Prognostic Factors for Surgically Resected N2 Non-small Cell Lung Cancer

Purpose: Non-small cell lung cancers (NSCLCs) with pathologically documented ipsilateral mediastinal lymph node (LN) metastases (pN2) are a broad spectrum of diseases. We retrospectively analyzed prognostic factors for cases of pN2 NSCLC treated by surgical resection.Methods: Clinicopathological data were reviewed for consecutive 121 patients who underwent anatomical pulmonary resection with mediastinal LN sampling or dissection for pN2 NSCLC over a 15-year period.Results: The 5-year survival rate for all patients was 29.9%. Clinical N status, curability, surgical procedure and adjuvant chemotherapy were favorable prognostic factors in univariate analysis, with 5-year survival rates of 35.0% for cN0/1 vs. 17.7% for cN2/3 cases; 33.1% for R0 vs. 14.7% for R1/2 resection; 31.5% for lobectomy vs. 25.0% for bilobectomy and 15.6% for pneumonectomy; and 72.7% with adjuvant chemotherapy vs. 23.8% without adjuvant chemotherapy. Survival did not differ significantly based on gender, age, smoking status, clinical T status, tumor location, histology, skip metastasis, subcarinal LN metastasis, or number of involved N2 levels. In multivariate analysis, adjuvant chemotherapy, R0 resection, and lobectomy emerged as independent favorable prognostic factors.Conclusion: Complete resection using lobectomy and adjuvant chemotherapy are favorable prognostic factors in cases of pN2 NSCLC.     

Reevaluation of the surgical indications for lung cancer based on the N factor

The Standard surgical treatment for stage I, II, and IIIa non-small cell lung cancer (NSCLC) is lobectomy with systemic mediastinal lymph node dissection. More than 50% of our series of 220 patients with cN2 disease were classified as pN0-1. The postoperative 5-year survival rate of patients with cN2 disease was 36%, and that of those with cN2-pN2 disease was 18%. Tumor cell type, surgical technique, or site of tumor had no prognostic significance, although pN, cT, and number of N2 sites were of prognostic significance. We conclude that the indications for surgery are T1-2 N2 disease with a single N2 site.     

Oncological issues in staging mediastinal lymph node metastasis for left lung cancer

ObjectiveWe aimed to discuss the underlying oncological issues in staging of mediastinal lymph node metastasis in patients with left lung cancer who underwent extended radical lymphadenectomy (ERL).MethodsThis multi-institutional retrospective study analyzed 116 patients with left non-small-cell lung cancer who underwent bilateral paratracheal lymph node dissection (ERL) via median sternotomy. The clinicopathological records of patients with mediastinal lymph node metastasis were examined for prognostic factors, including age, sex, histology, tumor size, cN number, preoperative data, metastatic stations (number and distribution), pT, and adjuvant chemotherapy.ResultsMediastinal lymph node metastases were found in 43 patients, and right paratracheal lymph node metastases (pN3) were found in 13 patients. The 5-year overall survival rate was 25.2% in patients with pN3 tumors (n = 13) and 23.1% in patients with pN2 tumors (n = 30). The prognosis did not differ between patients with pN3 and pN2. Univariate analyses showed that histology, cN, and adjuvant chemotherapy were significant prognostic factors in patients with mediastinal lymph node metastasis. In these 43 patients, cN and adjuvant chemotherapy were significant independent prognostic factors in multivariate analysis.ConclusionsThe prognostic factors for left lung cancer with mediastinal lymph node metastasis were cN status and adjuvant chemotherapy, and not pN status (pN2 or pN3). We hope that the study results, which suggest that there may be no difference in prognosis between pN2 and pN3, would broaden the discussion of oncological issues in the staging of mediastinal lymph node metastasis of left lung cancer.     

Favorable results after sleeve lobectomy or bronchoplasty for bronchial malignancies

Background. Sleeve lobectomy and bronchoplasty are established alternatives to pneumonectomy for bronchial malignancies involving a main bronchus. However, potential bronchial anastomotic complications have deterred the general application of these types of resection. Some reports have contained a mixture of non-small cell lung cancer (NSCLC) and tumors of low-grade malignancy, making it difficult to assess the long-term results of these procedures as an alternative to pneumonectomy for lung cancer.

Methods. We retrospectively reviewed our experience with sleeve lobectomy and bronchoplasty for bronchial malignancies from January 1988 to September 1998 separating NSCLC (n = 58) from tumors of low-grade malignancy (n = 19). We compared the overall results between sleeve lobectomy and pneumonectomy (n = 142) performed for NSCLC over the same time interval.

