- Email: [email protected]
P-378 Time trends and survival after operations for primary lung cancer from 1986 through 1997
Poster Session 2/Surgery
El377 P
Thoracoscopic lung resection for small nodular lesions using simultaneous intraoperative real-time computed tomography
Hideki Akamatsu, Makoto Sunamori, Katsuo Kojima. Tokyo Medical and Dental University Hospital, Tokyo, Japan Because the localization of small lung nodules at thoracoscopic resection is sometimes difficult, computed tomography (CT) guided marking (hook wire, etc) is usually performed. But this technique has some problems for patients as parn, pneumothorax or intrapulmonary bleeding. We have employed intraoperative real-time CT for thoracoscopic resection of those lesions. Two patients with lung nodules less than lcm in diameter and three patients with ground glass opacity (GGO) type lung nodules were treated using this technique. Detection of the lesion using CT and thoracoscopic resection is performed simultaneously in the interventional radiological CT examination room. After induction of general anesthesia with one-lung ventilation, the patient is placed in the lateral position. After draping, three thoracoports were inserted and the lung was examined with the thoracoscope. The lung nodule is detected using real-time CT and adjacent lung surface of the tumor was grasped with forceps under both thoracoscopic and CT visualization, Thoracoscopic resection of the nodule is performed in the usual fashion. Lung nodules were detected at right upper lobe and right lower lobe in two cases each, and left lower lobe in one case. Tumor size was 11.6mm in average and depth of the tumor from lung surface was 2.8mm in average. Operation time was 99 minutes in average with complete tumor resection and there was no complications. Pathology of the tumor was adenocarcinoma and atypical adenomatous hyperplasia (AAH) in two cases each, and inflammation in one case. Using intraoperative real-time CT, thoracoscopic lung resection can be performed easily and accurately.
P 378 El
Time trends and survival after operations for primary lung cancer from 1986 through 1997
Kazuhiro Yanaaihara, Fumihiro Tanaka, Tatsuo Nakagawa, Yozo Kawano, Yosuke Otake, Ryo Miyahara, Hiromi Wada. Dept. of Thoracic Surgery, Kyoto University, Kyoto, Japan To assess the time trends and survivals after operations for primary lung cancer, the cases of 882 consecutive patients who underwent thoracotomy except for exploratory thoracotomy between 1986 and 1997 were retrospectively reviewed by groups corresponding to year of the operation (the early period was 1986 to 1989, n = 260; the middle period was 1990 to 1993, n = 312, and the late period was 1994 to 1997, n = 310). The 5-year survivals at the early, the middle, and the late periods were 53.0%, 53.4%, and 65.2%, respectively, with significant improvement particularly at the late period (p = 0.0061 for the early or middle period vs the late period); the improvement was caused by increase in the ratio of patients with stage IA disease (21.9% at the early period, 30.1% at the middle period, 31.6% at the late period), and increase in the rates of adenocarcinoma (48.0%, 58.2%, 66.0%, respectively). Moreover the postoperative prognosis of patients with stage IA and IIIB disease at the late period (5-year survival 89.5% on IA, 40.8 on IIIB) showed significant improvement compared with the other periods (64.9%, 22.7% at the early period and 82.8%, 3.1% at the middle period, p = 0.0026 for IA and p = 0.0008). Postoperative survival for all NSCLC patients has been improved with significant increase of early-stage (p-stage IA) patients and advanced-stage (p-stage IIIB) patients.
I
P 379
Preoperative bacterial colonization cancer patients
of airways in lung
Armand David Molek’, Michael Pappiaswili’, llan Bar’. ’ Emek Medical Center Afula Chest Surgery Service, Afula, Israel; “Assaf Harofe Medical Center Genera/ Thoracic Surgery Unit, Zeriffin, lsrael The rate of infectious complications after thoracic surgery is moving between 20-30% in the literature. In order to understand, predict and prevent postoperative pulmonary infections, sputum cultures were performed in 100 consecutive lung cancer patients, waiting for thoracic surgery. In patients without sputum production,induced sputum with 5% Saline inhalation was used. Only sputum not containing epithel cells were accepted, and cultures were performed only, if polymorphonuclear cells were seen in the sputum smear. Otherwise,the bacterial contamination can no be ruled out. All patients with positive sputum cultures received one to three doses of preoperative guided preventive antibiotic&based on the sputum culture studies.78% of the patients with pulmonary malignancies were found to be colonized along with microscopically purulent sputum. The most frequent species were Pseudomonas, Multiresistent Pneumococcus, Acinetobacter, Hemophylus, and gram positive cocci as well as Candida species. This is in striking contrast with patients going to surgery with benign diseases,their airways were found colonized less then 20%. With this preventive proticolconsiderable drop in the postoperative pulmonary infectious complications was noted,6 established pneumonias occurred,and all of them had posi-
S187
tive preoperative sputum culture. All these patients were successfully treated by antibioticsbased on preoperative culture studies. Patients going to surgery with borderlined pulmonary function tests, were operated on under guided antibiotic protocoLand were mostly uneventful. The postoperative empyemas were caused by strains of bacteria different from that of the sputum cultures. We propose,that the airways of patients with lung cancer are colonized in high rates and the preoperative sputum culture is a useful in predicting,and an itinerary for prevention and treatment of infectious complications in thoracic surgery.
