95

survival rate which is much better as com- pared with the overall survival rate in

stage III. On the contrary, T3N2M0 cases in which mediastinal lymph nodes were involved had poor prognosis at 15.8% 5 year survival rate.

These results might justify to perform the concomitant resection of involved ad- jacent organs. The concomitant resections were performed to be following adjacent organs: chest wall 22, ribs 18, subclavian artery 2, superior vena cava 3, and aorta 2. Vascular reconstructions were performed in 13 cases, including pulmonary artery 6, superior vena cava 3, subclavian artery 2 and aorta 2.

Surgical Resection: Is It the Preferred Treatment for Elderly Patients With Bronchogenic Carcinoma. Guy, J., Amer, E., Moores, D. St. Clare's Mercy Hospital, St. John's Newfoundland,

Canada. Surgical resection has generally agreed

to be the treatment of choice for patients with bronchogenic carcinoma. However, this mode of treatment for the elderly patient is considered to carry an increased risk.

Over a seven year period 133 Datients over the age of 70 years were seen with broncho-

genic carcinoma, 49 of these patients under- went pulmonary resection for the treatment of their disease. There were 2 operative deaths, 31 patients remain alive for pe- riods greater than 18 months. All non-sur- gical candidates died within a 12 month

period. We feel that surgical resection can be

carried out with an acceptable morbidity and mortality and should be offered as the treatment of choice to those patients who are potential surgical candidates.

Role of Iterativ Surgical Therapy for Primary Lung Cancer. Bini, A., Di Gaetano, P., Fiacchi, M. Chirurgia Toracica, Universit~ di Bologna,

Italia. Conservative pulmonary resections for

lung cancer certainly help for the best survival rate and the least postoperative complications, but they give rise to an increase in possible local recurrence of tumors. A useful prophylaxis of those must be done with oncologically correct resec- tions (lymphonode dissection of the first and second presumed station, intraopera- tive demonstration of a free bronchial section, repeated pleural washings with boiling, salt solutions and or disinfec- ting solutions etc.). From 1979 to 1984 of 263 patients operated for lung cancer, 9 had an iterative resection for bronchial -4 parenchymal-2 and chest wall-3 recurren-

ces of lung cancer. Some of these recur-

ences also demonstrate the relative validity

of the histological intraoperative tests. All the patients with parenchymal or bronchial re- currences underwent a new staging, and were operated only if cNO and cMO. 2 patients had dissimilar histological type cancer (second tumor?; different grading?). Survival periods ranged from 5 months to 15 months and the four surviving patients are respectively 5,7,12,26 months after the second surgery. In conclusion: i) in the conservative resections for lung can- cer there is a real possibility of recurrences; 2) in all of the recurrences it is necessary to have a second staging and an iterative sur- gery if the patients are cNO and cMO; 3) a cor- rect indication for a seeond resection gives results as good as an elective resection in it's staging.

Prognostic Assessment of Bronchoplast~c Surge- ry for Lung Cancer Based on a 25-Year Experi- ence. Fujimura, S., Imai, T., Kondo, T., Handa, M., Nakada, T. Department of Surgery, The Research Institute for Chest Diseases and Cancer, Tohoku University, Sendai, Japan.

Since 1960 we have experienced bronchopla- stic surgery for lung cancer in 58 patients. Among them 56 were primary bronchogenic carci- nomas; 46 of squamous cell carcinomas, 7 of a- denocarcinomas and 3 of the other types. There were 9 patients with pulmonary artery recon- struction and 8 cases who underwent carina reconstruction.

Five-year survival rates of the patients with the reconstructive surgery were 37, 46, 66 and 8 per cent in over-all patients, squamous cell carcinoma, stage I and II, and stage III pa- tients, respectively. There were no patients who survived over 5 years in adenocarcinoma. Six of 8 patients died within 3 years after carina reconstruction, however, 2 are alive at 2 months, and 1 year and 3 months after left sleeve pneumonectomy. Postoperative tumor recurrence around the bronchial anastomosis was found in 8 cases within 4 years and 3 months after the operation, which was frequently obser- ved in the patients whose postoperative stained sections of the lung demonstrated tumor invasi- on through the larger bronchial wall.

These results indicate that any types of bron- choplastic operation can be conducted in stage I and II lung cancer patients. However, prophy- lactic radiation therapy may be necessary to prevent local tumor relapse after the operation for the advanced patients.

Persistent Perfusion Abnormality After Sleeve Lobectomy for Lung Cancer. Kaneda, ~., Higashi, K., Sakai, T., Suzuki, S., Kusagawa., M. Seicho Byoin National Sanatorium, Hakusan, Mie. i. Mie University, Tsu. Mie, Japan.