Results. For NSCLC, after sleeve lobectomy, the operative mortality was 5.2% (3 of 58 patients) and the overall 5-year actuarial survival was 37.5%. After pneumonectomy, the operative mortality was 4.9% (7 of 142 patients) and the overall 5-year actuarial survival was 35.8%. For tumors with low-grade malignancy, there was no operative mortality after sleeve lobectomy or bronchoplasty and the 5-year actuarial survival was 100%. Major bronchial anastomotic complications occurred in 3 patients among the 77 patients who underwent sleeve resection.

Conclusions. Sleeve resection can be performed with a low risk of bronchial anastomotic complication. The long-term survival after sleeve resection for NSCLC is similar to pneumonectomy. Excellent results are obtained after sleeve resection for low-grade malignancies.     

Preoperative prognostic factors for pN2 non-small cell lung cancer.

PURPOSE: The prognosis of non-small cell lung cancer (NSCLC) with pathologic mediastinal lymph node involvement (pN2) is poor in general. The majority of previously reported prognostic factors of pN2 disease are not available preoperatively. When we perform preoperative induction chemotherapy, we should undertake therapeutic planning according to preoperative factors. METHODS: We focused on preoperative clinicopathologic factors, and investigated the prognosis in 78 patients with pN2 NSCLC who received complete resection. RESULTS: Age, gender, histologic subtype, tumor location, smoking status and cT status were not related to patients' survival. On the other hand patients with cN0 disease and normal serum carcinoembryonic antigen (CEA) level had a significant favorable survival (p = 0.038 and p = 0.019, respectively). In addition, comorbidity had a significant survival impact (p = 0.031). Despite there being no independent prognostic factors by multivariate analysis, the patients without all of cN1-2 disease, elevated serum CEA level and comorbidity had a significant favorable prognosis (p = 0.008). CONCLUSION: Among the preoperative factors examined, pN2 patients with all cN0 disease, normal serum CEA level and no comorbidities might have a favorable prognosis. Combined use of these might be a useful prognostic determinant, and even in the presence of pN2 disease, patients without these unfavorable 3 factors might have a favorable prognosis when treated with surgery alone.     

Is segmentectomy with lymph node assessment an alternative to lobectomy for non-small cell lung cancer of 2 cm or smaller?

BACKGROUND: Lesser resection than the standard lobectomy for small-sized cT1N0M0 non-small cell lung cancers continues to be debated. METHODS: We reviewed specimens of 139 patients after lobectomy for cT1N0M0 cancer of 2 cm or less. In addition, we prospectively enrolled 70 patients able to tolerate a lobectomy, in a trial of lesser resection for these lesions. The limited procedure consisted of segmentectomy in which the resection line was delivered beyond the burdened segment, plus exploration of lymph nodes by frozen sectioning. This procedure was modified if the result was positive; this modified procedure was called extended segmentectomy. RESULTS: The nodal status after lobectomy was pN0, 107 patients; pN1, 12 patients; and pN2, 20 patients. Of the pN1 patients, 2 had only intralobar nodal involvement within the same segment of the main tumor. In the remaining 30 patients with nodal involvement, we ascertained the nodal involvement during the operation. Regarding intrapulmonary metastasis, 1 of 8 patients having this metastasis had the lesion at the segment where the main tumor was not located and had N2 disease, which was detected intraoperatively. If extended segmentectomy had been performed instead of lobectomy, the lesion could have been removed completely. The 5-year survival of patients with cT1N0M0 cancer of 2 cm or less was 87.3% after extended segmentectomy. There were no local recurrences and three noncancer-related deaths. Among patients with pT1N0M0 cancer of 2 cm or less, the 5-year survival was 87.1% in the extended segmentectomy group and 87.7% in the lobectomy group (p = 0.8008). CONCLUSIONS: Extended segmentectomy should be considered as an alternative for patients with cT1N0M0 non-small cell lung cancer of 2 cm or smaller.     

