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Multicentricity in resected occult bronchogenic squamous cell carcinoma
161 620
621
RESULTS AND OPERATIVE INDICATIONS OF LOBECTOMY WITH BRONCHOPLASTY FOR BRONCHOGENIC CARCINOMAS T. Sakamoto, N. Ishii, H. Yamagishi, M. Okada, H. Matsuoka, M. Okada Department of Surgery, Division II, Kobe University School of Medicine, Kobe, Japan We evaluated the results and operative indications of bronchoplastic lobectomy in patients with bronchogenic carcinomas. From 1980 to 1992, 34 patients underwent lobectomy in combination with a bronchoplastic procedure for lung cancer. In regard to the histological typing, they consisted of 18 squamous cell carcinomas, 9 adenocarcinomas, 3 large-cell carcinomas, 2 combined type of adenocarcinoma and squamous cell carcinoma, 1 small-cell carcinoma, and 1 carcinosarcoma. The 5-year survival rate of 18 cases of squamous cell carcinomas was 41%, whereas 9 cases of adenocarcinomas died within 3 years. We classified 34 cases into two groups according to the reason of indication for bronchoplasty. Group T (n=19) was the case whose tumor was spreading to the major bronchus. Group LN (n=14) was the case whose metastatic lymph nodes were invading to the major bronchus. Forty-two % of Group T was stage Ill or IV, while 93% of Group LN was stage Ill or IV. The J-year survival rate was 55% in Group T, and 8% in Group LN. There were statistical differences between both groups (pcO.05). In 73 patients who underwent pneumonectomy at the same period, the 5year survival rate was 32%. In conclusion, the bronchoplastic procedure might be recommended to Group T in comparison of that of Group LN.
MULTICENTRICITY
622
623
Effect of muscle sparing thoracotomy in early postoperative course. Y. lshii, F. Inoue, K. Orita. First Department of Surgery Okayama University Medical School, Okayama. Japan Muscle sparing thoracotomy (MST) is a thoracotomy to preserve latissimus dorsi and serratus anterior. We measured area of operation field, thoracotomy time, requirement of analgesics for 7days, pulmonaly function and range of upper extremity motion in early period of postoperative course and compared MST (N = 19) with posterolateral thoracotomy ( PLT , N = 25 ) . Pulmonary function and upper extremity motion were measured on 7th. 14th, 21st and 28th day after operation. (result) The area of operating field in MST was smaller than that in PLT. Thoracotomy time in MST needed longer than that in PLT. The total doses of analgesics were significantly less in MST group (P < 0.05). Better result of pulmonary function and mobility of upper extremity on 7th and 14th postoperative day was observed in MST group but there was no significance between two groups. Complication of MST was wound seroma. In this study we experienced eight seromas (42.8%) and three of them (15. 8%) were intractable. Cosmetic result was good in MST. (conclusion) MST is less painful in early postoperative period and cosmetically better but the procedure is complicated and seroma occurs more often than previous reports. We do not think MST is best procedure for thoracotomy but MST suits for young patients by cosmetic reason and might be suitable for elderly patients for preserving for pulmonary function in early post operative course. However you must pay attention carefully to prevent seroma.
A REVIEW
IN RESECTED
OCCULT
BRONCHOGENIC SQUAMOUS CELL CARCINOMA Saito,Y. Sato,M. Sagawa,M. Kanma,K. Takahashi, S. Usuda,K. Nagamoto,N. Endo,C. Chen,Y. Sakurada,A. Aikawa,H. Fujimura,S. Department of Thoracic Surgery, Institute of Development, Aging and Cancer, Tohoku University, Japan. The frequency and maatment of multicentricity in 127 cases with resected roentgenogmphically occult bmnchogenic squamous cell carcinoma (SCC) were studied. The cumulative rate and incidence of postoperative metachronous multiple primary lung cancer (MPLC) was 0.11 at 5 years and O.O22/patient-year, respectively. The cumulative rate and incidence of second primary lung cancer, which includes synchronous and subsequent metacbronous cancer in patients with initial lung cancer, were 0.17 at 5 years and O.Wl/patient-year. The cumulative rate and incidence of third primary lung cancer in patients with second primary lung cancer were 0.47 at 5 years, which was significantly higher (p=O.O5) than that of second primary lung cancer, and 0.1 l! patient-year, respectively. In all twelve cases with synchronous MPLC, no recurrence was observed after treatment, but three cases had subsequent MPLCs. Among the 13 patients with postoperative metachronous MPLC, recurrence was observed in one of the six patients who underwent resection and in two of the four patients treated with laser and/or radiation therapy. The overall survival rate at 5 years after initial operation in cases of solitary and multicentric occult bronchogeuic SCC was 0.90 and 0.59, respectively.