Sleeve lobectomy for lung cancer has been believed as good as simple lobectomy on the

term of preservation of respiratory function

96

after the operation. Some reported data

of spirometric examinations revelated no significant difference between these two groups. But to evaluate the total lung function, it is indispensable to study lung perfusion, since ventilation-perfusion mis- match gives pernicious effect in respira- tory function. Four patients were examined over 6 months after sleeve lobectomy by using 133-Xe regional lung function test. Ventilation study revealed nearly equal distribution between unoperated lung and operated one. But perfusion of anastomosed lung decreased markedly (Table). This suggested that, even long after the surgery, anastomosed lung did not show a good respi- ratory function as expected. To explain the cause of low perfusion of anastomosed lung, experimental data of rat lung trans- plantation is also presented.

(Table) V/vol. Q/vol. V/Q ratio

Operated side 0.838 0.675 1.345 Unoperated side 1.144 1.283 0.904

Surgical_~hmnagement of N~z L ung Cancer. 1 i

Gozzetti , G., ~astrorilli , M., Br~gaglia , R.B., S~hiavina , M., Francesc~elli , N., Busutti ~ L. Cipolla D{Abruzzo , G., q

Romualdi 6 A., Villani- I S., Parmeggiani-, A., Lelli , G., Possati , L. Departments of i. Surgery II, 2. Respirology, 3. Ane- sthesia, 4. Radiotherapy, 5. Statistics, 6. Chemotherapy. University of Bologna, Bologna, Italy.

Out of 171 procedures for stage III lung cancer operated between 1971 and 1984, 83 were for N o disease and follow-up was pos- sible in 79 patients (95.1%). Operative mortality was 1.2%. The procedures perform- ed were: 29 pneumonectomies with intra- pericardial ligation of the vessels (plus 6 atrial resections), 17 pneumonectomies, 5 Kergin pneumonectomies, 27 lobectomies (3 with costal resections), 4 bilobectomies and 1 sleeve lobectomy. Survival

Global 5-year-survival for N squamous 2

cell carcinoma was 29.7%. T seemed to have some influence. 5-year-survival according

to N 2 subdivision: positive sup. mediast. nodes 35%, inf. mediast, nodes 39.8% aortic nodes 33.3%, multiple sites 0%.

The 2-year-survival for N 2 adenocarci- noma was 28.3% and positive sup. mediast. nodes seem to fare better. Conclusions

N squamous cell carcinoma responds 2

well to surgery while adenocarcinoma should be selected after mediastinoscopy has been performed in CAT scan positive medi- astinal nodes.

Mediastinal Lymph Node Dissection and Its

Significance in Surgery of Lung Cancer.

Naruke, T., Suemasu, K., Ishikawa, S. National Cancer Center Hospital, Tokyo, Japan.

The significance of the dissection of the mediastinal lymph node was evaluated by compa- rison of the prognosis between cases with and without the dissection of the mediastinal lymph node and a study on the mediastinal metastasis.

The 5-yr survival rate for 218 cases of sta- ge III (U.I.C.C.) with the mediastinal lymph node dissection was 19.3% as compared to 2.7% recorded for 75 cases of stage III without the mediastinal resection. The 5-yr survival rate for curative resection cases with mediastinal lymph node metastasis was 17.2%.

The fact that long survivors were found among the cases showing metastasis to the superior mediastinal lymph node (~ i), anterior media- stinal lymph node (# 3) and tracheal bifurca- tion lymph node (# 7) suggests that operations associated with the mediastinal dissection are indicated in such cases.

Even in the absence of metastasis to the hi- far lymph node, mediastinal lymph node metasta- sis (Skipping) was observed in 24.2% of curati- ve resection cases.

Also preoperative evaluation of N2, lymph node mapping, techniques of lymph node dissec- tion and prognosis of intranodal and extranodal metastasis will be briefly mentioned.

Results of Surgical Treatment for N2 Disease. Sawamura, K., Mori, T., Hashimoto, S., Iuchi, K., Tada, H., Lee, Y-E, Mizuta, T., Ichimiya, A., Akashi, A., Etani, S. Department of Surge- ry, Kinki National Center Hospital, Osaka, Japan.

Out of 364 resected non-small cell broncho- genic carcinoma between 1975 and 1982, 107 N2 diseases excluding stage IV were analysed: 70 cases with TI-2 N2 (N2), 37 with T3 N2; 38 squamous cell carcinoma (SQC), 67 adenocarcino- ma (ACA) and 2 large cell carcinoma LGC).

In N2, the 5 year survival rate of the SQC was 38.5%, that of ACA and LGC was 22.7%. There was no 5 year survivors among the T3 N2 disease in any histological type.

The effect of the complete dissection of the mediastinal lymph nodes was remarkable especi- ally in case of N2 diseases; 5 year survival of SQC was 53.1% and that of ACA and LGC was 32%, while in case of the incomplete mediasti- nal lymph nodes dissection there was no 3 years survivors in any histological cell types. But, there was almost no effectiveness seen perform- ing complete mediastinal lymph node dissection on T3 N2 particularly in ACA and LGC.

Analysing N2 diseases at the standpoint of intranodal or perinodal invasion in mediasti- nal lymph nodes retrospectively, the effective- ness of the mediastinal lymph node dissection was recognized not only in case of SQC, but also in ACA and LGC even with perinodal invasion, 5 year survival rate - 58.3% in SQC, 21.6% - ACA and LGC.