157

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ANALYSIS OFTHEEARLYF'OSTOPERATIVESERUM CARCINOEMBRYONICANTIGENTIMECOURSEASA PROGNOSTICTOOLINRESECTED BRONCHOGENIC CARCINOMA Yoshimasu T.Miyoshi S,Maebeya SSuzuma TBessho T.Himi 1,Tanino H,Naito Y. Deptaitment of llwmcic & Cardiovascular Surgery. Wakayama Medical College. wakaymna. Japan. To predict rrm- of bmnchogenic carcinoma atier lung resection, we anelysed the

early postopemtive(postop) CEA time course, utilising the equation of “C(t)=(C&Ceq) exp(-kt)+Cq”, when t is postop day, C(t) postop CEA. CO preoperative CEA, Cq wstoo CEA at the dateau. ad k rate constant of CEA elimination obtained bv (lnZ)/ ihalf-iife). When cdg is 0, the equation(Eql)=COexp(-kt) which means that t&o; ceils producing CEA an: completely mmoved. When CO is Cq. The qati~n(E@)=Ol which means that tumor cells do not vield CEA at all. When the emwion(Ea3) is m BS a complete C(t), the situ&on is that some cells yielding’ CEA ‘&&I remained after surgery. [METHODS] CEA was measwed in 20 patients before ad after operation with enzyme immune assay. llx measurements &er operation we done more then 5 times within 3 weeks. ‘Ihe most z&q&ate variahles(CO, k, Ciq) of each eqoation(Eq1. 2, 3) wen calculated with non-linear least sqwe analysis sd Akaike’s information criterion(AIC) at each equation was calculated. ‘Ike equation which gives the least AIC was edqxed BE B most fitted regression equation for each patient. A postop CEA pmduction(PCP) was calculated with Ckq multiplied by k in a patient whose &ted equation is E43. [RESULTS] Although many investigators have used E!ql to obtain a half-life of CEA for prediction of the postop mxmm, Eqi was not &pted for any patient in this study. Eq2 was most fitted for 8 patients(Gmup-I) ard I$3 for 12 patients(Gmup-2). A mean half-life of CEA in Gmup2 was 1.32f 1.49(0.45-5.75)days. which wes shorter then the previously qoxted(4-9days). This diffuuxe seems to be because our half-life WBS obtained by F@ wd the previously reported were calculated by F.ql. We expedenced 3 patients in Group-2 who showed distant metastasis within 3 months after operation. A mean PCP of the 3 patients(4.6 f 5.5 @ml/day) WBS higher(p<0.05) than the non-twment patients(l.O+OA @ml/day). This finding suggests that the PCP may be useful to predict the postoperative rrmmnce in Group-2. [CONCLUSION] (1)For analysis of postoperative CEA time course in patients with bronchogenic carcinoma, three situation(Ep1, 2. 3) should be evaluated. (2)PCP may be a useful otwnostic tool to . _ predict the postoperative recurrence.

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SURGICAL TREATMENT AND ISCHEMIC HEART S.Nitta, T.Ohnuki,

FOR PATIENTS WITH LUNG CANCER DISEASE

Relationship between the pulmonary blood flow and

driving pressure before and after pneumonectomy. J.kei, T.Itaoka, M.Vokoyana,

M.Murasugl and H.Kaneyasu. Departlnent of Surgery I Tokyo Women's Medical College, Tokyo, Japan, 162

T.Onuki,S.Nitta. Department of Surgery Ist,

Tokyo Wemen's Medical College

RESULTS OF SLEEVE LOBECTOMY FOR BRONCHOOENIC CARCINOMA IN 184 PATIENTS. S. Iioka, ?I. Tada, T. Mori, T. Yasumitu, K. Kodama, Y. Fujii, 0. Kuwabara, T. Taki, M. Kuwabara, Y. Saitou, and A. Akashi. Osaka Lung Cancer Study Group, Osaka, Japan.

Sleeve lobectomy in the treatment of bronchogenic carcinoma is alternative to pneumonectomy. The conservation of lung tissue benefits both compromised and uncompromised patients. From 1982 to 1991, 184 patients (156 men and 29 women) with a mean age of 62.5 years underwent sleeve lobectomy for lung cancer. There were 114 procedures on the right side (upper-lobectomy, 92 procedures; upper & middle-, 3; middle 6 lower-, 19) and 70 on the left side (upper-, 58; lower-, 12). Pathological staging was: stage I, 84 patients (45.7%); stage II, 52 (28.3%); stage IIIA, 38 (20.7%); stage IIIB, 3 (1.6%); stage IV, 7 (3.8%). There were one operative death (30-day mortality) and twelve hospital death. Technical complications were infrequent, which were positive resection margin in 9 patients (4.9%), local recurrence in 19 (10.3%), anastomotic stricture in 31 (16.8%), and dehiscence of bronchial anastomosis in 4 followed by completion pneumonectomy. For the whole group, 3-, and 5-year survival rate were 62.8% and 53.6%. The 5-year survival rate of stage I, stage II, stage IIIA, stage IIIB, and stage IV were 70.3%, 54.0%, 25.2%, 0%, and 08, respectively.

Of 1900 lung resections in patients with lung can cer since 1952, the early post-operative mortality averaged 3.6% and of those in the last decade, 2%. Out of 350 patients undergone lung resections, 21

(6.5%) had ischenic heart disease; p-Stages were I ;13, Ill;6 and IV;2. Seven(Z% 4 underwent lung resections after non-ivasive pretreatment result- ing in 2 of perioperative acute nyocardial infarc- tiom and preoperative percutaneous coronary angio- plasty, respectively. Seven(2X) underwent surgical treatment for lung cancer and cornary disease si- multaneously without post-operative mortaliy with- in one month. In 3, right coronary artery bypass- grafting was perforned under beating heart.

One must extend benefit of lung resection to pa- tients with coexistence of lung cancer and ische- mic heart disease severe enough to preclude resec- tion surgery by critical evaluation and following appropriate treatment.

The purpose of this study LS to compare the

response of pulmonary driving pressure(DP) to

blood flow through the preoperative non-cancer

side(NCS) lung and through the same remaining lung

after pneumonectomy(PN). In Seven patients,

preope-rative relationship between blood flow and

DP in NCS lung was measured using the unilateral

pulmonary arterial occlusion testing(UPA0) and

pulmonary perfusion scanning. And this flow-

pressure relationships were compared with that in

the remaining lung after PN in ti;s same patients,

using exercise testing. After PN, PVRI and mean

pulmonary arterial pressure were lower than those

measured during UPAO, but there was good

correlation between the pre and post operative

slope of blood flow vs. DP line ;n the NCS lung. We suppose the slope in the NCS lung is the most

physiologlcal index to evaluate rhe vascular bed in NCS before PN.