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Thoracoscopy for suspected malignant pleural effusion: Report of 21 cases
146
SURGERY
560
561
ADJUVANT TREATMENT IN RESECTED STAGE II & III NON-SMALL CELL LUNG CANCER (NSCLC) PATIENTS (PTS) WITH PREOPERATIVE FALSE-NEGATIVE CHEST COMPUTED TOMOGRAPHY (CT) SCANS. M. Canela, R. Fenili, J. Maestre, A. Olazabal, I. Moreno, A. Resell, A. Font, F. Molina, R. Rosell. Hospital Germans Trias i Pujol, Badalona, Barcelona, Spain. Randomized trials of adjuvant chemotherapy (chT) in resected NSCLC have shown an improvement in disease-free survival (DFS) but not in overall survival. From February 1988 to June 1992, 69 stage II & III pts underwent surgery. Most of the pts were selected on the grounds of a falsenegative CT scan. All pts underwent thoracotomy for resection and mediastinal lymph node dissection. 19 of the Nl pts received no further treatment, 12 radiation therapy (RT) and 3 RT plus chT. 12 of the N2 pts had no post-operative treatment, the remaining 17 pts received either RT alone or chT. False-negative chest CT scans were averred in 26 (76 %) stage II pts and in 23 (66 %) stage IIIA pts. Median survival time (MST) for stage II pts was 29 months in those who received adjuvant treatment vs 15 months with no post-operative treatment (P = 0.07). However DFS was significantly better in the post-operative treatment group (P = 0.04). The MST in stage IIIA was 16 months in those pts who received post-operative treatment vs 5 months in those pts with no post-operative treatment (P = 0.01). In the light of these data, there is an obvious need to continue stratified randomized studies to define whether chT significantly improves the effect of pas-operative RT.
THE PLASTIC OPER$TION FOR TR:CHSA, CARINA AND BRONCHU,: (AN \NALYSIS Or 151 CASE;). Z.F. du, T.P. Lin. The Guangzhou First Affiliated Hosr?ital of Guangzhou Medical College, Guangzhou, P.R. China 151 tumor cases had reconstruction of trachea, carina and bronchus in our hodaitsl since 1978 to June Among them, 120 were males and 31 females. 1992. Age ranged
from 17 to 72, average
52.
Pathology
:
epidermoid 91, adenocarcinoma 25, small cell 16, mixed (adenosquamous) 6, carcinoid 5, cystadenoma 3, panilloma 3. Types of operation : sleeve resection of trachea 11; reconstruction of carina 23, including : carinal reconstruction + right pneumonectomy 5; + left pneumonectomy 3. 3 cases had mere carinal reconstruction 2nd 2 had resection of right half of carina + right pneumonectomy. sleeve lobectomy were done on 117 cases; including: upper lobe 28, left lower lobe 8, right upper lobe 71 and right middle lobe 10. Technically, the right U13per lobectomy is easier. 18 cases had pulmonary artery reconstruction and 6
had pulmonary vein ligated inside the uericardium. Follow up: chemotherapy OP radio therapy were given for most of our csses within 3 years after operation. There's no death within one month. The survival rate for 1, 2. 3, 5 years were 91.4y, 78.59c, 53.72 and 26.3~ respectively. There were no fistulae nor stricture on anestomotic sites. ?ie followed the orinciple resect
the lesion and minimally diminish function. The sleeve lobectomy h-rd the same effect a5 !meUmOnectOny, but with lesser morta_ lity and morbidity. of msximnlly the pulmonary
562
563
TREATMENT OF TRACHEAL OBBTRUCTION BY TUMORS. T.P. Lin. Guangzhou Medical College, Guangshou, P.R. China From 1986 to 1992, 16 patients with acute tracheal
THO?ACCSCOPY FOR SUdPECTED MALIGNA"'TPLEURAL EFFUSION : REPORT OF 21 CASES. G.Q. dang, S.Y. Li, M.J. Xie, F. Chi. Guangzhou Institute of Respiratory Disease, Guangzhou, P.R. China Since December, 1991 to July, 1993, we used thoracoscopy to examine the susoected malignant pleural effusion - totally 21 cases (13 male and 8 female). The youngest was 39 and oldest 73. The results from thoracoscopy with biopsy were encouraging. The pathologic examination revealed 17 malignant and 4 benign lesions. They were : 9 adenocarcinoma, 6 malignant mesothelioma, 1 mucocarcinoma, 1 small cell carcinoma, 3 tuberculous and 1 rheumatic effusion. All malignant lesions were metastatic ones-chiefly from pulmonary carcinoma. The procedure included stab wound on chest wall, insertion of thoracoscoue, sucking out the fluid and note the color and amount, biopsy of the lesion on pnrietal or viseral pleura, withdrawn the thoracoscope and suture the wound. We used Karl Store, (German) OP Olympus LTF (Japanese) thoracoscoues. All csses were diagnosed accurately and suitable treatments were then given. .Jeconclude that thoraCOZCOJ:I lu :i safe and valuable method i"l :!iagno;;,,_: Pleural effusion of unknown chsracter. It is mope accurate than X-ray, C.T. thoracentesis and even chromoaomal study. But, the stated :oethods can't be omitted. The thoracoscouy should be morn ridely used.
