Ⅰ期支气管肺泡细胞癌与肺腺癌外科治疗

目的 比较外科手术治疗的Ⅰ期支气管肺泡细胞癌与同分期肺腺癌在流行病学特点、临床表现、影像学特点、手术疗效以及复发转移方面的差异.方法 选取“肺叶切除手术病例登记统计系统”数据库收集的2006年9月至2011年12月北京大学人民医院胸外科完成的全部Ⅰ期支气管肺泡细胞癌手术病例,与同期同手术方法完成的Ⅰ期肺腺癌病例进行回顾性对比研究.结果 排除病理诊断中支气管肺泡细胞癌与腺癌混杂病例,研究共纳入337例,其中支气管肺泡细胞癌39例,肺腺癌298例.两组比较前者女性多见(69.2％对52.0％,P=0.042),年龄年轻(57.4岁对61.8岁,P=0.014),吸烟者比例较低(12.8％对29.9％,P=0.026);胸部CT上表现为磨玻璃样病变者多(35.9％对9.7％,P＜0.001),肿瘤直径小(1.4 cm对2.3 cm,P＜0.001);但在手术方式(全胸腔镜肺叶切除92.3％对95.0％,P=0.752)、手术时间(182.8 min对182.4 min,P=0.973)、术中出血量(188.2 ml对177.1 ml,P=0.700)和并发症发生率(2.6％对14.1％,P=0.076)方面两组无差异;3年无瘤生存率(100％对76.1％,P=0.030)和总生存率(100％对86.1％,P=0.041),Kaplan-Meier生存曲线显示支气管肺泡细胞癌患者均优于肺腺癌患者.结论 Ⅰ期支气管肺泡细胞癌与同分期肺腺癌相比在流行病学特点、临床表现、影像学特点和复发转移方式方面均具有特殊性,胸腔镜肺叶切除加系统淋巴结清扫是其首选合理手术方式,手术治疗预后良好.     

非小细胞肺癌伴巨块型淋巴结转移的外科治疗

目的 总结非小细胞肺癌伴巨块型淋巴结转移的外科治疗经验.方法 回顾性分析2009年27例病理和影像学诊断为非小细胞肺癌伴巨块型淋巴结转移(CT扫描图上淋巴结短径>2cm,长径>5cm)行肺叶或全肺切除加系统性纵隔淋巴结清扫术患者的临床资料.根据巨块型淋巴结的解剖部位分为左上纵隔组、右上纵隔组和肺门组.结果 全组均行根治性手术.无一例术中和住院死亡.肺叶切除19例,其中行肺动脉成形术、支气管成形术和支气管肺动脉双成形术各1例,全肺切除8例,其中2例心包内全肺切除.术后16例无并发症,5例出现心律失常,3例肺不张并发ARDS,1例出现乳糜胸,2例声嘶和包裹性胸腔积液3例.结论 非小细胞肺癌伴巨块型淋巴结转移可争取行根治性手术治疗,但手术难度大,术中可能变换术式,术后出现并发症的概率高.     