P 380 Tracheal resection in lung cancer surgery I Mikhail I. Davydov’, Boris Polotsky”, Sergey Gerasimov’, Seraev Volkov”, Yuri Buidenoks. ’ Blokhin Cancer Research Center RAMS, Moscow, Russia; 2 Blokhin Cancer Research Center, Moscow, Russia Between 1980-99, 57 patients underwent pneumonectomy with tracheal resection. All patients had non-small cell lung cancer - squamous cell (50), adenocarcinoma (5), large cell carcinoma (2). The tumors were localized in the right (50) and left (7) lung and were widespread to the proximal part of the main bronchus (6) or to tracheal angle or carina (51). There were 27 wedge resections of trachea and 30 resections of tracheal bifurcation. Mediastinal metastases were revealed in 19 cases. The operations were performed through standard thoracotomy for right-side lesions and with the use of sternotomy for leftside carcinomas. High frequency ventilation was used in all cases. In cases of sleeve tracheal resections, the anastomosis between trachea and the remaining bronchus was made with the use of original technique. The procedures were considered as curative in 50 patients and palliative in the others, due to residual disease on the margin of tracheal or adjacent tissues’ resection. Systematic mediastinal lymph nodes dissection was performed in all cases. Postoperative complications were registered in 13 (22.8%) patients, including 5 (8.8%) fistulas in tracheal anastomosis. There were 3 (5.3%) postoperative deaths. 6 (10.5%) cases were lost to follow-up. Among the remaining 48 patients there were, within five-year span, 29 (50.9%) deaths due to cancer progression, 9 (15.8%) non cancer-related deaths and 10 (17.5%) patients survived 5 years (including a patient after palliative pneumonectomy). Actuarial (Cutler-Ederer) I-3-5-year survival for the group of 57 patients (including 10 B-year survivors and 6 censored patients) was 77.2%, 31.9% and 25.2%.
piij.
lntraoperative Exfoliated Malignant Cells by Vrdeo-Assisted Thoracic Surgery for Lung Cancer: Analysis of Lavage Cytology of the Resected Materials
wTakaqi’, Nobuhide Kate*, Syuichi Sasamoto”, Yoshinobu Hata”, Mayumi Ishii3, Chikako Hasegawa 3, Kazutoshi Shibuya3. 7 Department of Thoracic Surgery, Toho university Oomori Hospital, Tokyo, Japan; ‘Department of Thoracic Surgery, Toho University Oomori Hospital, Tokyo, Japan; 3 Department of Pathology, Toho University Oomori Hospital, Tokyo, Japan Objective: Local recurrence often occurs after partial lung resection for lung cancer by video-assisted thoracic surgery (VATS). Lavage cytology of the resected materials was performed, and examined for intraoperative exfoliated malignant cells. Our objective was to study the relationship between the result of lavage cytology and local recurrence. Methods: From October 1998 to February 2003, partial lung resection was performed in nine lung cancer patients by VATS. They were 5 males and 4 females, and their ages ranged from 54 to 80 years old. Three cancers were classified as squamous cell carcinoma and 6 as adenocarcinoma. Resected materials that were attached to the metal autosuture needles were dipped in 20 mL of saline, and the exfoliated cells were subjected to Papanicolaou stain. Results: Malignant cells that had been derived from the lung parenchyma during the operative procedure, were detected in 5 of the 9 cases. Among the 5 cases, two cases whose cut margins were close to the primary lesion, developed recurrence within one year. Mechanical injury of the lung occurred during the operative procedure in five other cases. Conclusions: The operative field was frequently exposed to cancer cells during partial lung resection for lung cancer by VATS. Two out of 9 patients developed local recurrence within one year. It is important to find an adequate cut margin of the lung and to avoid mechanical injury of the lung while performing this procedure.
