Panpleuropneumonectomy for primary lung cancer patients with pleural dissemination]

Twelve patients of non-small cell lung cancer with carcinomatous pleuritis were subjected to panpleuropneumonectomy between June 1981 and December 1988. The median survival time was 13 months. One-year and 3-year survival rates were 52% and 26%, respectively. There was no significant difference in prognosis compared with the results of other modality therapies such as pleurodesis with talc and tube drainage for pleural effusion. After panpleuropneumonectomy the patients were divided into the group with only pleural dissemination and the one with pleural effusion. The median survival time in the group of pleural dissemination was 14 months. The three-year survival rate was 50%. The one patient survived for 51 months and the other for 45 months. The median survival time of patients with pleural effusion was 4 months without over 1-year survivor. The statistically significant difference was found between the two groups (p less than 0.05). We concluded that panpleuropneumonectomy is indicated only for the patients of non-small cell lung cancer with diffuse pleural dissemination and no pleural effusion.     

Surgical results of small sized (less than 3 cm) advanced lung cancer]

We studied the surgical results in 31 patients with small sized but advanced lung cancer. Twenty-two patients had mediastinal lymph node metastasis, 6 had pulmonary metastasis, 3 had pleural dissemination. Histological type were adenocarcinoma in 21 patients, large cell carcinoma in 5 patients, small cell carcinoma in 4 patients. The 5-year survival rate in patients with mediastinal lymph node metastasis (pT1N2) was 24.1%. The 5-year survival rate in patients (pT1N2) for clinical N0, N1 was 34.6%, but no patient with clinical N2 disease survived more than 2 years after the operation. In the patients with pulmonary metastasis or pleural dissemination none survived more than 5 years after the operation.     

Two cases of thymic carcinoma effectively treated by preoperative chemotherapy

A 67-year-old man was admitted with left pleural effusion on chest X-ray film. Chest CT scans showed an anterior mediastinal tumor, left pleural dissemination and pleural effusion. Percutaneous needle biopsy yielded a diagnosis of epitherial carcinoma. The patient underwent 3 courses of systemic chemotherapy (CDDP + ADM + VCR + CPA). At achievement of partial response, the tumor was completely resected. Examination of the resected tumor revealed partial response to chemotherapy. A 49-year-old woman was admitted our hospital with supraclavicular lymph nodes swelling. Chest CT scans showed an large mediastinal tumor. Percutaneous needle biopsy yielded a diagnosis of squamous cell carcinoma of thymus. The patient underwent 3 courses of systemic chemotherapy. At achievement of partial response, the tumor was completely resected. Examination of the resected tumor revealed partial response to chemotherapy. These cases indicate the usefulness of preoperative chemotherapy for advanced thymic carcinoma to reduce tumor size and to control local invasion, distant metastasis before operation.     

Thymic carcinoma with dissemination: a retrospective analysis of ten patients

OBJECTIVE: Thymic carcinoma is a rare mediastinal neoplasm with frequent pleural or pericardial dissemination. We retrospectively studied ten such cases and analyzed factors that influenced the survival of the patients. METHODS: Ten thymic carcinoma patients with dissemination have been treated since 1987. The clinical and pathological data were retrospectively reviewed. RESULTS: Pretreatment tumor biopsy was performed and demonstrated squamous cell carcinomas in nine and small cell carcinoma in one. In six of ten patients pleural or pericardial dissemination was clinically evident (cT4). These patients were basically regarded as inoperable and treated with chemotherapy and/or radiotherapy. Four other patients were diagnosed as cT3 preoperatively but were found to have dissemination at the time of thoracotomy. They underwent total resection of the thymic tumor and all visible pleural dissemination but without pericardial dissemination. Radiotherapy was performed pre-or postoperatively with or without chemotherapy. The 5-year survival rate in all patients was 42.0%. The patients with Masaoka stage IVa showed significantly better prognosis than the patients with stage IVb (MST, 69.7 months vs. 14.5 months; 5-year survival rate, 64.3% vs. 0%) (P = 0.03). The patients with cT3 disease showed significantly better prognosis (P = 0.016) than the patients with cT4 disease (MST, 69.7 months vs. 14.5 months; 5-year survival rate, 100% vs. 16.7%). CONCLUSIONS: Among thymic carcinoma patients with pleural or pericardial dissemination, there seem to be some patients who show good prognosis. These candidates are patients who underwent subtotal resection with disseminations that were identified only at the operation and without hematogenous or lymphogenous metastasis.     

