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operative electrocardiogram, a forced vital capacity of 2.8 liters or less, a one-se- cond forced expiratory volume (FEVsub i) of less than 1.7 liters, an oxygen tensi- on of less than 60 mm Hg, or the senior- ity of the surgeon (resident versus at- tending). An increased number of compli- cations (p < 0 05) was found in male pa- tients, in patients operated on for car- cinoma, and in patients older than 60 years. Stepwise discriminant analysis in- cluded FEVsub 1 as a significant predictor of postoperative complications. We con- clude that elective lobectomy in a well- supervised residency program can be per- formed with a low mortality and that modern care techniques bring the vast majority of complications to a success- ful resolution.

Pulmonary Resection in Patients after Pneumonectomy. Kittle, C.F., Faber, L P., Jensik, R.J., Warren, W.H. Department of Cardiovascular and Thoracic Surgery, Rush-Prebyterian St. Luke's Medical Center, Chicago, IL U.S.A. Ann. Thorac. Surg. 40: 294-299, 1985.

In 15 patients with a previous pneumo- nectomy (eight on the right and seven on the left), a new 'lesion' developed in the remaining lung. Fourteen had the pneumonectomy for carcinoma (13 men and 1 woman), and 1 woman had a pneumonectomy for blastomycosis. At the second operation (4 months to 16 years after the pneumo- nectomy), limited resection of a primary or metastatic malignancy was done. The excision ranged from lobectomy to multiple wedges. One patient died on the sixth postoperative day, presumably a cardiac death. Eight patients died 2 to 33 months postoperatively. Six patients are now li- ving: 3 have no evidence of disease (18, 35 and 70 months), and 3 have recurrent disease (26, 41, and 73 months). There is evidence that pulmonary resection after pneumonectomy is feasible with a low operative mortality and that resec- tion of these secondary' tumors can result in prolonged, worthwhile survival.

Effect of Initial Resection of Small-Cell Carcinoma of the Lung: A Review of South- west Oncology Group Study 7628. Friess, G.G., McCracken, J.D., Troxell, M.L. et al. Brooke Army Medical Center, San Antonio, TX, U S.A. J Clin. Oncol. 3: 964-968, 1985.

The role of surgery in small-cell car- cinoma of the lung (SCCL) has been recent- ly re-evaluated. We reviewed the records of 262 patients with limited SCCL on Southwest Oncology Group (SWOG) protocol 7628. Fifteen patients were identified

who presented after surgical resection (12 lobec- tomy, 3 pneumonectomy). All patients were subse- quently treated with chemotherapy, radiotherapy + or - immunotherapy (BCG). Median survival time was 10.5 months. Median survival time of patients with initial surgical resection was 25 months (P = .004). Forty-five percent of the surgical patients were alive at 2 years v 13.7% of the nonsurgical patients (P < .05). A second subgroup of 33 patients v,as i- dentified with small primary tumors who did not undergo surgical resection. Median survival time in this group was i0 months (P = .03). Site of ini- tial relapse was clearly documented in 142 patients. Fifty-six percent of patients notreceiving surge- ry had initial relapse within the chest compared tb 13% of patients undergoing surgery (P = .002). ~ether the survival benefit identified was caused by or was incidental to surgical resection of the primary lesion remains to be determined in rando- mized prospective trials of operable candidates.

Bronchoplastic Procedures and Pulmonary Artery Reconstruction in the Treatment of Bronchogenic Cancer. Belli, L., Meroni, A., Rondinara, G., Beati, C.A. Department of Surgery 'Pizzamiglio II', Niguarda Hospital, 20100 Milano, Italy. J. Thorac. Cardio- vasc. Surg. 90 167-171, 1985.

Nineteen patients with primary bronchogenic carci. noma underwent bronchoplastic procedures (six wedge and 13 sleeve resections) between 1970 and 1982. In six of them lobectomy was combined with sleeve resection and reconstruction of the pulmonary ar- tery: In one a synthetic prosthesis was insertedr Twelve patients had squamous cell carcinoma, five adenocarcinoma, and two large cell carcinoma. No operative deaths were observed, and the 5 year sur- vival rate is 28.1%. One patient had an early bron- chial fistula and two patients had bronchial steno- sis (one suture granulation and one local recur- rence). No patient with resection of the pulmonary artery had vascular complications. Survival rates on the basis of nodal involvement indicate 50% survival at 5 years without nodal metastasis (ii cases) versus 9.7% with nodal involvement (eight cases) (p < 0.05). Bronchoplastic procedures, even if accompanied by segmental resection of the pul- monary artery, can be performed safely with long- term results comparable to those following major pulmonary resections.

Bronchial Adenoma: Surgical Experience with Long- Term Follow-Up (4-17 Years). Halevy, A., Schachner, A., Nili, M. et al. Depart- ment of Thoracic and Cardiovascular Surgery, Bei- linson Medicine Center, Petach Tikva, Israel. J. Surg. Oncol. 29: 66-68, 1985.

Of 16 patients with bronchial adenoma who were operated on at Beilinson Medical Center from 1967 to 1980, only three presented the 'triad' of cough, hemoptysis, and recurrent pulmonary infections. In two patients the tumor was diagnosed incidentally and in five patients histological evidence of ade- noma was made during bronchoscopy. One patient died

of myocardial infarction following reoperation for