100

resections for primary bronchogenic carci- noma, accounting for 13% of all pulmonary

resections during this interval. Of the 21 patients, 16(76%) were older than 65 years, 9 of these were over 70 years. Patients selection depended upon the radiological demonstration of peripheral lung lesion of a size suitable for limited resection. The indications for limited resection were reduced pulmonary function in i0, car- diac diseases in 4, renal dysfunction in l, and contralateral thoracoplasty in i. The distribution of cell type of the tumors was adenocarcinoma in 13, and squamous cell carcinoma in 8. The segments resected were as follows:

Left Lung Right Lung upper lobe upper lobe

superior division 6 apical 1

inferior division 2 anterior 2 posterior 2

lower lobe lower lobe superior 1 superior 2 basal 4 ant. basal 1

Total 13 total 8

Three of the procedures were palliative and 18 were considered to be potentially curative.

No patients in this group died within the first 30 postoperative days and all patients were discharged except one. Four patients died of diseases related to pul- monary tumors 5, 5, 7 and 27 months after resection of the tumor 17 patients are alive from 2 to 53 months.

Segmental resection may be considered as acceptable procedures in the treatment of bronchial carcinoma in the patients with reduced cardiopulmonary reserve.

Intraoperative Fine Needle Aspiration Biopsy of The Lung. Fry, W.A., Christ, M.L. Evanston Hospital and Northwestern University Medical School, Evanston, Illinois 60201, U.S.A.

Intraoperative fine needle aspiration biopsy (IOFNA) of lung lesions at the time of thoracotomy with rapid staining amd im- mediate reading has been nick-named "frozen section cytology", as the concept and sur- gical application of IOFNA is rather similar to intraoperative frozen section tissue pathology. It has an accuracy approaching 100% in differentiating malignancy from non-neoplastic conditions.

IOFNA is particularly useful in limi- ting the amount of lung resected at the time of exploratory thoracotomy when a le- sion, which was originally suspected of being lung cancer, turns out to be benign. We routinely perform IOFNA at exploratory thoracotomy when a firm preoperative diag-

nosis has not been obtained. If the IOFNA

is reported benign, we do a local excision

of the lesion for final histologic confirmation of benignancy. That enables us to avoid a ma-

jor pulmonary resection (defined as a lobecto- my or more) on most benign lung lesions.

In a series of 24 lung lesions suspected of being malignant but ultimately proven benign, by using IOFNA only 3 (12.5%) patients requi- red resection as extensive as a lobectomy. IOFNA helps to preserve lung tissue.

Role of Bronchoplastic Procedures in Surgical Treatment of Primary Lung Cancer. .Deslauriers, J., Gaulin, P., Piraux, M. Centre de pneumologie de Laval, Ste-Foy, Qu4bec.

Bronchoplastic procedures are lung saving operations where a portion of the main bronahus is removed with lobectomy in order to preserve distal parenchyma. Between 1975 and 1985, these procedures were done in 72 patients with pri- mary lung cancer. The majority of operations were combined with upper lobectomy (RT upper: 51, RT upper and middle: 4, LT upper: 17). One patient had a left lower lobectomy with bron- choplasty and one patient had bilateral sleeve resections. There were no operative deaths and major complications occurred in 8% of patients. Most resected cancers were squamous (65/73) with bronchial margins free of tumor in all but 4 patients. Minimum 1 year follow-up was available on all patients and cumulative survi- val curves were correlated with nodal status. The 5 year survival for patients with uninvol- ved nodes (NO) (n: 35) was 67% and for patients with N1 disease (n: 32) was 60%. Five patients developed a second primary during the period of follow-up.

Sleeve lobectomy is safe, does not compromise long term tumor free survival and should be the operation of choice in central tumors invol- ving the upper lobe orifice. The presence of me- tastatic hilar nodes (NI) does not contraindi- cate the procedure when a complete resection is possible.

Preliminary Experience of HFJV in Carinal Re- sected and Reconstruction for Treatment of Lung Cancer. WU, S.F., Huang, O.L., Wu, S.C., Chow, Y.C., Sun, T.K., Rong, Z.B., Cheng, W.H., Gao, C.X., Wu, H.S., Wang, J.M., Jin, D.L., Gao, T.H., Ma, Y.F., Chow, O.F., Cheng, W.L., Jing, Y.H. Shanghai Chest Hospital, Shanghai, China.

The authors pioneerly succeeded performing carcinoma resection and reconstruction in China:

(i) Carinal resection and right sleeve pneu- monectomy (April 16, 1976)

(2) Carinal and right upper lobe resection and reconstruction (March ii, 1980)

(3)Carinal resection and left sleeve pneu- monectomy (July 27, 1984).

By end of November 1984, 32 cases, comprising seven type of carinal resection and reconstruc- tion were performed (slides). Operative morta- lity was 9.4%. No apparent complication. Except

two (p T 3 NOM0 and pTis NOMo), there was so far