- Email: [email protected]
One hundred and one cases of bronchoplasty for primary lung cancer
Abstracts/Lung Broochoplastic patients
procedures
for
lung cancer:
Clinical
study
in 136
Kawahara K, Akaminc S, Tsuji H, Nakamura A, Takahashi T, Tagawa Y et al. Firs: Depar(menr ofSwge~, Nagas& Unix School of Medicine, Sakamoto I7-1. Nagasaki852. World J Surg 1994;18:822-6. Behveen 1969 and 1991 a lotal of 136 patients (119 men, 17 women) underwent bronchoplastic procedures for lung cancer. A bronchoplastic procedure with angioplasty was performed in 37 patients. Ages ranged from 30 to 79 years (mean 62 years). The histologic type of cancer was squamous cell carcinoma in 97 patients (70.0%). The 3Oday mortality was 5.1% (7 patients), and morbidity was 30.1% (41 patients). The most common complications were bronchoplcural tistula in nine (6.6’%), stricture or stenosis in eight (5.9%) and atclectasis in eight patients. Local recurrence occurred in nine (6.6%) patients. The overall S-year survival for patients undergoing bronchoplastic procedures was 37.1%: 60.1% for patients with stage 1 disease (n = 41). 31.7% for stage II (n = 17). and 29.7% for stage UIA (n = 66). We conclude that bronchoplastic procedures are effective therapy for selected patients with lung cancer.
One bundnxl
and ooe cases of broachoplasty
for primary
lung cancer
Tsubota N, Yoshimura M, Murotani A, Miyamoto Y, Mat&a Y. Hygo Medico/ Cenler. General Thoracic Surgery, 13-70 Kilaoji. Hyogo. 675. Surg Today 1994;24:978-81. The results of 101 consecutive bronchoplastics performed bchwcn 1979 and 1993, including 8 eases of pncumonectomy, 88 caxs of lobectomy. 3 cases of segmentectomy, and 2 cases of bronchial resection, are herein reported. Squamous cell carcinoma was the most common disease (59%) followed by adcnacarcinoma (30 %) and other diseases (11%). Anastomosis was satisfactory in 96 cases. Among the five stenoaed cases, local reourrence was found in hvo cases, and there were three benign strictures. Two of the three benign strictures were treated with bouginage. The pulmonary artery was concomitantly reconstructed in seven cases with satisfactory results. Preoperative chcmoradiotherapy was performed in 15 advanced cases and was followed by acceptable surgical results. The 5-year survival rate, according to the post-operative staging of the 86 patients without induction therapy, was 86% in stage I (I9 patients), 49% in stage II (21 patients), and 27% in stage IIIA (40 patients). The overall survival rate was 46% at S years. There were hvo indications for this procedure i.e., 8 positive resection margin in 59 cases and positive hilsr nodes in 42 eases. Better survival was noted in patients with squamous cell carcinoma. stage I, and surgery was thus selected for B positive resection margin, and not for a positive node.
MMaganmtofregiooallyadvanced(stage~-
LCSG
celllungcaocec
831
Eagan RT. St. Joseph Hospiral Cancer Cenrer, Orange. CA. Chest 1994;106:Suppl:34OS-3s. Patients with regionally extensive non-small cell lung cancer (predominantly by virtue of metastases to mediastinal lymph nodes, less commonly by direct extension into the media&urn) were treated predominantly with chest radiation therapy alone until the early 1980s. At that time, baause of the high local recurrence rate, the higher likelihood of distant “etastases, and the poor S-year survival rates, studies were begun in these patients attempting to substitute a different local treatment modality (surgery) or to use both radiation therapy and surgery to decrease local recwrencc rates and to add chemotherapy as B systemic therapy to decrease distant mctastases. LCSG 831 explored the use of CAP (cyclophosphamide, doxorubicin, cisplatin) chemotherapy plus radiation therapy as preoperative or neoadjuvant therapy. Thirty-nine patients entered this phase 2 trial with 33 undergoing resection. Median survival was I I months, and I-year survival was 43%. These results are compared with the resulls of other simdar trials. Explanations for the poor and differing results are suggested as are possible ways to improve study design and results.