EMERGENCY
ranged obstruction were treated in R.I.C.U. Age There were 11 males and from 29 to 65, average 52. 5 females. All patients were very dyspneic. Chest
and neck X-ray, C.T. and fiberoptic bronchoscopy were done immediately, if condition allowed. secretion were sucked out and 02 given. We tried to pass a small Magill's tube, from mouth or nose, beyond If this failed, put a bigger the tumor (4 cases). tube proximal to the tumor (5). If the latter did not work, tracheostomy were done with Magill's tube passed through the wound and pushed beyond the tumor (3). If still difficult, just put on an ordinary tracheostomy tube (4). Mechanical assisted ventilation were used in most cases. We beleave the decreate of dead space, suckinu out of secretion and
the assisted ventilation could improve the respiration. Definite treatments were adopted 2-5 days after above mnne ement; they included sleeve resection of trachea (45:, radiation (61, cautery of tumor through bronchoscopy (5), trscheotomy + curretage + indwelling plastic tube + radiation (2). Pathologically: cystadenocarcinoma (51, epidermoid (51, c&inoid (5). mixed
(1).
All patients safely uassed the critical period. They lived from ?4 to 2 years.
SURGERY
560
561
ADJUVANT TREATMENT IN RESECTED STAGE II & III NON-SMALL CELL LUNG CANCER (NSCLC) PATIENTS (PTS) WITH PREOPERATIVE FALSE-NEGATIVE CHEST COMPUTED TOMOGRAPHY (CT) SCANS. M. Canela, R. Fenili, J. Maestre, A. Olazabal, I. Moreno, A. Resell, A. Font, F. Molina, R. Rosell. Hospital Germans Trias i Pujol, Badalona, Barcelona, Spain. Randomized trials of adjuvant chemotherapy (chT) in resected NSCLC have shown an improvement in disease-free survival (DFS) but not in overall survival. From February 1988 to June 1992, 69 stage II & III pts underwent surgery. Most of the pts were selected on the grounds of a falsenegative CT scan. All pts underwent thoracotomy for resection and mediastinal lymph node dissection. 19 of the Nl pts received no further treatment, 12 radiation therapy (RT) and 3 RT plus chT. 12 of the N2 pts had no post-operative treatment, the remaining 17 pts received either RT alone or chT. False-negative chest CT scans were averred in 26 (76 %) stage II pts and in 23 (66 %) stage IIIA pts. Median survival time (MST) for stage II pts was 29 months in those who received adjuvant treatment vs 15 months with no post-operative treatment (P = 0.07). However DFS was significantly better in the post-operative treatment group (P = 0.04). The MST in stage IIIA was 16 months in those pts who received post-operative treatment vs 5 months in those pts with no post-operative treatment (P = 0.01). In the light of these data, there is an obvious need to continue stratified randomized studies to define whether chT significantly improves the effect of pas-operative RT.
THE PLASTIC OPER$TION FOR TR:CHSA, CARINA AND BRONCHU,: (AN \NALYSIS Or 151 CASE;). Z.F. du, T.P. Lin. The Guangzhou First Affiliated Hosr?ital of Guangzhou Medical College, Guangzhou, P.R. China 151 tumor cases had reconstruction of trachea, carina and bronchus in our hodaitsl since 1978 to June Among them, 120 were males and 31 females. 1992. Age ranged
from 17 to 72, average
52.
