- Email: [email protected]
radiation therapy
Surgery/Plasty
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(ranging from 9 to 56 days). Five patients were still alive and two without evidence of disease. The median survival was 10.5 months (ranging from 3 to 13 months). The median time to relapse was 6 months. These combined extended resections are technically and anesthesiologically feasible, with no postoperative mortality but high morbidity (50%). This aggressive surgery might be useful in highly selected patients, such as T4N0-1, where adequate local control could achieve long term survival.
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Extended resection of the left atrium, great vessels, or both for locally advanced lung cancer: An experience of 248 cases
Q.H. Zhou, LX. Liu, Y. Wang, H.B. Zhang, J.J. Yang, Z.H. Yang.
Department of Thoracocardiac Surgery, Cancer center, First University Hospital, West China University of Medical Sciences, Chengdu, Sichuan 610041, PR China
artery in one) and in one patient a chest wall resection. Pathological staging was: 1 stage 0 (complete response 4%), 3 stage I (12%), 8 stage II (33%), 6 stage IliA (25%), 6 IIIB (25%) (2 T4N1 and 4 T4N2). There were no postoperative deaths. A postoperative complication occurred in 9 patients (37%), including 2 ARDS, 1 cardiac herniation, 3 cases of air leak exceeding 7 days, 3 cases of atrial fibrillation, 1 haemothorax, 1 pulmonary oedema and 1 atelectasis. There were no broncho-pleural fistulas. The median postoperative stay was 8 days (range 6-60 days). No significant difference in complication rate (Chi square test) has been found between the group of patients submitted to sleeve resections after preoperative chemo or chemo-radiation therapy in comparison with patients submitted to sleeve resection without neoadjuvant treatment (morbidity 27%), or patients treated with standard surgical procedures (morbidity 26% for Iobectomy and 32% for pneumonectomy) with or without a preoperative chemotherapy. Preoperative chemotherapy or combination of chemo-radio therapy is not associated with an additional risk of anastomotic complications in broncoplastic procedure.
Background: Lung cancer causes the first highest number of cancarrelated death in China. But, only one third of patients with lung cancer can be identified as operative candidates. For the other two thirds is inoperable, because they have advanced lung cancer with distant metastasis or locally advanced lung cancer involving neighboring organs. Recently introduction of the technique of cardiovascular surgery into lung cancer surgery has made possible en bloc resection of the lung combined with part of the involved left atrium, aorta, superior vena sava, and pulmonary artery. Methods: Two hundred and fourty-eight patients with locally advanced lung cancer were admitted into our hospital from February, 1983 to December, 1999. A Single additional organ was resected in 216 patients, two organs in 24 patients and three organs in 8 cases. Of these patients, combined resection of the lung and left atrium was performed in 85 patiens, the pulmonary artery in 125 cses, superior vena cava in 31 and aorta in 3. Results: There were one operative death in this series and 0.4% for operation-related death. The 1-year, 3-year, 5-year and 10-year survival rate for all patients were 76.63%, 60.50%, 32. 66% and 20.97% respectively. The 5-year survival rate after left atrium resection was 31.43%, pulmonary artery resections and reconstructions was 38.94%, superior vena cava 25.0% and auta 33.3%. Conclusions: Our data presented here offer a clear evidence that extended resection of left atrium, great vessles, or both was worthwith for the patients with locally advanced lung cancer.
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Special patterns of tracheobronchoplastic operation for lung cancer
Z. Huang. Tumor Hospital, Guangzhou, RR. China
Objective: To introduce some special patterns of tracheobronchoplasitc operation of non-wedge and non-sleeve resection for lung cancer. Methods: With lung resection and elimination of involved tracheobronchoal parts adaptive shaping of healthy portions of bronchi was used to reestablish the airways. Results: From 1985 to 1999, six types (Fig 1-6) of plastic operations were successfully performed in 12 cases with lung cancer. No postoperatively complication occurred. Media survival time was 18 months. Conclusions: Indications for these special patterns were adapted to special involved sites of tracheobronchi. These procedures were simple, less the post-operatively complications and can eliminate the focus with best reserving pulmonary function. In some instances, this type of operation may be used instead of complex tracheobronchial or carla resecton and effectively reestablished airways, it broadens surgical indications for lung cancer.