Current
status of surgical
resection
for lung cancer
Pearson EG. Toronto General Hospiral. Toronto. Onr. Chest 1994;106. supp1:337s-9s. There have been no major breakthroughs in surgical management for primary lung cancer during the past 40 years. Improved 5-year survival relates primarily to improved preoperative staging end appropriate selection of patients for
Cancer
12 (1995)
265-329
resection. Perioperative morbidity and mortality, however, has been significantly reduced. Certain principles pertain to current surgical managements resection remains the best treatment for patients with localized, non-small cell primary lung cancer. Accurate preoperative diagnosis and staging: whenever possible, it is desirable to establish the diagnosis and cell type before operation. Accurate evaluation of the N status warrants wide application of invasive staging with mediastinoscopy or a variant. Indications for resection: only patients in whom a complete resection is anticipated should be s&&cd for surgery. Such cases included Tl to T4 stages, NO and Nl tumors, and selected N2 cases. The indication for resection in patients with hcmatogenous metestases are anecdotal. Intraopcrativc staging: accurate and deliberate intraopcrative staging with evaluation of nodes using the American Thoracic Swiety map is highly desirable. The natore of nodal “etastases exerts a critical influence on prognosis and in the selection of patients for surgical resection. At present, there is no clear indication foradjuvant therapy in surgically resected casesother than for evaluation end clinical trials.
General
priociplea
of surgery
quality
control
Holmes EC. 10833 LeConre, Los Angeles. CA 90024. Chest 1994;106: Suppl:334S-6s. Randomized clinical trials are currently the most reliable research technique to generate reliable treatment data. Quality control and monitoring with statistical credibility are essential. This requires nurse data managers and coordinators and statisticians, as well as the surgeons and physicians. A wellstructured operating infrastructorc is key. From the surgical point of view, careful intraoperativc staging and standardization of the surgical procedures are a must. Strict eligibility criteria must be documented and enforced. Finally, careful stratification for prognostic variables before randomization in phase 3 trials is essential.
Prospective resections
assessment in lungcaacer
of 30-day
operative
morbidity
for surgical
Deslauricrs J, Ginsberg RJ,Piantadosi S, Foumier B. HopifalLavol, 2725 chemin, Saink-Fey. Que. GlV4G5. Chest 1994;106:Suppl:329S-30s Prospective morbidity and mortality rates associated with reSection of lung cancer that are reflective of the current trend toward preoperative therapy are riot readily available in the current literature. To determine their prevalence. we prospectively analyzed the results of 783 resections performed within contributing Lung Cancer Study Group (LCSG) centers. There were 543 men and 240 women with a mean age of 63.44 years. Of the 783 resections, there were 41 I lobectomies, 135 pneumonectomies, and 237 other procedures. Thirty patients died postopexativcly (motility, 3.8%) and 21 I had a major complication (27%). Compbcations occurred more commonly in men (34.3%, p-0 00 I ). in patients age 60 or older (34.0%, p=O.OOl), and in patients with a Kamofsky index + (44%, p&001). There was no significant difference between mortality, significant morbidity rates for lobectomy (28.2%), and pneumonectomy (3 1 9%), or for simple (28.3%) and extended resection (3 I .9%). The seemingly higher incidence of major postoperative events reported in this series not only reflects the prospective nature of this analysis but also the fact that over 25% of patients were in other therapeutic trials involving neoadjuvant or postoperative adjuvant regimens. Within that context. these data appear to be a reasonable estimate of modem surgical morbidity rates in the treatment of lung caocer.