直径≤3cm的周围型非小细胞肺癌纵隔淋巴结转移规律的初步研究

目的探讨直径≤3cm的周围型非小细胞肺癌(non-small cell lung cancer,NSCLC)纵隔淋巴结转移的情况,分析早期周围型NSCLC纵隔淋巴结转移的规律。方法 2000年1月1日～2008年12月31日治疗直径≤3cm的周围型NSCLC161例,男89例,女72例,年龄(63.4±10.7)岁,行肺叶切除或肺局限性切除加系统性纵隔淋巴结清扫术,分析其临床特征、病理特点及纵隔淋巴结转移规律。结果全组手术顺利,无死亡及严重并发症发生。肺叶切除153例,肺楔形切除7例,肺段切除1例。全组共清扫淋巴结2456枚,平均每例4.5±1.6组、13.1±7.3枚。术后病理:腺癌99例,鳞癌30例,肺泡细胞癌19例,其他类型肺癌13例。术后TNM分期:ⅠA期50例,ⅠB期62例,ⅡA期6例,ⅡB期10例,ⅢA期33例。N1组淋巴结转移率为23.6%(38/161),N2组转移率为20.5%(33/161),其中隆突下淋巴结转移率为8.1%(13/161),跳跃式纵隔转移率为6.8%(11/161),全组未发现下纵隔淋巴结转移。肺泡细胞癌及直径≤2cm的鳞癌、直径≤1cm的腺癌均无pN2转移。上肺癌发生pN2转移时上纵隔100%(19/19)受累,其中21.1%(4/19)同时伴有隆突下淋巴结转移;下肺癌则除主要转移至隆突下外(64.3%,9/14),还常直接单独转移至上纵隔(35.7%,5/14)。转移的纵隔淋巴结左肺癌主要分布在第5、6、7组,右肺癌主要分布在第3、4、7组。结论对于直径≤3cm的周围型NSCLC,肿瘤直径越大,其纵隔淋巴结转移率越高,肺泡细胞癌、直径≤2cm的鳞癌和≤1cm的腺癌其纵隔淋巴结转移率相对较低;上肺癌主要转移在上纵隔,下肺癌则隆突下及上纵隔均可转移;第5、6、7组淋巴结是左肺癌主要转移的位置,第3、4、7组是右肺癌主要转移的位置,术中应重点清扫。     

3例肺转移癌纵隔淋巴结转移

山东省立医院和阜新矿务局总医院胸外科 1990～ 2 0 0 0年 ,共发现肺转移癌伴纵隔淋巴结转移 3例 ,术前ＣＴ扫描均证实纵隔淋巴结增大 (ｃＮ2 )。术后病理均证实肺和淋巴结为转移腺癌。临床资料见表 1。表 1　病人临床资料一览表性别年龄 原发癌 肺转移部位无病间 隔期 (月 ) 术　式 术中淋巴结 (ｃｍ)摘　除淋巴结生存(月 )女 47乳泉癌右下叶 2 3楔形切除 2第 7组 30女 6 1结肠腺癌右下叶 30肺叶切除 1.5第 3组 11男 70直肠腺癌左上叶 8楔形切除 2 .2第 5组 2 3　注 : 指原发癌根治手术距确诊肺转移癌的时间间隔讨论　肺是全身各部位恶性…     

电视胸腔镜在肺部小结节诊断与治疗中的应用

目的探讨电视胸腔镜技术对早期周围型肺癌诊治的临床意义。方法自2007年1月至2011年1月南京军区福州总医院共施行电视胸腔镜肺部小结节切除手术245例,其中男147例,女98例;年龄(55.8±6.7)岁。行全胸腔镜肺叶切除术160例,术中中转开胸在胸腔镜辅助下经小切口行肺叶切除术23例,肺楔形切除术62例。结果本组无死亡,所有患者均明确病理诊断,确诊率100%。术后住ICU时间1～5(2.6±1.5)d,胸腔引流时间1～8(3.8±1.2)d,术后住院时间5～12(7.9±3.5)d。术后病理诊断:良性病变55例,其中肺炎性假瘤27例,肺结核球13例,肺错构瘤15例;恶性肿瘤190例,其中细支气管肺泡癌116例,腺癌38例,细支气管肺泡癌合并腺癌28例,鳞癌5例;转移癌3例。随访242例,随访时间1～48个月,平均随访21个月,失访3例。55例良性疾病患者远期无并发症发生;187例原发性恶性肿瘤患者,术后未发生肿瘤远处转移,随访至今无死亡患者。结论电视胸腔镜技术有利于早期非小细胞肺癌的诊断,提高手术切除率,改善预后。     

