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Surgical treatment for stage III a nonsmall cell lung cancer
168 648
649
At TRFATMFNTFORSTAEk&Q@W I CFt_j&JNGCANCFR MFluggieri, A. Caminiti, M. Lepore, G. Paolini. M. Batori, R. Dell’Arte, “La Sapienza” G. Sodani, A. Paolini. IV Clinica Chirurgica _ Universita Roma , Italia. A retrospective study on long time survival was performed on 25 patients, non small cell lung cancer with stage Illa, who underwent surgery in our department. Our patients were 18 males and 7 females; lobectomy was performed in 12 patients, pneumonectomy in 13. Histologic type was squamous cell carcinoma in 14 cases, adenocarcinoma in 9 cases and large cell carcinoma in 2 cases. In our patients (25) the TNM definitions for the llla stage was: Ti N2M0(2), T2N2MO(iO). TBNOMO (3) T3NlMO (2) T3N2M0(8). The 2 years survival rate was 32%; the 5 years survival rate was 12%. The survival rate of patients undergoing lobectomy was 25%: for patients undergoing pneumonectomy was 59% (fig.1). The results of surgery for non small cell lung cancer with stage llla are not encouraging. The other therapy don’t modify survival for ____ _ _____ patients in this stage. 120 ----------
VIDEO-ASSISTED LOWER LOBECTOMY FOR cTlNOM0 LUNG CANCER. G. Gotti, P. Paladini, M. DiBisceglie, L. Voltolii, G. Biagi. lstitutc di Chirurgia Tom&a e Cardiovascolare - Universti di Siena - Italy Nowadaysthesuperof~~~~~~ic~~~~ thoracotomy in the treatment of small nxnalignant l&us of the pleura and the lung is well accepted because it offers a short time of drainage, a minimal postoperative pain and early recovery. Moreover video-assisted operation is a surgical technique which obviates the need for a thoracotomy with its well knonm pi&k Here we are describing our prebminary experience in video-assisted lobectomy and lymph node dissection in patients with lung cancer. During the last year we performed 8 lobectomiesof tbe lower lobe for lung cancer. The arocedwe is oerformed under ~eneml anesthesia with Wacheal A liited thoracotomy of 5-7 cm, without rib spread, is performed on 6th intercostal space on the mid-axillmy line and the exploratory thorauxcope is introduced in the aleural cavitv. A 2nd and 3rd incision of 2 cm are uetformed
1) Martini N. et al. : The role of surgery in N2 lung cancer.” Surg. Clin. North. Am.1997 ; 67: 1037 2) Bunn P.A. : “Biology of lungcancer.” New Frontersin Lung Cancer International Meeting Genoa - Italy - May 30th -June3rd , 1993 treatment for higher stage non -smallcell lung 3) Ginsberg R.J. : *Surgical cancer Ann.Thorac.Surg. 1992; 54: 999
The bronchus, the a&y and the veil are sutured with app&iate staplers positioned along tbe interlobar fissures. Subsequently, the resected lobe is e&acted throogb tbe limited thoracotomy. Moreover, visible bilar and carioal lymph node dissection is carried out. After assuring haemostasis, a tube drainage is positioned throogbthe posterior incision. The duration of the procedure raoged a medium of 3 hours. The postoperative course was uneventful and there were no deaths. The average postoperative dmatioo of hospital stay was of 4 days. To our opinion lower lobe resection can be carried out in video-assisted lobectomywithoutmajortechnicalproblems.Peribronchiallymphnodedissection can also be done with this teclmique. The superior displacement of the bronchus exposes the car&l lymph nodes rendering possible their eodoscopic removal. In conclusion it is possible toperform lower lobe resecticn and satisktory lymph node dissection with this method because this approach is relatively simple when the neoplasm is not involvingthe &sure aad the bronchial hilum and above allwhenthecontrast~~hancedhighdefinitionCTscansdanonstratesnosuspected lymph node of the bilum and mtxiia&um.
650
651
100 nsc
‘\ ..
O0
0 Survival
e.0 40/_
SURGICAL TREAT;.E%NTof A. Jeckevicius, The reeection in
towerda
the the
‘underwent riod
out
therapy the
cases
(X1,12)
to
with
performe
partial
bronchoplastic has
of
During
increasing
the
adjuvant our
in
in
lung the
to
resection the
pe-
most
a domithe
total
or
both).In
lymph
nodes
There
is
the
past
IO years
of
lung
/lobectomy,
and others/. follow-up
com-
lobectomy
adjuvant
was given. in
center
become
received of
1203
first
Cut of
chemotherapy
resection improved
as
involvement
clinic
Lithuania
was the
1980.
patients
therapy
treatment.