Pathology
:
epidermoid 91, adenocarcinoma 25, small cell 16, mixed (adenosquamous) 6, carcinoid 5, cystadenoma 3, panilloma 3. Types of operation : sleeve resection of trachea 11; reconstruction of carina 23, including : carinal reconstruction + right pneumonectomy 5; + left pneumonectomy 3. 3 cases had mere carinal reconstruction 2nd 2 had resection of right half of carina + right pneumonectomy. sleeve lobectomy were done on 117 cases; including: upper lobe 28, left lower lobe 8, right upper lobe 71 and right middle lobe 10. Technically, the right U13per lobectomy is easier. 18 cases had pulmonary artery reconstruction and 6
had pulmonary vein ligated inside the uericardium. Follow up: chemotherapy OP radio therapy were given for most of our csses within 3 years after operation. There's no death within one month. The survival rate for 1, 2. 3, 5 years were 91.4y, 78.59c, 53.72 and 26.3~ respectively. There were no fistulae nor stricture on anestomotic sites. ?ie followed the orinciple resect
the lesion and minimally diminish function. The sleeve lobectomy h-rd the same effect a5 !meUmOnectOny, but with lesser morta_ lity and morbidity. of msximnlly the pulmonary
562
563
TREATMENT OF TRACHEAL OBBTRUCTION BY TUMORS. T.P. Lin. Guangzhou Medical College, Guangshou, P.R. China From 1986 to 1992, 16 patients with acute tracheal
THO?ACCSCOPY FOR SUdPECTED MALIGNA"'TPLEURAL EFFUSION : REPORT OF 21 CASES. G.Q. dang, S.Y. Li, M.J. Xie, F. Chi. Guangzhou Institute of Respiratory Disease, Guangzhou, P.R. China Since December, 1991 to July, 1993, we used thoracoscopy to examine the susoected malignant pleural effusion - totally 21 cases (13 male and 8 female). The youngest was 39 and oldest 73. The results from thoracoscopy with biopsy were encouraging. The pathologic examination revealed 17 malignant and 4 benign lesions. They were : 9 adenocarcinoma, 6 malignant mesothelioma, 1 mucocarcinoma, 1 small cell carcinoma, 3 tuberculous and 1 rheumatic effusion. All malignant lesions were metastatic ones-chiefly from pulmonary carcinoma. The procedure included stab wound on chest wall, insertion of thoracoscoue, sucking out the fluid and note the color and amount, biopsy of the lesion on pnrietal or viseral pleura, withdrawn the thoracoscope and suture the wound. We used Karl Store, (German) OP Olympus LTF (Japanese) thoracoscoues. All csses were diagnosed accurately and suitable treatments were then given. .Jeconclude that thoraCOZCOJ:I lu :i safe and valuable method i"l :!iagno;;,,_: Pleural effusion of unknown chsracter. It is mope accurate than X-ray, C.T. thoracentesis and even chromoaomal study. But, the stated :oethods can't be omitted. The thoracoscouy should be morn ridely used.
EMERGENCY
ranged obstruction were treated in R.I.C.U. Age There were 11 males and from 29 to 65, average 52. 5 females. All patients were very dyspneic. Chest
and neck X-ray, C.T. and fiberoptic bronchoscopy were done immediately, if condition allowed. secretion were sucked out and 02 given. We tried to pass a small Magill's tube, from mouth or nose, beyond If this failed, put a bigger the tumor (4 cases). tube proximal to the tumor (5). If the latter did not work, tracheostomy were done with Magill's tube passed through the wound and pushed beyond the tumor (3). If still difficult, just put on an ordinary tracheostomy tube (4). Mechanical assisted ventilation were used in most cases. We beleave the decreate of dead space, suckinu out of secretion and
the assisted ventilation could improve the respiration. Definite treatments were adopted 2-5 days after above mnne ement; they included sleeve resection of trachea (45:, radiation (61, cautery of tumor through bronchoscopy (5), trscheotomy + curretage + indwelling plastic tube + radiation (2). Pathologically: cystadenocarcinoma (51, epidermoid (51, c&inoid (5). mixed
(1).
All patients safely uassed the critical period. They lived from ?4 to 2 years.