支气管哮喘并发肺癌的联合手术治疗

目的 探讨支气管哮喘患者并发肺癌进行联合手术的可行性。方法 在根治性切除肺部肿瘤的同时,采用肺门神经彻底切断术治疗支气管哮喘。１例右上叶周围型肺癌,行右上肺叶切除、淋巴结清扫的同时作同侧肺门迷走神经和交感神经的彻底切断。另１例左上肺巨大中心型肺癌,行全肺切除后,摘出可保留的左下肺叶,采用自体肺移植技术将其重植于原左肺上叶位置。结果 随访至１９９９年１１月底,２例已分别存活６年８个月及１７个月。术后     

肺癌肾上腺转移切除后5年仍生存1例

肺癌肾上腺转移疗效不好 ,据大宗病例统计 ,中位生存期仅 7个月 ,生存最长也仅 2 0个月 (包括手术切除 ) 〔1〕。我们治疗 1例肺癌术后 4年发现肾上腺转移癌 ,切除治疗后无瘤健在又已 5年 ,报告如下。病人　男 ,6 0岁。 1990年 8月初行右下肺癌手术 ,术前有血性胸水 ,术中未见胸膜转移 ,肿瘤位于右下叶底部 ,直径3ｃｍ ,下肺静脉受侵并有瘤栓凸至左心房内。切除中、下肺叶及 1ｃｍ宽的左房壁 ,清扫纵隔淋巴结。病理报告 :肺中分化腺癌 ,淋巴结无转移 ,右下肺静脉有肿瘤侵及直至根部 ,内有瘤栓 ,支气管切缘及左房切缘无瘤组织。术后 1个月以…     

全胸腔镜下支气管/肺动脉切除成形肺叶切除术治疗中央型肺癌

目的探讨全胸腔镜下支气管/肺动脉切除成形肺叶切除术的可行性及探索性适应证。方法 2016年4~6月对11例中央型肺癌行全胸腔镜下支气管/肺动脉切除成形肺叶切除及系统性淋巴结清扫术,其中3例行右肺上叶支气管袖式切除成形术,7例行右肺上叶支气管楔形切除成形术,1例行左肺上叶支气管楔形切除成形及左肺动脉干侧壁成形肺叶切除。均采用三孔法全胸腔镜下解剖性肺叶切除。支气管成形采用连续缝合法,经主操作孔吻合成形,肺动脉成形采用近远端阻断后,经主操作孔侧壁成形后加固。结果 11例均顺利完成肺叶切除,其中10例支气管切除成形重建,1例同时行肺动脉干成形,均行系统性淋巴结清扫。右肺上叶支气管楔形切除成形手术时间(切皮至缝皮,下同)210~300 min(中位时间240min),右肺上叶支气管袖式切除成形手术时间210~300 min(中位时间270 min),左肺上叶支气管楔形切除成形+肺动脉干侧壁切除成形手术时间260 min。支气管楔形切除吻合时间11~30 min,中位时间15 min;支气管袖式切除吻合时间25~74min,中位时间30 min;肺动脉侧壁成形15 min。术后无吻合口漏、出血、肺不张、肺部感染、刺激性咳嗽、咯血等并发症,无围手术期死亡。术后平均住院5.1 d(4~7 d)。术后病理:鳞癌9例,腺癌1例,神经内分泌癌1例。11例随访2~4个月,未见肿瘤复发转移征象。结论全胸腔镜支气管/肺动脉成形肺叶切除术治疗中央型肺癌安全可行,其探索性适应证为叶、段支气管开口且无明显肺门淋巴结钙化的中央型肺癌。     

