Abstracts/Lung Cancer I2 (1995) 265-329

wedge resection or scgmmtectomy had recurrence. Five and IO-year survivals after wedge resection or scgmentectomy were 59% and 35%, respectively, significantly less than survivals ofthose undergoing lobe&my (5 years, 77%; 10 years., 70%). The S- and IO-year survivals in the 38 patients who had no lymph node dissection were reduced to 59% and 32%, respectively. Apart from the favorable prognosis observed in this group of patients, three facts emerge as significant: (I) Systematic lymph node dissection is necessary to ensure that the disease is accurately staged; (2) lesser resections (wedge/segment) result in high recurrence rates and reduced survival regardless of histologic type; and (3) second primary lung cancers we prcvalcnt in long-term survivors.

L.ong-term antimicrobial prophylaxis in lungkukcer surgery: Corrc- lation between mlcmbii findiags and empyema deveIopment Ratto GB, Fantino G, Tassan E. Angelini M, Spessa E, Parodi A. Isfihrto di Parokqia Chirwgiw Vnivesiryof Genoa. &de BenedetkA’VlO, 16132 Genoa. Lung Cancer (Ireland) 1994,11:345-52.

This study was planned in order to determine the value of antimicrobial prophylaxis in preventing post-operative empyema in patients undergoing lung cancer surgery. Two-hundred consecutive subjects operated upon for lung cancer received teicoplanin and aztreonam, starting at the induction of anesthesia and lasting until removal of the pleural drains. Cultures for aerobic and anaerobic bacteria were taken from: (1) the bronchus at the time of surgical division (2) the pleural space before closure of the chest; (3) the pleural fluid during the postoperative period; and (4) the tips of chest drains at the time of their removal. In the 200 patients receiving antibiotic prophylaxis, the number of post-operative empyemas (I%) was lower than that (7.5%) found in 53 comparable patients who were previously treated with placebo. In the ‘placebo group’, ompyems ww due to gram-positive bacteria, while in the ‘prophylaxis group’, it WBS caused by Gram-negative bacteria (F’seudomonos aeruginosa). A signiticant (P < 0.05) correlation between infected bronchial secretions,pleural space contamination at surgery, contamination of chest fluid and drains during the post-operative period, and empyema development was demonstrated. In conclusion, antibiotic prophylaxis, while being effective in preventing post-operative empyema, may induce the colonization of the respiratory tract with highly resistant gram-negative bacteria.

A ocw procedure for light upper lobcctomy of hmg with rccoa-struction ofthe carinn Ding J-A. Shanghai First Pulmonmy Dis. Hosp.. Shanghai. Chin J Clin Oncol 1994;2l:g69-72.

Right upper lobectomy with resection and reconstruction of the carina for lungcanccrinvadingcarinaand/or~acheacanbedoncifthisproccdure isconsidered to be curative. In the pest, the modes of carinsl reconstruction under such circumstances are either the trachea being reanastomosed with the right intermediate bronchus with the left main-bronchus end to end or the trachea being reanastomosed with the IcA main-bronchus end to end and the right intermediate bronchus with the left main-bronchus end to side. The operative techniques, anesthetic management and operative exposure in the above mentioned procedures are imbued with difficulties. The authors concluded from animal experiments that the reanastomosing trachea with the let? main-bronchus end to end as well as end to side with the right intermediate bronchus is an ideal approach of carinal resection and reconstruction. The surgical technique is simpler and the tension of the anastomotic site is rather low. One of the key points is that this technic would allow the resection of a suffXent length of trachea and main-bronchus. Recently we have successfully used this technic of carinal reconstruction on patients.

Prognostic sigaiiiance ofp53 and ras geaeabaotmalities io lung adem+ carcinoma patients with stage I disease at%er curative resection Is&e T, Hiyama K, Yoshida Y, Fujiwara Y, Yamakido M. Second Departmenf Mernal Medicine, Hiroshima Unitersi&, School of Medicine, l-2-3 Kasumi, Minami-ku. Hiroshima 734. Jpn J Cancer Rcs 1994;85: 1240-6.

We investigated the prognostic significance of p53 gene abnormalities and ras gene mutations in patients with curatively resected stage I lung adenocarcinoma. Formalin-fixed and paraffinembedded tissues were obtained from 30 patients who had undergone curative resection for stage I lung adenocarcinoma.

