Surgery/Plasty
[•7
Southern blot analysis for the allelic deletion of nm23 genes in human lung cancer
Q.H. Zhou, J. Chen, Z.L. Sun, Y. Qing, L.X. Liu. Department of
Thoracocardiac Surgery, Cancer Center, First University Hospital, West China University of Medical Sciences, Chengdu Sichuan 610041, PR China Backgrand and Methods: Tumor metastasis is not only the malignant marker and characteristics of lung cancer, but also the key cause of failure to cure and lose of their life. Recently, many studies have been emphasized on how to early predict and diagnose subclinical metastasis of lung cancer, and how to clarify the molecular mechanism of tumor metastasis of the lung metastasis, expecially nm23 genes, in order to explore the relationship between the allelic deletion of nm23 genes and the oncogenesis, development and metastasis of human lung cancer, allelic deletion of nm23 Genes has been determined in 52 cancer tissue samples of patients with lung cancer and their corresponding normal tissues as control by southern blot. Results: (1) Loss of heterozygosity (LOH) of nm23-H1 gene was found in 14 out of the 47 inoformative lung cancers existd loss of heterozygosity of nm23-H2 gene, with a LOH rate of 4.26%. (2) The LOH of nm23-H1 gene in cancer with lymph node or distant metastasis (42.85%) was very significantly higher than that in lung cancer without metastasis (8.33%) (P < 0.01). (3) The LOH of nm23-H1 gene in undifferentiated and poor-differentiated cancer (45.45%) was also remarkably higher than that in moderate-well differentiated cancer (13.33%) (P < 0.05). (4) No significant differences were observed between the LOH of nm23-H1 gene and histological classification, PTNM stages, size of the primary tumor, location of the cancer, age and sex of the patients (P > 0.05). (5) A new Belll pollymorphism of nm23-H1 gene was observed in one patient. Conclusions: Our data pressented here offer a clear evidence that: (1) nm23 gene can involoved in the differentiation and metastasis of human lung cancer, and nm23-H1 gene has more important role in regulating cell differentiation and metastasis of lung cancer than that of nm23-H2 gene and the alleiic deletion of nm23-H1 gene may be the key cause of lung cancer metastasis. (2) There is new other Bglll polymorphism in nm23-H1 gene in different regional people and different human race. after pneumonectomy in patients with lung 144--•Mortality cancer and known cardiac disease J.L. Duque. Bronchogenic Carcinoma Cooperative Group of the
Spanich Society of Pneumologyand Thoracic Surgery (GCCB-S); Department of Thoracic Surgery, Hospital Universitario, Valladolid,
Spain Purpose: To estimate mortality in patients with known cardiac disease who undergo pneumonectomy. Material and Methods: Data has been colleced from a prospective registry performed in 19 hospitals (GCCB-S registry); 2992 patients with lung cancer who underwent thoracotomy since october-1993 to september-1997 have been included. Postoperative mortality is considered as that happened within 30 days after surgery. Results: 406 patients had known cardiac disease (13.6%). Pneumonectomy was performed on 885 patients; 10.4% of them (92•885) had cardiac disease. Postoperative mortality was 7.6% (22812292); it was 13.4% (1191885) in pneumonectomized patients. Mortality was higher in patients pneumonectomized with cardiac disease (25%; 23/92) than in the remaining patients (12%; 96/793); (relative risk: 2.07, 95% Ch 1.04-2.05). Of the 2107 not pneumonectomized patients, 314 (14.9%) had known cardiac disease and 7.6% (241314) died early after surgery versus only 4.6% in patients without cardiac disease (relative risk: 1.61, 95% CI: 1.04-2.05). After adjusted by the type of intervention a relative risk of 1.81 (95% CI: 1.34-2.05) in patients with previously known cardiac disease has been calculated. Conclusions: Previously known cardiac disease increases risk in 81% in patients with lung cancer who undergo surgery. Patients with known cardiac disease who underwent pneumonectomy have a slightly higher risk of death compared to patients without cardiac disease.
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Wednesday, 13 September 2000
4:00-5:00 pm
ORAL SESSION
Surgery/Plasty
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Surgery for malignancy of trachea carina and main bronchus (An analysis of 269 cases)
Z.-F. Wu, H.-Z. Chen. First Affiliated Hospital of GuangzhouMedical
College, Guangzhou510120, P..R. China 269 tumor cases had reconstruction of trachea, carina and bronchus in our hospital since 1978 to June 1997. Occupying 5.8% of all lung cancer resections. Among them, 176 were males and 93 females. Age ranges from 17 to 76, average 56. Pathology: Epidemoid 148, adenocarcinoma 53, small cell 29, mixed (adenosquamous) 13, carcinoid 11, cystadenoma 9, parilloma 6. Patients, in our series, were mostly stage II and stage Ilia. Types of operation: sleeve resection of trachea 35; reconstruction of carina 27, including: carinal reconstruction + right pneumonectomy 15; + left pneumonectomy 5; 4 cases had mere carinal reconstruction and 3 had resection of right half of carina + riht pneumonectomy. Sleeve hobectomy were done on 205 cases; including: left upper lobe 49, left lower lobe 32, right upper obe 103 and right middle lobe 21. Techmically, the right upper Iobectomy is easier. 21 cases had pulmonary artey reconstruction and 25 had pulmonary vein ligated inside the pericardium. Follow up: chemotherapy or radio therayp were given for most of our cases within 3 years after operation. There's no death within one month. The survival rate for 1, 2, 3, 5 years were 90.2%, 74.1%, 56.5% and 325% respectively. There were no fistulae nor stricture on anestomotic sites. The result was satisfactory. Conclusion: Surgery for cancer of trachea and main bronchus are of special clinical value. The postopoerative chemo and radiotherayp will improve the effect. We followed the principle of maximally resect the lesion and minimally impain the pulmonary function. The sleeve Iobectomy had the same effect as pneumonectomy, but with lesser mortality and morbidty.
[•7]
Tracheal sleeve and superior vena cava resection for bronchogenic carcinoma
L Spaggiari, P. Solli, F. Leo, G. Veronesi, F. D'Ovidio, M. D'Aiuto, U. Pastorino. EuropeanInstitute of Oncology, Milan; Thoracic Surgery
Department, European Institute of Oncology, Italy Extended resections of trachea and superior vena cava (SVC) for locally advanced non small cell lung cancer (NSCLC) are infrequently performed, and their oncological benefit in comparison with exclusive chemo/radiotherapy remains uncertain. From January 1998 until December 1999, 6 patients with NSCLC infiltrating the main carina or right tracheobronchial angle, as well as SVC, underwent combined extended resection. All patients had received induction chemotherapy and one had sequential hyperfractionated radiotherapy prior to resection. Four of them had preoperative mediastinoscepy. The surgical approach was muscle sparing lateral thoracotomy in 4 cases and hemiclamshell approach in 2 cases. There were 4 tracheal sleeve pneumonectomies, 1 tracheal sleeve right upper Iobectomy, and 1 tracheal sleeve upper bilobectomy. There were 3 SVC complete resections and substitution with a PTFE graft. The other three cases underwent partial resection with vascular staplers. Three patients had N2 disease. There were no perioperative complications and no postoperative mortality. Three postoperative complications (50%) were recorded: a post pneumonectomy oedema, an ARDS after rethoracotomy for bleeding and an early graft occlusion successfully medically treated, The median intensive care unit stay was 3 days (ranging from 1 to 42 days) and the median hospital stay was 25 days