全胸腔镜支气管袖式/成形肺叶切除治疗中央型肺癌120例

目的探讨胸腔镜支气管袖式/成形肺叶切除治疗中央型肺癌的安全性、有效性。方法2016年4月~2019年8月我院行胸腔镜支气管袖式/成形肺叶切除治疗中央型肺癌120例,采用三孔法,先行系统性淋巴结清扫,然后行解剖性肺叶切除,最后行支气管切除吻合。结果110例完成全胸腔镜支气管袖式/成形肺叶切除(支气管袖式切除86例,支气管楔形切除成形24例);10例中转开胸(8.3%):肺门叶间淋巴结钙化4例,肿瘤侵犯肺动脉干4例(2例中转为左全肺切除),术中大出血2例。手术时间115~440 min,中位数210 min;出血量50~1000 ml,中位数200 ml。术后平均带管5.8 d(2~34 d),平均住院6.6 d(3~35 d)。术后病理:非小细胞不明类型肺癌2例,鳞癌91例,腺癌13例,混合癌3例(鳞癌为主),神经内分泌癌2例,腺样囊性癌、肉瘤样癌、类癌、肺母细胞瘤、黏液表皮样癌各1例,小细胞肺癌4例。无围手术期死亡,3级以上并发症(Clavien分级)11例(9.2%),包括肺部感染支气管镜吸痰4例(2例呼吸衰竭经历ICU过渡治疗),胸壁皮下气肿行胸腔闭式引流6例,支气管吻合口漏二次手术1例。新辅助化疗后19例中,2例发生3级以上术后并发症(均为皮下气肿置管引流)。113例随访1~41个月,中位随访时间20个月,非肿瘤死亡1例,全身广泛转移死亡11例,Kaplan-Meier生存分析1、2、3年累积生存率分别是98.9%、90.7%、85.4%。结论全胸腔镜支气管袖式/成形肺叶切除治疗包含部分局部晚期的中央型肺癌安全有效,新辅助化疗不额外增加手术风险,值得临床推广。     

肺动脉、支气管成形肺叶切除术治疗中央型肺癌

目的 总结肺动脉、支气管成形肺叶切除术治疗中央型肺癌的临床经验,探讨手术的应用指征及方法,以提高手术疗效和患者的生存率. 方法 自1995年1月至2005年12月,对64例中央型肺癌患者施行肺动脉、支气管成形肺叶切除术,包括袖式肺叶切除术21例,支气管楔形肺叶切除术11例,支气管、动脉双袖式肺叶切除术2例,肺动脉成形(楔形+线形)肺叶切除术30例. 结果 全组无手术死亡.术后发生并发症12例(18.75%),其中肺不张7例次,心律失常7例次,有肺不张、心律失常和肺部感染2例.术后随访64例,随访时间1～5年,随访期间死亡9例,死亡原因为肿瘤远处转移,包括脑、纵隔、颈部淋巴结和全身骨转移.术后1、3、5年的生存率分别为88%、58%和42%,中位生存时间为45.76个月.N0患者(21例) 1、3、5年生存率分别为93%、82%和56%;N1患者(28例)为75%、56%和39%;N2患者(15例)为55%、21%和12% (P<0.01). 结论 肺动脉、支气管成形肺叶切除术扩大了肺癌患者的手术指征,减少了因肺动脉受侵犯而行全肺切除术,提高了患者术后的生存质量.对该类手术,淋巴结转移分期仍然是影响术后生存率的主要因素.     

肺癌跳跃性纵隔淋巴结转移及其廓清的临床研究

目的　总结肺癌跳跃性纵隔淋巴结转移的特点及转移方式 ,为制定合理的纵隔淋巴结廓清范围提供依据。方法　回顾性研究了 1988～ 1999年间 ,系统性纵隔淋巴结廓清术后 ,131例病理证实的非小细胞肺癌伴纵隔淋巴结转移病人的临床资料。结果　发现跳跃性纵隔淋巴结转移 2 3例 (17 5 % ) ,腺癌占绝大多 (82 6 % ) ,多数为周边型肺癌 (74 0 % ) ,T1 和T2 肿瘤占优势 (91 3% ) ,转移部位与原发肿瘤的位置密切相关 ,大多累及区域纵隔淋巴结。结论　肺上叶非小细胞肺癌跳跃性转移多发生在上纵隔 ,下叶肿瘤跳跃性转移多在下纵隔 ;因此 ,在无肺门淋巴结转移时可单独廓清区域性纵隔淋巴结     