Analysis of Risk Factors for Bronchopleural Fistula after Surgical Treatment of Lung Cancer

Purpose: Bronchopleural fistula (BPF) is a potential serious complication of lobectomy or more radical surgery for non-small-cell lung cancer (NSCLC). We aimed to evaluate the risk factors for BPF.Methods: The study cohort comprised 635 patients who had undergone lobectomy or more radical surgery for NSCLC from March 2005 to December 2017. We examined the following risk factors for BPF: surgical procedure, medical history, preoperative treatment, and surgical management.Results: In all, 10 patients (1.6%) had developed postoperative BPFs. Univariate logistic regression analysis showed that surgical procedure, medical history (arteriosclerosis obliterans [ASO]), and bronchial stump reinforcement were significant risk factors. Multivariate analysis showed that only surgical procedure (right lower lobectomy, p = 0.011, odds ratio = 17.4; right middle lower lobectomy, p = 0.003, odds ratio = 59.4; right pneumonectomy, p <0.001, odds ratio = 166.0) was a significant risk factor. Multivariate analysis confined to the surgical procedure of lobectomy showed that right lower lobectomy (p = 0.011, odds ratio = 36.5) and diabetes (HbA1c ≥8.0) (p = 0.022, odds ratio = 31.7) were significant risk factors.Conclusion: When lobectomy or more radical surgery is performed for NSCLC, right lower lobectomy, middle lower lobectomy, and right pneumonectomy are significant risk factors for postoperative BPF. Thoracic surgeons should acquire the techniques of bronchoplasty and angioplasty to avoid such invasive procedures.     

Evaluation of lung function as a prognostic index before and after surgical resection due to NSCLC

BACKGROUND: Although there were several studies on survival, death and morbidity rates after lung resection, considering both limited and extended resections, lung exercise capacity has been quite seldom taken into account as an index for prognosis. The aim of this study compare the consequences of three kinds of lung resections (pneumonectomy, lobectomy and wedge resection), to test pre- and post-surgery exercise capacity for patients affected by NSCLC in order to obtain more detailed prognostic indices. METHODS: All the patients were studied by means of thorough lung static function and hemogas analytical tests before and after surgical resection, from 15 days to 12 twelve months' time past surgery. RESULTS: In fact, in relation to lung resection due to neoplasms, several studies pointed out that zone-limited resections show an obvious anatomical benefit in terms of parenchyma spair compared to lobectomy; however, it is underlined that the functional benefits of small resections don't really prevail over post-lobectomy anatomical advantages. Furthermore local relapses are more common after small resections rather than after lobectomy. CONCLUSIONS: Neither limited lung resection nor lobectomy alone, therefore, in accordance with nearly all the recent and still ongoing studies in this huge research field, has a significant effect on exercise capacity. Only pneumonectomy is associated with impaired exercise performance, and, nevertheless, quite below our expectations.     

Bronchoplastic surgery for lung cancer and the results

Fifty-nine patients with lung cancer underwent bronchoplastic surgery in our institute from September, 1965 to May, 1982. The post surgical stages of disease were as follows: 7 cases of Stage I disease, 7 cases of Stage II, 41 cases of Stage III, 4 cases of Stage IV. The bronchoplastic surgery performed included sleeve resection combined with lobectomy in 35, wedge resection combined with lobectomy in 11, reconstruction of the lower area of the trachea in 5, bronchial sleeve resection combined with pulmonary artery resection in 6 and bronchial wedge resection combined with pulmonary artery resection in 2. There was no case of operative mortality within 30 days after the operation. To prevent postoperative complications, careful techniques are required in suturing and postoperative bronchoscopic suction of intrabronchial secretion is necessary. The use of Dexon or Dexon S, polyglycolic acid sutures, showed good results. Adjuvant therapies were performed on 42 cases, including preoperative infusion of Mitomycin C into the bronchial arteries or postoperative irradiation or both. Twenty-eight of 59 were alive and well from 7 months to 16 years after the operations. The relative 5 year survival rates were 40.5 per cent in total cases and 46.5 per cent in those with squamous cell carcinomas. The prognosis of patients undergoing bronchoplasty was compared with that of patients undergoing lobectomy and pneumonectomy. There was a statistical difference between bronchoplasty and pneumonectomy.     

