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Simultaneous operations in lung cancer surgery
Surgery~Chest Wall
140
Results: There were 2 cases of mortality (3.2%). Patients with osteoblastoma, chondrosarcoma and desmoid showed better longterm survival. Results were much worse in patients with malignant flbrogistiocytoma and metastatic invasion in chest wall. Life quality was improved in 83% of patients: no pain syndrome and destructed tumor. Conclusions: Chest wall resection for malignant disease is an operation of choice. Aggressive manipulations are justified by prolonged and improved life quality.
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Completion pneumonectomy for lung cancer
Cheng Xin Gao, O. Huang. Shanghai Chest Hospital, Shanghai,
China Completion pneumonectomy refers to the surgery of complete resection of ipsilateral lung tissue left from previous operation. From 1973 to 1998, 82 patients with lung cancer had completion pneumonectomy. There were 71 male and 11 female patients, aged 24 to 73 years. Fifty completion pneumonectomies were performed on the right side and 32 were performed on the left side. The initial operations were Iobectomy in 50 cases, bilobectomy 19, sleeve Iobectomy 5, segmentectomy 5 and wedge resection 3. The interval between initial pulmonary resection and completion pneumonectomy for patients with recurrent lung cancer ranged from 5 months to 12 years and 10 months. The interval of 2 years or more was found in those patients staged T1N0-1 M0 or T2NoM0 at initial surgery. The histologic diagnosis of the 75 patients with recurrent lung cancer were squamons cancer in 35 cases, adenoearcinoma 37 and others 3. The postoperative complications and mortality (6.1%) were comparable to those for standard pneumonectomy. The 1, 3, 5 and 10 year survival rates were 80.6%, 30.2%, 21.4% and 16.7% respectively. None of those patients with histologically proved tumor remaining in the hemithorax at the time of reoperation survived longer than 2 years. Our experiences show that recurrence of lung Cancer seems to be related to the imcomptele resection and not to the types of cancer cell or to the adjuvant therapy.
metastasis (new T4) of non-small cell lung [4--6-67Intrapulmonary cancer. A prognostic assessment T. Okumura, H. Asamura, K. Suzuki, H. Kondo, R. Tsuchiya. Division
of Thoracic Surgery, National Cancer Center Hospital, Tokyo, Japan Objective: According to the revision of TNM classification in 1997, intrapulmonary metastasis (PM) in the same lobe of the primary tumor (PM1) was designated as T4 and, PM in the other lobe (PM2) as M1. To assess their prognosis, we retrospectively analyzed the postoperative survival of patients with PM, T4, and M1 (distant organ metastasis excluding PM2). Methods: From January 1982 to December 1996, 2,340 patients with non-small cell lung cancer underwent surgical resection. First, the overall survival of completely resected patients (n = 1,536) was analyzed according to the PM status: patients without PM (PM0, n = 1,413), PM1 (n = 105), and PM2 (n = 18). For comparison, patients with M1 (n = 18) were also analyzed. Second, to evaluate the prognostic significance of PM as T4 and M1 descriptors, the comparison of survival was performed in the same nodal category as NO, N1, and N2. Results: The overall 5-year survival rates of patients with PM0 (T13), T4 (with vital organ invasion and dissemination), PM1, PM2, and M1 were 61.2%, 33.9%, 34.1%, 11.1%, and 5.6%, respectively. The differences in survival between PM0 and PM1 (p < 0.0001, log-rank test) as well as between PM1 and M1 (p < 0.0001) were significant. However, there was no difference between PM1 and T4. For T1-3N0 cases, the 5-year survival rates of patients with PM0, PM1, and PM2 were 75.2%, 36.8%, and 12.5%, respectively, and that of T4 patients was 37.5%. While the prognostic difference between PM0 and PM1 was significant (P < 0.0001), there was no difference between PM1 and T4. Conclusions: From PM0 to PM2, the survival was worsened in a stepwise manner. In terms of prognosis, PM1 was comparable to T4, and PM2 to M1. The revised T4 descriptor for tumors with satellite tumor nodule in the primary lobe seemed appropriate.
