Category: Lung cancer

Bronchoplastic and Bronchovascular Procedures of the Tracheobronchial Tree in the Management of Primary Lung Cancer: ConclusionThe results, including hospital deaths from bronchoplasty, lobectomy, and pneumonectomy, were 40.5% for broncho-plastic cases, and 43.3% for lobectomy cases, and 23.9% for pneumonectomy case. Many reports describe end results of cases for which bronchoplastic procedures and bronchovascular procedures were done.’** Operative mortality of bronchoplastic procedures were 0-and 11.4%. Anastomotic stricture rates were 0-17.0%, while the rate of bronchial fistula was 1-11.4% and that of local recurrence 2-51%. As to operative mortality of bronchovascular procedures, Toomes and Vogt-Moykopf reported 17% among 88 cases and 11.1% in 36 cases with angioplastic procedure only. Many reports described a 30% 5-year survival rate. It is evident that operative curability depends on the extent of lymph node metastasis as well as histologic status in prognosis.
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Results
From 1965 to 1987, bronchoplastic procedures were performed on 111 Japanese patients with primary lung cancer. Of these 111 cases, sleeve lobectomy was performed in 91 cases, including 19 cases in which sleeve lobectomy was done with concomitant resection of the pulmonary artery, and 20 wedge resection cases including 1 case in which wedge resection combined with resection of the pulmonary artery. Age and sex distribution in these 111 cases ranged from 25-76 years, with 103 male and 8 female subjects. These cases are classified by histologic types as 84 cases of squamous cell carcinoma, 13 cases of adenocarcinoma, 5 cases of large cell carcinoma, 3 cases of adenosquamous cell carcinoma, 2 cases of double cancer, 1 unclassified case, 2 cases of carcinoid and 1 case of mucoepidemoid. In terms of pathologic stage, there were 18 cases in stage 1, 19 in stage 2, 62 in stage 3A, 7 in stage 3B, and 5 in stage 4.
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Bronchoplastic and Bronchovascular Procedures of the Tracheobronchial Tree in the Management of Primary Lung Cancer: Operative ProceduresLigation and dissection of the pulmonary vein, mediastinal lymph node dissection, and ligation and dissection of pulmonary artery are carried out. On the right side, the azygos vein is resected. When dissection of the azygos vein is performed, it is done at the side of the superior vena cava to prepare it for use as a cover of the site of the suture line. The pulmonary ligament must be cut so that the lung can be mobilized upward. After placing stay sutures of 3-0 H-Cron at the proximal portion of bronchus and distal side of bronchus, the bronchus is resected. Although the location of the cancer can be determined preoperatively, pathologic examination of the bronchial stump should be made intraoperatively. cfm-online-shop.com
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Decision and Extent of Range to be Resected
For operative determination on range of cancerous invasion in bronchus required to judge whether this procedure is appropriate or not, major subjects are the change on the surface of bronchial mucous membrane observed by endoscopy and the extent of invasion of bronchial epithelium as well as bronchial wall, identified by CT scan, tomography, etc. However, as modes of cancer spread within the bronchus are difficult to identify, in many cases the accurate extent of the invasion is very difficult to confirm. For extent of cancerous invasion of surface of bronchial mucosa, it is appropriate to depend on transbronchoscopical biopsy. It is most important to carry out pathologic examination on bronchial stumps during the operation in every case. When results are positive, additional resection or the second best treatment should be applied. ventolin inhalers
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Bronchoplastic and Bronchovascular Procedures of the Tracheobronchial Tree in the Management of Primary Lung CancerPrice Thomas performed the first sleeve lobectomy in a case of bronchial adenoma in 1947 and Allison the first bronchovascular procedure for bronchial carcinoma in 1952. Paulson and Shaw reported 9 cases of bronchoplasty for lung carcinoma in 1955 as a compromise operation for patients whose pulmonary reserve was inadequate to permit pneumonectomy. After these initial reports many others* were published. Paulson and associates reported 54 cases of bronchoplasty performed in 1970,8% of total lung cancer resection cases. Further, Jensik and associates reported 57 cases of bronchoplasty indicated for lung cancer cases in 1972. Bronchoplasty was already common in the US in these years. …Read the rest of this article

The reason that various investigators differ in their criteria for mediastinal adenopathy is that until recently there have been few defined standards for mediastinal normality at specific mediastinal locations. One site where normal nodes have been analyzed is in the pretracheal retrocaval space. Normal nodes at this site had a mean diameter of 5.5 ± 2.8 mm on a transverse tomographic image in Swiss nationals. Additional work* has established normal node diameters for other mediastinal locations and is presented in Table 2. Lymph node size cannot be an entirely accurate predictor of nodal status, since enlarged nodes can be tumor-free and normal-sized nodes can contain tumor. Recent work has suggested that metastases to normal-sized nodes are not uncommon: in a study from my institution the sensitivity of CT on a node-by-node basis was only 33%. However, sensitivity in detection of presence/absence of mediastinal metastasis in an individual patient is much higher, approximating 80% in our recent study. Thus, although CT is inaccurate in assessing nodal status in any individual node, we believe it has fairly high accuracy in an individual patient.
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Radiologic Staging of Lung Cancer Using CT and MRILung cancer is a major health problem in the United States; it currently is the leading cause of cancer death in men and women over 35 years of age. Despite significant advances in chemotherapy and radiation therapy cure of non-small cell lung cancer is achievable only by surgical resection. Accurate preoperative staging of lung cancer is extremely desirable to select those patients with localized neoplasm for operative therapy. Surgical procedures including mediastinoscopy and mediastinotomy have been developed for staging purposes and have proved useful in selected groups of patients. These surgical staging procedures have reduced the percentage of unnecessary thoracotomies from 40% to 10% or lower in some centers;nevertheless, the procedures have definite limitations and are only 80-85% accurate in mediastinal nodal evaluation. Preliminary experience indicates that these techniques are more accurate when directed by CT to areas of morphologic abnormality. A major limitation of these techniques is the inability to detect extramediastinal spread of lung cancer. This is a significant problem as evidenced by recent reports that unsuspected adrenal masses are present in 10-21% of patients who are evaluated by CT preoperatively for lung cancer. mycanadianfamilypharmacy.net
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