Embed Size (px)
Abstracts/Lung Cancer 11 (1994) 123-150
Bronchoscopic diathermy resection and stent insertion: A cW effective treatment for tracheobronchial obstruction Petrou M, Kaplan D, Golstraw P. Depurtmetu of l?wracic Surgery, Royal Brompton, National Heart and Lung Hospital, London SW3 6NP. Thorax 1993;48: 1156-9.
Background. Major ainvays obstruction is a distressing cause of morbidity and mortality. For disease that is extensive and recurrent, there is a need for a safe and cost effective technique for palliation. Methods. The results of 29 patients with tracheobronchial obstruction (24 malignant and five benign) treated by diathermy resection alone or in combination with endobronchial stenting have been reviewed. Results. The major site of obstruction was the trachea in 14, main carina in seven, right main bronchus in six, and left main bronchus in hvo patients. Fifteen had received other forms of treatment beforehand includingexternal radiotherapy, endoscopicdilatation, andlase.rresection (Nd:YAG). Five patients required two or more treatment sessions for symptom recurrence. Ten patients also received additional treatment with a stent (nine) or insertion of gold grains (one). There were no intraoperative deaths or complications and the average length of stay was five days (range 2-14). Twenty eight patients reported immediate symptomatic relief, and objective improvement in the results of lung function tests was seen in eight patients whose. condition was less acute and where preoperative lung function tests could be undertaken (average improvement in FEV, of 53.1 I and in FEV of 20.6%). Conclusions. Bronchoscopic diathermy resection is an effective and safe method for relieving the symptoms of tracheobronchial obstruction at appreciably less cost than laser resection.
Pulmonary resection after pneumonectomy in patients &th bronchogenic carcinoma Westermann CJJ, Van Swieten HA, De la Riviere AB, Van den Bosch JMM, Duurkens VAM. d. Anton& Hospital, Postbox 2500,343OEM Nieuwegein. J Thorac Gudiovasc Surg 1993; 106:868-74.
Eight patients with a previous pneumonectomy for bronchogenic carcinoma underwent an additional resection because of a second primary carcinoma in the remaining lung. One patient died of pulmonary embolism in the postoperative period. The postoperative course was otherwise uneventful except for prolonged air leak. Two patients died after 3 months (bone metastasis) and 5 months (recurrent small-cell carcinoma). Two patients were alive at the time this article was written but had evidence. of recurrence after 18 months (distant metastasis) and 21 months (local recurrence at the site of positive resection margins). Three patients were alive and doing well without evidence of disease after 16, 17, and 40 months. After careful selection, even patients with a previous pneumonectomy may be good candidates for additional resection of a second primary bronchogenic carcinoma.
.Thoracoscopic mediastinal lymph node sampling: Useful for mediastinal lymph node stations inaccessible by cervical mediastinoscopy LandreneauRJ,HazehiggSR,MackMJ,FitzgibbonLD, DowlingRD, Acuff TE et al. Section of lhoracic Surgery, Lilliane Kaufinann Building, Uniwrsify of Pittsburgh, 3471 [email protected] Ave., Pinsburgh, PA 15213. J Thorac Cardiovasc Surg 1993;106:554-8.
Cervical mediastinoscopy is useful for the diagnosis of paratracheal lymph node metastasis from bronchogcnic carcinoma. Access to adenopathy in the aorticopulmonary window, anterior mediastinal, periazygos, and subcarinal lymph node-s is difficult with this t&&nique.
Operative visibility in these locations through anterior mediastinotomy, the Chamberlain procedure, is limited. We have used thoracoscopic mediastinal exploration in 40 patients with computed tOmOgraphiC scan evidence of enlarged aorticopulmonary window (n = 30) or enlarged right periazygos or subuninal lymph nodes (n = 10). This procedure was used primarily as an adjunct to cervical mediastinoscopy in the staging of bronchogenic carcinoma. Adjunctive thomcoscopic nodal sampling was 100% sensitive and 100% specific in diagnosing the mediastinal adenopathy. It did not significantly delay thoracotomy in cases of benign adenopatby. Visibility of the ipsilateml pleural space and media&mm was excellent. Thoracoscopic exploration with medias~inalnodal samplingisavalusbledirgnosticadjunct forassessment ofadenopathy inaccessibletocervicnl mediastinoscopy andcanovercome many of the limitations of anterior mediastinotomy.
Prognosis of unsuspected but completely resectable N2 non- small cell lung cancer Van Khwenm R, Festen J, Otten HJAM, Cox AL, De Graaf R, Lacquet LK. University Lung Centre Dekkerswald. PO Box 9001, 6560 GB Groesbeek. Ann Thorac Surg 1993;56:300-4.
Of 111 patients with non-small cell lung cancer without clinically evident N2 disease, 95 underwent mediastinoscopy berween 1975 and 1985. In 63 cases mediastinoscopy was positive and in 32 negative. The patients with a positive mediastinoscopy were considered to have inoperable disease. Their 3- and S-year survival rates were 5 % and 0 96, respectively. The patients with a negative mediastinoscopy and 16 patients in whom no mediastinoscopy was performed because of a peripheral tumor underwent operation. They underwent complete tumor resection and mediastinal lymph node dissection. Unsuspected N2 disease was found. Their 3- and S-year survival rates were 19 96 and 1096, respectively. The better survival rate in the operated group was statistically significant and mainly due to a better survival of the lobectomy group. Multiple regression analysis showed no favorable prognostic factors in the nonoperated group, but in the operated group lobectomy and central location of the tumor significantly improved the prognosis. We conclude that patients with unsuspected stage IIIa non- small cell lung cancer discovered at thoracotomy benefit from complete tumor resection and mediastinal lymph node dissection, especially if the resection can be confined to lobectomy and if the tumor is located centrally.
Cz+ and Ca’+ channel antagonists in the control of human small cell lung carcinoma cell proliferation Cnttaneo $lG, Gullo M, Vicentini LM. Department of Pharmacology, UniversityofMilano, Via Vanvi~elli32,20129Milano. Eur J Pharmacol Mel Pharmacol Sect 1993;247:325-31,
Small cell lung carcinoma cells possess voltage-dependent calcium channels (VDCCs) of the L, omega-conotoxin-sensitiveand P-like type. We hypothesized that these VDCCs might regulate the secretion of autocrine growth factors and thus influence the proliferation of these cells. We found that extracellular Ca** plays a stimulatory role in the proliferation of the GLCS cell line. L-type calcium channel blockers of the diiydropyridine, phenyhdkylamine and benzothiazepine classes inhibited rH]thymidine incorporation in these cells, however at concentrations higher than those required to block L-type channel function. Moreover, the growth of murine Swiss 3T3 fibroblasts which do not possess L-type Ca’* channels, was inhibited by the G?* channel