1
4
6
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Simultaneous operations in lung cancer surgery
1 4Surgical - 6results - 5for T4• lung cancer
S. Guerassimov, M. Davydov, R. Akchurin, I. Stilidi, Z. Machaladze, B. Polotsky, G. Ungeadze. The N.N. Blokhin Cancer Research Center
F. Rea, L. Bortolotti, M. Grapeggia, A. Zuin, M Michelon, T. Gobbi, F. Sartori. Division of Thoracic Surgery, University of Padova, Padova,
(Surgical Dept. of Thoracic and Abdominal Oncology), Moscow, Russia
italy Extensive experience in the treatment of T4 lung cancer is rare and the results of surgical treatment are controversial. Between 1980 and 1999, 196 consecutive cases of T4 lung cancers were operated on. One hundred twenty-one (62%) procedures were open-close thoracotomy; the remaining 75 (38%) procedures had various extents of pulmonary resection. The group of patients (75) that received a resectional procedure had the follow local invasion: - Pulmonary vascular root or left atrium (16 patients) - SVC or renominate vein or aorta (14 patient) - Vertebral body (9 patients) - Trachea and/or carina (36 patients). The cell types included 46 squamous cell carcinomas, 20 adenocarcinomas, and 9 miscellaneous malignancies. There were 13 (17%) postoperative complications and 8 (11%) postoperative death. The 5 year survival rate was 23% for the group of resected patients. The 5 year survival rate was 35% for the NO N1 patients and 0% for the N2 patient. The 5 year survival rate was 34% for the pts with carinal resection and 7% for the pts with great vessels or vertebral body resection. Our experience suggest that the surgery for T4 lung cancer should only be performed in highly selected patients after an aggressive staging; the surgical resection is associated with high complication and mortality rates; the presence of N2 disease is a controindication to surgery; the best results can be obtained in patients with tracheal and/or carinal invasion.
Simultaneous interventions improve resectability and widen indications for surgery, thus the analysis is of importance to demonstrate the benefit of such procedures. There were 23 patients with lung carcinomas operated on simultaneously for synchronous multiple primaries (17) and concomitant angina pectoris (6). Simultaneous lung resections for non small cell carcinoma (15 Iobectomies and 2 pneumonectomies) were supplemented with proximaland-distal gastric resections or total gastractomies, esophageal resections, 2 laryngeal resections and laryngectomy. Gastric/esophageal procedures were performed through combined abdominal-thoracic approach and completed with intrathoracic esophagogastrostomies. There was 1 postoperative death. Median survival time turned to be 26 months. Lung resections for carcinoma and simultaneous heart surgery for angina pectoris were performed by two brigades of surgeons through sternotomic approach, with the use of artificial blood circulation. Aorticcoronary shunt (5) or mitral comissurotomy were performed the first, then was the turn for pneumonectomy, tracheal (2) or pulmonary (3) resections. The patients well tolerated the procedures. One died due to progression, the others were seen 2 years later with no evidences of the diseases (and videofilm about 5 minutes: "Simultaneous biIobectomy on the right and subtotal resection of esophagus for cancer").
140
Results: There were 2 cases of mortality (3.2%). Patients with osteoblastoma, chondrosarcoma and desmoid showed better longterm survival. Results were much worse in patients with malignant flbrogistiocytoma and metastatic invasion in chest wall. Life quality was improved in 83% of patients: no pain syndrome and destructed tumor. Conclusions: Chest wall resection for malignant disease is an operation of choice. Aggressive manipulations are justified by prolonged and improved life quality.
•
Completion pneumonectomy for lung cancer
Cheng Xin Gao, O. Huang. Shanghai Chest Hospital, Shanghai,
China Completion pneumonectomy refers to the surgery of complete resection of ipsilateral lung tissue left from previous operation. From 1973 to 1998, 82 patients with lung cancer had completion pneumonectomy. There were 71 male and 11 female patients, aged 24 to 73 years. Fifty completion pneumonectomies were performed on the right side and 32 were performed on the left side. The initial operations were Iobectomy in 50 cases, bilobectomy 19, sleeve Iobectomy 5, segmentectomy 5 and wedge resection 3. The interval between initial pulmonary resection and completion pneumonectomy for patients with recurrent lung cancer ranged from 5 months to 12 years and 10 months. The interval of 2 years or more was found in those patients staged T1N0-1 M0 or T2NoM0 at initial surgery. The histologic diagnosis of the 75 patients with recurrent lung cancer were squamons cancer in 35 cases, adenoearcinoma 37 and others 3. The postoperative complications and mortality (6.1%) were comparable to those for standard pneumonectomy. The 1, 3, 5 and 10 year survival rates were 80.6%, 30.2%, 21.4% and 16.7% respectively. None of those patients with histologically proved tumor remaining in the hemithorax at the time of reoperation survived longer than 2 years. Our experiences show that recurrence of lung Cancer seems to be related to the imcomptele resection and not to the types of cancer cell or to the adjuvant therapy.