OF 573 SURGICALLY
Viet Co, To Kieu Dung.
National
Disease
Vietnam.
(NITRD),
From
Hanoi,
1960 to June
Vietnam.
TREATED Institute
1993, 573 cases
Four hundred
and eighty
LUNG CANCER of Tuberculosis
of lung cancer
seven
cases
CASES.
Nguyen
and Respiratory
were operated
(84 99%) were
at NITRD,
at the age of 40-
64. *Clinical
Symptoms: Chest
pain
Cough Hemoptysis Weight
loss
Low grade Fierce Marie *Cigarette Tumor
Syndrome
tlmmr
Smoking:
size under
3cm were found
upper lobe: 302 cases *Surgical Treahnent:
(50.78%) (47.46%)
127
(22.16%)
97
(16.92%)
29
( S.O6%) were
located
( 0.92%) (53 40%) ( 7.50%)
43
Squamous
80 134
cell carcinoma:
II2
Large Small
39 45 25
cell carcinoma cell carcinoma
Unclassified *Staging,
(15.00%) (23.38%) (59.59%)
323 cases
Adenocarcinoma
of squamous
(70.16%) Tumors
5 cases 306
Pneumonectomy Exploratory Thoracotomy
In Hanoi, Vietnam, smoking with initial
(56.02%)
272
(52.61%).
Bilobectomy
stage
(76.78%)
291
402 cases in 14 cases (2.44%).
Segmentectomy Lobectomy
*Pathology:
(72.25%)
321 fever
Clubbing Pancoast’s
414 cases 440
cases
(20.66%)
(
7.20%) ( 8 30%) 4.54%
stage stage
1 II
stage
III
38.64%
stage
IV
56.82%
9.09%
lung cancer is usually found to be related to cigarette symptoms of chest pain, cough and hemoptysis. Advanced cell carcinoma
is the most common
status.
in
621
RESULTS AND OPERATIVE INDICATIONS OF LOBECTOMY WITH BRONCHOPLASTY FOR BRONCHOGENIC CARCINOMAS T. Sakamoto, N. Ishii, H. Yamagishi, M. Okada, H. Matsuoka, M. Okada Department of Surgery, Division II, Kobe University School of Medicine, Kobe, Japan We evaluated the results and operative indications of bronchoplastic lobectomy in patients with bronchogenic carcinomas. From 1980 to 1992, 34 patients underwent lobectomy in combination with a bronchoplastic procedure for lung cancer. In regard to the histological typing, they consisted of 18 squamous cell carcinomas, 9 adenocarcinomas, 3 large-cell carcinomas, 2 combined type of adenocarcinoma and squamous cell carcinoma, 1 small-cell carcinoma, and 1 carcinosarcoma. The 5-year survival rate of 18 cases of squamous cell carcinomas was 41%, whereas 9 cases of adenocarcinomas died within 3 years. We classified 34 cases into two groups according to the reason of indication for bronchoplasty. Group T (n=19) was the case whose tumor was spreading to the major bronchus. Group LN (n=14) was the case whose metastatic lymph nodes were invading to the major bronchus. Forty-two % of Group T was stage Ill or IV, while 93% of Group LN was stage Ill or IV. The J-year survival rate was 55% in Group T, and 8% in Group LN. There were statistical differences between both groups (pcO.05). In 73 patients who underwent pneumonectomy at the same period, the 5year survival rate was 32%. In conclusion, the bronchoplastic procedure might be recommended to Group T in comparison of that of Group LN.