Acceptable definition of peripheral early lung cancer

This study was conducted to evaluate the outcome of 88 patients who underwent surgical resection for peripheral non-small cell lung cancers less than 20 mm in diameter. Twenty-one cases with lesions smaller than 10 mm had no lymph node metastasis, intrapulmonary metastasis, pleural dissemination, or distant metastasis. The 5-year survival rate of them was 100%. However, 67 patients with tumors larger than 10 mm showed lymph node metastasis in 14 cases, intrapulmonary metastasis in 3, pleural dissemination in 2 and distant metastasis in 1. And the 5-year survival rates of patients with tumor dimensions of < or = 15 mm and < or = 20 mm were 77.9% and 74.4%, respectively. In addition, patients having adenocarcinoma categorized A and B by Noguchi's classification had no lymph node metastasis, intrapulmonary metastasis, pleural dissemination, or distant metastasis, and showed 100% of 5-year survival rate. To be defined as early cancers in terms of curability, it is thought that the 5-year survival rate of the patients with them is over 95%. Therefore, these results suggest that tumors smaller than 10 mm or adenocarcinoma less than 20 mm in diameter diagnosed as Noguchi's A and B are considered as peripheral early lung cancers.     

Study of surgical treatment of advanced small lung cancer

We analyzed 15 patients with small but advanced primary lung cancer operated from 1965 to 1988. The size of tumors were less than 2.0 cm in largest dimension and their pathological stages III A, III B and IV. The histological types were adenocarcinoma in 13 cases and squamous cell carcinoma in 2 cases. Nine patients (69%) had elevated levels of preoperative serum CEA. The prognosis of patients with intrapulmonary metastases was better than that of those with pleural dissemination. In adenocarcinoma patients with mediastinal lymph node metastases, the survival rate of cases with small cancer less than 2.0 cm in diameter was higher than those with large cancer more than 5.0 cm in diameter.     

Resected cases of middle lobe primary cancer

Of 200 lung cancer lesions resected in our hospital, there were 15 cases (7.5%) with middle lobe origin. The histological types were adenocarcinoma in 13 patients (4 patients with alveolar cell carcinoma), squamous cell carcinoma in one and large cell carcinoma in one. These patients were classified into two groups according to the type of operation they received and each group was evaluated. Group I (resection of the middle lobe) included 8 patients. Each one of Stage IIIB and Stage IV received the operation to improve their symptoms. The six patients of Stage I received only middle lobectomy as absolute curable cases. Group II (resection of the middle and lower lobes) included 7 patients, who had preoperative diagnosis of stage III. Two of them were postoperatively found to be cases of Stage I and Stage II. Although it was still short-term, the follow-up evaluation proved that these patients survived without local recurrence and distant metastasis, except for two with pleural dissemination and one with cerebral metastasis, who had received lobectomy as palliative operation. No difference was observed between the two groups receiving different types of operation.     

Prognosis of patients after resection for lung cancer with intrapulmonary metastasis in different lobes

BACKGROUND: The prognosis of lung cancer patients with intrapulmonary metastasis in different lobes (pm2) is poor. However, some patients achieve long-term survival. We retrospectively investigated the prognosis of resected primary lung cancer patients with pm2. METHOD: Among 845 patients with primary lung cancer who underwent complete resection from 1984 to 2003, 14 cases that had lung cancer with pm2 were evaluated about prognostic factors. RESULTS: The overall 5-year survival rate was 9.5%. The analysis of survival curve based on clinicopathological factors (surgical procedure, histology, tumor size, lymph nodal metastasis, pleural invasion, pleural dissemination and number of pm2) revealed that bronchioloalveolar carcinoma (BAC), the absence of pleural invasion and the absence of pleural dissemination are better prognostic factors. CONCLUSION: Lung cancer patients with pm2 whose lesions show BAC histology, the absence of pleural invasion or pleural dissemination may achieve long-term survival and could be candidates for surgical treatment.     

