administrations. The control group was submitted at the same intervals to the same Fi02. The groups were comparable according to preoperative and postextubations blood gases values. All the patients received thoracic physiotherapy. During the first 72 postoperative hours, vital signs and blood gases were monitored. Roentgenograms of the chest were taken daily, so as the survey of air loss from the thoracic drains. At the end of observation period 45.4% of the patients of the control and 9% of C.P.A.P. group developed atelectasis (p/0.05). Oxigenation of controls was lower of a mean of mm i0 Hg at the same time. The duration of air loss was not influenced by the treatment. We conclude that C.P.A.P. can improve postoperative outcome. Median Survival: A n Original Approach for Long T e r m Survival in Lung Cancer Patients.