)
attitude
Prom 1970
(radiotherapy,
in
surgical
treatment
280
cases,
,Vilnius,
waa performed
pneumonectomy be
(1957-1992
1957-1992.Our
changes.
procedure
tendency
therapy
of
intervention.
surgical 1203
lung
surgical
(1957-1970)
turned of
of course
several
mon surgery net
Center
Dncologicel
Lithuanian
cases
UJEG CAXER
P.Baujokaitis
a to
hdjuvant results
Of
FAVOUPABLE OUTCOME OF PATIENTS WITH BRONCHIAL CARCINOID /EXPERIENCE 1963-1993/. z. Skbcel, M. Marel, L. Melfnovb. Pneumological Clinic, Charles University, Prague, Czech Republic. During 30 years 35 patients were treated for bronchial carcinoid in our hospital. Goal of the review was to compare prognosis of patients with typical and atypical carcinoids and to learn frequency of progression to small cell lung cancer /SCLC/. Most common surgery was lobectomy /LE/ - 26x, 3 pneumectomies, 2 bronchotomies, 3 endoscopical exscisions and lasertherapy. All resection - except one - /97%/ were complete, in 97% lymphnodes were not infiltrated. Histologically 20 tumors were typical and 15 atypical and in 1 case progression to SCLC was observed. In most cases /24/ carcinoid was growing outside bronchial cartilage and invaded lung tisin 1 case mediastisue, in 2 cases pericardium, num and chest wall and in 1 case there was metastasis into ipsilateral lung. In median follow-up of 7 years there are 2 deaths lb%/ related to carcinoid. In conclusion, carcinoid, incl. atypical has favourable prognosis, even in locally very advanced tumors complete resection was possible and tumors didn-t relapse. There was 1 progression to SCLC /3%/ and 2 deaths /b%/. Because in most cases invasion outside cartilage is observed, LE is commonly the most appropriate kind of surgical treatment, but other kinds of treatment in selected cases can be feasible.
649
At TRFATMFNTFORSTAEk&Q@W I CFt_j&JNGCANCFR MFluggieri, A. Caminiti, M. Lepore, G. Paolini. M. Batori, R. Dell’Arte, “La Sapienza” G. Sodani, A. Paolini. IV Clinica Chirurgica _ Universita Roma , Italia. A retrospective study on long time survival was performed on 25 patients, non small cell lung cancer with stage Illa, who underwent surgery in our department. Our patients were 18 males and 7 females; lobectomy was performed in 12 patients, pneumonectomy in 13. Histologic type was squamous cell carcinoma in 14 cases, adenocarcinoma in 9 cases and large cell carcinoma in 2 cases. In our patients (25) the TNM definitions for the llla stage was: Ti N2M0(2), T2N2MO(iO). TBNOMO (3) T3NlMO (2) T3N2M0(8). The 2 years survival rate was 32%; the 5 years survival rate was 12%. The survival rate of patients undergoing lobectomy was 25%: for patients undergoing pneumonectomy was 59% (fig.1). The results of surgery for non small cell lung cancer with stage llla are not encouraging. The other therapy don’t modify survival for ____ _ _____ patients in this stage. 120 ----------
VIDEO-ASSISTED LOWER LOBECTOMY FOR cTlNOM0 LUNG CANCER. G. Gotti, P. Paladini, M. DiBisceglie, L. Voltolii, G. Biagi. lstitutc di Chirurgia Tom&a e Cardiovascolare - Universti di Siena - Italy Nowadaysthesuperof~~~~~~ic~~~~ thoracotomy in the treatment of small nxnalignant l&us of the pleura and the lung is well accepted because it offers a short time of drainage, a minimal postoperative pain and early recovery. Moreover video-assisted operation is a surgical technique which obviates the need for a thoracotomy with its well knonm pi&k Here we are describing our prebminary experience in video-assisted lobectomy and lymph node dissection in patients with lung cancer. During the last year we performed 8 lobectomiesof tbe lower lobe for lung cancer. The arocedwe is oerformed under ~eneml anesthesia with Wacheal A liited thoracotomy of 5-7 cm, without rib spread, is performed on 6th intercostal space on the mid-axillmy line and the exploratory thorauxcope is introduced in the aleural cavitv. A 2nd and 3rd incision of 2 cm are uetformed