management of bronchoplastic Iobectomy [45-• Perioperation's in lung cancer ×.-Y. Zhi. IASLC, Beijing Thoracic Tumor Institute & Hospital, Beijing
Bronchoplastic procedures after induction chemolradiation therapy
G. Veronesi, P. Solli, F. Leo, C. Ratcliffe, F. D'Ovidio, M. D'Aiuto, L. Spaggiari, U. Pastorino. lEO, Milan; European Institute of Oncology,
Division of Thoracic Surgery, Milan, Italy Bronchoplastic procedures often may avoid pneumonectomy or allow radical lung resection when the tracheobronchial angle is involved. It is not clear whether induction chemotherapy represents an additional risk factor for morbidity and mortality in these cases. From January 1998 to January 2000, 24 patients underwent a bronchial sleeve resection after induction treatment for lung cancer. They represent approximately the 27% of lung resections after neoadjuvant treatment (70 cases) and the 57% (24/42) of all sleeve resections performed during this period. They were 21 (88%) men and 3 (12%) women with a mean age of 58 years (ranging from 25 to 75). Histology was: 16 epidermoid carcinoma, 5 adenocarcinoma, 2 SCLC and 1 carcinoid. In 18 cases (75%) the preoperative treatment was a cisplatin based polichemotherapy (16 cases out of 23 received CDDP and GEM for 3 cycles), in 5 (21%) patients a chemo-radiation therapy and in 1 patient (4%) radiotherapy alone. A tracheal sleeve pneumonectomy was undertaken in 5 patients (21%), a sleeve Iobectomy in 18 (75%) (in two of them a tracheal bronchoplastic was performed) and a tracheal sleeve bilobectomy in 1 (4%). In 9 cases (37%) we also performed a vascular resection (superior vena cava resection in 8, and tangential resection of pulmonary
101149, China Sleeve Iobectomy, an alternative to pneumonectomy, offers a better long term survival rate than pneumonectomy and provides an improved quality of life to the patient. 263 cases were treated by sleeve Iobectomy from 1978 to 1994. Age and sex distribution in these 263 patients ranged from 22-77 years, with 225 male & 38 female patient. Most of these eases were squasmous cell carcinoma (215 cases). The postoperative TNM classification showed 102 cases of stage I, 86 of stage II, 69 of stage Ilia 6 of stage IIIb Upper lobe sleeve Iobectomy was used in 232 cases (right upper 168, left upper 65). In 29 cases of them Iobectomy was combined with sleeve resection and reconstruction of the pulmonary, artery. Six patients underwent partial resection or reconstruction of superior vena cava. The vena cava was replaced with the heterogenetic allogenetic blood vessel bypass graft between the left brachiocephalic vein, or the confluence of both brachiocephalic vein, and the right atrium. Two patients died within 30 days after operation. Postoperative complications occured in 26 cases. The 5-year survival rate was 49.7%. Chemotherapy and/or radiotherapy were given for most eases within 3 years after operation. After adopting sleeve Iobectomies, many pneumonnectomies have been avoided. Sleeve Iobectomy may eradicate the lesion to a maxinal extent and impair the lung function to a minimal extent, the sleeve Iobectomy had the similar effect as pneumonectemy, but had much lesser mortality and morbidity. The indication and the techniques of this operation, the perioperation's management and the principle of
136
(ranging from 9 to 56 days). Five patients were still alive and two without evidence of disease. The median survival was 10.5 months (ranging from 3 to 13 months). The median time to relapse was 6 months. These combined extended resections are technically and anesthesiologically feasible, with no postoperative mortality but high morbidity (50%). This aggressive surgery might be useful in highly selected patients, such as T4N0-1, where adequate local control could achieve long term survival.
~-~
Extended resection of the left atrium, great vessels, or both for locally advanced lung cancer: An experience of 248 cases
Q.H. Zhou, LX. Liu, Y. Wang, H.B. Zhang, J.J. Yang, Z.H. Yang.
Department of Thoracocardiac Surgery, Cancer center, First University Hospital, West China University of Medical Sciences, Chengdu, Sichuan 610041, PR China
artery in one) and in one patient a chest wall resection. Pathological staging was: 1 stage 0 (complete response 4%), 3 stage I (12%), 8 stage II (33%), 6 stage IliA (25%), 6 IIIB (25%) (2 T4N1 and 4 T4N2). There were no postoperative deaths. A postoperative complication occurred in 9 patients (37%), including 2 ARDS, 1 cardiac herniation, 3 cases of air leak exceeding 7 days, 3 cases of atrial fibrillation, 1 haemothorax, 1 pulmonary oedema and 1 atelectasis. There were no broncho-pleural fistulas. The median postoperative stay was 8 days (range 6-60 days). No significant difference in complication rate (Chi square test) has been found between the group of patients submitted to sleeve resections after preoperative chemo or chemo-radiation therapy in comparison with patients submitted to sleeve resection without neoadjuvant treatment (morbidity 27%), or patients treated with standard surgical procedures (morbidity 26% for Iobectomy and 32% for pneumonectomy) with or without a preoperative chemotherapy. Preoperative chemotherapy or combination of chemo-radio therapy is not associated with an additional risk of anastomotic complications in broncoplastic procedure.