Video-assisted thoracic lobectomy with bronchoplasty for lung cancer, with special reference to methodology

Few studies have described video-assisted thoracic surgery (VATS) to bronchoplasty with pulmonary resection. Here, we report the successful implementation of VATS bronchoplasty, as determined retrospectively. Between 2005 and 2010, 362 patients underwent elective lung resection for malignant or benign lung tumors. Of these patients, VATS lobectomy with bronchoplasty was performed in seven patients (four men, three women; median age, 72.9 years). The medical records were retrospectively reviewed. Of the seven patients, six had primary lung cancer (PLC), and one had metastatic cancer of the lung. The surgical procedures were lobectomy with wedge bronchoplasty. The patients with PLC also underwent mediastinal or hilar lymph node dissection. The median total operating time was 230 min, and the median blood loss was 152 ml. The median postoperative hospital stay was seven days, without major postoperative complications. The most important feature of the described method is that the surgeon mainly observes the operative field directly, through a working wound; the surgical team observes via a monitor. An advantage for the surgeon is the ability to use the same instruments in VATS as are used in conventional thoracotomy, as well as the same suturing techniques in vascular reconstruction, especially involving the pulmonary artery.     

微创外科技术在中央型肺癌治疗中的应用

微创手术有助于减少手术创伤和疼痛,帮助患者康复,改善生活质量。包括胸腔镜和机器人在内的微创肺切除术目前主要用于早期周围型肺癌的外科治疗,中央型肺癌由于肿瘤位置、淋巴结转移和治疗模式等原因,手术难度较大、技术要求较高,尤其是袖状切除术和全肺切除术,大多需要开胸手术切除。随着微创手术技术的不断进步,近年来临床上开始尝试将其应用于中央型肺癌的外科治疗,其可行性和安全性已得到初步结果证明,代表了微创胸肺癌外科的发展方向。但仍需要更多研究结果证实其功能优越性和肿瘤学效果,让更多肺癌患者从外科技术的进步中获益。     

Pulmonary resection after pneumonectomy

Patients who have a lung cancer in the residual lung after pneumonectomy should not be automatically excluded for surgical consideration. These patients should be carefully staged and evaluated physiologically. The most important initial differentiation is to distinguish a true second primary lung cancer from metastatic recurrent lung cancer. Meticulous staging with chest CT, PET, brain MRI, and mediastinoscopy should be able to successfully exclude metastatic disease, multifocal disease, or locally advanced tumors. Only patients who have stage I disease are candidates for this type of extended resection. Ideally, these patients should have small peripheral tumors that can be encompassed with a low-volume wedge resection. More extended resections, such as segmentectomy or right middle lobectomy, may be considered in some patients but seem to bear a higher operative morbidity and mortality. The need for an upper or lower lobectomy after contralateral pneumonectomy is probably an absolute contraindication to surgical resection. To tolerate pulmonary resection after pneumonectomy, and to obtain the desired survival benefit, patients should have a good to excellent performance status, no serious comorbidities, and a ppoFEV1 greater than 1.0 L/second. In these highly selected patients, pulmonary resection after pneumonectomy can be accomplished with an acceptable operative morbidity and mortality and, in true cases of metachronous second primary lung cancers, may achieve a 5-year survival rate of up to 50%.     

Bronchoplasty at the level of the segmental bronchus

The efficacy of anastomosis including the segmental bronchus performed in Hyogo Medical Center was reviewed. There were 18 patients with anastomosis of segmental bronchi (group 1), 14 patients with anastomosis between the upper, lingular, or basal segmental bronchus and main bronchus, avoiding pneumonectomy (group 2), and a miscellaneous group (group 3). Patients in group 1 had early-stage lung cancer or low-grade malignant tumors, whereas those in group 2 had advanced hilar tumors. Though technical requirements for these operations are higher than for typical bronchoplasty, they provide better quality of life postoperatively and reasonably good outcomes without increasing morbidity. The specialist in general thoracic surgery must make every effort to avoid excessively large resection of lung tissue such as lobectomy or pneumonectomy.     

Supraventricular arrhythmias after resection surgery of the lung.

OBJECTIVE: Two hundred consecutive patients undergoing resection surgery of the lung during 1999 were retrospectively reviewed to define prevalence, type, clinical course and risk factors for postoperative supraventricular arrhythmias (SVA) with particular reference to atrial fibrillation or flutter (AF). METHODS: Records of 200 lung patients were collected and analysed with particular attention to preoperative physiologic values and associated pathologies, lung functional status, electrocardiogram registration, extent of surgical resection of the lung and were also analysed to confirm or exclude correlation between them and postoperative AF; three patients were excluded as they were affected preoperatively by SVA. RESULTS: Forty-five episodes of SVA, 41 of AF were identified in 197 patients (22%) and were more prevalent in several groups of patients such as those with increased age, pneumonectomy and superior lobectomy. Rhythm disturbances were most likely to develop on the second day after surgery. Ninety-eight percent of AF disappeared within a day of discharge and sinus rhythm was restored with digitalis or other antiarrhythmic drugs in all patients except one who was discharged with persistent atrial fibrillation. Arrhythmias were not direct causes of any in-hospital deaths. There is a tendency in the difference of the AF rate between pneumonectomy and upper lobectomy patients versus inferior lobectomy ones, probably related to the different anatomic structure of the proximal trunks of the upper and inferior veins of the lung, respectively. CONCLUSIONS: Statistical analysis revealed that increased age, extent and type of pulmonary resection, such as pneumonectomy and superior lobectomy were significant risk factors. Despite these factors, arrhythmias after lung surgery could be managed easily and were not closely related to higher mortality. Direct cause of AF after lung resection surgery remains unclear; anatomical substrate such as surgical damage to the cardiac plexus or to the proximal trunks of the pulmonary veins covered by myocardial sleeves with electrical properties are to be considered.     