MULTICENTRICITY
622
623
Effect of muscle sparing thoracotomy in early postoperative course. Y. lshii, F. Inoue, K. Orita. First Department of Surgery Okayama University Medical School, Okayama. Japan Muscle sparing thoracotomy (MST) is a thoracotomy to preserve latissimus dorsi and serratus anterior. We measured area of operation field, thoracotomy time, requirement of analgesics for 7days, pulmonaly function and range of upper extremity motion in early period of postoperative course and compared MST (N = 19) with posterolateral thoracotomy ( PLT , N = 25 ) . Pulmonary function and upper extremity motion were measured on 7th. 14th, 21st and 28th day after operation. (result) The area of operating field in MST was smaller than that in PLT. Thoracotomy time in MST needed longer than that in PLT. The total doses of analgesics were significantly less in MST group (P < 0.05). Better result of pulmonary function and mobility of upper extremity on 7th and 14th postoperative day was observed in MST group but there was no significance between two groups. Complication of MST was wound seroma. In this study we experienced eight seromas (42.8%) and three of them (15. 8%) were intractable. Cosmetic result was good in MST. (conclusion) MST is less painful in early postoperative period and cosmetically better but the procedure is complicated and seroma occurs more often than previous reports. We do not think MST is best procedure for thoracotomy but MST suits for young patients by cosmetic reason and might be suitable for elderly patients for preserving for pulmonary function in early post operative course. However you must pay attention carefully to prevent seroma.
A REVIEW
IN RESECTED
OCCULT
BRONCHOGENIC SQUAMOUS CELL CARCINOMA Saito,Y. Sato,M. Sagawa,M. Kanma,K. Takahashi, S. Usuda,K. Nagamoto,N. Endo,C. Chen,Y. Sakurada,A. Aikawa,H. Fujimura,S. Department of Thoracic Surgery, Institute of Development, Aging and Cancer, Tohoku University, Japan. The frequency and maatment of multicentricity in 127 cases with resected roentgenogmphically occult bmnchogenic squamous cell carcinoma (SCC) were studied. The cumulative rate and incidence of postoperative metachronous multiple primary lung cancer (MPLC) was 0.11 at 5 years and O.O22/patient-year, respectively. The cumulative rate and incidence of second primary lung cancer, which includes synchronous and subsequent metacbronous cancer in patients with initial lung cancer, were 0.17 at 5 years and O.Wl/patient-year. The cumulative rate and incidence of third primary lung cancer in patients with second primary lung cancer were 0.47 at 5 years, which was significantly higher (p=O.O5) than that of second primary lung cancer, and 0.1 l! patient-year, respectively. In all twelve cases with synchronous MPLC, no recurrence was observed after treatment, but three cases had subsequent MPLCs. Among the 13 patients with postoperative metachronous MPLC, recurrence was observed in one of the six patients who underwent resection and in two of the four patients treated with laser and/or radiation therapy. The overall survival rate at 5 years after initial operation in cases of solitary and multicentric occult bronchogeuic SCC was 0.90 and 0.59, respectively.
OF 573 SURGICALLY
Viet Co, To Kieu Dung.
National
Disease
Vietnam.
(NITRD),
From
Hanoi,
1960 to June
Vietnam.
TREATED Institute
1993, 573 cases
Four hundred
and eighty
LUNG CANCER of Tuberculosis
of lung cancer
seven
cases
CASES.
Nguyen
and Respiratory
were operated
(84 99%) were
at NITRD,
at the age of 40-
64. *Clinical
Symptoms: Chest
pain
Cough Hemoptysis Weight
loss
Low grade Fierce Marie *Cigarette Tumor
Syndrome
tlmmr
Smoking:
size under
3cm were found
upper lobe: 302 cases *Surgical Treahnent:
(50.78%) (47.46%)
127
(22.16%)
97
(16.92%)
29
( S.O6%) were
located
( 0.92%) (53 40%) ( 7.50%)
43
Squamous
80 134
cell carcinoma:
II2
Large Small
39 45 25
cell carcinoma cell carcinoma
Unclassified *Staging,
(15.00%) (23.38%) (59.59%)
323 cases
Adenocarcinoma
of squamous
(70.16%) Tumors
5 cases 306
Pneumonectomy Exploratory Thoracotomy
In Hanoi, Vietnam, smoking with initial
(56.02%)
272
(52.61%).
Bilobectomy
stage
(76.78%)
291
402 cases in 14 cases (2.44%).
Segmentectomy Lobectomy
*Pathology:
(72.25%)
321 fever
Clubbing Pancoast’s
414 cases 440
cases
(20.66%)
(
7.20%) ( 8 30%) 4.54%
stage stage
1 II
stage
III
38.64%
stage
IV
56.82%
9.09%
lung cancer is usually found to be related to cigarette symptoms of chest pain, cough and hemoptysis. Advanced cell carcinoma
is the most common
status.
in