Quality
uf lie in luagcancer
surgical
adjuvant
MoJitt
trials
Ruckdeschcl JC, Piantadosi S. H. Lee Cancer Center. Resewn-h Indime Tampa. FL Chest 1994,106:Suppl:324S-8s. The Functional Living Index-Cancer (FLIC) was administered to 438 patients in the Lung Cancer Study Group on whom long-term follow-up was available in 1993. Across all trials, the total FLIC score was predictive for survival even when corrected for extent of disease, although individual items on the FLIC were not. There was no significant impact of a short course of chemotherapy on quality of life. The FLIC is a reliable means of assessing quabty of life in lung cancer surgical adjuvant trials.
procedures
for
lung cancer:
Clinical
study
in 136
Kawahara K, Akaminc S, Tsuji H, Nakamura A, Takahashi T, Tagawa Y et al. Firs: Depar(menr ofSwge~, Nagas& Unix School of Medicine, Sakamoto I7-1. Nagasaki852. World J Surg 1994;18:822-6. Behveen 1969 and 1991 a lotal of 136 patients (119 men, 17 women) underwent bronchoplastic procedures for lung cancer. A bronchoplastic procedure with angioplasty was performed in 37 patients. Ages ranged from 30 to 79 years (mean 62 years). The histologic type of cancer was squamous cell carcinoma in 97 patients (70.0%). The 3Oday mortality was 5.1% (7 patients), and morbidity was 30.1% (41 patients). The most common complications were bronchoplcural tistula in nine (6.6’%), stricture or stenosis in eight (5.9%) and atclectasis in eight patients. Local recurrence occurred in nine (6.6%) patients. The overall S-year survival for patients undergoing bronchoplastic procedures was 37.1%: 60.1% for patients with stage 1 disease (n = 41). 31.7% for stage II (n = 17). and 29.7% for stage UIA (n = 66). We conclude that bronchoplastic procedures are effective therapy for selected patients with lung cancer.
One bundnxl
and ooe cases of broachoplasty
for primary
lung cancer
Tsubota N, Yoshimura M, Murotani A, Miyamoto Y, Mat&a Y. Hygo Medico/ Cenler. General Thoracic Surgery, 13-70 Kilaoji. Hyogo. 675. Surg Today 1994;24:978-81. The results of 101 consecutive bronchoplastics performed bchwcn 1979 and 1993, including 8 eases of pncumonectomy, 88 caxs of lobectomy. 3 cases of segmentectomy, and 2 cases of bronchial resection, are herein reported. Squamous cell carcinoma was the most common disease (59%) followed by adcnacarcinoma (30 %) and other diseases (11%). Anastomosis was satisfactory in 96 cases. Among the five stenoaed cases, local reourrence was found in hvo cases, and there were three benign strictures. Two of the three benign strictures were treated with bouginage. The pulmonary artery was concomitantly reconstructed in seven cases with satisfactory results. Preoperative chcmoradiotherapy was performed in 15 advanced cases and was followed by acceptable surgical results. The 5-year survival rate, according to the post-operative staging of the 86 patients without induction therapy, was 86% in stage I (I9 patients), 49% in stage II (21 patients), and 27% in stage IIIA (40 patients). The overall survival rate was 46% at S years. There were hvo indications for this procedure i.e., 8 positive resection margin in 59 cases and positive hilsr nodes in 42 eases. Better survival was noted in patients with squamous cell carcinoma. stage I, and surgery was thus selected for B positive resection margin, and not for a positive node.
MMaganmtofregiooallyadvanced(stage~-
LCSG
celllungcaocec
831
Eagan RT. St. Joseph Hospiral Cancer Cenrer, Orange. CA. Chest 1994;106:Suppl:34OS-3s. Patients with regionally extensive non-small cell lung cancer (predominantly by virtue of metastases to mediastinal lymph nodes, less commonly by direct extension into the media&urn) were treated predominantly with chest radiation therapy alone until the early 1980s. At that time, baause of the high local recurrence rate, the higher likelihood of distant “etastases, and the poor S-year survival rates, studies were begun in these patients attempting to substitute a different local treatment modality (surgery) or to use both radiation therapy and surgery to decrease local recwrencc rates and to add chemotherapy as B systemic therapy to decrease distant mctastases. LCSG 831 explored the use of CAP (cyclophosphamide, doxorubicin, cisplatin) chemotherapy plus radiation therapy as preoperative or neoadjuvant therapy. Thirty-nine patients entered this phase 2 trial with 33 undergoing resection. Median survival was I I months, and I-year survival was 43%. These results are compared with the resulls of other simdar trials. Explanations for the poor and differing results are suggested as are possible ways to improve study design and results.
