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Bronchoplastic segmentectomy for hilar lung cancer
Surgery~Limited
1
4
•
Tumor angiogenesis and small cell lung cancer
A. Chella, M. Lucchi, G. Fontanini 1, F. Basolo 1, A. Mussi, C.A. Angeletti. Division of Thoracic Surgery, Cardiac and Thoracic
Department; 1Division of Pathology, Department of Oncology, University of Pisa, Italy Objective: Tumor angiogenesis, expressed by the microvessel count (MC), significantly correlates with metastases in surgically treated nonsmall cell lung cancer as well as a lot of other solid neoplasms. Small cell lung cancer (SCLC) is rarely treated by surgery, as a consequence, most of the authors have few specimens to perform a biological characterization. We reviewed our experience in the surgical treatment of SCLC with particular reference to the angiogenetic expression and its correlation to the stage of disease and prognosis. Methods: We retrospectively investigated 53 patients (51 males, 2 females) with SCLC treated by surgery and adjuvant chemotherapy between 1980 and 1990. Their median age was 61 years (range 3473). All the patients were completely staged. The surgical procedures included: 21 pneumonectomies and 32 Iobectomies. There were 28 NO, 8 N1 and 17 N2-disease. The adjuvant chemotherapy consisted of 4 - 6 courses of cyclophosphamide, epidoxorubicine, etoposide. The microvessel count was determined by the same technique previously tested on NSCLC. Results: With a median follow-up of 168 months (range 108-222), 8 patients are still alive and well. Thirty-four patients died of local (n = 3) or systemic (n = 31) relapse. The median MC was 68 (range 18145). MC does not correlate either with the lymphnodal status or the stage of disease. The overall survival at 5 years was 35% (median = 20 months). At univariate analysis the N status (p = .001), the stage (p = .005), the MC (p = .0002) significantly affected the survival. On multivariate analysis only the MC (p = .005) and the N-status (p = .005) were independent prognostic factors. Conclusions: Angiogenesis plays a role in the metastatic process of the SCLC as well as NSCLC. SCLC has a higher neo-vascularization than NSCLC as results from the higher number of microvessels. SCLC may be a ideal field to test new antiangiogenic drugs associated to chemotherapy.
Friday, 15 September 2000
4 : 0 0 - 5 : 0 0 pm
ORAL SESSION
SurgerylLimited
•70-]
Anatomical segmentectomy for peripheral non-small cell lung cancers
Y. Nakajima, Y. Shiraishi, K. Takasuna, N. Katsuragi, S. Yoshida.
Dept. of Chest Surgery, Fukujuuji Hospital, Japan Anti-Tuberculosis Assoc., Kiyose City, Tokyo, Japan The segmentectomy is expected as the limited resection with some radicality for peripheral non-small cell lung cancers (NSLC) in small size. Usually the stapller uses to cut the intersegmental plane, but we have been doing true anatomical segmentectomies with the dissection along through the anatomical intersegmental plane by electroceutery. This report is the result of our anatomical segmentectomies for NSLC. Material and Method: In 1985 ~ 99, there are 39 cases of curative anatomical segmentectomy in our hospital. Twenty six cases are in male (55-83 yrs., ave. 70.1), 13 in female (46-81 yrs., ave. 65.9). Twenty cases are adenocarcinomas, 18 cases squamous cell carcinomas and one is carcinoid tumor. All tumor diameters are destributed as 5 cases in ~<10 ram, 18 in 11 ~ 20 mm, 8 in 21 ~ 30 mm, 7 in 31 mm~<. The resected segments are as follows; S6:18 cases, rt.S2:3, rt.S 1 + Sb3:1, rt.S2b + $3:1, rt.SS:l, It.$1*2:5, upper div.:4, lingual div.:5, It.$8+9:1. In these 39 cases 33 are compromised cases. Result and Comment: There were s ix cases of Iocoregional recurrence, 3 recurred in hilar or mediastinal lymphnodes, 2 in both
141
hilar-mediastinal lymphnodes and lung parenchima. Only one case recurred in a residual segment of the same primary lobe with solitary, nodule. All of them were compromised cases and thief lymphnode dissections were imcomplete. There have never been any tumorous recurrence in the surfaces of dissecting intersegmental planes. The prognosis of p-stage I cases (N = 33) is excellent, its 5 year survival rate is 88.5%. The mean loss of ventilatory functions after segmentectomy was nearly half that of Iobectomy. We conclude the anatomical segmentectomy is effective to the limited resection of small-sized NSLC with stage I.
