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Query: UMLS:C0729233 (Thoracic)
 6,478 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

The authors describe their experience with the surgical treatment of metachronous homolateral lung cancer by completion pneumonectomy. In the Department of Thoracic Surgery of the National Cancer Institute of Milan, over a period ranging from 1982 to 1996, 30 completion pneumonectomies were performed for local relapses or second primary tumors. The patients submitted to this intervention had a lobectomy as their first operation in 23 cases (77%), a bilobectomy in 4 (13%) and a typical segmentectomy in 3 (10%). Associated with these interventions we performed 2 en bloc chest wall resections and a contralateral wedge resection. Two subjects received neoadjuvant chemo-therapy. Histology revealed squamous carcinoma in 14 cases (47%) and adenocarcinoma in 16 (53%). Seventeen patients (57%) were classified as stage I, 8 as stage II (26%), 4 as stage III (13%) and 1 as stage IV (4%). Four patients received adjuvant chemotherapy and/or radiotherapy. Lung cancer relapse occurred as a single lesion in 27 cases (90%) and as multiple lesions in 3 (10%). We performed 18 right (60%) and 12 left (40%) completion pneumonectomies. In 1 case (4%) a sleeve pneumonectomy was necessary. Associated with these interventions we performed 5 en bloc chest wall resections. The perioperative mortality was 10% and the postoperative morbidity 40%. Histological tests showed 12 squamous carcinomas (40%) and 18 adenocarcinomas (60%). Two patients (7%) had a different histology. Disease was classified as stage I in 13 cases (44%), as stage II in 9 (30%) and as stage III in 8 (26%). Four patients received adjuvant chemotherapy and/or radiotherapy. Two subjects developed a metachronous contralateral tumor (7%). The disease-free interval was 22.70 +/- 14.69 months, with a median value of 17 months (range: 7-53 months). Mean survival after completion pneumonectomy was 49.77 +/- 49.29 months, with a median value of 26.5 months (range: 4-190 months). The 5-year actuarial survival rate, calculated using the Kaplan-Meier method, was 30%. Completion pneumonectomy is a technically very demanding intervention carrying a high risk of morbidity. On the basis of the analysis of our data, we can affirm that mean postoperative survival seems to be satisfactory and to justify this aggressive attitude towards recurrent tumor. We should stress the importance of careful evaluation of indications and precise selection of patients.
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PMID:[Surgery in the treatment of metachronous homolateral non-small cell lung cancer]. 1119 May 46

The authors describe the usefulness of video-assisted thoracoscopic surgery (VATS) in the staging and diagnosis of primary lung cancer. In the Oncological Thoracic Surgery Department of Milan's National Cancer Institute, over the period from January 1995 to January 2000, 46 patients, suspected of having mediastinal lymphadenopathies in the presence of lung cancer, were proposed for a VATS biopsy. Forty-four patients underwent a thoracoscopic lymph node biopsy (95%), while in 2 subjects, in whom pleural metastases were found, the histological diagnosis was established by pleural metastatic nodule thoracoscopic biopsy (5%). A VATS lymph node biopsy was performed in 16 cases at level 5 (35%), in 13 at level 6 (28%), in 9 at level 7 (19%) and in 6 at level 8 (13%). Lymph node biopsies were ipsilateral in 37 patients (80%) and contralateral in 7 (15%). No postoperative complications were observed. Histological examination revealed adenocarcinoma in 23 cases (50%), epidermoid carcinoma in 12 (26%), microcytoma in 8 (17%) and giant-cell lung carcinoma in 3 (7%). Two patients were classified as stage IV (5%), 7 as stage III B (15%) and 21 as stage III A (45%). The subsequent treatment was neoadjuvant chemotherapy for stage III A patients and chemotherapy in association with radiotherapy for stage III B subjects. The patients with microcytoma underwent integrated radiotherapy and chemotherapy and pan-encephalic radiotherapy. Sixteen patients, with negative frozen-section histological findings for mediastinal lymph node neoplastic disease, underwent pulmonary resection after thoracotomy in the same operating session (35%) and were subsequently classified as stages I and II. In conclusion, VATS proved extremely useful in the diagnosis and staging of patients affected by lung cancer with synchronous lymph node enlargement. This procedure allowed the diagnosis of suspect involved mediastinal lymph nodes in all cases thus affected and the exclusion of lymph node disease in patients subsequently treated by lung resection in a single session. The precise staging obtained then made it possible to direct the patients towards the most appropriate form of treatment.
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PMID:[Significance of video-assisted thoracoscopic surgery in the diagnosis and staging of primary pulmonary neoplasms]. 1145 13

