Resection For Bronchogenic Carcinoma Research Articles

Synchronous pulmonary and esophageal cancers: Is combined esophagectomy and anatomic lung resection appropriate?

341 Background: Resection is the best treatment for both esophagus and lung cancer, however, concerns that a combined resection of synchronous lung/esophagus tumors might be associated with higher morbidity may preclude surgical therapy. We sought to review a multi-institutional experience on combined esophagus/lung cancer resections. Methods: Patients undergoing esophagectomy and those with concurrent anatomic resection for bronchogenic carcinoma between 1997-2018 at three high-volume North American centers were identified from prospectively collected databases. Combined resection cases (E+L) were matched in a 1:3 ratio to patients who underwent esophagectomy alone (E), based on age, sex, stage, neoadjuvant therapy, procedure (2/3hole), and approach (MIE/open). Patient demographics, tumour characteristics, and post-operative outcomes were compared. Statistical analysis was performed using unpaired t-test or Wilcoxon sum-rank test for continuous variables and Fisher’s exact test for categorical data. Statistical significance was defined as p < 0.05. Results: Of over 2500 patients undergoing esophagectomy, synchronous anatomic lung resection was performed in 20; 4 were excluded due to incomplete data (n = 16). Matching yielded 48 patients and 4 duplicates were removed (n = 44); there were no significant differences in patient demographics, neoadjuvant therapy, clinical stage, or procedure. Anatomic resection consisted of lobectomy (16/20), segmentectomy (3/20) and pneumonectomy (1/20), combined with 2-hole (14/20), 3-hole (4/20), or left thoraco-abdominal (2/20) esophagectomy. The proportion of patients with any complication in E+L was 50%, and 66% in E (p = 0.42). Pulmonary complications were 19% and 27% in the respective groups (p = 0.74). Mortality did not differ (E+L = 0/16:E = 1/44)NS. The median length of stay for both groups was similar (E+L = 10.5 days(IQR 5.7): E = 10.0 days (IQR 8.7))NS. Conclusions: Patients with synchronous localized lung and esophageal cancer, although rare, should not be biased towards non-surgery therapy, as the morbidity associated with combined esophagectomy and anatomic lung resection does not differ significantly from esophagectomy alone.

A controlled clinical trial between bronchial sleeve resection and bronchial wedge resection for the treatment of bronchopulmonary carcinoma

Objective To make contrast analysis of sleeve lobectomy and wedge resection in lung cancer treatment by observing the clinical curative effect.Methods 100 patients with lung cancer using random table method, all the patients were divided into the observation group （ 50 cases, treated with sleeve resection ） , control group （50 cases,treated with wedge resection）,follow-up after treatment lasted respectively for 3 years.Results In the two groups,anastomotic fistula incidence and mortality rates of the observation group were 4%,6%;6% and 8% in the control group,there were no statistical difference （χ^2=0.00,0.00,all P〉0.05）;the positive rate of stump cancer cell bronchial in the observation group was 4%,it was obviously less than 16% in the control group,and the differ-ence was obvious （χ^2=4.00,P〈0.05） .The anastomotic scar tissue hyperplasia and recurrence rate of the observa-tion group during the follow-up period were 2%,2%;which were lower than 16%,18% of the control group （χ^2=4.40,7.11,all P〈0.05）.The 1,3 year survival rates of the observation group were 92%,64%,which were higher than 62%and 42%of the control group （χ^2=12.70,4.86,all P〈0.05）.Conclusion Taking sleeve resection for bronchogenic carcinoma can effectively control the positive rate of bronchial stump with cancer cells,inhibit anasto-motic scar tissue hyperplasia,reduce the recurrence rate,and the curative effect is very good,which is worth of clinical application. Key words: Lung neoplasms; Pneumonectomy

Curative-intent resection for bronchogenic carcinoma in patients with prior spinal cord injury: The Department of Veterans Affairs experience

