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CYTOLOGICAL EXAMINATION OF INTRAOPERATIVE PLEURAL LAVAGE IN PRIMARY LUNG CANCER PATIENTS Satoh,T. ,Tsukamoto,T., Ablko,M. ,Yamada,K., and Nagasawa,M. Departments of Surgery and Internal Medicine, Yamagata Prefectural Central Hospital, Ymagata 990, Japan We performed cytological examination of pleural lavage fluid obtained during thoracotomy for lung cancer where pleural dissemlnatlon or malignant pleural effusmns were not noted at surgery. Based on these examinations, we attempted to determine recurrence pattern and prognostic factors. 144 patients underwent resection for lung cancer at our hospital from January 1989 to December 1992. Patients with definite pleural dlssemlnation, malignant pleural effusion or severe adhesion were excluded, and the remainmg 119 patients were studied. Cytology was performed twice: firstly Immediately after the opening of the chest and secondary at the end of the operation. Those patients who indicated negative results on both occasions were defined as belonging to the negatwe group, and those who indicated posltwe on either or both occasions were defined as belonging to the positive group. Twelve patients (10.1%) were found to belong to the positwe group. Their histological types were as follows: adenocarcino- ma in six patients, squamous cell carcinoma in three. large cell carcinoma in three, large cell carcinoma IFI two, and adenosquamous cell carcinoma in one. Recurrence with pleurltls carcinomatosa was observed in four of these 12 patients. Eight died, three of plewitis carcinomatosa. When cumulative surwval rates were compared between the two groups. 3-year survival in the positive group was 30%. and l&year survival in the negative group was 66%. This indicated that progno- sis was significantly poorer in the positive group.

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USE OF CARCINOEMBRYONIC ANTIGEN RATIO IN PLEURAL WASHINGS FROM PRIMARY LUNG CANCER PATIENTS AS A PARAMETER FOR PLEURAL INVASION Tanaka, S. Asao, T. Kato, Ft. Shimizu, Y. Nagamachi, Y. Department of Surgery, Gunma University School of Medicine, Maebashi, 371 Japan

The ratio of carcinoembryonic antigen (CEA) levels in pleural

washings to serum levels were determined. The pleural washings

were obtained at the time of thoracotomy from 66 patients with

primary lung cancer, 5 with metastatic lung cancer and 12 with

benign lung disease. Elevated values (>lOO ml/g protein) were

observed in 15 of 66 (22.7 %) patients with primary lung cancer, in

1 of 5 (20%) patients with metastatic lung cancer , whereas in no

patient with benign lung disease. Among the patients with primary

lung cancer, positive rate of elevated CEA ratio in patients with

pleural tumor invasion was significantly higher, 44 % (11/25),

when compared with 9.6 % (4/41) in patients without pleural

invasion. Four patients who developed pleural dissemination had positive CEA ratio at the time of surgery. Positive cytology was

obtained from only 4 patients, and all of them had elevated CEA

ratio.

In conclusion, we have found that the CEA ratio could be a

sensitive detector of pleural invasion and micro dissemination.

SELF-EXPANDABLE YBTALIC STENTS PLACEMENT FOR MALIGNANT TRACHEOBQONCHIAL STENOSIS

Mitsuru Koike*, M. Ishida*,Y. Nakajima**, S. Koooo**. H. Niimi”.

T. Ishikawa**. H.Osada ***. Department of Internal Medicine I *, Radiology ??*, Surgery III***, St.Mariaona University School of Medicine, Kanagawa Japan.

Purpose:To evaluate clinical usefuloesa ot self-expandable metallic steots(EMS) for malignant tracheobroacbial stenosis by mean of improvemeot of quality of life in the patients with advanced disease. Materials and Methods:The materials include 4 lung cancer patients and 7. esophageal carcinoma with the stenosis of trachea in 3, left main bronchus ia 3 and right main bronchus in 3. The inidicationa for treatment are

imminent asphyxia. breathlessness aad repeated obstructive pneumonia. EMS we used are Giaoturco original and Modified type. The EMS were placed under tluoroscopic and/or endoscopic control.

Results:All stents were placed in ideal position and immediate increase in the airway and clinical improvement were satisfactory. No complication was encountered. In 3 out of 5. multiple endoscopic treatmentwas required

for remarkable increase of bronchial secretion in a week after EMS placement, and 1 patient was died 15 days after setting. Radiation therapy in 3 and repeated lasertreatment in 4 were performed and achieved good

respiratory status until their terminal stage in 3 to 4 months after

stating. Conclusion:EMS for malignant tracheobronchial stenosis is safe nod promising forimmediate dilatation, but additional treatments such as repeated laser treatment and/or irradiation are required to achieve satisfactory long term results.

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A CLINICAL ANALYSIS OF SURSICAL CASES OF LUNG CANCER COMPLICATED WITH IDIOPATHIC P LMONARY FIBROSIS. Tanimura, S.l), Tomoyasu, H.' Y , Banba, J.'), Masaki, M.l), Matsushita, H.*) Dept. of Thoracic Surgeryl) and Dept. of Pathology'), Toranomon Hospital, Tokyo, Japan. As the prognosis of lung cancer associated with idiopa-

thic pulmonary fibrosis (IPF) is very poor, previous reported studies were mainly performed on nonsurgical or postmortem cases. We investigated the clinicopathological features and the problems of intraoperative and postopera- tive management in 13 cases with lung cancer complicating IPF. The average age of the patients was 63 years, and all of them were males and heavy smokers (average 6.1: 1160). Four had squamous cell carcinoma, five had adenocarcinoma, two had small cell carcinoma, and one had large cell carcinoma, and all tumors were located in the peripheral regions of the lung. Concerning the prognosis, five patients are alive and eight patients are dead. Six died due to recurrence of lung cancer or new cancer of other organ, while two died of exacerbation of IPF.

Because excessive oxygenation during surgery might exacerbate IPF, we tried to keep the Pa02 less than 100 Torr during or after surgery. This was effective in protecting against the exacerbation of IPF, as no relapse was observed in controlled nine cases.