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A., Villani I, S., parmeggiani 5, A., Possati I ,

L. Departments i. of Surgery, 2. Radiothe- rapy, 3. Respirology, 4. Statistics, 5. Ane- sthesia. University of Bologna, Bolagna,

Italy. From 1971 to 1984, 171 procedures for

stage III lung cancer were performed, 154 radical (90%) and 16 palliative. Procedures performed: ii Kergin pneumonec- tomies, 69 pneumonectomies with intraperi- cardial vessel ligation (plus 12 atrial, 1 parietal, 1 caval resections), 27 pneu- monectomies (i caval resection), 45 lobec- tomies (7 parietal, 2 diaphragmatic resect.), 5 bilobectomies, 4 sleeve and 5 wedge re- sections (3 parietal resections), 5 Paulson procedures for Pancoast Tumor. Lymphadenec- tomy became routine since 1971. Actuarial Survival of 163 controlled pa- tients (95.9%). - Squamous cell carcinoma: palliative resections-no survival after 47 months.

Radical surgery global 5-year survival 24,3%- T N M 17,9% T N M 21,7% T N

• 300 310 1-32 M 0 29,7%. - Adenocarcinoma: Radical surgery global

5-year-survival 7,5%: T3NoM 0 11.3%. TI_ 3 N~M D at 2-years 28•3%. GIoSal operative mortality was 3.5% and major complications were 5 bronchial fi- stulae, 18 arrhythmias and 2 cases of chylothorax. Conclusions

All stage III squamous cell carcinoma should be considered for surgery.

The Value of Bronchial Resection in Lung Cancer Patients with Inadequate Respira- tory Reserve. Thoracic Department Metaxas Memorial Cancer Hospital Greece, S. Zellos-D., Papanastasiou.

During the last 15 years 18 patients with squamous cell type bronchial carcinoma and inadequate respiratory reserve were operated upon in the department of Thoracic Surgery Metaxas Memorial Cancer Hospital in Greece• 12 patients underwent RT sleeve resection upper lobectomies and 6 had on the left. None of the patients had preope- rative x-ray therapy nor chemotherapy.

Though the indication for bronchial re- section is more applicable in patients with bronchial adenoma in certain patients with border-line respiratory reserve the operation offers to the patient the same chance as in those with standard techniques.

More details regarding technical pro- cedures and suture material and follow-up data will be given in the presentation of the manuscript.

Operations of Lung Cancer by Using Median- sternotomy. Nakagawa, A., Araki, M., Kihara, S., Kawazu,

R., Akagi, M. Medical School, Kumamoto Univer- sity, Kumamoto, Japan.

In these days we performed the operations of lung cancer by using mediansternotomy instead of posterolateral approach. Ten patients in total were operated in order to compare with the conventional posterolateral method in our surgical department. The checked items were operating time, blood loss, duration of tube- dwelling, admission days, pulmonary function, antalgic doses and so on.

The different results were found postopera- tively in pulmonary function and antalgic do- ses between two groups. Pulmonary function was preserved better in the cases of mediansternoto- my than in those of posterolateral thoracotomy. In the other items such as blood loss, admis- sion days and so on, there was no difference between the two groups•

Besides, it was the most significant thing of all that the dissection of lymph nodes in mediastinum was much easier in mediansternotomy than in posterolateral method and it was possib- le to dissect the lymph nodes of the counter side mediastinum in mediansternotomy. Therefore, mediansternotomy may be preferred in the upper lobectomy of lung cancer than in posterolateral method.

Five Years Experience of Superradical Operation for Lung Cancer Through the Median Sternotomy. Hata, E., Take, A., Kamisawa, O., Ohara, T., Fukushima, K., Hasegawa, T. Department of Tho- racic and Cardiovascular Surgery, Jichi Medical School, Tochigi-ken, Japan 329-04.

New method of superradical operation for left lung cancer through median sternotomy was de- vised in order to figure out the difficulty of complete systematic lymphadenectomy through the standard left thoracotomy. By this method, extensive resection of mediastinal nodes in- cluding contralateral paratracheal nodes in possible en bloc with the affected lung as pre- sented at this latest conference in 1982 at Tokyo.

Although during initial 3 years this proce- dure was applied only to left lung cancer, the indication have been extended to the advanced right lung cancer. From October 1979 to January 1985, 24 patients with left lung cancer and 2 patients with right lung cancer were operated.

AS for left lung cancer, 22 patients were male and 2 female, aged 31 to 70. The cell types were squamous cell carcinoma in 17 cases, ade- nocarcinoma in 5, large cell carcinoma and small cell carcinoma in one each. Thirteen left penumonectomies combined with partial resecti- on of left atrium in 3 cases and partial cari- nal resection in one and ii left upper lobec- tomies were carried out, with one operative death in case of T3N 2 (operative mortality 4%). Postoperative staglng was as follows: II cases of stage III, 3 cases of stage II and i0 cases of stage I. Four of nine N 2 cases had contrala-

teral paratracheal nodes involvement. Four N2

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cases have survived for 6 months to 5 years, but four died of the distant metastases du-

ring 2 to 15 months postoperatively. It is noteworthy that one of the two sur-

vivors over 5 years, who had squamous cell carcinoma with N disease, had contralate-

2 ral paratracheal node involvement.