Background: Lung cancer causes the first highest number of cancarrelated death in China. But, only one third of patients with lung cancer can be identified as operative candidates. For the other two thirds is inoperable, because they have advanced lung cancer with distant metastasis or locally advanced lung cancer involving neighboring organs. Recently introduction of the technique of cardiovascular surgery into lung cancer surgery has made possible en bloc resection of the lung combined with part of the involved left atrium, aorta, superior vena sava, and pulmonary artery. Methods: Two hundred and fourty-eight patients with locally advanced lung cancer were admitted into our hospital from February, 1983 to December, 1999. A Single additional organ was resected in 216 patients, two organs in 24 patients and three organs in 8 cases. Of these patients, combined resection of the lung and left atrium was performed in 85 patiens, the pulmonary artery in 125 cses, superior vena cava in 31 and aorta in 3. Results: There were one operative death in this series and 0.4% for operation-related death. The 1-year, 3-year, 5-year and 10-year survival rate for all patients were 76.63%, 60.50%, 32. 66% and 20.97% respectively. The 5-year survival rate after left atrium resection was 31.43%, pulmonary artery resections and reconstructions was 38.94%, superior vena cava 25.0% and auta 33.3%. Conclusions: Our data presented here offer a clear evidence that extended resection of left atrium, great vessles, or both was worthwith for the patients with locally advanced lung cancer.
•
•4-•
Special patterns of tracheobronchoplastic operation for lung cancer
Z. Huang. Tumor Hospital, Guangzhou, RR. China
Objective: To introduce some special patterns of tracheobronchoplasitc operation of non-wedge and non-sleeve resection for lung cancer. Methods: With lung resection and elimination of involved tracheobronchoal parts adaptive shaping of healthy portions of bronchi was used to reestablish the airways. Results: From 1985 to 1999, six types (Fig 1-6) of plastic operations were successfully performed in 12 cases with lung cancer. No postoperatively complication occurred. Media survival time was 18 months. Conclusions: Indications for these special patterns were adapted to special involved sites of tracheobronchi. These procedures were simple, less the post-operatively complications and can eliminate the focus with best reserving pulmonary function. In some instances, this type of operation may be used instead of complex tracheobronchial or carla resecton and effectively reestablished airways, it broadens surgical indications for lung cancer.
management of bronchoplastic Iobectomy [45-• Perioperation's in lung cancer ×.-Y. Zhi. IASLC, Beijing Thoracic Tumor Institute & Hospital, Beijing
Bronchoplastic procedures after induction chemolradiation therapy
G. Veronesi, P. Solli, F. Leo, C. Ratcliffe, F. D'Ovidio, M. D'Aiuto, L. Spaggiari, U. Pastorino. lEO, Milan; European Institute of Oncology,
Division of Thoracic Surgery, Milan, Italy Bronchoplastic procedures often may avoid pneumonectomy or allow radical lung resection when the tracheobronchial angle is involved. It is not clear whether induction chemotherapy represents an additional risk factor for morbidity and mortality in these cases. From January 1998 to January 2000, 24 patients underwent a bronchial sleeve resection after induction treatment for lung cancer. They represent approximately the 27% of lung resections after neoadjuvant treatment (70 cases) and the 57% (24/42) of all sleeve resections performed during this period. They were 21 (88%) men and 3 (12%) women with a mean age of 58 years (ranging from 25 to 75). Histology was: 16 epidermoid carcinoma, 5 adenocarcinoma, 2 SCLC and 1 carcinoid. In 18 cases (75%) the preoperative treatment was a cisplatin based polichemotherapy (16 cases out of 23 received CDDP and GEM for 3 cycles), in 5 (21%) patients a chemo-radiation therapy and in 1 patient (4%) radiotherapy alone. A tracheal sleeve pneumonectomy was undertaken in 5 patients (21%), a sleeve Iobectomy in 18 (75%) (in two of them a tracheal bronchoplastic was performed) and a tracheal sleeve bilobectomy in 1 (4%). In 9 cases (37%) we also performed a vascular resection (superior vena cava resection in 8, and tangential resection of pulmonary
101149, China Sleeve Iobectomy, an alternative to pneumonectomy, offers a better long term survival rate than pneumonectomy and provides an improved quality of life to the patient. 263 cases were treated by sleeve Iobectomy from 1978 to 1994. Age and sex distribution in these 263 patients ranged from 22-77 years, with 225 male & 38 female patient. Most of these eases were squasmous cell carcinoma (215 cases). The postoperative TNM classification showed 102 cases of stage I, 86 of stage II, 69 of stage Ilia 6 of stage IIIb Upper lobe sleeve Iobectomy was used in 232 cases (right upper 168, left upper 65). In 29 cases of them Iobectomy was combined with sleeve resection and reconstruction of the pulmonary, artery. Six patients underwent partial resection or reconstruction of superior vena cava. The vena cava was replaced with the heterogenetic allogenetic blood vessel bypass graft between the left brachiocephalic vein, or the confluence of both brachiocephalic vein, and the right atrium. Two patients died within 30 days after operation. Postoperative complications occured in 26 cases. The 5-year survival rate was 49.7%. Chemotherapy and/or radiotherapy were given for most eases within 3 years after operation. After adopting sleeve Iobectomies, many pneumonnectomies have been avoided. Sleeve Iobectomy may eradicate the lesion to a maxinal extent and impair the lung function to a minimal extent, the sleeve Iobectomy had the similar effect as pneumonectemy, but had much lesser mortality and morbidity. The indication and the techniques of this operation, the perioperation's management and the principle of