17127 Background: There are approximately 250,000 people with spinal cord injury (SCI) in the US, and they have a high prevalence of smoking. A literature search yielded no published information concerning the clinical course of SCI patients who subsequently develop bronchogenic carcinoma and undergo pulmonary resection for this condition. We hypothesized that poorer outcomes of surgery would be observed in this population, as compared to neurally-intact patients. Methods: We conducted a study of all veterans at Department of Veterans Affairs (DVA) Medical Centers during fiscal years 1993–2002 who were diagnosed with SCI, subsequently developed non-small cell lung cancer and were then surgically treated with curative intent. Inclusion criteria included American Spinal Injury Association type A injury (complete loss of neural function distal to the injury site) and traumatic etiology. Data were compiled from national DVA datasets and supplemented by operative reports, pathology reports, progress notes, and discharge summaries. Results: Of 12,634 patients who underwent surgery for bronchogenic carcinoma, 55 also had codes for prior SCI; 7 were evaluable. The mean age was 64. Five (71%) had one or more co-morbid conditions in addition to their spinal cord injuries. All 7 underwent pulmonary lobectomy. Post-operative complications occurred in 4 patients (57%). Two patients died post-operatively on days 29 and 499, yielding a 30-day mortality rate of 14% and an in-hospital mortality rate of 29%. Conclusions: We believe this isthe only report in the English language literature on this topic. SCI patients with resectable bronchogenic carcinoma have a high incidence of co-morbid conditions. Those who undergo curative-intent surgery have high morbidity and mortality rates. This evidence suggests that SCI should be considered a risk factor for adverse outcomes of surgery for primary lung cancer, strengthening the case for alternative treatments. No significant financial relationships to disclose.

Triple reconstruction of pulmonary artery, superior vena cava and bronchus for lung cancer

We report on a case of a complete resection for bronchogenic carcinoma necessitating right upper sleeve lobectomy with prosthetic replacement of right pulmonary artery (PA) and superior vena cava (SVC). A 74-year-old male with squamous cell carcinoma had a tumor which extended to the right main bronchus, right PA and SVC. After reconstruction of the SVC with a ringed polytetrafluoroethylene (PTFE) graft between the left brachiocephalic vein (BCV) and right atrial auricle, the tumor was completely resected en bloc. Bronchial anastomosis followed by the prosthetic reconstructions of PA and SVC between the right BCV and the origin of SVC were performed. Pathological staging was t4n2m0 (stage IIIB). The postoperative course was uneventful and the patient discharged from the hospital on the 29th postoperative day. He has been doing well without recurrence and keeping a good graft patency for more than 3 years.

Discordance between predicted postoperative forced expiratory volumes in one second (ppoFEV1) calculated before and after resection of bronchogenic carcinoma

The aim of this study is to evaluate the concordance between predicted postoperative forced expiratory volumes in 1s (ppoFEV1) calculated on the basis of data known before surgery with ppoFEV1 calculated after completing surgical procedure. We have prospectively studied 66 consecutive patients (55 cases scheduled for lobectomy and 11 for pneumonectomy) operated on for bronchial carcinoma. According to location, 33 tumours were classified as central and 33 as peripheral. In all cases, ppoFEV1 was calculated twice: first (ppoFEV1-A) according to the scheduled surgical procedure; second (ppoFEV1-B) according to the procedure eventually performed. At operation, 43 lobectomies (65.2%) and 23 pneumonectomies (34.8%) were performed. Differences between ppoFEV1 A and B were found in 18 cases (12 central tumours). In three of them (4.5% of 66 cases), ppoFEV1-B was under 40%. Pearson coefficient was 0.85 (P<0.001) for the whole series of cases; 0.83 (P<0.001) for central and 0.87 (P<0.001) for peripheral tumours. On multiple regression analysis, R2 was 0.76 and ppoFEV1-A had the highest influence on the dependent variable. We have found that: (1) there is no perfect correlation between ppoFEV1 calculated with data known before and after surgery; (2) discrepancies are most important in centrally located tumours and (3) in 4.5% of cases, discrepancies could have influenced the preoperative risk estimation.

Applicability of logistic regression (LR) risk modelling to decision making in lung cancer resection

The objective of this study was to evaluate the performance of a locally derived risk-adjusted model to predict cardiorespiratory morbidity after major lung resection for bronchogenic carcinoma. A logistic regression risk model has been developed using a database of 515 patients undergoing major lung resection between 1994 and 2001. Independent studied variables were: age of the patient, body mass index, predicted postoperative forced expiratory volume in the first second (ppoFEV1%), cardiovascular co-morbidity, diabetes mellitus, induction chemotherapy, tumour staging, extent of resection, chest wall resection, and perioperative blood transfusion. The analyzed outcome was the occurrence of postoperative cardiorespiratory complications prospectively recorded and codified. Variables with an influence on the outcome on univariate analysis were entered in the risk model. The calculated probabilities of complication were compared to its actual occurrence in 53 consecutive cases operated on between January and June 2002 and a receiver operating characteristic (ROC) curve was constructed. On logistic regression analysis, age (P < 0.001) and ppoFEV1 (P = 0.003) independently correlated with the outcome. The accuracy for morbidity prediction (area under the ROC curve) was 0.55 (95% CI: 0.31-0.78). These data show that this locally derived lung resection risk-adjusted model fails to predict postoperative cardiorespiratory morbidity in individual patients.