N2期非小细胞肺癌的预后因素分析

目的 探讨有纵隔淋巴结转移(N2期)的非小细胞肺癌(NSCLC)的外科治疗疗效及影响预后的因素.方法 回顾性分析1999年1月至2003年5月手术治疗的117例N2 NSCLC患者(男性88例,女性29例,年龄29～79岁)的生存率,分析手术方式(肺叶切除、全肺切除、姑息性切除),病理类型(腺癌、鳞状细胞癌、混合癌、大细胞癌和其他类型),T分期以及术后综合治疗对预后的影响.结果 中位生存期为22个月,3年和5年生存率分别为28.1%和19.0%.年龄、性别、病理类型、围手术期化疗、术后放疗均未见与5年生存率有相关性.肺叶切除者的5年生存率为22.2%,全肺切除者为25.0%,均高于姑息性切除者的9.1%(P=0.001).T4期患者5年生存率为11.1%,低于T1-2期患者的37.5%(P=0.01).COX多因素分析示,手术方式和T分期与5年生存率相关.结论 外科治疗对T1-2 N2期NSCLC是最佳选择.对于T4期患者,由于不完全切除比例大,术前新辅助治疗比率低,手术提高长期生存率的效果有限.     

Surgical treatment of lung cancer with mediastinoscopic positive lymph nodes]

There are no definite criteria for the indication of surgery in lung cancer with mediastinal lymph node involvement. During the past 20 years, 100 patients (76 patients with adenocarcinoma and 24 patients with squamous cell carcinoma) have undergone thoracotomy for lung cancer with mediastinoscopic positive lymph nodes at our hospital. Of these, relatively curative resection was performed on 13 patients. The 5-year survival rate in these 13 patients was 28%, which was significantly higher than the 0% in 42 patients with relatively non-curative resection and the 0% in 26 patients with absolutely non-curative resection. The 5-year survival rate was 9% in both T1 (n = 14) patients and T2 (n = 37) patients. No T3 (n = 21) and T4 (n = 9) patients survived 3 years. The 5 year survival rate in patients with squamous cell carcinoma was 12% and that in patients with adenocarcinoma was 0%, but there was no significant difference. The survival rates of T1 and T2 patients were significantly higher than that of T3 patients (p less than 0.02 and p less than 0.005) respectively. Contralateral mediastinal lymph node metastasis (N3) was observed significantly more frequently in patients with adenocarcinoma (38%) than in those with squamous cell carcinoma (13%), but there was no significant difference in the survival rate. In N2 patients, the survival rate was compared between those with mediastinal nodal involvement of an early stage (N2-1) and those with lymph node metastasis of more advanced stage (N2-2) according to the lobe bearing the primary cancer.(ABSTRACT TRUNCATED AT 250 WORDS)     

Rational lymph node dissection for lung cancer according to the occurrence lobe and histological type]