Characteristics of Tumor Extension Requiring Bronchoplasty and Pneumonectomy in Patients with Lung Cancer and Positive Bronchoscopic Findings

Purpose The characteristics of tumor extension determine whether pneumonectomy or lobectomy with bronchoplasty should be performed for central lung cancer. We investigated how the characteristics of tumor extension determined the operative methods and the surgical outcomes. Methods We conducted a retrospective chart review of 151 patients with positive bronchoscopic findings who underwent lung cancer operations between January 1995 and March 2002. Twenty-five patients underwent pneumonectomy, 88 underwent lobectomy/segmentectomy (Lob/Seg), and 38 underwent Lob/Seg with bronchoplasty. Results Pathologic staging was higher in the pneumonectomy group than in the Lob/Seg groups, with or without bronchoplasty (P = 0.002). Interlobar extension and hilar lymph node involvement were more frequent, and mucosal invasion was less frequent, in the pneumonectomy group than in the Lob/Seg with bronchoplasty group. The frequencies of all specific pulmonary complications and 30-day mortality were similar among the three groups. The 5-year overall survival rates were 23.7%, 51.5%, and 72.8% for the pneumonectomy, Lob/Seg, and Lob/Seg with bronchoplasty groups, respectively (P = 0.0004). There was a significant difference in survival between patients with mucosal and those with submucosal types of lung cancer (P = 0.0114). Conclusions Lob/Seg with bronchoplasty was feasible without a higher risk of operative complications or poorer long-term survival. The nature of tumor extension was important in the selection of operative methods and in predicting survival.     

Combined Resection of Great Vessels or the Heart for Non-Small Lung Cancer

Objectives: The surgical indications for non-small cell lung cancer (NSCLC) infiltrating a great vessel or the heart are controversial. We assessed clinical features and surgical outcomes of patients with non-small cell lung cancer who underwent combined resection of a lung and great vessel.Methods: Fourteen patients underwent great vessel resection under a lobectomy (n = 9), sleeve lobectomy (n = 2), or pneumonectomy (n = 3) between 2000 and 2011, in whom the aorta was resected in 6, superior vena cava in 5, right atrium in 1, and left atrium in 2. The histological types were adenocarcinoma (n = 8) and squamous cell carcinoma (n = 6).Results: Complete resection was performed in 12 patients. Of all patients, 7 had pN0 disease, 2 had pN1, and 4 had pN2. The postoperative morbidity rate was 28.6% and mortality rate was 7.1%. The 5-year survival rate was 26.8% for all patients, 46.9% for those with an adenocarcinoma, 0% for those with a squamous cell carcinoma, 53.6% for those with pN0, and 0% for those with pN1-2.Conclusion: Resection of the great vessels and heart involved by NSCLC can be performed with acceptable morbidity and mortality, and results in prolonged survival in patients, with an adenocarcinoma or N0 status.     

支气管加肺血管、上腔静脉联合成形治疗肺癌

目的探讨支气管袖式或楔形切除加肺血管、上腔静脉成形术在肺癌治疗中的应用及效果。方法全组106例肺癌患者,行支气管袖式切除38例,楔形切除59例;支气管肺血管成形99例,支气管上腔静脉成形7例。结果术后发生并发症11例,其中出血1例,支气管胸膜漏1例,肺不张2例,心衰4例,肺部感染3例,无同术期死亡。1、3、5年生存率分别为76．0％、54．0％、32．4％。结论支气管成形加肺血管、上腔静脉成形对扩大肺癌手术指征,缩小切除范围,提高生存质量有重要意义。     

Evaluations of bronchoplasty and pulmonary artery reconstruction for bronchogenic carcinoma.

