Transcript
Page 1: The value of bronchial resection in lung cancer patients with inadequate respiratory reserve

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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