Tracheal sleeve and superior vena cava resection for bronchogenic carcinoma

Tracheal sleeve and superior vena cava resection for bronchogenic carcinoma

Simultaneous repair of an abdominal aortic aneurysm and resection of bronchogenic carcinoma: Report of a case

A 69-year-old man successfully underwent simultaneous repair of an abdominal aortic aneurysm and resection of bronchogenic carcinoma during the same operation. Pulmonary lobectomy was performed following complete closure of the abdomen after aneurysmectomy to prevent any contamination. If the patients are carefully selected, an operation for abdominal aortic aneurysm and bronchogenic carcinoma can be safely performed with the advantage of treating both lesions simultaneously and thus sparing the patients from having to undergo the physical and psychosomatic pain, as well as the risk, of a second operation.

The effectiveness of standardized follow-up studies after resection of non-small cell bronchial carcinoma

The outcomes of 190 patients in whom a non-small-cell bronchogenic carcinoma had been resected with curative intent in the Department of Surgery, University of Cologne, between 1. 1. 1977 and 31. 12. 1987 were analysed retrospectively. Sixty-seven (35%) of these patients underwent regular, 64 (34%) irregular, and 59 (31%) no standardized follow-up programmes. During follow-up procedures tumour recurrences were detected in 33 patients (25%). Thirteen (39%) of these recurrences were completely asymptomatic at the time of diagnosis. Three recurrences (9%) were resected with curative intent, but the patients died between 14 and 17 months later due to recurrent disease. Seven recurrences (21%) were treated by radiotherapy, three (9%) by chemotherapy, and 20 patients (61%) received no oncologic therapy. The survival rates after diagnosis of recurrence were not affected by the type of treatment or by the presence of clinical symptoms. There is no evidence that long-term results following resection of non-small-cell bronchogenic carcinoma can be improved by regular and standardized follow-up programmes. The observed incidence of postoperative pulmonary disorders and the patients' self-assessment underline the necessity for postoperative care after resection of bronchogenic carcinoma. Apart from clinical studies, follow-up should primarily focus on individual symptoms and should no longer include standardized investigations in asymptomatic patients except occasional X-ray checks of the thorax.

Results of resection for bronchogenic carcinoma in patients over the age of 80

Results of resection for bronchogenic carcinoma in patients over the age of 80

Wedge resection for bronchogenic carcinoma in high-risk patients.

At the Veterans Administration Medical Center in Washington, DC, 73 patients with bronchogenic carcinoma had pulmonary wedge resection from February 1967 to March 1988, with a 1.4% perioperative mortality and a 4.1% morbidity. Mean age of the patients was 63 years. Patients were considered poor risk with a mean Goldman index of 9 +/- 4 (class II), mean ASA physical status classification II, mean 1-second forced expiratory volume (FEV1) of 1.25 liters (42% predicted), ratio of FEV1 to forced vital capacity 30% predicted, and maximum voluntary ventilation 24% predicted. Staging of the bronchogenic carcinomas indicated 68% stage I, 15% stage II, and 17% stage III, and histology showed 41% epidermoid, 40% adenocarcinoma, 12% bronchoalveolar, 3% large cell, and 4% small cell type. For the 72 patients eligible for follow-up, data were available on 62 for a period ranging from 4 months to 15 years. Survival was 94% at 1 year, 55% at 3 years, 29% at 5 years, 5% at 10 years, and 2% at 15 years. Within 5 years, 21% of the patients had died of causes other than bronchogenic carcinoma. The rate of recurrence was 16%. Analysis by each stage of lung cancer showed local recurrence in 4% of patients with stage I disease, in 9% of those with stage II disease, and in 59% of those with stage III disease. We conclude that wedge resection provided acceptable surgical treatment in a group of high-risk surgical patients.

Predictability of FEV1 after pulmonary resection for bronchogenic carcinoma.