Bronchoplastic and reconstructive operations (BPRO) are a major issue in the broad methodological spectrum of thoracic surgery. It is the aim of the study to analyze the indications, operative technique and results of such operations on the basis of experience gained in the Clinic of Thoracic Surgery over a 5-year period. A total of 19 patients (14 men and 5 women) at mean age 50.7 y (range 16 to 70 y) are operated. By histological variant of the tumor operated on, the patients are distributed as follows: carcinoid--4 cases, fibromas--1, squamous cell carcinoma--10, adenocarcinoma--1, bronchoalveolar carcinoma--1, small-cell carcinoma--1 and leiomyosarcoma--one. The reconstructive operations performed include: isolated bronchus resection--2, right upper lobectomy with cuff resection--7, right upper bilobectomy with cuff resection--2, left upper lobectomy with cuff resection--7 (in two instances in conjunction with angioplasty), and left lower lobectomy with cuff resection and angioplasty--one. No intraoperative and perioperative lethality (within 30 days) is recorded. An overweight female patient with diabetes hardly lending itself to compensation develops severe suppuration. In two instances serious concurrent complications necessitate reoperation. Overall postoperative hospital stay--20 days; without the 3 severe complications--12.8 days. One patient dies of brain metastases within 6 months of the intervention. The survivorship term in the remainder varies from 1 year to 4 years 9 months, averaging 31 months. There are no stenoses or granulations of the anastomoses requiring endoscopic treatment. Presumably, BPRO are an adequate therapeutic approach to patients presenting centrally located malignant and benign tumors. The results of their application in the series being examined are estimated as very good.
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PMID:[Plastic and reconstructive surgery of the bronchial tree]. 1148 51

Bronchial resection and anastomosis represents an alternative to the pneumonectomy in patients with severe impairment of pulmonary function and/or other diseases which make such radical surgery too risky. The authors present two clinical cases of right upper lobe lung cancer (a squamous-cell carcinoma and an adenocarcinoma) admitted in the Thoracic Surgery Department of the National Institute of Pulmonology "Marius Nasta" from Jan-March 2001, in which they could not perform pneumonectomy because of unacceptable high risks. In both patients a right upper lobectomy with "sleeve" resection was done, with the anastomosis of right main bronchus to the intermediary one. The clinical, bronchoscopic and functional results were excellent. The literature review also shows very good results of this technique in the surgical treatment of lung cancer. For these reasons, the authors recommend this procedure in all the cases in which it can be technically applied; more than that, the survival rate is similar with other more radical techniques, but without any complications.
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PMID:[The indications of bronchial resection and anastomosis in lung cancer]. 1158 70

The aim of this report was to evaluate the effectiveness of video-assisted thoracoscopic surgery (VATS) in staging, diagnosis, and treatment of lung cancer. Fifty-two patients were scheduled for mediastinal lymph node VATS biopsy at the Oncologic Thoracic Surgery Department of the National Cancer Institute in Milan. Fifty patients underwent lymph nodal thoracoscopic biopsy (96%), whereas for the other 2 patients, histologic diagnosis was done by pleural metastatic nodule thoracoscopic biopsy (4%). We performed 17 lymph nodal biopsies in level 5 (33%), 14 in level 6 (27%), 12 in level 7 (23%), and 7 in level 8 (13%). No postoperative complications were observed, and 19 subjects (36%) underwent open lung resection. The histologic diagnosis was adenocarcinoma in 25 cases (48%), epidermoid carcinoma in 14 (27%), microcytoma in 9 (17%), and giant-cell lung carcinoma in 4 (8%); 10 patients were at stage I (19%), 9 at stage II (17%), 31 at stage III (60%), and 2 at stage IV (4%). The use of VATS allowed diagnosis of the suspected involved mediastinal lymph nodes in lung cancer patients and obviated the need for painful thoracotomy, enabling accurate staging and thus selection of the optimal treatment.
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PMID:Video-assisted thoracoscopic surgery for diagnosis, staging, and management of lung cancer with suspected mediastinal lymphadenopathy. 1194 96