[
4
7
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Bronchoplastic segmentectomy for hilar lung cancer
T. Oka, T. Sawada, M. Muraoka, T. Nagayasu, S. Akamine, T. Takahashi, Y. Tagawa, H. Ayabe. First DepL of Surgery, Nagasaki
University, Nagasaki, Japan From March 1985 through November 1997, 14 patients underwent bronchoplastic segmentectomies for hilar lung cancer. All were male, ranging in age from 48 to 74 (mean age, 63.0) years. Bronchoplastic segmentectomy was indicated for hilar early lung cancer in 13 patients and for having severe restricted pulmonary function in 1 patient. Histologically all cases were squamous cell carcinoma, 2 patients had Stage 0 disease and 12 patients Stage I disease. Bronchoplastic procedures were sleeve type in 11 patients and wedge type in 3. Eight patients (57.1%) had postoperative complications. Arrhythmia, secretory retention and atelectasis were recognized in 3, 3 and 2 patients, respectively. A short-term stenosis of the bronchial anastomosis developed in 1 patient, however, no patient experienced bronchopleural fistula. There was no operative mortality following bronchoplastic procedure. Ten of 14 patients are alive with no evidence of disease at 120, 108, 75, 80, 58, 51, 44, 42, 41, and 35 months, respectively. Four patients died of unrelated to the primary lesions 36, 19, 14, and 3 months after surgery, respectively. As a result, bronchoplastic segmentectomy is acceptable as a curative operation with preserving pulmonary function for hilar early lung cancer.
I•
Video-assisted thoracoscopic surgery for lung cancer Experience in Okayama University
M. Aoe, A. Andou, H. Date, N. Shimizu, I. Nagahiro, S. Ichiba, S. ¥oshihumi. Okayama University, Okayama, Japan Since the introduction of new thoracoscopic technique into clinical practice, video-assisted thoracoscopic surgical procedure (VATS) is applied to almost all the chest surgical field. In this presentation, we will clarify the indication of video-assisted thoracoscopic surgical procedure (VATS) for pulmonary carcinomas and the results in our department. The indications for applying VATS technique are followed. 1, Pulmonary wedge resection via VATS is suitable for making the diagnosis of peripheral minute lesion, which can not be denied as malignant. 2, In the same meaning, VATS is also better way for diagnostic and therapeutic option for multiple pulmonary lesions. 3, For pulmonary malignancies, VATS should be chosen in the case of elder or poor pulmonary function patients. 4, Recently, we apply VATS procedure to the standard Iobectomy and mediastinal lymphnode dissection in Stage IA lung cancer patients. From April 1991 to January 2000, we performed VATS Iobectomy and mediastinal lymphnode dissection in 88 lung cancer patients. All of these patients were clinical TINOM0 Stage IA. Fifty nine out of 88 had a small tumor, the diameter of which were less than 2 cm. Complete medias final lymphnode dissection was performed in 66 cases, and lymph-node sampling was performed in two. The mean of operation time is 214.0 minutes, and mean of blood loss during operation is 198.8 ml, respectively. The pathological stages are IA in 64 cases and IliA in 4 cases. Up to now, we lose two patients from post-operative pulmonary embolism and intrapulmonary recurrence 30 months after operation, but there are no other recurrences in any cases. The five-year survival rate of these 88 cases is 98%, respectively. We think VATS Iobectomy and mediastinal lymph-node dissection should be chosen as a standard procedure for Stage IA lung carcinoma patients.