The aim of this study was to review the reliability of prediction of postoperative FEV1 in patients with bronchogenic carcinoma using a Tc-99m perfusion scan and simple spirometry. Over a 27-month period, 40 patients without known recurrent disease had their FEV1 measured. One quarter of the postoperative values for FEV1 differed from predicted values by less than 5% (2/11 pneumonectomies, 5/23 lobectomies, 3/6 segmental resections) and half differed by no more than 10% of predicted FEV1 (4/11 pneumonectomies, 12/23 lobectomies, 3/6 segmentectomies). One tenth of the predicted values differed by more than 30% and up to 760 mls (1/11 pneumonectomies, 2/23 lobectomies, 1/6 segmentectomy). Disease recurrence, phrenic nerve paralysis, exacerbation of obstructive pulmonary disease and poor collaboration during spirometry explained the most severe erroneous results. Age, preoperative smoking, tumour stage and histology, absence of symptoms at the time of diagnosis and adjuvant radiotherapy showed no statistically significant effect on predictability. Twenty-one patients had a postoperative Tc-99m pulmonary scan simultaneous to the spirometric control. Overestimation of postoperative FEV1 was associated with heterogeneous distribution of ventilation and perfusion.

Results of resection for bronchogenic carcinoma with mediastinal lymph node metastases in selected patients

Between 1982 and 1988, 254 consecutive patients underwent resection for bronchogenic carcinoma with mediastinal lymph node metastases at Marie Lannelongue Hospital. Selection of cases for surgery was carried out using CT and mediastinoscopy. The surgical procedure performed were pneumonectomy (169), lobectomy (65), or bilobectomy (20) associated with resection of ipsilateral mediastinal lymph nodes. Almost all diseased nodes appeared grossly enlarged at surgery and only a few were of normal size. Postoperative mortality was 5.6%. Resection was potentially curative in 191 cases (75%) and palliative in 63 cases (25%). Almost all patients received adjuvant treatment (mainly radiotherapy). Actuarial 5-year survival was 18% for the entire group, and 23% for those who underwent curative resection. No patient with palliative resection survived 5 years. The following factors proved to be significantly associated with a better prognosis: complete resection, independent lymph node metastases, involvement of only one level, lower paratracheal involvement. On the other hand, there was no difference between pathological types (squamous cell carcinomas, adenocarcinomas, oat cell carcinomas) with regard to prognosis. We advocate an aggressive approach in selected cases of N2 bronchogenic carcinoma. Neoadjuvant chemotherapy should be tested in these specific patients with a view to the possibility of improving results.

En bloc resection for bronchogenic carcinoma with chest wall invasion Value of pre-operative radiotherapy

A small number of patients with lung cancer will have a tumour invading the chest wall. Pre-operative radiotherapy and surgical resection provide the best results in patients with Pancoast's tumours, although chest wall invasion is often considered to indicate incurability. We reviewed the outcome in 46 patients with bronchogenic carcinoma and non-apical chest wall invasion and have tried to clarify the role of adjuvant pre-operative radiotherapy. All patients underwent combined chest wall and lung resection for treatment of lung cancer which had extended grossly and microscopically into the chest wall. In this retrospective study, we identified two groups of patients, those (n = 21) who received and those (n = 25) who did not receive pre-operative radiotherapy. Curative resection had been possible in 80% of the patients. There was one early post-operative death, due to pneumonia. The survival in all 46 patients is 32% at 5 years. In the most favourable cases, those without nodal involvement and who received pre-operative radiotherapy, the 5-year survival is 56%. In our series, there was a notable difference in 5-year survival between irradiated and non-irradiated patients at every stage of disease.

Pleural lavage after pulmonary resection for bronchogenic carcinoma

Pleural lavage after pulmonary resection for bronchogenic carcinoma

Chest wall resection for bronchogenic carcinoma

Chest wall resection for bronchogenic carcinoma

Chest wall resection for bronchogenic carcinoma.