P 382 El
Role of surgery in the management of small cell lung cancer
Krzysztof Kurowski, Witold Rzyman, Wojciech Zurek, Piotr Chwirot, Jan Skokowski. Medical University of Gdansk, Gdansk, Poland Objective: To assess the results of institute surgery as part of multimodality therapy in the treatment of selected cases of small cell lung cancer, the analysis of long-term results and influence of prognostic factors in 76 consecutive
El377 P
Thoracoscopic lung resection for small nodular lesions using simultaneous intraoperative real-time computed tomography
Hideki Akamatsu, Makoto Sunamori, Katsuo Kojima. Tokyo Medical and Dental University Hospital, Tokyo, Japan Because the localization of small lung nodules at thoracoscopic resection is sometimes difficult, computed tomography (CT) guided marking (hook wire, etc) is usually performed. But this technique has some problems for patients as parn, pneumothorax or intrapulmonary bleeding. We have employed intraoperative real-time CT for thoracoscopic resection of those lesions. Two patients with lung nodules less than lcm in diameter and three patients with ground glass opacity (GGO) type lung nodules were treated using this technique. Detection of the lesion using CT and thoracoscopic resection is performed simultaneously in the interventional radiological CT examination room. After induction of general anesthesia with one-lung ventilation, the patient is placed in the lateral position. After draping, three thoracoports were inserted and the lung was examined with the thoracoscope. The lung nodule is detected using real-time CT and adjacent lung surface of the tumor was grasped with forceps under both thoracoscopic and CT visualization, Thoracoscopic resection of the nodule is performed in the usual fashion. Lung nodules were detected at right upper lobe and right lower lobe in two cases each, and left lower lobe in one case. Tumor size was 11.6mm in average and depth of the tumor from lung surface was 2.8mm in average. Operation time was 99 minutes in average with complete tumor resection and there was no complications. Pathology of the tumor was adenocarcinoma and atypical adenomatous hyperplasia (AAH) in two cases each, and inflammation in one case. Using intraoperative real-time CT, thoracoscopic lung resection can be performed easily and accurately.
P 378 El
Time trends and survival after operations for primary lung cancer from 1986 through 1997
Kazuhiro Yanaaihara, Fumihiro Tanaka, Tatsuo Nakagawa, Yozo Kawano, Yosuke Otake, Ryo Miyahara, Hiromi Wada. Dept. of Thoracic Surgery, Kyoto University, Kyoto, Japan To assess the time trends and survivals after operations for primary lung cancer, the cases of 882 consecutive patients who underwent thoracotomy except for exploratory thoracotomy between 1986 and 1997 were retrospectively reviewed by groups corresponding to year of the operation (the early period was 1986 to 1989, n = 260; the middle period was 1990 to 1993, n = 312, and the late period was 1994 to 1997, n = 310). The 5-year survivals at the early, the middle, and the late periods were 53.0%, 53.4%, and 65.2%, respectively, with significant improvement particularly at the late period (p = 0.0061 for the early or middle period vs the late period); the improvement was caused by increase in the ratio of patients with stage IA disease (21.9% at the early period, 30.1% at the middle period, 31.6% at the late period), and increase in the rates of adenocarcinoma (48.0%, 58.2%, 66.0%, respectively). Moreover the postoperative prognosis of patients with stage IA and IIIB disease at the late period (5-year survival 89.5% on IA, 40.8 on IIIB) showed significant improvement compared with the other periods (64.9%, 22.7% at the early period and 82.8%, 3.1% at the middle period, p = 0.0026 for IA and p = 0.0008). Postoperative survival for all NSCLC patients has been improved with significant increase of early-stage (p-stage IA) patients and advanced-stage (p-stage IIIB) patients.
I
P 379
Preoperative bacterial colonization cancer patients
of airways in lung
Armand David Molek’, Michael Pappiaswili’, llan Bar’. ’ Emek Medical Center Afula Chest Surgery Service, Afula, Israel; “Assaf Harofe Medical Center Genera/ Thoracic Surgery Unit, Zeriffin, lsrael The rate of infectious complications after thoracic surgery is moving between 20-30% in the literature. In order to understand, predict and prevent postoperative pulmonary infections, sputum cultures were performed in 100 consecutive lung cancer patients, waiting for thoracic surgery. In patients without sputum production,induced sputum with 5% Saline inhalation was used. Only sputum not containing epithel cells were accepted, and cultures were performed only, if polymorphonuclear cells were seen in the sputum smear. Otherwise,the bacterial contamination can no be ruled out. All patients with positive sputum cultures received one to three doses of preoperative guided preventive antibiotic&based on the sputum culture studies.78% of the patients with pulmonary malignancies were found to be colonized along with microscopically purulent sputum. The most frequent species were Pseudomonas, Multiresistent Pneumococcus, Acinetobacter, Hemophylus, and gram positive cocci as well as Candida species. This is in striking contrast with patients going to surgery with benign diseases,their airways were found colonized less then 20%. With this preventive proticolconsiderable drop in the postoperative pulmonary infectious complications was noted,6 established pneumonias occurred,and all of them had posi-
S187
tive preoperative sputum culture. All these patients were successfully treated by antibioticsbased on preoperative culture studies. Patients going to surgery with borderlined pulmonary function tests, were operated on under guided antibiotic protocoLand were mostly uneventful. The postoperative empyemas were caused by strains of bacteria different from that of the sputum cultures. We propose,that the airways of patients with lung cancer are colonized in high rates and the preoperative sputum culture is a useful in predicting,and an itinerary for prevention and treatment of infectious complications in thoracic surgery.