Between January 1989 and December 1998, 134 cases of squamous cell carcinoma and 244 cases of adenocarcinoma underwent surgical resection of the lung with systematic lymph node dissection in our hospital. The cN diagnosis by CT scan and pN diagnosis were compared. In squamous cell carcinoma pN 2-3 cases were only one patient (2%) out of 60 patients with cN 0, 5 patients (18%) out of 28 patients with cN 1, and 21 patients (46%) out of 46 patients with cN 2-3. On the other hand in adenocarcinoma pN 2-3 cases were 27 patients (14%) out of 193 patients with cN 0, 3 patients (25%) out of 12 patients with cN 1, and 24 patients (62%) out of 39 patients with cN 2-3. The pathways of the lymphatic metastases to the mediastinal nodes were analized in 27 patients with squamous cell carcinoma and 54 patients with adenocarcinoma undergoing systematic lymph node dissection. All patients had histologically proven mediastinal metastasis. Histologically there was no difference in pathways of the lymphatic metastases to the mediastinal nodes. 1. The dominant lymphatic drainage from the right upper lobe flowed into the superior mediastinal nodes. The direct metastatic passages to the superior mediastinal nodes were observed (47%). Subcarinal and inferior mediastinal node involvement was rare (3%). 2. The dominant lymphatic drainage from the middle and the lower lobe flowed into the subcarinal nodes (85%). The involvement of the superior mediastinal nodes occurred in 53% of subcarinal node positive patients on the right side. 3. The dominant lymphatic drainage from the left upper lobe flowed into the subaortic or paraaortic nodes (69%). Subcarinal and inferior mediastinal node involvement was rare (6%). We conclude that subcarinal and inferior mediastinal lymph node dissection is not necessary for upper lobe lung cancers, and that superior mediastinal lymph node dissection can be omitted in middle and lower lobe lung cancers without hilar and subcarinal lymph node involvement, especially in the cases of cN 0.     

A clinical study of small advanced lung cancer with metastasis to mediastinal lymph node

From January 1981 through December 1989, 15 patients with small advanced lung cancer were treated surgically at the Tenri Hospital. In these cases, the diameter of peripheral lung cancer did not exceed 3.0 cm (T1) and mediastinal lymph nodes were proved to be N2 postoperatively by lymph node dissection or sampling. The histological types were as follows: 8 adenocarcinoma, 4 large cell carcinoma, 1 squamous cell carcinoma, 1 small cell carcinoma, and 1 adenosquamous carcinoma. All but one patient were received postoperative chemotherapy and/or radiotherapy. The survival rate was 44.5% at 3 years, and median survival time was 36 months. The mediastinal lymph node metastasis with small peripheral lung cancer (T1N2) was ominous, and it should be said that complete mediastinal lymph node dissection and adjuvant therapy were indispensable to small advanced adenocarcinoma of lung.     

Significant Prognostic Factors for Completely Resected pN2 Non-small Cell Lung Cancer without Neoadjuvant Therapy

Purpose: To identify prognostic factors for pathologic N2 (pN2) non-small cell lung cancer (NSCLC) treated by surgical resection.Methods: Between 1990 and 2009, 287 patients with pN2 NSCLC underwent curative resection at the Cancer Institute Hospital without preoperative treatment.Results: The 5-year overall survival (OS), cancer-specific survival (CSS), and recurrence-free survival (RFS) rates were 46%, 55% and 24%, respectively. The median follow-up time was 80 months. Multivariate analysis identified four independent predictors for poor OS: multiple-zone mediastinal lymph node metastasis (hazard ratio [HR], 1.616; p = 0.003); ipsilateral intrapulmonary metastasis (HR, 1.042; p = 0.002); tumor size >30 mm (HR, 1.013; p = 0.002); and clinical stage N1 or N2 (HR, 1.051; p = 0.030). Multivariate analysis identified three independent predictors for poor RFS: multiple-zone mediastinal lymph node metastasis (HR, 1.457; p = 0.011); ipsilateral intrapulmonary metastasis (HR, 1.040; p = 0.002); and tumor size >30 mm (HR, 1.008; p = 0.032).Conclusion: Multiple-zone mediastinal lymph node metastasis, ipsilateral intrapulmonary metastasis, and tumor size >30 mm were common independent prognostic factors of OS, CSS, and RFS in pN2 NSCLC.     

