148

568 569

SURGICAL INDICATION AND LIMITATION OF T4 SQUAMOUS CiLL LUNG CANCER. Shoji Namikawa,Makoto Kimura, Isa0 Yada. Department of Thoracic Surg.,Mie Univ. School of Medicine, Tsu, JAPAN

In surgical treatment of primary lung cancer, Tqcases show a remarkably low five-year survival rate of 13%. In this presentation, we discuss op- erative indication and limitation of surgical tr- eatment for squamous cell lung cancer among the T4 cases. Of the 109 surgically-treated T4 cases, 47 cases(43.l%)received exploratory thoracotomy, while excision was employed in remaining 62 cases. Extended operations were performed in 34 cases (31.2%). Squamous cell lung cancer was most com- mon and was noted in 54 cases. Exploratory thora- cotomy was performed in 23 cases(42.6%), while extended operation was done in 18 cases(33.3%). Of the individual organs in T4 cases, the rate of excision was high in the great vessels and the left atrium,but as low as approximately 40% in cases of infiltration into the mediastinum inclu- ding the main pulmonary artery and vein. In terms of the postoperative prognosis, the three-year survival rate was over 20% for the left atrium and the disseminated cases. This result is signi- ficant in terms of surgical treatment.Examination of survivors of T4 cases for periods exceeding two years showed that similar involving the med- iastinum,including the left atrium:the trachea: and the main pulmonary artery.The operative indi- cation was observed in cases of infiltration to these organs. However, prognosis was unfavorable in T4 cases with mediastinal lvmnh node metasta- sis.We concluded that limitation of operation should be considered.

570

NITINOL ALLOY ENDOTRACHEAL STENT USED IN TREATMENT OF TRACHEAL STENOSIS: EXPERIMENTAL AND CLINICAL APPLICATIONS Sun Yu-E. Liu Yang, Zbou N&Rang. et al. Department of Thoracic surgery. Gana*al Hospital of People'8 Liberation Army, Beijing 100863.

A new method used in treatment of tracheal steno& by maaua of nitinol alloy intraluminal tracheal etrnt ( Ni-Ti ITS) ia introduced. Altogether 7 atenta wera implanted into tracheas of 7 mongrels each with a model of tracheal stenosis. The observation periods ranged from 2 to 6 mouths. The experimental results shored: the Nl-Ti IT& could maintain long term patency without severe infection or obstruction by granulations or secretion. No displacement wae found. There were no signs of either generalized or localiaed corrosion on the eurface of stente. The shape -msmory property remained unchanged.

On the baais of animal experimental study. the ateut was successfully wed in clinical treatment. From July 1991. 6 patient6 with aevepe tracheal atenosis who wara not suitable to surgical operation received this treatment. Among thoee, two ware caused by squamous carcinoma, two by adeno-cystic caroiaoma, one by recurrent anastomotic stricture. Long term follow-up showed that they all bad satisfactoty results. It ia suggeeted that Ni-Ti ITS have Borne remarkable advantages in comparison with auy other kind of tracheal @tent. It can be used as a uaw endoprostbesis in #tenting narrowed trachea. especially for patients with long segment and @were tracheal stenosis.

LONG-TERM RESULTS OF OPERATION FOR N.S.C. LUNG CANCER Vanni Beltrami Clinica Chirurgica dell' Universitl degli Studi di Chieti - Italy

Up to june 1993. 1116 patients, selected from a total of 2784 observed cases, underwent surgery for Lung cancer. There were 290 pneumonectomies and 560 lobectomies and minor resections; the number of exploratory operations was 30 per cent before 1981, 21 per cent from 1982 to 1986 and less than 10 per cent from 1987. Mortality rate was around 5 per cent; 16 patients were lost to follow-up. Long-term survival was considered far patients operated an within 1982 (184) and 1987 (263). Mare than 73 per cent of those with TIN0 disease fared well after 5 years; the figure was 57 per cent after 10 years. Survival with T N

20 disease was

respectively 50 and 27 per cent; T3N0 patients survived to 5 years in 34 per cent of cases, but after 10 years only 11 per cent of them survived. A high percentage of the late deaths (around 50 per cent) vias related to the development of metastases. Local recurrences were not frequent; a second primary carcinoma was observed five times. The results of surgical resection could improve in coming years. due to the increasing number of patients subjected to neoadjuvant therapy.

571

RANDOMISED TRIAL OF SURGICAL RESECTION WITH OR WITHOUT POST-OPERATIVE RADIOTHERAPY (RT) IN NON- SMALL CELL LUNG CANCER (NSCLC). British Medical Research Council Lung Cancer Working Party, 5 Shaftesbury Road, Cambridge CB2 2BW, UK. Presented by N.M.Bleehen.

Previous reports have shown that in patients who have had an intended “curative” resection of NSCLC, the duration of subsequent survival is greatly reduced if the mediastinal nodes are found to he involved. It is important to determine whether post-operative thoracic RT improves upon the results of resection alone in patients with or without media&al node involvement; previous random&d trials have been inconclusive and have not included adequate TNM staging.

308 patients with pathologically staged Tl-2, Nl-2, MO, histologically confirmed NSCLC, WHO performance status O-2, who had undergone c&prehensive node sampling at surgical resection thought to he macroscopically comolete, were admitted from 16 centres between Julv 1986 and Gcto&r lg93. They were allocated atrandomto receive post-ope;ative thoracic RT (SR group, 154) or no RT (S group, 154). The SR group were given a central midline dose of 40 Gy in daily fractions 5 days per week over 3 weeks, starting 4 to 6 weeks post-operatively. 23 SR and 23 S patients had TlNl disease, 10 and 13 TlN2,69 and 68 T2N1, and 42 and 41 T2N2, respectively. 101 in each group had squamous carcinoma, 82 and 73 underwent pnenmonectomy and 64 and 75 lobectomy, respectively.

Of the 308 patients, 187 (61%) (93 SR, 94 S) have died. The median survival neriods were 16 months in the SR moue and 19 months in the S group. &% of the. SR and 67% of the S page& were alive at 1 year, but the curves then crossed the rates at 2 wars h&e 40% and 33% resnectivelv. In a pre-specified com&ison of the ?NM grou$, the only subgro;p in which there was any suggestion of benefit from giving post-operative RT was the T2N2 group, the provisional 2-year survival rates being 46% in tbe SR group compared with 27% in the S group.

In conclusion, post-operative RT did not influence survival except possibly in patients with T2N2 disease. Further random&d trials of post- operative RT in patients with microscopic involvement of the media&al nodes would he valuable.