Early and long-term results after completion pneumonectomy

Absrracts

/Lung

Cancer

Combined medinstiaal

tborrcoscopy and mediastinoscopy for the evaluation of lympb node metastasis in left upper lobe lung cancer Nakanishi R, Mitsudomi T, Osaki T. Second Lkparbnenl o/Swge~, School of Medicine. Univ. Occupot./Envinmmmtal Health. 1-I Iseigaoko. Yaharanishiku, Kira&w!w 607. J Cardiovasc Surg 1994;35:347-9. Cervical mediastinoscopy has an important but limited role in the evaluation of mcdiastinal adcnopathy of the aonioopulmonary window in patients with let? lung ~.sncer. Thoracoseopy is another valuable diagnostic procedure in the assessment of medisstinal adenopathy. Combined thoracosoopic and mediastinoscopic evaluation may be more accurate for assessing mediastinal lymph node metastasis in left lung cancer than either procedure alone.

Basic and clinical studies oo serum cytokeratin 19 fragment assay using eentocoP CYFBA 21-l kit in patients with lung cancer Hamase A, Sugimoto Y, Maeda M, Kitani H, Fukuchi

clear Medicine.

Hyogo

College

of Medicine.

M. Deparbnenf ofNuKakuigaku

Nishinomiyo.

1994,31:969-76. We evaluated the newly developed tumor marker assay kit, ‘CentocoP CYFRA 21-l’, an immunoradiometric assay (JRMA) kit for determining the serum cytokeratin 19 fragment using the scra of healthy subjects, patients with benign lung diseases and patients with lung cancer. The assay procedure is simple and based on the one-step IRMA system. There were no problems in reproducibility, dilution test and recovery test. The minimum detectable dose was 0.3 rig/ml. The antigen measured by this kit was immunologically crossreactive with tissue polypeptide antigen (TPA) and CYFRA 21-l concentration was closely correlated with TPA concentration in the patient’s serum (r = 0.86, p
Surgery EYly~dloagtrrm~Pftere~npktioapwumoaectomy Massard

Deparbnm: Strasbourg.

G, Lyons G, Wihlm

J-M, Fcrnoux

P, Dumont

of Thwacic Surgery. Hopiknu Universitains Ann Thorac Surg 1995;59:196-200.

12 (1995)

265-329

uneventful stmightloward recovery (62%). The 32 patients with bronchogenic cancer were followed up until date of death or July 1, 1993. Overall 5-year survival was 44.5% (59.7% for stage I, 41.6% for stage II, and 21.2% for stage III). We conclude that there is rm increased operative risk after completion pneumoncctomy; however, this risk is acceptable with respect to long-term survival.

Pneumowcton~y

after contralateral

lobe&my:

Is it reasonable?

Vaaler AK, Hosannah HO, Wagner RB. 50 W Edmonston Dr. Rockviile MD 20852. Ann Thomc Surg 1995;59:178-83. Conservative resection of a saondprimary lung cancer is desirable but not alweys feasible. We recently canied out three lcfi pneumoncctomics for the removal of metachronous primary lung cancers in patients who had previously undergone right upper lobe resection for the treatment ofbrcachogcnic’ carcinoma. In each patient, the results of pulmonary function tests plus the findings from quantitative perfusion lung scans predicted a postpneumoncctomy forced mpiratory volume in 1 second ofat least 1.OO L. All 3 patients had uncomplicated postoperative courses, and were doing satisfactorily at follow-up 2 to 6 months later. One patient died 5 months atIer pncumonectomy due to unrelated causes, another died 8 months e!?er pneumonatomy from infection after resection of a brain metastasis, and the third is doing well I5 months at?er pncumonectomy. The rarity ofpreviously reported cases suggests that performing a pncumonectomy after contralateral lobe&my may be considered too radical. Our experience indicates the procedure may be considered if the patients pulmonary function meets the standard criteria for pneumonectomy.

