Segmental pulmonary resection for cancer
1
271 Universit~ts-Klinik, A-8036 Graz, Austria. Prax. Klin. Pneumol. 39: 846, 1985. During 1971 to 1983 the authors opera- ted on 28 carcinoid patients in accordance with the criteria of carcinoma surgery. The 5-year survival ra~e was 95%, operation mor- tality 0%. In view of the fact that the tumour status cannot be predicted in indi- vidual cases of bronchus carcinoid, and also because of the high rate of incidence of irreversible poststenotic changes we believe that procedures aiming at preserving the parenchyma are feasible only for very spe- cific indications. Wedge Resection as an Alternative Procedure for Peripheral Bronchogenic Carcinoma in Poor-Risk Patients. Errett, L.E., Wilson, J., Chiu, R.C.-J., Munro, D.D. The Montreal Chest Hospital, Montreal, Que., Canada. J. Thorac. Cardio- vasc. Surg. 90: 656-661, 1985. Although lobectomy is the procedure of preference forpatients with peripheral, clinical Stage I bronchogenic carcinomas, wedge resection of the tumor may be a sa- tisfactory alternative in poor-risk patients. Between 1965 and 1982, 197 patients with peripheral bronchogenic carcinomas were operated upon. Clinical staging was esta- blished by radiography, bronchoscopy, and mediastinoscopy. Ninety-seven patients underwent lobectomies and I00 had wedge re-- sections. The decision to perform the wedge resection was made preoperatively in the majority of cases based on the assessment of operative risks. Compared to lobectomy patients, these who had wedge resections were older (70.3 + or - 0.5 versus 64.9 + or - 0.5 years, p < 0.001) and had a lower 1 second forced expiratory volume (1.56 + or - 0.03 versus 1.94 + or - . Segmental Pulmonary Resection for Cancer. Stair, J.M., Womble, J., Schaefer, R.F., Read, R.C. Department of Surgery, John L. McClellan Memorial Veterans Hospital, Little Rock, AR 72205, U.S.A. Am. J. Surg. 150: 659-664, 1985. Segmental pulmonary resection was em- ployed in 61 patients with cancer whose ages ranged from 44 to 82 years (average 62 years). There were 39 patients in the curative group with disease staged TINoM0, 9 patients in the limited group with resl- dual thoracic disease, 8 patients in the palliative group with severe chronic ob- structive pulmonary disease, and 5 patients in the metastatic group. Two patients died within 30 days after operation. Significant palliation was obtained in the limited and metastatic groups. Most patients in the palliative group died from emphysema within 1 to 2 years after resection. Early survi- val rates (64% after an average of 16 months) ~n the curative group were not as good as had been anticipated because small peWiphe- ral, asymptomatic, and predominantly scar adenocarcinoma spread systemically more than similar bronchoqenic cancer. Furthermore, about half the deaths were related to the many other diseases of smoking. However, the local recurrence rate of 5% was low. Seg- mentectomy was well tolerated, even in patients with compromised pulmonary function. Local Recurrence of Resectahle Non~Dat Cell Carcinoma of the Lung. A Warning Against Conservative Treatment for N0 and N1 disea- se. lascone, C., DeMeester, T.R., Albertucci, M. et al. Creighton University School of Medi- cine, Department of Surgery, St. Joseph Hospital, Omaha, NE 68131, U.S.A. Cancer 57: 471-476, 1986. Ninety-five patients with non-oat cell lung cancer underwent resection of all ap- parent disease and were followed for a mini- mum of 36 months. Incidence of recurrence was 34% in 47 patients with NO disease, 65% in 32 patients with NI disease, and 81.3% in 16 patients with N2 disease (P < 0.02 and P < 0.005, respectively). Seventy-five percent of the recurrences with NO disease were local, compared with 28.6% with N1 disease (P < 0.01) and 15.6% with N2 disea- se (P < 0.005). Presumably some of the pa- tients with NO disease could have been cured by eradication of local disease with a pneu- monectomy. Patients with N1 disease had a greater rate of local recurrence when treat- ed with lobectomy compared with pneumonec- tomy, and as with NO patients, some could have been cured by eradication of local dis- ease with the more extensive procedure. Pa- tients with N2 disease were more apt to have distant before local recurrence, which obviates the benefits of a more extensive resection. The incidence of distal recur- rence was statistically great@r in NI than in NO disease (P < 0.001) and similar be- tween NI and N2 disease. It was concluded that, when NO and NI disease is present, a more extensive procedure should be con- sidered, even though it appears that all disease would be removed by a conservative resection. Incidence, Cause and Survival Time of Ex- ploratoryThoracotomy in Bronchial Carci- noma Selected via Mediastinoscopy. Greschuchna, D. Ruhrlandklinik, D-4300 Essen 16, Germany. Prax. Klin. Pneumol. 39: 821-822, 1985. Between 1962 and 1980, we terminated in 1448 thoracotomies for bronchial carcinoma, and with the routine use of mediastinoscopy, the surgical procedure prematurely in the sense of an exploratory thoracotomy. In only 4.3% routine preoperative mediastinoscopy
Transcript of Segmental pulmonary resection for cancer
271
Universit~ts-Klinik, A-8036 Graz, Austria.
