223

dicting long term survival. Of patients

with tumors < or = 3 cm, only one of six with an early scar died with cancer, whe- reas four of eight patients with advanced scars died with cancer. All tumors > 3 cm had advanced scars and five of eight pa- tients in this category died with cancer.

These findings support the concept that the scar develops secondary to the can- cer and that the maturity of the scar can be used as a prognostic criterion in re- sected tumors.

6, SURGERY

The Biological Operability of Stage III Non-Small Cell Lung Cancer. Mountain, C F. University of Texas, M.D. Anderson Hospital and Tumor Institute, Houston, TX 77030, U.S.A. Ann. Thorac. Surg. 40: 6064, 1985.

Stage III non-small cell lung cancer represents a broad spectrum of anatomical and histological subsets of patients with differing biological characteristics and prognostic expectations. Our experience with 161 consecutive patients undergoing complete resection for Stage III non-small cell lung cancer at the M D. Anderson Hospital and Tumor Institute from 1965 through 1980 includes 69 patients with T3 NO or N1 disease and 92 patients with an N2 classification. The cumulative 5-year survival overall was 30%; 35.6% for the T3 NO or N1 group and 26% for the N2 patients. Seventy-three patients had squamous cell carcinoma and 76, ade- nocarcinoma. Small numbers of patients had other miscellaneous classifications (N = 12). In the T3 NO or N1 subset, 43% of the patients with squamous cell car- cinoma (N = 37) and 23% of those with adenocarcinoma (N = 25) survived 5 years. In the N2 subset, 39% of the patients with squamous cell carcinoma (N = 36) and 14% of the group with adenocarcinoma (N = 52) achieved long-term survival. Failure of treatment was clinically docu- mented in 61 patients. The first observed recurrence or metastasis was at a distant site in the majority of these patients. Operative intervention for patients with Stage III M0 non-small cell lung cancer is effective and reflects the impact and limitation of resection on disease pro- gression. Adjuvant irradiation was not shown to improve the outcome over the

results of operation alone. Effective sy- stemic therapy will be required to pro- duce substantial changes in end results.

Prognostic Evaluation of Tracheobronchial Reconstruction for Bronchogenic Carcinoma. Fujimura, S , Kondo, T., Imai, T. et al.

Department of Surgery, The Research In-

stitute for Chest Diseases and Cancer, Tohoku Uni-

versity, Sendai 980 Japan. J. Thorac. Cardiovasc. Surg. 90: 161-166, 1985.

Fifty-two patients had undergone tracheobron- chial reconstruction for bronchogenic carcinomas over a 20 year period and have been evaluated from the view point of prognosis. Five-year survival rates of the patients undergoing reconstructive operations were as follows: 35% for the total group, 50% for those with squamous cell carcinoma, and 64% for those with Stage I and II disease. No pa- tients with adenocarcinoma or Stage III disease have survived more than 5 years. However, the num- ber of patients with early adenocarcinoma was too small for use to conclude that the histologic type per se affected survival. Six of eight patients with sleeve lobectomy and pulmonary artery recon- struction died within 2 years, 7 months postopera- tively. Five of seven patients died within 1 year after carinal reconstruction. However, two are alive at 4 months and 2 yeats , 9 months after left or severe sleeve pneumonectomy. In summary, any types of lobectomy or pneumonectomy with recon- struction of the tracheobronchial tree can be con- ducted in patients with Stage I and II lung cancer. Sleeve lobectomy with pulmonary artery reconstruc- tion can be an alternative to pneumonectomy when pneumonectomy is contraindicated because of low cardiopulmonary reserve. In patients undergoing re- construction of the carina, prophylactic radiation therapy may be necessary during the postoperative course.

Elective Pulmonary Lobectomy: Factors Associated with Morbidity and Operative Mortality. Keagy, B.A., Lores, M.E., Starek, P.J.K et al. Division of Cardiothoracic Surgery, Department of Surgery, The University of North Carolina School of Medicine, Chapel Hill, NC 27514, U.S.A. Ann. Thorac. Surg. 40: 349-352, 1985.

Periodic review of clinical results is essenti- al to ensure that high-quality patient care is maintained. To that end, we reviewed the morbidity and operative mortality in a consecutive series of 369 pulmonary lobectomies performed between January i, 1970 and December 31, 1983. There were 251 male and I18 female patients with a mean age of 50.6 years. The thirty-day operative mortality was 2.2% (8/369), with 6 of these deaths related primarily to respiratory insufficiency. Two hun- dred twenty-four postoperative management problems occurred in 151 patients and included arrhythmia, air leak, pneumothorax, respiratory difficulties, postoperative bleeding, pleural effusion, wound infection, myocardial infarction, pulmonary embo- lus, empyema, bronchial stump leak, and lobar gan- grene. Multiple factors were related to the occur- rence of post-operative morbidity and mortality using both chi-square analysis to examine each individual item and discriminant analysis to exa- mine each individual item and discriminant analy- sis to evaluate their interaction. Chi-square tabulation showed no difference in the occurrence of major post-operative complications (p > 0.05)

related to the side of operation, an abnormal pre-