The incidence rate of chest wall invasion in bronchogenic carcinoma is difficult to estimate, but is possibly as high as 5%. These cancers can be locally extensive without systemic dissemination. From 1973 to 1982, 9 patients in our hospital underwent en bloc pulmonary and partial chest wall resection for bronchogenic carcinoma with local invasion of the thoracic wall. All the patients were male, their ages ranging from 49 to 67 years. Pain was the most prominent symptom. Bronchoscopy examination revealed no tumors in 7 of the 9 patients, in one a tumor was seen in the apex of the right lower lobe and in another in the apex of the right upper lobe. Seven lobectomies and 2 pneumonectomies were performed. The macroscopic size of the tumour ranged from 3 to 17 cm, the number of partially resected ribs ranged from 1 to 4. In 8 cases squamous cell carcinoma was found, in one adenocarcinoma. After operation 7 patients were classified as T3N0M0 and 2 as T3N1M0. One T3N0M0 patient died shortly after operation due to a lung embolism. Two out of the 6 patients with T3N0M0 neoplasm survived more than 5 years, none of the patients with T3N1M0 neoplasm survived more than 3 months. Late deaths were due to recurrent carcinoma in the chest wall (2 cases), cerebral metastasis (1 case), cardiac failure (1 case) and unknown causes (2 cases). In cases where the lymph nodes are not involved, the survival rate is not unfavorably influenced by chest wall invasion. In the literature the mean operative mortality rate is 12%, the median survival time approximately one year and the mean 5-year survival rate 18%; resection is also of great importance in relieving pain.

En bloc (non-chest wall) resection for bronchogenic carcinoma with parietal fixation: Factors affecting survival

Seventy-three patients (57 men and 16 women) underwent en bloc resection of lung and attached parietes between 1970 and 1982. All patients had documented malignant pleural invasion. Chest wall parietal pleura was invaded in 33 patients, pericardium in 14, phrenic or vagus nerve in nine, left atrium in five, superior vena cava in four, esophagus in two, diaphragm in one, and multiple structures in five. No patient underwent chest wall resection. Parietal pleurectomy was performed in all patients with involvement of the chest wall parietal pleura; 37 lobectomies and 36 pneumonectomies were performed. Operative mortality was 12.3%. The actuarial overall 5 year survival rate (Kaplan-Meier method) was 39.7%. We conclude that en bloc resection for primary bronchogenic carcinoma with invasion of adjacent intrathoracic structures, although associated with a significant mortality, can be performed with a reasonable likelihood of long-term survival.

Further observation on empyema after resection of bronchogenic carcinoma and survival.

Out of 11,247 cases undergoing resectional therapy for bronchogenic carcinoma at 39 institutions, 6,348 were operated before July 1976 and the remaining 4,899 thereafter. Analyzing both series, the following results were obtained: 1) The rate of pneumonectomies to lobectomies was 1:2.3 in the former and 1:3.9 in the latter. Pneumonectomies were more on the left side, whereas the right lobectomies were about twice as many as the left ones. 2) Postoperative empyema occurred in 180 cases (2.8%) in the former and 79 cases (1.6%) in the latter. The incidence was significantly higher in the cases of right pneumonectomy than in the cases of left pneumonectomy, and in the cases of pneumonectomy than in the cases of lobectomy. Although the incidence of postpneumonectomic empyema decreased only slightly, overall incidence decreased significantly because of marked increase of lobectomy cases. 3) Out of 180 cases of empyema in the former series, 17 died within 30 days. 4) The 5-year survival rate of the patients with empyema was 28 per cent. 5) The 5-year survival rate was 30 per cent in 93 cases of squamous cell carcinoma, 30 per cent in 50 cases of adenocarcinoma and 15 per cent in 13 cases of large cell carcinoma. There was no survivor among 7 cases of small cell carcinoma. 6) Out of 259 cases of empyema, micro-organisms were cultured in 161 cases, were negative in 20, and unknown in 78. Although various organisms were found, gram-negative bacteria and Pseudomonas were most frequently isolated, i.e. 37 per cent and 36 per cent, respectively. 7) As for the treatment of 5-year survival cases of empyema, thoracoplasty and bronchial closure were frequent as compared with open thoracic window technics such as Eloesser's and Symbas' operation. And, more than half of the cases of empyema seem to have been complicated with bronchial fistulae.

Analysis of simple pulmonary function screening tests in preoperative assessment before lung resection for bronchogenic carcinoma.

Simple pulmonary function screening tests were performed prospectively in a group of patients with carcinoma of the bronchus being evaluated for lung resection. Of the 22 who subsequently had a resection performed, 7 suffered post-operative ventilatory difficulties unrelated to technical surgical complications. By analysis of combinations of variables, it was possible to separate significantly the complication group from the non-complication group. This was not possible using one variable alone. The method of empiric determination of values which produce maximum separation is described and contrasted with the more statistically acceptable technique of discriminant analysis. With the latter it is possible to incorporate information from any number of variables and to achieve greater definition of the two groups. It is proposed that such an analysis might provide the means for more valid scientific assessment of simple pre-operative screening tests than is usually employed.