1
4
•
Tumor angiogenesis and small cell lung cancer
A. Chella, M. Lucchi, G. Fontanini 1, F. Basolo 1, A. Mussi, C.A. Angeletti. Division of Thoracic Surgery, Cardiac and Thoracic
Department; 1Division of Pathology, Department of Oncology, University of Pisa, Italy Objective: Tumor angiogenesis, expressed by the microvessel count (MC), significantly correlates with metastases in surgically treated nonsmall cell lung cancer as well as a lot of other solid neoplasms. Small cell lung cancer (SCLC) is rarely treated by surgery, as a consequence, most of the authors have few specimens to perform a biological characterization. We reviewed our experience in the surgical treatment of SCLC with particular reference to the angiogenetic expression and its correlation to the stage of disease and prognosis. Methods: We retrospectively investigated 53 patients (51 males, 2 females) with SCLC treated by surgery and adjuvant chemotherapy between 1980 and 1990. Their median age was 61 years (range 3473). All the patients were completely staged. The surgical procedures included: 21 pneumonectomies and 32 Iobectomies. There were 28 NO, 8 N1 and 17 N2-disease. The adjuvant chemotherapy consisted of 4 - 6 courses of cyclophosphamide, epidoxorubicine, etoposide. The microvessel count was determined by the same technique previously tested on NSCLC. Results: With a median follow-up of 168 months (range 108-222), 8 patients are still alive and well. Thirty-four patients died of local (n = 3) or systemic (n = 31) relapse. The median MC was 68 (range 18145). MC does not correlate either with the lymphnodal status or the stage of disease. The overall survival at 5 years was 35% (median = 20 months). At univariate analysis the N status (p = .001), the stage (p = .005), the MC (p = .0002) significantly affected the survival. On multivariate analysis only the MC (p = .005) and the N-status (p = .005) were independent prognostic factors. Conclusions: Angiogenesis plays a role in the metastatic process of the SCLC as well as NSCLC. SCLC has a higher neo-vascularization than NSCLC as results from the higher number of microvessels. SCLC may be a ideal field to test new antiangiogenic drugs associated to chemotherapy.
Friday, 15 September 2000
4 : 0 0 - 5 : 0 0 pm
ORAL SESSION
SurgerylLimited
•70-]
Anatomical segmentectomy for peripheral non-small cell lung cancers
Y. Nakajima, Y. Shiraishi, K. Takasuna, N. Katsuragi, S. Yoshida.
Dept. of Chest Surgery, Fukujuuji Hospital, Japan Anti-Tuberculosis Assoc., Kiyose City, Tokyo, Japan The segmentectomy is expected as the limited resection with some radicality for peripheral non-small cell lung cancers (NSLC) in small size. Usually the stapller uses to cut the intersegmental plane, but we have been doing true anatomical segmentectomies with the dissection along through the anatomical intersegmental plane by electroceutery. This report is the result of our anatomical segmentectomies for NSLC. Material and Method: In 1985 ~ 99, there are 39 cases of curative anatomical segmentectomy in our hospital. Twenty six cases are in male (55-83 yrs., ave. 70.1), 13 in female (46-81 yrs., ave. 65.9). Twenty cases are adenocarcinomas, 18 cases squamous cell carcinomas and one is carcinoid tumor. All tumor diameters are destributed as 5 cases in ~<10 ram, 18 in 11 ~ 20 mm, 8 in 21 ~ 30 mm, 7 in 31 mm~<. The resected segments are as follows; S6:18 cases, rt.S2:3, rt.S 1 + Sb3:1, rt.S2b + $3:1, rt.SS:l, It.$1*2:5, upper div.:4, lingual div.:5, It.$8+9:1. In these 39 cases 33 are compromised cases. Result and Comment: There were s ix cases of Iocoregional recurrence, 3 recurred in hilar or mediastinal lymphnodes, 2 in both
141
hilar-mediastinal lymphnodes and lung parenchima. Only one case recurred in a residual segment of the same primary lobe with solitary, nodule. All of them were compromised cases and thief lymphnode dissections were imcomplete. There have never been any tumorous recurrence in the surfaces of dissecting intersegmental planes. The prognosis of p-stage I cases (N = 33) is excellent, its 5 year survival rate is 88.5%. The mean loss of ventilatory functions after segmentectomy was nearly half that of Iobectomy. We conclude the anatomical segmentectomy is effective to the limited resection of small-sized NSLC with stage I.