1) Martini N. et al. : The role of surgery in N2 lung cancer.” Surg. Clin. North. Am.1997 ; 67: 1037 2) Bunn P.A. : “Biology of lungcancer.” New Frontersin Lung Cancer International Meeting Genoa - Italy - May 30th -June3rd , 1993 treatment for higher stage non -smallcell lung 3) Ginsberg R.J. : *Surgical cancer Ann.Thorac.Surg. 1992; 54: 999
The bronchus, the a&y and the veil are sutured with app&iate staplers positioned along tbe interlobar fissures. Subsequently, the resected lobe is e&acted throogb tbe limited thoracotomy. Moreover, visible bilar and carioal lymph node dissection is carried out. After assuring haemostasis, a tube drainage is positioned throogbthe posterior incision. The duration of the procedure raoged a medium of 3 hours. The postoperative course was uneventful and there were no deaths. The average postoperative dmatioo of hospital stay was of 4 days. To our opinion lower lobe resection can be carried out in video-assisted lobectomywithoutmajortechnicalproblems.Peribronchiallymphnodedissection can also be done with this teclmique. The superior displacement of the bronchus exposes the car&l lymph nodes rendering possible their eodoscopic removal. In conclusion it is possible toperform lower lobe resecticn and satisktory lymph node dissection with this method because this approach is relatively simple when the neoplasm is not involvingthe &sure aad the bronchial hilum and above allwhenthecontrast~~hancedhighdefinitionCTscansdanonstratesnosuspected lymph node of the bilum and mtxiia&um.
650
651
100 nsc
‘\ ..
O0
0 Survival
e.0 40/_
SURGICAL TREAT;.E%NTof A. Jeckevicius, The reeection in
towerda
the the
‘underwent riod
out
therapy the
cases
(X1,12)
to
with
performe
partial
bronchoplastic has
of
During
increasing
the
adjuvant our
in
in
lung the
to
resection the
pe-
most
a domithe
total
or
both).In
lymph
nodes
There
is
the
past
IO years
of
lung
/lobectomy,
and others/. follow-up
com-
lobectomy
adjuvant
was given. in
center
become
received of
1203
first
Cut of
chemotherapy
resection improved
as
involvement
clinic
Lithuania
was the
1980.
patients
therapy
treatment.
)
attitude
Prom 1970
(radiotherapy,
in
surgical
treatment
280
cases,
,Vilnius,
waa performed
pneumonectomy be
(1957-1992
1957-1992.Our
changes.
procedure
tendency
therapy
of
intervention.
surgical 1203
lung
surgical
(1957-1970)
turned of
of course
several
mon surgery net
Center
Dncologicel
Lithuanian
cases
UJEG CAXER
P.Baujokaitis
a to
hdjuvant results
Of
FAVOUPABLE OUTCOME OF PATIENTS WITH BRONCHIAL CARCINOID /EXPERIENCE 1963-1993/. z. Skbcel, M. Marel, L. Melfnovb. Pneumological Clinic, Charles University, Prague, Czech Republic. During 30 years 35 patients were treated for bronchial carcinoid in our hospital. Goal of the review was to compare prognosis of patients with typical and atypical carcinoids and to learn frequency of progression to small cell lung cancer /SCLC/. Most common surgery was lobectomy /LE/ - 26x, 3 pneumectomies, 2 bronchotomies, 3 endoscopical exscisions and lasertherapy. All resection - except one - /97%/ were complete, in 97% lymphnodes were not infiltrated. Histologically 20 tumors were typical and 15 atypical and in 1 case progression to SCLC was observed. In most cases /24/ carcinoid was growing outside bronchial cartilage and invaded lung tisin 1 case mediastisue, in 2 cases pericardium, num and chest wall and in 1 case there was metastasis into ipsilateral lung. In median follow-up of 7 years there are 2 deaths lb%/ related to carcinoid. In conclusion, carcinoid, incl. atypical has favourable prognosis, even in locally very advanced tumors complete resection was possible and tumors didn-t relapse. There was 1 progression to SCLC /3%/ and 2 deaths /b%/. Because in most cases invasion outside cartilage is observed, LE is commonly the most appropriate kind of surgical treatment, but other kinds of treatment in selected cases can be feasible.