106例肺癌合并胸腔积液患者临床分析

目的总结和分析肺癌合并胸腔积液的特点,加强认识,提高诊治水平。方法分析106例在笔者所在科室经病理诊断确诊为肺癌合并胸腔积液患者的资料。结果 106例患者中,45岁以上89例（83.9%）;腺癌50例（47.2%）,鳞癌29例（27.4%）,小细胞癌12例（11.3%）,大细胞癌8例（7.5%）,类癌3例（2.8%）,其他病理类型4例（3.8%）;大量胸腔积液47例（44.3%）,中量36例（33.9%）,少量23例（21.7%）;痰液细胞学检查首诊的患者17例（16.1%）,X线胸片首诊的27例（25.5%）,经胸部CT首诊的41例（38.7%）;右侧积液59例（55.7%）,左侧积液31例（29.2%）,双侧积液16例（15.1%）;渗出液97例（91.5%）,漏出液9例（8.5%）;血性积液83例（78.3%）,非血性23例（21.7%）。结论对胸腔积液患者全面检查,分析积液性质,可提高肺癌确诊率。     

Histological appearance of carcinoma of the upper bile duct and the mode of its spread

The histopathology of 34 resected cases of carcinoma of the upper bile duct was reviewed in relation to its mode of spread and prognosis of the patients. The patients with papillary adenocarcinoma showed 3-year survival rate of 75 percent which was better than those with carcinoma of other histologic types. There were no 2-year survivals in patients with poorly differentiated adenocarcinoma. Infiltration to the serosa of the bile duct and to the liver, lymph node metastasis, and venous, lymphatic or perineural invasion of carcinoma were thought to be important prognostic factors, since the chance for survival was definitely better for patients without those factors than with those factors. In four patients with papillary adenocarcinoma, no involvement of hepatic parenchyma and lymph node metastasis was found. Three of these patients had no cancer infiltration to the serosa of the bile duct. Most cases of poorly differentiated adenocarcinoma, in contrast, had positive and extensive association of those prognostic factors. Seventy-five percent of patients with papillary adenocarcinoma and only 22 percent of those with poorly differentiated adenocarcinoma were microscopically considered curable by resection. It is noteworthy that histological appearance of carcinoma may be valid as a fundamental factor to determine mode of spread of carcinoma of the upper bile duct and prognosis of the patients.     

A clinical analysis of small-sized lung cancer with advanced disease

A clinical analysis of small-sized lung cancers with advanced disease was conducted on a total of 58 patients: 34 diagnosed as T1N2, 6 as T1N3, 9 as T1M1, and 9 as T4 due to pleural dissemination. The cumulative 5-year survival rate after surgery for the 34 patients with a T1N2 lesion was 17.4%. Of these 34 patients, 24 underwent a curative operation resulting in a 5-year survival rate of 23.7%, but the remaining 10 patients, who underwent a non-curative operation, had a 5-year survival rate of 0%. Extended lymph node dissection for N3 disease has only been performed in recent years, so it is not yet clear whether it will affect the survival rate or not. T4 disease due to pleural dissemination and T1M1 disease associated with intrapulmonary metastasis encountered at thoracotomy could be expected to have relatively long-term survival with the combined use of systemic immunochemotherapy after surgery. In cases diagnosed as T4 due to pleural dissemination, we have recently employed resection of the primary lesion with parietal pleurectomy as the standard operative procedure. For cases of T1M1 with intrapulmonary metastasis confined to the same lobe as the primary lesion, a lobectomy is usually performed, while for cases with intrapulmonary metastasis extending to another lobe, a lobectomy with enucleation of metastatic nodules or pneumonectomy is most often performed instead of an exploratory thoracotomy.     

Postoperative recurrence of the patients with the stage I, II non small cell lung cancer

The study population consisted of 42 patients with squamous cell carcinoma and 46 patients with adenocarcinoma of stage I, 12 patients with squamous cell carcinoma and 7 patients with adenocarcinoma of stage II lung cancer who underwent curative surgical resection. Local recurrence and metastasis was not significant in both histological types in stage I, II. Lung and bone metastasis was dominant in the both cases of squamous cell carcinoma, adenocarcinoma and brain metastasis in the cases of adenocarcinoma. Concerning the period to first recurrence following the operation, the recurrences of stage I squamous cell carcinoma occurred 28% within 1 year after surgery, 28% during 1-2 years after surgery and those of stage II squamous cell carcinoma occurred 11% within 1 year. On the other hand, the recurrences of stage I adenocarcinoma occurred 25% within 1 year, 31% during 1-2 years, 25% over 2 years after surgery and those of stage II adenocarcinoma occurred 13% within 1 year. In the cases with squamous cell carcinoma, the 5-year survival rate (56%) of stage I was not significant compared with those (59%) of stage II. On the other hand, in the adenocarcinoma, the 5-year survival rate (54%) of stage I was significantly better than those (29%) of stage II (p less than 0.05).     