P 380 Tracheal resection in lung cancer surgery I Mikhail I. Davydov’, Boris Polotsky”, Sergey Gerasimov’, Seraev Volkov”, Yuri Buidenoks. ’ Blokhin Cancer Research Center RAMS, Moscow, Russia; 2 Blokhin Cancer Research Center, Moscow, Russia Between 1980-99, 57 patients underwent pneumonectomy with tracheal resection. All patients had non-small cell lung cancer - squamous cell (50), adenocarcinoma (5), large cell carcinoma (2). The tumors were localized in the right (50) and left (7) lung and were widespread to the proximal part of the main bronchus (6) or to tracheal angle or carina (51). There were 27 wedge resections of trachea and 30 resections of tracheal bifurcation. Mediastinal metastases were revealed in 19 cases. The operations were performed through standard thoracotomy for right-side lesions and with the use of sternotomy for leftside carcinomas. High frequency ventilation was used in all cases. In cases of sleeve tracheal resections, the anastomosis between trachea and the remaining bronchus was made with the use of original technique. The procedures were considered as curative in 50 patients and palliative in the others, due to residual disease on the margin of tracheal or adjacent tissues’ resection. Systematic mediastinal lymph nodes dissection was performed in all cases. Postoperative complications were registered in 13 (22.8%) patients, including 5 (8.8%) fistulas in tracheal anastomosis. There were 3 (5.3%) postoperative deaths. 6 (10.5%) cases were lost to follow-up. Among the remaining 48 patients there were, within five-year span, 29 (50.9%) deaths due to cancer progression, 9 (15.8%) non cancer-related deaths and 10 (17.5%) patients survived 5 years (including a patient after palliative pneumonectomy). Actuarial (Cutler-Ederer) I-3-5-year survival for the group of 57 patients (including 10 B-year survivors and 6 censored patients) was 77.2%, 31.9% and 25.2%.
piij.
lntraoperative Exfoliated Malignant Cells by Vrdeo-Assisted Thoracic Surgery for Lung Cancer: Analysis of Lavage Cytology of the Resected Materials
wTakaqi’, Nobuhide Kate*, Syuichi Sasamoto”, Yoshinobu Hata”, Mayumi Ishii3, Chikako Hasegawa 3, Kazutoshi Shibuya3. 7 Department of Thoracic Surgery, Toho university Oomori Hospital, Tokyo, Japan; ‘Department of Thoracic Surgery, Toho University Oomori Hospital, Tokyo, Japan; 3 Department of Pathology, Toho University Oomori Hospital, Tokyo, Japan Objective: Local recurrence often occurs after partial lung resection for lung cancer by video-assisted thoracic surgery (VATS). Lavage cytology of the resected materials was performed, and examined for intraoperative exfoliated malignant cells. Our objective was to study the relationship between the result of lavage cytology and local recurrence. Methods: From October 1998 to February 2003, partial lung resection was performed in nine lung cancer patients by VATS. They were 5 males and 4 females, and their ages ranged from 54 to 80 years old. Three cancers were classified as squamous cell carcinoma and 6 as adenocarcinoma. Resected materials that were attached to the metal autosuture needles were dipped in 20 mL of saline, and the exfoliated cells were subjected to Papanicolaou stain. Results: Malignant cells that had been derived from the lung parenchyma during the operative procedure, were detected in 5 of the 9 cases. Among the 5 cases, two cases whose cut margins were close to the primary lesion, developed recurrence within one year. Mechanical injury of the lung occurred during the operative procedure in five other cases. Conclusions: The operative field was frequently exposed to cancer cells during partial lung resection for lung cancer by VATS. Two out of 9 patients developed local recurrence within one year. It is important to find an adequate cut margin of the lung and to avoid mechanical injury of the lung while performing this procedure.
P 382 El
Role of surgery in the management of small cell lung cancer
Krzysztof Kurowski, Witold Rzyman, Wojciech Zurek, Piotr Chwirot, Jan Skokowski. Medical University of Gdansk, Gdansk, Poland Objective: To assess the results of institute surgery as part of multimodality therapy in the treatment of selected cases of small cell lung cancer, the analysis of long-term results and influence of prognostic factors in 76 consecutive