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lntraoperative Sonography for Localization of Pulmonary Nodule in Video-Assisted Thoracoscopy Surgery H. Hsu, J. Su, M. Huang, H. Chang. Division of Thoracic Surgery, Veterans General Hospital-Kaohsiung. Kaohsiung, Taiwan, R.O.C.

Video-Assisted thoracoscopy Surgery (VATS) is very useful in diagnosis of peripheral pulmonary nodules. During VATS it is impossible to do manual palpation. There has limitation to localize deep seated subpleural nodules. With CT-guided hook wiring or methylene blue injection, it shows some help but still has handycap.

Recently we have used intraoperative sonography (OmniPlane, HP SONOS 500, 5 MHz) In VATS for 30 consecutive patients. These patients had peripheral pulmonary nodules which were not subpleural located. Chest CT scans of the patients were used as a control. In CT scan the distance from pleura to the posterior margin of the nodule was defined as Cp, to the anterior margin as Ca and nodule itself as Cm. In collapsed lung with sonography it was defined as Sp, Sa and Sm.

We found that with careful measurement the Cm and Sm were always the same. With diffent condition of patient’s lung and

gas block, the anterior margin of the nodule could not be well defined. The Sa and Sp had poor correlation with Ca and Cp. Sonography could detect any nodule with Cp less than 4 cm.

We concluded that intraoperative sonography is feasible in VATS to localize pulmonary nodules.

642

Surgery For N1 Non-Small Cell Lung Cancer

Min-Hsiung HUANG, Shyu-Lisng Hsu, Biingahiun Huang, Wen-Hu Hsu, LiangShun WANG, Kwsog-Yu CHIEN Division of Thoracic Surgery, Department of Surgery, Veterans General Hospital-Taipei, Taiwan, R.O.C.

Surgical resection for early lung cancer (LC) remains the treatment of choice, yet for those with regional nodal (NJ involvement , the result was still unsatisfactory.

Totally 175 LC patients with N, involvement were treated in VGH- Taipei between 1980 to 1992 and the data was reviewed. The age distribution was hpm 19 to 78 years old with male predominence. We found that the cell types had no significant difference influence of survival rate, but sugical modalities had. Pneumonectomy was performed in 74 patients, bilobectomy in 26 and lobectomy in 75. The lobectomy group had less surgical morbility than the other two groups, and the pneumonectomy group bad the worst survival rate among the 3 groups. There was also no statistical significant difference of survival in regarding the T factor (T,, T2, Ts) of the tumor in WT series.

We detail OUT experience in different treatment modalities of Nl-non smlal cell lung cancer and the results achieved to date.

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IS BILOBECTOMY SUPERIOR TO LOBECTOMY IN TREATING NON-SMALL CELL LUNG CANCER (NSCLC) OF THE RIGHT LOWER LUNG FIELD?

Biin - e Shiun HUANG, Ching-Yuan CHENG, Wen-Hu Hsu, Liang-Shun WANG, Min-Hsiung HUANG, Kwang-Yu CHIEN Division of Thoracic Surgery, Deportment of Surgery, Veterans General Hospital-Taipei, Taiwan, R.O.C.

Lung cancer is the common cause of death in human being and

surgical intervention remains the treatment of choice for NSCLC. Cunenlly, radical lobectomy is the mOst frequently performed procedure. Under the concept of radical lymph nodes dissection and lymphatic sump of Honie, ‘lbilobectomy for cancer of either middle or lower lobe was generally accepted.

From June 1980 to June 1993, two hundred and thirty live consecutive patients with right middle or lower lobe lung cancer underwent

surgical treatment at Veterana Ckneral Hospital, Taipei R.O.C.. There were one hundred and thirty-live patienls underwent bilobectomy or lobectomy. The numbers of patients received lobectomy were as follow: 69 stage I; 13

stage II; 13 stage 111; and 5 stage IV. Of the 61 patients received

bilolxxlomy. they were 30. 7 and 24 in stage 1. II, and 111 respectively. The surgical morbidity was much higher in the bilobectomy group. The mean

survial time of bilobectomy and lobeclomy were: 36 v.s 39 months in stage 1

group; 33 v.s 38 months in stage II group and 21 v.s 17 months in stage 111 group. All showed no significant difference.

In conclusion: Radical lobectomy is still the best treatment for

curable NSCLS, but bilobcctomy should not bc considered as a routine

pmccdare for cancer of the right lower lung tield. It might be reserved for some special situation such as: incomplete fissure. tumor invades the other lohe, cancer near the second catina.