Clinical study on adenocarcinoma of the prostate

In 92 patients with prostatic carcinoma who were treated at the Takamatsu Red Cross Hospital from January 1976 to December 1985, we analyzed the age, chief complaint, degree of advancement, grade of tumor, way of therapy and prognosis. The age of the patients was between 51 and 87 years (mean: 74.8 years). The most frequent chief complaint was dysuria. In terms of the degree of advancement, 14 cases were assessed as Stage A, 23 cases as Stage B, 16 as Stage C and 39 as Stage D. Analysis of the grade of tumor disclosed that 38 cases (41.3%) had well differentiated adenocarcinoma, 20 cases (21.7%) had moderately differentiated adenocarcinoma and 29 cases (31.5%) poorly differentiated adenocarcinoma. Forty-four of the subjects have already died. The 5-year survival rate was 41.2% when calculated pursuant to life table method. The 5-year survival rate was 85.7% for Stage A, 36.1% for Stage B, 53.4% for Stage C and 24.3% for Stage D. The 5-year survival rate was 54.7% for well differentiated adenocarcinoma, 61.7% for moderately differentiated adenocarcinoma and 12.7% for poorly differentiated adenocarcinoma. Comparison of the 3-year survival rate among the 4 ways of therapy revealed only a small intergroup difference; namely, the rate was 58.5% for hormone therapy, 51.6% for intraarterial neocarzinostatin therapy, 77.1% for total prostatectomy and 57.1% for radiation therapy. These results indicate that our way of chemotherapy, which chiefly employs intraarterial administration of neocarzinostatin as an induction therapy, is at least comparable or superior to hormone therapy in terms of efficacy.     

电视纵隔镜手术128例

目的探讨电视纵隔镜检查术（video-mediastinoscopy，VM）在肺癌术前分期、纵隔肿物诊断和恶性胸腔积液诊治中的价值。方法采用全麻单腔螺纹气管插管，48例行颈部纵隔镜术，33例行胸骨旁纵隔镜检查术，47例行经肋间纵隔镜术。结果125例经电视纵隔镜术后确诊：肺腺癌38例，肺转移性低分化鳞癌33例，结核9例，淋巴结炎症8例，肺小细胞癌7例，胸腺鳞状细胞癌6例，非霍奇金淋巴瘤5例，纵隔神经母细胞瘤4例，胸腺瘤4例，胸膜间皮瘤3例，霍奇金淋巴瘤2例，后纵隔神经鞘瘤2例，结节病1例，胸腺增生1例，类癌1例，中纵隔原始神经外胚叶肿瘤1例。1例电视纵隔镜检查纵隔淋巴结为反应性增生，行左下肺叶切除，病理为鳞癌。2例术前纤维支气管镜病理确诊左下肺鳞癌，电视纵隔镜检查右气管旁淋巴结转移。术中发生气胸1例、出血1例、喉返神经麻痹和切口感染各2例。结论电视纵隔镜术不但是肺癌术前病理分期、纵隔疾病的重要检查方法，而且也是诊治恶性胸腔积液的简便方法。     