Prax. Klin. Pneumol. 39: 846, 1985.
During 1971 to 1983 the authors opera- ted on 28 carcinoid patients in accordance with the criteria of carcinoma surgery. The 5-year survival ra~e was 95%, operation mor- tality 0%. In view of the fact that the tumour status cannot be predicted in indi- vidual cases of bronchus carcinoid, and also
because of the high rate of incidence of irreversible poststenotic changes we believe that procedures aiming at preserving the parenchyma are feasible only for very spe- cific indications.
Wedge Resection a s a n Alternative Procedure for Peripheral Bronchogenic Carcinoma in Poor-Risk Patients. Errett, L.E., Wilson, J., Chiu, R.C.-J., Munro, D.D. The Montreal Chest Hospital, Montreal, Que., Canada. J. Thorac. Cardio- vasc. Surg. 90: 656-661, 1985.
Although lobectomy is the procedure of preference forpatients with peripheral,
clinical Stage I bronchogenic carcinomas, wedge resection of the tumor may be a sa- tisfactory alternative in poor-risk patients. Between 1965 and 1982, 197 patients with peripheral bronchogenic carcinomas were operated upon. Clinical staging was esta- blished by radiography, bronchoscopy, and mediastinoscopy. Ninety-seven patients underwent lobectomies and I00 had wedge re-- sections. The decision to perform the wedge
resection was made preoperatively in the
majority of cases based on the assessment of operative risks. Compared to lobectomy patients, these who had wedge resections were older (70.3 + or - 0.5 versus 64.9 + or - 0.5 years, p < 0.001) and had a lower 1 second forced expiratory volume (1.56 +
or - 0.03 versus 1.94 + or - .
Segmental Pulmonary Resection for Cancer. Stair, J.M., Womble, J., Schaefer, R.F., Read, R.C. Department of Surgery, John L. McClellan Memorial Veterans Hospital, Little Rock, AR 72205, U.S.A. Am. J. Surg. 150:
659-664, 1985. Segmental pulmonary resection was em-
ployed in 61 patients with cancer whose ages ranged from 44 to 82 years (average 62 years). There were 39 patients in the
curative group with disease staged TINoM0, 9 patients in the limited group with resl- dual thoracic disease, 8 patients in the palliative group with severe chronic ob-
structive pulmonary disease, and 5 patients in the metastatic group. Two patients died within 30 days after operation. Significant
palliation was obtained in the limited and metastatic groups. Most patients in the palliative group died from emphysema within 1 to 2 years after resection. Early survi-
val rates (64% after an average of 16 months)
~n the curative group were not as good as had been anticipated because small peWiphe- ral, asymptomatic, and predominantly scar
adenocarcinoma spread systemically more than similar bronchoqenic cancer. Furthermore, about half the deaths were related to the many other diseases of smoking. However, the local recurrence rate of 5% was low. Seg- mentectomy was well tolerated, even in patients with compromised pulmonary function.
Local Recurrence of Resectahle Non~Dat Cell Carcinoma of the Lung. A Warning Against Conservative Treatment for N0 and N1 disea- se. lascone, C., DeMeester, T.R., Albertucci, M.
et al. Creighton University School of Medi- cine, Department of Surgery, St. Joseph Hospital, Omaha, NE 68131, U.S.A. Cancer
57: 471-476, 1986. Ninety-five patients with non-oat cell
lung cancer underwent resection of all ap-
parent disease and were followed for a mini- mum of 36 months. Incidence of recurrence was 34% in 47 patients with NO disease, 65% in 32 patients with NI disease, and 81.3%
in 16 patients with N2 disease (P < 0.02 and P < 0.005, respectively). Seventy-five percent of the recurrences with NO disease
were local, compared with 28.6% with N1 disease (P < 0.01) and 15.6% with N2 disea- se (P < 0.005). Presumably some of the pa- tients with NO disease could have been cured by eradication of local disease with a pneu- monectomy. Patients with N1 disease had a greater rate of local recurrence when treat- ed with lobectomy compared with pneumonec- tomy, and as with NO patients, some could have been cured by eradication of local dis- ease with the more extensive procedure. Pa- tients with N2 disease were more apt to have distant before local recurrence, which obviates the benefits of a more extensive resection. The incidence of distal recur- rence was statistically great@r in NI than in NO disease (P < 0.001) and similar be- tween NI and N2 disease. It was concluded that, when NO and NI disease is present, a more extensive procedure should be con- sidered, even though it appears that all disease would be removed by a conservative
resection.
Incidence, Cause and Survival Time of Ex- ploratoryThoracotomy in Bronchial Carci- noma Selected via Mediastinoscopy. Greschuchna, D. Ruhrlandklinik, D-4300 Essen 16, Germany. Prax. Klin. Pneumol. 39:
821-822, 1985. Between 1962 and 1980, we terminated in
1448 thoracotomies for bronchial carcinoma, and with the routine use of mediastinoscopy, the surgical procedure prematurely in the sense of an exploratory thoracotomy. In only
4.3% routine preoperative mediastinoscopy