[
4
7
•
Bronchoplastic segmentectomy for hilar lung cancer
T. Oka, T. Sawada, M. Muraoka, T. Nagayasu, S. Akamine, T. Takahashi, Y. Tagawa, H. Ayabe. First DepL of Surgery, Nagasaki
University, Nagasaki, Japan From March 1985 through November 1997, 14 patients underwent bronchoplastic segmentectomies for hilar lung cancer. All were male, ranging in age from 48 to 74 (mean age, 63.0) years. Bronchoplastic segmentectomy was indicated for hilar early lung cancer in 13 patients and for having severe restricted pulmonary function in 1 patient. Histologically all cases were squamous cell carcinoma, 2 patients had Stage 0 disease and 12 patients Stage I disease. Bronchoplastic procedures were sleeve type in 11 patients and wedge type in 3. Eight patients (57.1%) had postoperative complications. Arrhythmia, secretory retention and atelectasis were recognized in 3, 3 and 2 patients, respectively. A short-term stenosis of the bronchial anastomosis developed in 1 patient, however, no patient experienced bronchopleural fistula. There was no operative mortality following bronchoplastic procedure. Ten of 14 patients are alive with no evidence of disease at 120, 108, 75, 80, 58, 51, 44, 42, 41, and 35 months, respectively. Four patients died of unrelated to the primary lesions 36, 19, 14, and 3 months after surgery, respectively. As a result, bronchoplastic segmentectomy is acceptable as a curative operation with preserving pulmonary function for hilar early lung cancer.
I•
Video-assisted thoracoscopic surgery for lung cancer Experience in Okayama University
M. Aoe, A. Andou, H. Date, N. Shimizu, I. Nagahiro, S. Ichiba, S. ¥oshihumi. Okayama University, Okayama, Japan Since the introduction of new thoracoscopic technique into clinical practice, video-assisted thoracoscopic surgical procedure (VATS) is applied to almost all the chest surgical field. In this presentation, we will clarify the indication of video-assisted thoracoscopic surgical procedure (VATS) for pulmonary carcinomas and the results in our department. The indications for applying VATS technique are followed. 1, Pulmonary wedge resection via VATS is suitable for making the diagnosis of peripheral minute lesion, which can not be denied as malignant. 2, In the same meaning, VATS is also better way for diagnostic and therapeutic option for multiple pulmonary lesions. 3, For pulmonary malignancies, VATS should be chosen in the case of elder or poor pulmonary function patients. 4, Recently, we apply VATS procedure to the standard Iobectomy and mediastinal lymphnode dissection in Stage IA lung cancer patients. From April 1991 to January 2000, we performed VATS Iobectomy and mediastinal lymphnode dissection in 88 lung cancer patients. All of these patients were clinical TINOM0 Stage IA. Fifty nine out of 88 had a small tumor, the diameter of which were less than 2 cm. Complete medias final lymphnode dissection was performed in 66 cases, and lymph-node sampling was performed in two. The mean of operation time is 214.0 minutes, and mean of blood loss during operation is 198.8 ml, respectively. The pathological stages are IA in 64 cases and IliA in 4 cases. Up to now, we lose two patients from post-operative pulmonary embolism and intrapulmonary recurrence 30 months after operation, but there are no other recurrences in any cases. The five-year survival rate of these 88 cases is 98%, respectively. We think VATS Iobectomy and mediastinal lymph-node dissection should be chosen as a standard procedure for Stage IA lung carcinoma patients.