Current
status of surgical
resection
for lung cancer
Pearson EG. Toronto General Hospiral. Toronto. Onr. Chest 1994;106. supp1:337s-9s. There have been no major breakthroughs in surgical management for primary lung cancer during the past 40 years. Improved 5-year survival relates primarily to improved preoperative staging end appropriate selection of patients for
Cancer
12 (1995)
265-329
resection. Perioperative morbidity and mortality, however, has been significantly reduced. Certain principles pertain to current surgical managements resection remains the best treatment for patients with localized, non-small cell primary lung cancer. Accurate preoperative diagnosis and staging: whenever possible, it is desirable to establish the diagnosis and cell type before operation. Accurate evaluation of the N status warrants wide application of invasive staging with mediastinoscopy or a variant. Indications for resection: only patients in whom a complete resection is anticipated should be s&&cd for surgery. Such cases included Tl to T4 stages, NO and Nl tumors, and selected N2 cases. The indication for resection in patients with hcmatogenous metestases are anecdotal. Intraopcrativc staging: accurate and deliberate intraopcrative staging with evaluation of nodes using the American Thoracic Swiety map is highly desirable. The natore of nodal “etastases exerts a critical influence on prognosis and in the selection of patients for surgical resection. At present, there is no clear indication foradjuvant therapy in surgically resected casesother than for evaluation end clinical trials.
General
priociplea
of surgery
quality
control
Holmes EC. 10833 LeConre, Los Angeles. CA 90024. Chest 1994;106: Suppl:334S-6s. Randomized clinical trials are currently the most reliable research technique to generate reliable treatment data. Quality control and monitoring with statistical credibility are essential. This requires nurse data managers and coordinators and statisticians, as well as the surgeons and physicians. A wellstructured operating infrastructorc is key. From the surgical point of view, careful intraoperativc staging and standardization of the surgical procedures are a must. Strict eligibility criteria must be documented and enforced. Finally, careful stratification for prognostic variables before randomization in phase 3 trials is essential.
Prospective resections
assessment in lungcaacer
of 30-day
operative
morbidity
for surgical
Deslauricrs J, Ginsberg RJ,Piantadosi S, Foumier B. HopifalLavol, 2725 chemin, Saink-Fey. Que. GlV4G5. Chest 1994;106:Suppl:329S-30s Prospective morbidity and mortality rates associated with reSection of lung cancer that are reflective of the current trend toward preoperative therapy are riot readily available in the current literature. To determine their prevalence. we prospectively analyzed the results of 783 resections performed within contributing Lung Cancer Study Group (LCSG) centers. There were 543 men and 240 women with a mean age of 63.44 years. Of the 783 resections, there were 41 I lobectomies, 135 pneumonectomies, and 237 other procedures. Thirty patients died postopexativcly (motility, 3.8%) and 21 I had a major complication (27%). Compbcations occurred more commonly in men (34.3%, p-0 00 I ). in patients age 60 or older (34.0%, p=O.OOl), and in patients with a Kamofsky index + (44%, p&001). There was no significant difference between mortality, significant morbidity rates for lobectomy (28.2%), and pneumonectomy (3 1 9%), or for simple (28.3%) and extended resection (3 I .9%). The seemingly higher incidence of major postoperative events reported in this series not only reflects the prospective nature of this analysis but also the fact that over 25% of patients were in other therapeutic trials involving neoadjuvant or postoperative adjuvant regimens. Within that context. these data appear to be a reasonable estimate of modem surgical morbidity rates in the treatment of lung caocer.
Quality
uf lie in luagcancer
surgical
adjuvant
MoJitt
trials
Ruckdeschcl JC, Piantadosi S. H. Lee Cancer Center. Resewn-h Indime Tampa. FL Chest 1994,106:Suppl:324S-8s. The Functional Living Index-Cancer (FLIC) was administered to 438 patients in the Lung Cancer Study Group on whom long-term follow-up was available in 1993. Across all trials, the total FLIC score was predictive for survival even when corrected for extent of disease, although individual items on the FLIC were not. There was no significant impact of a short course of chemotherapy on quality of life. The FLIC is a reliable means of assessing quabty of life in lung cancer surgical adjuvant trials.