局限性胸膜肺切除术治疗伴癌性胸水非小细胞肺癌的远期结果

目的　评估局限性胸膜肺切除术治疗伴癌性胸水非小细胞肺癌的远期效果和应用价值。　方法　对1994年 1月至 1998年 12月间采用该术式治疗的 16例伴癌性胸水肺癌患者进行定期随访 ,了解患者生活质量、复发情况和生存时间。计算术后中位数复发和中位数生存时间。　结果　本组无手术死亡 ,无严重手术并发症。术后胸闷、呼吸困难、胸腹壁疼痛症状明显缓解 ,恶病质迅速消失 ,未见胸水复发 ,但后期均发生远处脏器转移。术后肿瘤复发距手术时间 3～ 36个月 ,中位数复发时间 12个月。随访至 2 0 0 0年 8月 ,所有病例死亡 ,存活期 7～ 39个月。存活 1年以上 15例 ,1年生存率 94% ;存活 18个月以上 13例 ,生存率 81% ;存活 2年以上 7例 ,生存率 44 % ;存活 3年以上 2例 ,生存率 13% ;中位数生存期 2 1.5个月。　结论　此术式控制胸水、缓解症状效果肯定。术后晚期均发生远处脏器转移 ,但其中位数生存期明显长于仅做姑息性肺内癌灶切除或内科治疗患者 ,且长于全胸膜肺切除术。本术式有推广应用价值     

Colorectal cancer in a patient younger than 20 years of age: Report of a case and a review of the Japanese literature

This article presents a case of advanced cancer of the transverse colon seen in an 18-year-old woman who underwent a potentially curative resection. The histological type of cancer was well-differentiated adenocarcinoma. After reviewing the clinicopathological features of 110 colorectal cancer cases in patients younger than 20 years of age compiled from the Japanese literature, the high incidence of poorly differentiated carcinoma (51.5% for poorly differentiated adeno-carcinoma, signet-ring cell carcinoma, mucinous carcinoma, and undifferentiated carcinoma) and of more advanced stages (67.1% for clinical stages IIIb and IV) were found to be characteristic for patients with colorectal cancer younger than 20 years of age. The presence of more advanced disease and the high incidence of poorly differentiated carcinoma thus seem to be related to the low postoperative survival rates. The 2-year survival rate was 19.8% and the 5-year survival rate was 8.8% in colorectal cancer patients younger than 20 years of age.     

A study of lung cancer with presence of pleural effusion at the time of thoracotomy--cytologic evaluation of a relatively small amount of pleural effusion and prognosis after removal

The cytologic evaluation of a relatively small amount of pleural effusion in lung cancer at the time of thoracotomy has not been previously considered, and prognosis after removal has not been clarified. In order to clarify these points, 99 cases of removed lung cancer with presence of pleural effusion at the time of thoracotomy were examined following cytology. Our study was conducted with regard to the amount and nature of pleural effusion, pleural effusion cytology, tumor development and its relation to prognosis. On the basis of this study a formula was developed relating the occurrence rate of cytologically positive pleural effusion with the development of tumor employing multivariate analysis, specifically the multiple regression analysis. 21% of these cases showed cytologically positive pleural effusion, indicating an absence of its correlation to the amount of pleural effusion; the conducting of cytology regardless of the amount of pleural effusion was found to be significant in determining the precise stage. The occurrence rate of cytologically positive squamous cell carcinoma was significantly few compared with those in other cell types. Regarding the pleural effusion of a relatively small amount, the prognosis after removal showed a relatively high three-year survival rate of 32% for those cases with negative pleural metastasis despite the positive showing of pleural effusion cytology, indicating the viability of surgery. From the occurrence rate of cytologically positive pleural effusion (Y) and the degree of pleural metastasis (X1)/the degree of pleural invasion (X2)/the degree of lymph nodes metastasis (X3), the following formula was obtained employing multiple regression analysis: Y = 0.344X1 + 0.050X2 + 0.034X3 + 0.075 (proportion 0.840).(ABSTRACT TRUNCATED AT 250 WORDS)     

腹腔镜肝切除治疗肝细胞癌的安全性和长期疗效观察

目的 探讨腹腔镜肝切除治疗肝细胞癌的安全性及长期疗效。方法 回顾性分析2014年1月至2019年12月间在佛山市第一人民医院诊治的197例肝细胞癌患者的手术时间、中转开腹率、术中出血、术中输血量及术后并发症等围术指标,术后平均住院时间、肿瘤复发率、无瘤生存率,术后1、3、5年总的生存期等数据。结果 术中出血量为263.59±252.9 mL,手术时间为320.5±119.56 min。无围手术期死亡病例,术后发生腹腔积液9例（4.6%）,胸腔积液9例（4.6%）,胆漏3例（1.5%）,术后出血4例（2.0%）,术后肺炎2例（1.0%）,术后总并发症发生率为13.7%(27/197)。术后住院时间为8.9±3.63天。随访至2021年6月1日,共有67例患者肿瘤复发,无瘤中位生存时间为78个月,复发率34%。术后1、3、5年无瘤生存期分别为84.2%、65.2%、59.4%。术后1、3、5年总生存期分别为96.3%、86.8%、83.6%。结论 腹腔镜肝切除治疗肝细胞癌是安全可行的,长期疗效与开腹肝切除无明显差异。     

The significance of intraoperative pleural effusion during surgery for bronchogenic carcinoma.