metastasis (new T4) of non-small cell lung [4--6-67Intrapulmonary cancer. A prognostic assessment T. Okumura, H. Asamura, K. Suzuki, H. Kondo, R. Tsuchiya. Division
of Thoracic Surgery, National Cancer Center Hospital, Tokyo, Japan Objective: According to the revision of TNM classification in 1997, intrapulmonary metastasis (PM) in the same lobe of the primary tumor (PM1) was designated as T4 and, PM in the other lobe (PM2) as M1. To assess their prognosis, we retrospectively analyzed the postoperative survival of patients with PM, T4, and M1 (distant organ metastasis excluding PM2). Methods: From January 1982 to December 1996, 2,340 patients with non-small cell lung cancer underwent surgical resection. First, the overall survival of completely resected patients (n = 1,536) was analyzed according to the PM status: patients without PM (PM0, n = 1,413), PM1 (n = 105), and PM2 (n = 18). For comparison, patients with M1 (n = 18) were also analyzed. Second, to evaluate the prognostic significance of PM as T4 and M1 descriptors, the comparison of survival was performed in the same nodal category as NO, N1, and N2. Results: The overall 5-year survival rates of patients with PM0 (T13), T4 (with vital organ invasion and dissemination), PM1, PM2, and M1 were 61.2%, 33.9%, 34.1%, 11.1%, and 5.6%, respectively. The differences in survival between PM0 and PM1 (p < 0.0001, log-rank test) as well as between PM1 and M1 (p < 0.0001) were significant. However, there was no difference between PM1 and T4. For T1-3N0 cases, the 5-year survival rates of patients with PM0, PM1, and PM2 were 75.2%, 36.8%, and 12.5%, respectively, and that of T4 patients was 37.5%. While the prognostic difference between PM0 and PM1 was significant (P < 0.0001), there was no difference between PM1 and T4. Conclusions: From PM0 to PM2, the survival was worsened in a stepwise manner. In terms of prognosis, PM1 was comparable to T4, and PM2 to M1. The revised T4 descriptor for tumors with satellite tumor nodule in the primary lobe seemed appropriate.
1
4
6
•
Simultaneous operations in lung cancer surgery
1 4Surgical - 6results - 5for T4• lung cancer
S. Guerassimov, M. Davydov, R. Akchurin, I. Stilidi, Z. Machaladze, B. Polotsky, G. Ungeadze. The N.N. Blokhin Cancer Research Center
F. Rea, L. Bortolotti, M. Grapeggia, A. Zuin, M Michelon, T. Gobbi, F. Sartori. Division of Thoracic Surgery, University of Padova, Padova,
(Surgical Dept. of Thoracic and Abdominal Oncology), Moscow, Russia
italy Extensive experience in the treatment of T4 lung cancer is rare and the results of surgical treatment are controversial. Between 1980 and 1999, 196 consecutive cases of T4 lung cancers were operated on. One hundred twenty-one (62%) procedures were open-close thoracotomy; the remaining 75 (38%) procedures had various extents of pulmonary resection. The group of patients (75) that received a resectional procedure had the follow local invasion: - Pulmonary vascular root or left atrium (16 patients) - SVC or renominate vein or aorta (14 patient) - Vertebral body (9 patients) - Trachea and/or carina (36 patients). The cell types included 46 squamous cell carcinomas, 20 adenocarcinomas, and 9 miscellaneous malignancies. There were 13 (17%) postoperative complications and 8 (11%) postoperative death. The 5 year survival rate was 23% for the group of resected patients. The 5 year survival rate was 35% for the NO N1 patients and 0% for the N2 patient. The 5 year survival rate was 34% for the pts with carinal resection and 7% for the pts with great vessels or vertebral body resection. Our experience suggest that the surgery for T4 lung cancer should only be performed in highly selected patients after an aggressive staging; the surgical resection is associated with high complication and mortality rates; the presence of N2 disease is a controindication to surgery; the best results can be obtained in patients with tracheal and/or carinal invasion.
Simultaneous interventions improve resectability and widen indications for surgery, thus the analysis is of importance to demonstrate the benefit of such procedures. There were 23 patients with lung carcinomas operated on simultaneously for synchronous multiple primaries (17) and concomitant angina pectoris (6). Simultaneous lung resections for non small cell carcinoma (15 Iobectomies and 2 pneumonectomies) were supplemented with proximaland-distal gastric resections or total gastractomies, esophageal resections, 2 laryngeal resections and laryngectomy. Gastric/esophageal procedures were performed through combined abdominal-thoracic approach and completed with intrathoracic esophagogastrostomies. There was 1 postoperative death. Median survival time turned to be 26 months. Lung resections for carcinoma and simultaneous heart surgery for angina pectoris were performed by two brigades of surgeons through sternotomic approach, with the use of artificial blood circulation. Aorticcoronary shunt (5) or mitral comissurotomy were performed the first, then was the turn for pneumonectomy, tracheal (2) or pulmonary (3) resections. The patients well tolerated the procedures. One died due to progression, the others were seen 2 years later with no evidences of the diseases (and videofilm about 5 minutes: "Simultaneous biIobectomy on the right and subtotal resection of esophagus for cancer").