OBJECTIVE: To evaluate the surgical results of bronchovascular reconstruction and the prognostic factors for lung cancer. METHODS: From 1976 to 1995, 78 patients with a mean age of 55.1 years (range 26-69 years) underwent bronchoplasty for non-small-cell lung cancer (NSCLC) including pulmonary artery (PA) reconstruction in 21 patients. There were 47 right upper lobectomies (60.3%), 24 left upper lobectomies (30.8%), and seven other atypical types of operations (8.9%). The bronchoplasty was a full sleeve in 71 patients, and a bronchial wedge resection in seven. Thirteen PA tangential resections and eight PA sleeve resections were performed. Tissue diagnosis was squamous cell carcinoma in 56 patients, adenocarcinoma in six, adenosquamous carcinoma in ten, neuroendocrine carcinoma in two and others in four. No patient had a microscopically positive bronchial resection margin. The follow up is complete for all patients. Seventy-five patients were statistically analyzed using STATA software. The survival rate was calculated with life table method. Comparisons of the difference of survival rates between groups were made according to the log-rank test. RESULTS: The operative mortality rate (30 days) was 3.8% (3/78). The prolonged atelectasis necessitating repeated bronchoscopy was the most common major complication which occurred in 12 patients (16%). Tumor recurrence around the anastomotic site confirmed by bronchoscopic biopsy was observed in four patients. The overall survival at 5 and 10 years was 48.9 and 38.8%, respectively. The 5- and 10-year survival for patients with stage I disease were 66.1 and 57.5%, and for patients with stage II were 62.8 and 44.2%, respectively. The 3- and 5-year survivals for patients with stage III were 11.1 and 0%, respectively (P = 0.0000). The 5-year survival rates for those with N0 tumor (n = 36) were 63.3%, 53.6% for those with N1 (n = 26), and with no survivors for N2 (n = 13), respectively (P = 0.0000). The 5- and 10- year survival rates with bronchoplasty (n = 54) were 55.0 and 47.8%, and 33.3 and 16.7% with bronchovascular reconstruction (n = 21), respectively (P = 0.0033). Multivariate analysis showed that long-term results were influenced chiefly by nodal stage among five factors of pT, pN, bronchoplasty with or without PA reconstruction, cell types, and postoperative adjuvants (P = 0.004). CONCLUSIONS: Any type of lobectomy with bronchial reconstruction is an adequate cancer operation for both compromised and uncompromised patients especially in patients with stages I and II lung cancer with reasonably good results. Sleeve lobectomy with PA reconstruction may finally be indicated in patients considered compromised because of cardiac or respiratory impairment contraindicating pneumonectomy.     

Extended sleeve lobectomy for interlobar lymph node metastasis invading the bronchus from peripheral lung cancer

Although extended sleeve lobectomy has been used as an alternative to pneumonectomy for the treatment of centrally located lung cancer, the validity of this surgical procedure is unclear in patients with peripheral lung cancer with interlobar lymph node metastasis invading the bronchus. We herein report four patients with peripheral lung cancer in the left lower lobe who underwent extended sleeve lobectomy consequent to interlobar lymph node metastasis. The tumor and metastasized lymph node was extirpated en bloc with division of the main bronchus and upper division bronchus, and those bronchi were anastomosed using the telescope method. All patients were doing well without recurrence. Extended sleeve lobectomy may be applicable to patients with peripheral lung cancer with interlobar lymph node metastasis invading the bronchus to avoid pneumonectomy.     

Clinicopathological study of surgically treated cases of tracheobronchial adenoid cystic carcinoma

Between 1980 and 2007, five patients were pathologically diagnosed as tracheobronchial adenoid cystic carcinoma (ACC). All five patients were women aged 37–67 years. Four tumors were located in the larger airways, and one tumor was located in the peripheral lung. The following operations were done: bronchoplastic procedures in three (carinal resection with doublebarreled carinoplasty in one, sleeve right pneumonectomy in one, sleeve middle lobectomy in one), left pneumonectomy in one, and left upper lobectomy in one. Three of the five patients have survived for 172, 144, and 10 months after surgery, respectively. The best local treatment for ACC of the major airway is considered to be sleeve resection of the trachea or bronchus in an area where airway reconstruction may not be disturbed and to add postoperative irradiation when there is residual carcinoma at the stump. However, it seems controversial to recommend adjuvant radiotherapy in all patients undergoing resection.