Some problems of tracbeobmacboplasty Hospital in Bussia Otzheshkovsky

OV, Rcshctov

AV, Gridncv

for lungcancer

in a Regional

AV, Grinchcnko

SA, Makrinova

ON. Deparbnen:ofllrorocicStt~ .knbtgradRegiwaaiHospi&~ Lunatcha+y Ave. 49, St. Petersburg 194291. JR Co8 Surg Edinburgh 1994,39:365-9. Trachcobronchoplastic procedures formed part of the operation for lung cancer in 41 patients of a Regional Hospital in Russia over the past 2 and a half years. Twenty-nine patients underwent sleeve lobectomy, in B further I2 patients, right pncumonectomy was combined with resection of other mcdiestinal structures. In 16 patim&., sleeve lobectomy was indicated by the high risk of pneumonectomy. Involvement of the car-inn in the tumour indicated its resection. High frequency jet ventilation was a particular feahwe of anaesthesia for carinal resection. Omentopcxy was used in 10 patients to prevent dehisccnce of the bronchial anastomosis. Postoperative complications were encountered in IO patients. The most frequent, in patients, was dehisecncc of the tracheobronchial anastomosis atIer resection of the catina. Five patients died atIer operation, the closes of death being dchiscence of anastomosis. pneumonia, empyema, and act& heart failure. Despite the frequency of complications, trachcobmnchoplastic operations are o&en the only possible option in the surgery of extensive lung cancer.

P, Kessler R et al. Skasbourg F-67091

From Janwy I, 1978 to December 31, 1992, 37 patients underwent a completion pneumonectomy atIer a previous lobectomy (36 men and 1 woman; mea” age, 60 years; range, 41 to 77 years). These account for 4.8% of 758 pneumonectomies. The pmpose ofthe present study was to evaluate the operative results of completion pncumonectomy and long-term survival in patients with bmnchogcnic cancer. The initial lung resection had been performed for primary bronchogenic canca in 23, metastatic thyroid ade-nowcinoma in I, and benign diseases in 13 (tuberculosis in I I, aspergilloma in I, and 1, bmnchiectasis in 1). Completion pncumonectomy was required for bronchogenic cancer in 32 (15 stage 1.6 stage II, I I stage III). One patient had relapsing metsstatic thyroid carcinoma, 2 had bronchiectasis, and 2 had a venous infarction a&r lotectomy. Four patients (10.8%) died perioperativcly of the following causes: I fatal intraoperativc bleeding, 1 fatal postoperative bleeding, I pneumonia, and 1 malignant hypercalcemia. Median operative blood loss was II000 mL, and 19 patients experienced bleeding exceeding I.000 mL (5 1%). Six patients had intraoperative vascular injury. Nonfatal surgical complications occurred in 9 patients (24%). including 5 clotted hemothoraces, 3 empyemas, and I bronchoplcural tistula. Four patients had medical complications (2 pulmonary edemas, 1 sinus tachycardia, and I unexplained fever). Twenty-three had an

Incidenceof local ~eurrence stage I lung cancer

and second primary

tumors

in resected

Martini N, Bains MS, Burt ME, Zakowski MF, McCormack P, Rusch VW et al. 1275YorkAw., New York, NY10021. JThoracCardiovasc Surg 1995;109:120-9. From 1973 to 1985.598 patients underwent resection for stage I non- smsllcell lung center. There were 291 Tl lesions and 307 T2 lesions. The male/f&r& ratio was 1,9: I. The histologic type was squamous carcinoma in 233 and nonsquamous carcinoma in 365. Lobcetomy was performed in 51 I patients (85%). pneumonectomy in 25 (4%). and wedge resection or segmenteetomy in 62 (11%). A mediastinal tymph node dissection ~a.8 carried out in 560 patients (94%) and no lymph node dissection in 38 (6%). Fourteen postoperative deaths oecurrcd (2.3%). Nindy-nine pcrecnt ofthc patients were observed for a minimum of 5 years or until death with an overall median follow-up of 9 I months. The overall 5-and IO-year survivals (Kaplan-Meier) were 75% end 67%, respectively. Survival in patients with Tl NO tumors was 82% at 5 years and 74% at 10 years compared with 68% at 5 years and 60% at IO years for patients with T2 tumors (p < OXKl4). The overall incidence of recurrence was 27% (local or regional 7%, systemic 20%) and was not influenced by histologic type. Second primary CB~OXSdeveloped in 206 patients (34%). Of these, 70 (34%) were second primaty lung c~nccm. Despite complete resection, 31 of 62 patients (50%) who had