Abnormalities of the p53 gent were detected using polymerax chain rcaction- denaturing gradient gel electrophoresis (PCR-DGGE) analysis and immunohistochcmistry and ras mutations were detected using PCR-restriction fragment length polymorphism (RFLP) analysis. Both univariate and multivariate analyses were performed to assess the relationship between the presence of abnormalities of these genes and the patients’ disc&w-free survival. Eleven tumors (37%) had inutated p53 sequences and 11(37%) showed pS3 overexpression. A total of IS tumors (50%) had ~53 gene abnormalities and the concordance rate was 73%. Seven tumors (23%) showed mutated ras sequences. The univariate analysis revealed that the disease-free survival of patients with any pS3 abnormality was shorter than that of those without abnormalities (P = 0.02, generalized Wilcoxon test), and survival of those with ~53 protein overexpression was more significantly shorter (P = 0.003, generalized Wilcoxon test). Multivariate analysis using the Cox proIxxtional hazards model indicated that the presence of ~53 abnormalities was a significantly (p = 0.01) unfavorable prognostic factor. There was no significant correlation bchveen the presence of res mutation and survival. These results suggest that analysis of the p53 gene may be helpful for the selection of high-risk patients for clinical trials of adjuvant therapy for stage I lung adenocaminome.

Evahiation ofpr@mstic signikance ofp53 gene alterations ia patients with surgically resected lung cancer Kashii T, Mizushima Y, Lima CEQ, Noto H, Sate H, Saito H et al. First Dept. of In~emal medicine. ToyMtaMedical/Phann~Eculical Univ. 2630 Sugitani, Toyama 930-01. Int 1 Oncol 1995;6:123%.

Clinical significance of p53 gene alterations, as a prognostic factor, was assessed in 69 patients with surgically resected lung cancer. The ~53 gene alterations (exon 5-9) were examined by the polymerase chain reaction-single strand conformation polymorphism @‘CR-SSCP) method of genomic DNA. The ~53 gene alterations were detected in all histological types of lung cancer, with a positive rate of 45% (3 l/69). In the alteration-positive group, patients in the advanced stages of Ill and IV were seen more frequently than in the negative group (58% vs. 2l%, p 4 0.05). Such a differera was not observed in other parameters such as age, gender, histological type and smoking habit. The prognosis was, on a whole, poorer in the alteration-positive group than for the -negative one (5-year survival rate: 19.3% vs. 40.6%, MST: 17 months vs. 36 months), but the difference did not reach statistical significance. However, in the case of females (p < O.OS), adenocarcinoma (p < O.Ol), early stages of I and lI (p < 0.05) and non-smokers (p < O.OOS), a signiticantly poorer prognosis was observed in the gene alteration-positive group than for the -negative one. These results suggest that the ~53 gene alteration may be a useful prognostic factor in certain subgroups with lung resected for cancer.

Quality-af-life following thoracotomy for long cancer Dales RE, Belanger R, Shamji FM, Leech J, Crcpeau A, Sachs HJ. 011awa General Hospifal, 501 Smyth Road, Olfawa. Onr. KIH 8L6. J Clin Epidemiol 1994;47:1443-9.

Contrary to the issues of perioperative morbidity and survival following surgery for lung cancer, little attention has been given to quality-of-life. To address this, quality-of-life was assessed preopemtively and I, 3,6 and 9 months postoperatively in a cohort of 117 consecutive subjects who underwent thoracotomy with a cettain or presumptive diagnosis of lung cancer. Those with cancer (n = 91) confirmed at thoracotomy were contrasted to those without (n = 26). Moderate to severe dyspnes, reported in 14% preoperatively, increased to 34% at I and 3 months (p < 0.005) but returned to approximately 10% at 6 and 9 months. Similarly, activities of daily living were impaired in 1 I % preoperativelv; this disability increased to 21% at 1 month (p < 0.005), and timed to baseline at 6 and 9 months. Those with cancer compared to those without a postoperative diagnosis of cancer had similar quality-of-life prcoperatively but deteriorated more in the postoperative period. This study demonstrates that important deterioration in quality-of-life occurs during the first 3 months postoperatively in those with a final diagnosis ofcancer but improvement back to baseline can be expected thereafter.