Incidence of local recurrence and second primary tumors in resected stage I lung cancer

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

Abstracts/Lung

Cancer

wedge resection or scgmmtectomy had recurrence. Five and IO-year survivals after wedge resection or scgmentectomy were 59% and 35%, respectively, significantly less than survivals ofthose undergoing lobe&my (5 years, 77%; 10 years., 70%). The S- and IO-year survivals in the 38 patients who had no lymph node dissection were reduced to 59% and 32%, respectively. Apart from the favorable prognosis observed in this group of patients, three facts emerge as significant: (I) Systematic lymph node dissection is necessary to ensure that the disease is accurately staged; (2) lesser resections (wedge/segment) result in high recurrence rates and reduced survival regardless of histologic type; and (3) second primary lung cancers we prcvalcnt in long-term survivors.

L.ong-term antimicrobial lation between mlcmbii

prophylaxis in lungkukcer findiags and empyema

surgery: CorrcdeveIopment

Ratto GB, Fantino G, Tassan E. Angelini M, Spessa E, Parodi A. Isfihrto di Parokqia Chirwgiw Vnivesiryof Genoa. &de BenedetkA’VlO, 16132 Genoa. Lung Cancer (Ireland) 1994,11:345-52. This study was planned in order to determine the value of antimicrobial prophylaxis in preventing post-operative empyema in patients undergoing lung cancer surgery. Two-hundred consecutive subjects operated upon for lung cancer received teicoplanin and aztreonam, starting at the induction of anesthesia and lasting until removal of the pleural drains. Cultures for aerobic and anaerobic bacteria were taken from: (1) the bronchus at the time of surgical division (2) the pleural space before closure of the chest; (3) the pleural fluid during the postoperative period; and (4) the tips of chest drains at the time of their removal. In the 200 patients receiving antibiotic prophylaxis, the number of post-operative empyemas (I%) was lower than that (7.5%) found in 53 comparable patients who were previously treated with placebo. In the ‘placebo group’, ompyems ww due to gram-positive bacteria, while in the ‘prophylaxis group’, it WBS caused by Gram-negative bacteria (F’seudomonos aeruginosa). A signiticant (P < 0.05) correlation between infected bronchial secretions,pleural space contamination at surgery, contamination of chest fluid and drains during the post-operative period, and empyema development was demonstrated. In conclusion, antibiotic prophylaxis, while being effective in preventing post-operative empyema, may induce the colonization of the respiratory tract with highly resistant gram-negative bacteria.

A ocw procedure ofthe carinn

for light upper lobcctomy

of hmg with rccoa-struction

Ding J-A. Shanghai First Pulmonmy Dis. Hosp.. Shanghai. Chin J Clin Oncol 1994;2l:g69-72. Right upper lobectomy with resection and reconstruction of the carina for lungcanccrinvadingcarinaand/or~acheacanbedoncifthisproccdure isconsidered to be curative. In the pest, the modes of carinsl reconstruction under such circumstances are either the trachea being reanastomosed with the right intermediate bronchus with the left main-bronchus end to end or the trachea being reanastomosed with the IcA main-bronchus end to end and the right intermediate bronchus with the left main-bronchus end to side. The operative techniques, anesthetic management and operative exposure in the above mentioned procedures are imbued with difficulties. The authors concluded from animal experiments that the reanastomosing trachea with the let? main-bronchus end to end as well as end to side with the right intermediate bronchus is an ideal approach of carinal resection and reconstruction. The surgical technique is simpler and the tension of the anastomotic site is rather low. One of the key points is that this technic would allow the resection of a suffXent length of trachea and main-bronchus. Recently we have successfully used this technic of carinal reconstruction on patients.

Prognostic carcinoma

sigaiiiance ofp53 and ras geaeabaotmalities patients with stage I disease at%er curative

io lung adem+ resection

Is&e T, Hiyama K, Yoshida Y, Fujiwara Y, Yamakido M. Second Departmenf Mernal Medicine, Hiroshima Unitersi&, School of Medicine, l-2-3 Minami-ku. Hiroshima 734. Jpn J Cancer Rcs 1994;85: 1240-6.

Kasumi,

We investigated the prognostic significance of p53 gene abnormalities and ras gene mutations in patients with curatively resected stage I lung adenocarcinoma. Formalin-fixed and paraffinembedded tissues were obtained from 30 patients who had undergone curative resection for stage I lung adenocarcinoma.