OBJECTIVES: To analyze patients submitted to thoracotomy for lung carcinoma presenting with an intraoperative pleural effusion (PE). METHODS: From 1993 to 1999, 1279 patients received thoracotomy with curative intent for primary lung carcinoma. Intraoperatively, 52 patients (4%) presented a PE >100ml which was not diagnosed preoperatively. Of these, seven patients had received preoperative transthoracic fine-needle biopsy FNB and were excluded from the analysis. In the remaining 45 patients pleural fluid cytology was undertaken. In patients with cytology-negative PE, clinico-pathologic characteristics including intratumoral vascular invasion, intratumoral perineural invasion, peritumoral lymphocytic infiltrate, visceral, parietal and mediastinal pleural involvement, pTNM and survival were analyzed and compared with our total population of lung cancer patients operated on during the same period. RESULTS: The mean amount of collected fluid was 210ml (100-450ml). Of the 45 patients with intraoperative PE, 16 (35%) received exploratory thoracotomy because of pleural carcinosis or major involvement of mediastinal structures; eight (18%) received resection of the tumor, although the cytologic examination of the pleural fluid eventually resulted positive for neoplastic cells. Median survival for the two groups was 6 and 9 months, respectively. Twenty-one patients (47%) received resection of the tumor with a cytology-negative pleural fluid. In this group, analysis of clinico-pathologic characteristics revealed that squamous cell type and mediastinal pleural involvement were significantly associated with the presence of intraoperative PE (P=0.01 and P=0.05, respectively); 3- and 5-year survivals of this group were similar to those observed in our total population of resected lung cancer patients (68 and 56% vs. 54 and 42%, P=0.27). CONCLUSIONS: The presence of a PE at thoracotomy during surgery for lung carcinoma is an infrequent occurrence. In more than 50% of the cases cytology is positive and prognosis is poor. In the remaining cases, however, cytology is negative and the PE should be considered as reactive; in these patients a curative resection can be accomplished with an anticipated chance of long-term survival.     

Survival and prognostic factors of surgically resected T4 non-small cell lung cancer

BACKGROUND: Category T4 nonsmall cell lung cancer (NSCLC) encompasses heterogenous subgroups. We retrospectively analyzed the survival of patients with surgically resected T4 NSCLC to evaluate the evidence for prognostic implications according to the subgroups of T4 category, nodal status, and resection completeness. METHODS: Seventy-six patients with T4N0-2M0 NSCLC were divided into three subgroups within the T4 category: 24 patients with the tumor invading the mediastinal organs (mediastinal group), 16 with a malignant pleural effusion or dissemination (pleural group), and 36 with satellite tumor nodules within the ipsilateral primary tumor lobe (satellite group). Complete resection was possible in 47 patients (61.8%). The pathologic N statuses were N0 in 28, N1 in 13, and N2 in 35 patients. RESULTS: The overall survival of the 76 patients was 19.1% at 5 years. The overall 5-year survivals according to the three subgroups of the T4 category were as follows: mediastinal group, 18.2%; pleural group, 0%; and satellite group, 26.7% (mediastinal/satellite versus pleural, p = 0.037). Factors significantly influencing the overall 5-year survival were the pathologic N status (N2 versus N0-1, p = 0.022) and the completeness of resection (complete versus incomplete, p = 0.0001). A multivariate survival analysis demonstrated that the pathologic N status and the completeness of resection were significant independent predictors of a poorer prognosis even after adjusting for the subgroup of the T4 category. CONCLUSIONS: Resectable T4N0-1 NSCLC that is not due to pleural disease deserves consideration of aggressive surgical resection with expected 5-year survival of about 20%.