168

648

At TRFATMFNTFORSTAEk&Q@W I CFt_j&JNGCANCFR MFluggieri, A. Caminiti, M. Lepore, G. Paolini. M. Batori, R. Dell’Arte, G. Sodani, A. Paolini. IV Clinica Chirurgica _ Universita “La Sapienza” Roma , Italia.

A retrospective study on long time survival was performed on 25 patients, non small cell lung cancer with stage Illa, who underwent surgery in our department. Our patients were 18 males and 7 females; lobectomy was performed in 12 patients, pneumonectomy in 13. Histologic type was squamous cell carcinoma in 14 cases, adenocarcinoma in 9 cases and large cell carcinoma in 2 cases. In our patients (25) the TNM definitions for the llla stage was: Ti N2M0(2), T2N2MO(iO). TBNOMO (3) T3NlMO (2) T3N2M0(8).

The 2 years survival rate was 32%; the 5 years survival rate was 12%. The survival rate of patients undergoing lobectomy was 25%: for patients undergoing pneumonectomy was 59% (fig.1).

The results of surgery for non small cell lung cancer with stage llla are not encouraging. The other therapy don’t modify survival for patients in this stage. 120 ----------

/_

____ _ _____

100

nsc O0 ‘\ . . 0 Survival e.0

40

1) Martini N. et al. : The role of surgery in N2 lung cancer.” Surg. Clin. North. Am.1997 ; 67: 1037 2) Bunn P.A. : “Biology of lung cancer. ” New Fronters in Lung Cancer - International Meeting Genoa - Italy - May 30th -June 3rd , 1993

3) Ginsberg R.J. : *Surgical treatment for higher stage non -small cell lung cancer Ann.Thorac.Surg. 1992; 54: 999

650

SURGICAL TREAT;.E%NT of UJEG CAXER (1957-1992 ) A. Jeckevicius, P.Baujokaitis

Lithuanian Dncologicel Center ,Vilnius, Lithuania

The reeection of lung waa performed in 1203

cases in the course of 1957-1992.Our attitude towerda the surgical treatment of lung center ‘underwent several changes. During the first pe- riod (1957-1970) pneumonectomy was the most com- mon surgery intervention. Prom 1970 lobectomy turned out to be increasing as to become a domi- net surgical procedure in 1980. Cut of the total of 1203 cases, 280 patients received adjuvant therapy (radiotherapy, chemotherapy or both).In the cases with the involvement of lymph nodes (X1,12) adjuvant therapy was given. There is a tendency in our clinic in the past IO years to performe partial resection of lung /lobectomy, bronchoplastic resection and others/. hdjuvant therapy has improved the follow-up results Of surgical treatment.

649

VIDEO-ASSISTED LOWER LOBECTOMY FOR cTlNOM0 LUNG CANCER. G. Gotti, P. Paladini, M. DiBisceglie, L. Voltolii, G. Biagi. lstitutc di Chirurgia Tom&a e Cardiovascolare - Universti di Siena - Italy

Nowadaysthesuperof~~~~~~ic~~~~ thoracotomy in the treatment of small nxnalignant l&us of the pleura and the lung is well accepted because it offers a short time of drainage, a minimal postoperative pain and early recovery. Moreover video-assisted operation is a surgical technique which obviates the need for a thoracotomy with its well knonm pi&k Here we are describing our prebminary experience in video-assisted lobectomy and lymph node dissection in patients with lung cancer.

During the last year we performed 8 lobectomies of tbe lower lobe for lung cancer. The arocedwe is oerformed under ~eneml anesthesia with Wacheal

A liited thoracotomy of 5-7 cm, without rib spread, is performed on 6th intercostal space on the mid-axillmy line and the exploratory thorauxcope is introduced in the aleural cavitv. A 2nd and 3rd incision of 2 cm are uetformed

The bronchus, the a&y and the veil are sutured with app&iate staplers positioned along tbe interlobar fissures. Subsequently, the resected lobe is e&acted throogb tbe limited thoracotomy. Moreover, visible bilar and carioal lymph node dissection is carried out. After assuring haemostasis, a tube drainage is positioned throogb the posterior incision. The duration of the procedure raoged a medium of 3 hours. The postoperative course was uneventful and there were no deaths. The average postoperative dmatioo of hospital stay was of 4 days.

To our opinion lower lobe resection can be carried out in video-assisted lobectomywithoutmajortechnicalproblems.Peribronchiallymphnodedissection can also be done with this teclmique. The superior displacement of the bronchus exposes the car&l lymph nodes rendering possible their eodoscopic removal.

In conclusion it is possible to perform lower lobe resecticn and satisktory lymph node dissection with this method because this approach is relatively simple when the neoplasm is not involving the &sure aad the bronchial hilum and above allwhenthecontrast~~hancedhighdefinitionCTscansdanonstratesnosuspected lymph node of the bilum and mtxiia&um.

651

FAVOUPABLE OUTCOME OF PATIENTS WITH BRONCHIAL CARCINOID /EXPERIENCE 1963-1993/. z. Skbcel, M. Marel, L. Melfnovb. Pneumological Clinic, Charles University, Prague, Czech Republic.

During 30 years 35 patients were treated for bronchial carcinoid in our hospital. Goal of the review was to compare prognosis of patients with typical and atypical carcinoids and to learn fre- quency of progression to small cell lung cancer /SCLC/.

Most common surgery was lobectomy /LE/ - 26x, 3 pneumectomies, 2 bronchotomies, 3 endoscopical exscisions and lasertherapy. All resection - ex- cept one - /97%/ were complete, in 97% lymphnodes were not infiltrated.

Histologically 20 tumors were typical and 15 a- typical and in 1 case progression to SCLC was ob- served. In most cases /24/ carcinoid was growing outside bronchial cartilage and invaded lung tis- sue, in 2 cases pericardium, in 1 case mediasti- num and chest wall and in 1 case there was meta- stasis into ipsilateral lung.

In median follow-up of 7 years there are 2 dea- ths lb%/ related to carcinoid.

In conclusion, carcinoid, incl. atypical has favourable prognosis, even in locally very advan- ced tumors complete resection was possible and tumors didn-t relapse. There was 1 progression to SCLC /3%/ and 2 deaths /b%/. Because in most ca- ses invasion outside cartilage is observed, LE is commonly the most appropriate kind of surgi- cal treatment, but other kinds of treatment in selected cases can be feasible.