Anterior Approach For The Apical Invading Lung Cancer. Masaoka, A., Mizuno, T., Ichimura, H., Niwa, H., Nakamae, K. Nagoya City Universi- ty Medical School, Nagoya, Japan.

Merits and demerits of the anterior ap- proach for the apical invading lung cancer were investigated. The apical invading lung cancer consists of superior sulcus tumor and anterior apical tumor. The former situates posteriorly and invades into plex- us brachialis. The latter situates anterior- ly and invades into subclavian artery and vein.

We performed operation by the anterior approach in 9 apical invading lung cancers, consisted of 7 superior sulcus tumors and 2 anterior apical tumors. One case of the superior sulcus tumors necessitated an ad- ditional posterolateral approach. In all cases, I, II or I, II, III ribs were re- sected. As the anterior approach makes the manipulation of subclavian artery and vein easier, it is the procedure of first choice for the anterior apical tumor. For the su- perior sulcus tumor, it provides field of good view, but demerit is the deep situa- tion of the lesion.

Risk Score to Evaluate The Preoperative Patients With Lung Cancer. Nakamoto, K., Nakamura, K., Nanjo, S., Mori, T., Kotake, Y., Maeda, M., Sawamura, K. Department of Surgery, Kagawa Medical School, Kagawa and National Kinki Central Hospital, Osaka, Japan.

As a method to evaluate preoperative patients with lung cancer, we established a "Risk Score" (RS). The correlation be- tween this RS, and postoperative complica- tion and the operative death was examined respectively by using 256 cases of resec- ted lung cancer from June, 1977 to May,

1982. The RS was calculated as a total by ad-

ding each point of four risk factors which are in the case of age over 70, smoking index over 400, FEV less than 1500 ml

i. and preexistent disorder of cardiovasvular, respiratory and metabolic functions.

The postoperative complications was en- countered 2.0% in RS-0, 16.1% in RS-I, 37.4% in RS-2, 57.1% in RS-3 and 80.0% in RS~4. The incidence of the operative death and the death relating to operation was calculated as 0.0% in RS-0, 1.1% in RS-I, 5.5% in RS-2, 14.3% in RS-3 and 40.0% in

RS-4. The RS actually prospected the postope-

rative course at the probability of 72.0% in total.

Since July, 1983, the RS was actually used in 34 cases. Among them, 5 cases of RS-3 and RS-4 were excluded from operation after the furthermore examinations. In the remainder 29 cases, there were no operative death with the functional disorders.

Sununarizing these results, it is concluded that the RS established is clinically useful score for preoperative evaluation of the func- tionally high risk patients with lung cancer.

The Chest Wall Reconstruction After Combined Resection. Tanaka, H., Mizuno, T., Kobayashi, S., Shibata, K., Kobayashi, M., Nishida, T., Satake, A., Sano, M., Nakamae, K., Masaoka, A. Department of Surgery, Nagoya City University Medical School, Nagoya, Japan.

The con%bined resection of the chest wall due to the invasion of tumors had been performed on 14 cases of primary lung cancer. Among them, the reconstruction of the chest wall was re- quired in 2 cases.

Additional 7 cases of primary or metastatic malignancies were also resected and reconstruc- ted. Although we had used several prosthesis, Marlex polyethylene mesh was superior in regard to the rigidity and biofittness. A sandwich type composition of Marlex mesh and methyl me- tacrylate was used in the cases with wide and full thickness resection, to obtain enough ri- gidity and good air tightness. The respiratory failure due to the atelectasis was observed experimentally after the resection of the chest wall, especially in widely resected dogs with- out reconstruction.

The indication and the technique of the chest wasll reconstruction will be discussed.

The Segmental and Atypical Resection of Primary Lung Cancer. Kulka, F., Forrai, I. Thoracic Surgical Clinic Budapest, Hungary.

Between 1960 and 1983, 449 segmental and a- typical resection with stapler were carried out because of primary lung cancer. Age 68.5 years /average/. Operative mortality 0.5%. The follow up over 5 years was at 187 pts. The survival rate is 35%. If patients in stadium I were taken into account (107 pts) only, the survival rate is 60%. In the first i0 year the operation was performed only on pts over 70 years and/or with decreased cardio respiratory function. Based on our experiences recently, the operation might be performed on an elective basis too.

Segmentectomy For Primary Lung Cancer. Ayabe, H., Kawahara, K., Mori, M., Ohta, Y., Kimino, K., Tomita, M. First Department of Sur- gery, Nagasaki University Hospital, Nagasaki,

Japan 852.

From 1980 to 1984, we performed 21 segmental