Validation of pN2 sub-classifications in patients with pathological stage IIIA N2 non-small cell lung cancer

Optimal surgical treatment for patients with stage IIIA N2 non-small cell lung cancer (NSCLC) remains a matter of debate, because of the outcomes. The outcomes may be affected from variations in patterns of lymph node metastasis. As the patterns of lymph node sub-classifications, multiple station metastases of mediastinal lymph nodes (MN2), highest metastasis of the mediastinal lymph nodes (HM), distribution of metastatic nodes (skip N2 or non-skip N2), and clinical (c-) N factor have been cited. We investigated these factors for patients with pathological stage IIIA (pIIIA) N2 NSCLC. We reviewed 121 consecutive patients with pIIIA N2 who underwent complete resection. Age, gender, tumor laterality, histology, lobe location of the tumor, c-T factor, pathological (p-) T factor, c-N factor, MN2, HM and skip N2 condition were used as prognostic variables. Overall five-year survival rate was 41.8%. Based on log-rank testing, c-T factor (P = 0.022), p-T factor (P = 0.0002), c-N factor (P = 0.009), HM (P = 0.019) and skip N2 (P = 0.030) were identified as significantly prognostic. Using these variables, p-T factor, c-N factor and skip N2 showed significance and independence on Cox multivariate analysis. The sub-classification of lymph node metastasis in patients with p-stage IIIA N2 NSCLC has clinical implications for the prognosis.     

Resection of multifocal non-small cell lung cancer when the bronchioloalveolar subtype is involved

OBJECTIVE: Bronchioloalveolar lung cancer is commonly multifocal and can also present with other non-small cell types. The staging and treatment of multifocal non-small cell cancer are controversial. We evaluated the current staging of multifocal bronchioloalveolar carcinoma and the therapeutic effectiveness of resection when this tumor type is involved. METHODS: We reviewed our experience between 1992 and 2000 with complete pulmonary resections for bronchioloalveolar carcinoma. Kaplan-Meier survival curves were calculated from the dates of pulmonary resection. RESULTS: Among 73 patients with bronchioloalveolar carcinoma, 14 patients, 7 male and 7 female with a mean age of 65 years (51-87 years), had multifocal lesions without lymph node metastases. Follow-up was 100% for a median of 5 years (range 2.6-8.5 years). Tumor distribution was unilateral in 9 patients and bilateral in 5 patients. The multifocal nature of the disease was discovered intraoperatively in 4 patients. Nine patients had 2 lesions, 4 patients had 3 lesions, and 1 patient had innumerable discrete foci in a single lobe. Operative mortality was 0. Postoperatively, 10 patients were staged pIIIB or pIV on the basis of multiple foci of similar morphology; 4 patients had some differences in histology (implying multiple stage 1 primaries). The median survival time to death from cancer was 14 months (141 days-5.6 years). The overall 5-year survival after resection of multifocal bronchioloalveolar carcinoma was 64%. Unilateral or bilateral distribution had no impact on survival. CONCLUSIONS: The current staging system is not prognostic for multifocal bronchioloalveolar carcinoma without lymph node metastases. Complete resection of multifocal non-small cell lung cancer when bronchioloalveolar carcinoma is a component may achieve survivals similar to that of stage I and II unifocal non-small cell lung cancer. When bronchioloalveolar carcinoma is believed to be one of the cell types in multifocal disease without lymph node metastases, consideration should be given to surgical resection.     

Pulmonary pleomorphic carcinoma

Pleomorphic carcinoma is a rare primary pulmonary malignancy. We report 2 surgical cases of pulmonary pleomorphic carcinoma. The first case was a 71-year-old male. Chest computed tomography (CT) showed a rapidly growing tumor with irregular density. Transbronchial lung biopsy revealed the tumor to be malignant. Left lower lobectomy was performed. Pathological diagnosis was pleomorphic carcinoma (pT2N2M0, stage IIIA). He died 8 months after surgery due to brain metastasis and mediastinal lymph node metastasis. The second case was a 74-year-old male who complained of bloody sputum. Chest CT showed a tumor with cavity in the right middle lobe. Brushing cytology under bronchofiberscopy revealed atypical cell. Right middle lobectomy and partial resection of the right lower lobe were performed. Pathological diagnosis was also pleomorphic carcinoma (pT2N0M0, stage IB). He has no findings of recurrence nor metastasis 15 months after the operation.