Abstracts/Lung Cancer 11 (1994) 423-444 431

diagnosis of the resected speci- (n = 18) was atypical carcinoid in one, pure small cell carcinoma of the lung in 15, and mixed small cell and non-small cell carcinoma of the lung in two patients. Fourteen patients also received chemotherapy and 10 received prophylactic cranial irradiation postoperatively. Excluding the patient with a final diagnosis of atypical carcinoid, the median survival (o = 20) was 29 months (range two to 133+). Median survival for patients with pathological stage I and II disease (n = 13) was 40 months (range nine to 133 +) and for patients with pathological stage III disease (o = 7) 20 months (range two to 116 +). The median disease free survival was 23 months. Eleven patients relapsed between two snd 101 months. There was no advantage for those patients who received postoperative chemotherapy. Conclu.rion - Curative resection offers the best chance for long term survival in patients with small cell carcinoma of the lung with very limited stage disease.

Video assisted thoracoscopic surgery Jaocovici R, Poos F, Cooan J, Natali F, Vaylet F. Swvicede Chirurgie Ihoraciquc. Hopital du Val de Grace, 47&I& Port Royal, 75230 Paris Ceder 05. Rev Pneumol Clin 1994;50: 15-20.

Since the team at the bnnec hospital lirst performed an extra- pleural thoracoscopy in 1990. a certain number of thoracic surgery units have started using this new technique. Video-assisted thoracoscopy is an absolutely revolutionary technique allowing an intrapleural approach to the mediastioum and to the pulmonary parenchyma without a thomcotomy. It requires a sophisticated technical set up including a video camera, direct or sngular optics, and a video screen. The patient isplPcedinthespmepo~tionasf~athorpcotomy.Fortbepneumothonx and dystmpic bullae, video assisted th omcoscopic surgery has been largely shown to be the superior technique. The pleura is heated by avivement or sometimes by pleurectomy. Pulmonary biopsies are offen taken. Pmoperativecomputed tomography with methyleneblueinjectioo is olieo required for the exe&s of peripheral pareochymatous sub- pleural nodules and sometimes a small fishhook has to be placed within the tumour. Inversely, scgmcotectomies or lobectomies are rarely performed. There is a certain amount of rislt involved in closed cheat vascular dissections, and the question of carcinologic rigour has to be raised. Turnouts of the mediastinum, both cystic and solid turnouts, are relatively easy to approach by dissection using video assisted thoracoscopy. Finally, this technique offers new possibilites for staging bronchial cancers, the treatment of broncho-pleural fistulns, and more recently for non operated chest trauma. This new technique is of great importance for the thoracic surgeon, although an evaluation of long- term results are still required.

Recurrence at tbe bronchial stump after resection of long cancer Miura H, Konaka C, Kato H, Kawate N, Taita 0.1163 T&e-Machi, Hachioji City, Tokyo 193. Ann Surg 1994;219:306-9.

Objectiw: Recurrence at the bronchial stump frequently is difficult todiagnosebeforethedi-progresses. Patientswithrecutreoceat the bronchial stump after surgical treatment were studied to clarify characteristics. Summary Background Data: Reports on this type of rccurrcnce arc few. Mcrhods: Between January 1979 and December 1988, 625 primary lung cancers were resected. Fourteen patients (2.2%), in whom recurrence occurred at the bronchial stump, were studied pathologically and clinically. Results: Eight tumors (57.1%) were squamous cell carcinomas, five (35.7%) wem. adenocarcinomas, and one (7.1%) was small cell carcinoma. Pathologically, six tumors (42.9%) were stage I, four (28.6%) were stage II, two (14.3%) were stage III(A), and two (14.3 96) were stage IV. Eight patients had bloody

sputum at recurrence; two cases were asymptomatic. Submucosal tumors were observed bmochoscopically at reourrcnce in 11 patients. Considering lymphadenopathy on chest x-ray, the submucosal type recurrence may have been direct invasion from metastatic lymph nodes. The periods from the operation to the recurrence were. 7 to 102 months (mean28.8months). InSof 14patieots, recurrcnccwasobservedwithin 24 months. Al1 but one patient died within 24 months of recurrence detection. Conclusions: Long survival could be expected only if there were no metastascs in the mediastinal lymph nodes. If the tumors were detected earlier, it was possible to cure the tumors by intensive therapy, even iosubmucosal type recurrence. Regular bronchoscopic examination is needed to diagnose the recurrence at the bronchial stump as early as possible.

Surgicnl treatment of tbe non-small cell lung cancer: Stage I (TlNO- TZNO) and stage II (TlNl-T2Nl). Prognostic factors, results and recurrence Ramacciato G, Aurello P, D’Angelo F, Barillari P, Paolini A, Tosato F. Istituto di I Clinica Chirurgica, Universita a’egli Studi ‘La Sapienza ‘, Hale de1 Policlinico. 00161 Roma. Chirurgia 1993;6: 791-8.

From 1978 to 1989 270 patients with stage I and stage II oonsmall cell lung cancer were treated by resection. All patients were classified postsurgically accordiig to the New Interoational Staging System. There were 202 stage I and 68 stage II. 36 patients were classified TlNO, 166 T2N0, and in the stage I 81 patients were squamous carcinoma, 80 adeo-inoma and 41 large cell carcinoma. There were 31 patients TlNl and 55 T2Nl and stage II 30 patients were squamous, 26 adenocarcinoma and 12 large cell carcinoma. The 5 year survival rate was 56 46 for stage I patients, and 29 96 for stage II patients. There was significant difference in survival rates behveen TlNO and T2NO. Five year survival rate for TlNO and T2NO was 76% and 51% respectively. The survival was not affected by the characteristic ofthe T lesions in Nl patients. The5yeardiscascfrcesurvival was3246 and281 respectively forT1N1andT2N1patients.Diseaserecurredin52.4%ofpatients.The rate of recurrence differed by the N factor. There was a lower incidence of recurrence for NO disease (46.5%) than for those with Nl (63 W). In the subsets TlNO and T2NO the incidence of local relapse was lower, respecttvely27.396 and47.296, thantheincidenceofdistantrecurrences (72.7% and 52.8%); while in patients with Nl disease higher relapse rate of distant metastases compared to the local recurrence has been found. The relationship between the rate of failure and the type of surgical resection showed the same incidence of total recurrence between patients treated with lobectomy and those treated with pneumonectomy. An higher incidence of local intrathoracic recurrence (48.9%)hasbeenobsetvedafterlobectomy, comparedto thoseobservcd allerpoeumonectomy(30%), whileconcerning thedistantextrathoracic failure there were greater incidence rate after pneumonectomy (69.7 96) than after lobectomy (51%).

Chemotherapy

S&r&de dependency of IV-paditaxel against SC-M 109 mouse lung cancer Fujimoto S. Division of Chemotherapy, Chiba Cancer Center, Research Insrirure, Chibarhi. Jpo J Cancer Chemother 1994;21:671-7.

Although paclitaxel was shown to have a broad spectrum of antitumor activity against various experimental tumors, the optimal treatmeat schedule of this drug is not yet detemkd. In the present study, atrial wascarriedouttodetermioetheoptimaltreatmcntschedule of pa&axe1 given IV against M 109 mottsc lung cancer implanted SC.