I2 (1995)

265-329

Abnormalities of the p53 gent were detected using polymerax chain rcactiondenaturing gradient gel electrophoresis (PCR-DGGE) analysis and immunohistochcmistry and ras mutations were detected using PCR-restriction fragment length polymorphism (RFLP) analysis. Both univariate and multivariate analyses were performed to assess the relationship between the presence of abnormalities of these genes and the patients’ disc&w-free survival. Eleven tumors (37%) had inutated p53 sequences and 11(37%) showed pS3 overexpression. A total of IS tumors (50%) had ~53 gene abnormalities and the concordance rate was 73%. Seven tumors (23%) showed mutated ras sequences. The univariate analysis revealed that the disease-free survival of patients with any pS3 abnormality was shorter than that of those without abnormalities (P = 0.02, generalized Wilcoxon test), and survival of those with ~53 protein overexpression was more significantly shorter (P = 0.003, generalized Wilcoxon test). Multivariate analysis using the Cox proIxxtional hazards model indicated that the presence of ~53 abnormalities was a significantly (p = 0.01) unfavorable prognostic factor. There was no significant correlation bchveen the presence of res mutation and survival. These results suggest that analysis of the p53 gene may be helpful for the selection of high-risk patients for clinical trials of adjuvant therapy for stage I lung adenocaminome.

Evahiation ofpr@mstic signikance ofp53 gene alterations with surgically resected lung cancer

ia patients

Kashii T, Mizushima Y, Lima CEQ, Noto H, Sate H, Saito H et al. First Dept. of In~emal medicine. ToyMtaMedical/Phann~Eculical

Univ. 2630 Sugitani, Toyama

930-01. Int 1 Oncol 1995;6:123%. Clinical significance of p53 gene alterations, as a prognostic factor, was assessed in 69 patients with surgically resected lung cancer. The ~53 gene alterations (exon 5-9) were examined by the polymerase chain reaction-single strand conformation polymorphism @‘CR-SSCP) method of genomic DNA. The ~53 gene alterations were detected in all histological types of lung cancer, with a positive rate of 45% (3 l/69). In the alteration-positive group, patients in the advanced stages of Ill and IV were seen more frequently than in the negative group (58% vs. 2l%, p 4 0.05). Such a differera was not observed in other parameters such as age, gender, histological type and smoking habit. The prognosis was, on a whole, poorer in the alteration-positive group than for the -negative one (5-year survival rate: 19.3% vs. 40.6%, MST: 17 months vs. 36 months), but the difference did not reach statistical significance. However, in the case of females (p < O.OS), adenocarcinoma (p < O.Ol), early stages of I and lI (p < 0.05) and non-smokers (p < O.OOS), a signiticantly poorer prognosis was observed in the gene alteration-positive group than for the -negative one. These results suggest that the ~53 gene alteration may be a useful prognostic factor in certain subgroups with lung resected for cancer.

Quality-af-life

following

thoracotomy

for long cancer

Dales RE, Belanger R, Shamji FM, Leech J, Crcpeau A, Sachs HJ. 011awa General Hospifal, 501 Smyth Road, Olfawa. Onr. KIH 8L6. J Clin Epidemiol 1994;47:1443-9. Contrary to the issues of perioperative morbidity and survival following surgery for lung cancer, little attention has been given to quality-of-life. To address this, quality-of-life was assessed preopemtively and I, 3,6 and 9 months postoperatively in a cohort of 117 consecutive subjects who underwent thoracotomy with a cettain or presumptive diagnosis of lung cancer. Those with cancer (n = 91) confirmed at thoracotomy were contrasted to those without (n = 26). Moderate to severe dyspnes, reported in 14% preoperatively, increased to 34% at I and 3 months (p < 0.005) but returned to approximately 10% at 6 and 9 months. Similarly, activities of daily living were impaired in 1 I % preoperativelv; this disability increased to 21% at 1 month (p < 0.005), and timed to baseline at 6 and 9 months. Those with cancer compared to those without a postoperative diagnosis of cancer had similar quality-of-life prcoperatively but deteriorated more in the postoperative period. This study demonstrates that important deterioration in quality-of-life occurs during the first 3 months postoperatively in those with a final diagnosis ofcancer but improvement back to baseline can be expected thereafter.