Morbidity of lung cancer in Lithuania is increasing. Early diagnostics of this disease is important, difficult and necessary. During 2001, 169 patients with first and second stages of lung cancer were treated in Department of Thoracic Surgery at Kaunas Oncology Hospital. Age of patients was 30-80 years. We have analysed 20 patients with small peripheral lung tumors. Diagnosis was not confirmed by X-ray and fibrobronchoscopic examination. Percutaneous transthoracic fine needle aspiration of small lung tumors was determined by computed tomography (CT) examination. The diameter of tumors were 2.5-4.5 cm. After percutaneous transthoracic fine needle aspiration the diagnosis of lung cancer was confirmed to 15 (70.5 perc.) patients: carcinoma planocellulare - 13, Adenocarcinoma - 2 patients. Metastasis (solitary) from carcinoma renis to 1, abscessus pulmonis (necrotic masses) to 2, tuberculoma (tuberculosis) to 1 patients. After CT examination, percutaneous transthoracic fine needle aspiration and histologic examination diagnosis were confirmed: Carcinoma pulmonis stage I (T1N0M0-T2N0M0) to 5 patients, Carcinoma pulmonis stage II (T2N1M0-T3N0M0) to 9 patients, Carcinoma pulmonis III (T2N2M0) to 1 patient. There were 3 complications after percutaneous transthoracic needle aspiration: hemorrhage in tumor place to 2 patients, local pneumothorax to 1 patient. In all cases when we can not confirm diagnosis of small peripheral lung tumors we have to do CT examination and percutaneous transthoracic fine needle aspiration.
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PMID:[Percutaneous transthoracic fine needle aspiration of lung tumors by computed tomography examination]. 1256 Jun 20

A Domestic Shorthaired cat was presented with coughing and severe respiratory distress. Thoracic radiographs revealed a lobar mass and numerous additional cavitated intrapulmonary masses. The cat was euthanized and submitted for necropsy. Histological examination of the large mass revealed 2 distinct neoplastic components consisting of bronchial adenocarcinoma admixed with neoplastic areas composed of highly atypical undifferentiated spindle cells (sarcomatous component). Simultaneous expression of vimentin and cytokeratin by a subpopulation of neoplastic epithelial cells and by rare neoplastic spindle cells was identified. On the basis of histology and immunohistochemical results, a diagnosis of primary pulmonary carcinosarcoma with intrapulmonary epithelial metastases was made. Pulmonary carcinosarcoma is a well-known pathological entity in humans. It is a rare tumor in animals and has not been previously reported in cat.
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PMID:Pulmonary carcinosarcoma in a cat. 1266 29

A case of peripheral arterial tumor embolization in a cat is described. The cat presented with signs of aortic thromboembolism, including decreased peripheral pulse quality, pallor, and coolness of the distal limbs, as well as proprioceptive deficits. Thoracic radiographs revealed a cavitary lung mass; echocardiography was unremarkable. Cytologic evaluation of aspirates of the mass suggested malignancy. The left hindlimb was amputated, and histopathology confirmed embolization of an adenocarcinoma. Although rare, peripheral arterial tumor embolization should be considered as a differential in cats presenting with signs of thromboembolic disease.
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PMID:Ischemic neuromyopathy due to peripheral arterial embolization of an adenocarcinoma in a cat. 1462 6

Lung cancer is one of the most common cancers and its associated mortality continues to rise in Japan. The lung cancer cure rate is still very low. To improve the survival of patients with lung cancer, well-designed and well-conducted clinical trials are essential. Several Japanese study groups have been conducting clinical trials for lung cancer. However, most randomized phase III studies were conducted by the Japan Clinical Oncology Group (JCOG), the West Japan Thoracic Oncology Group, and pharmaceutical companies supporting temporarily organized groups. In the past decade, the quality of Japanese clinical studies has improved tremendously. The results of JCOG9511 have recently been reported; and demonstrated that treatment with irinotecan/cisplatin significantly improved patient survival in extensive-stage small-cell lung cancer over standard etoposide/cisplatin, with less myelosuppression. A randomized phase II study using gefitinib (ZD1839; Iressa) for non-small-cell lung cancer was also recently reported and showed a high response rate against platinum-refractory lung cancer, especially in adenocarcinoma and in females. A 4-arm multicenter, randomized cooperative phase III study for advanced non-small-cell lung cancer is currently underway.
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PMID:Results of recent Japanese clinical trials in lung cancer. 1466 31

A 79-year-old man, who had an occupational history of handling rushes (which were treated with pigmented earth containing 25% silica) for 30 years and a past history, eight years earlier, of primary pulmonary adenocarcinoma in the left lower lung (T2N2M0), was admitted to our hospital for the investigation of two nodular shadows in the right upper S3 which showed a double lesion detected on chest CT. A histological diagnosis of pulmonary adenocarcinoma was obtained by bronchoscopic examination, and so he was transferred to the Department of Thoracic Surgery and video-assisted thoracoscopic surgery (VATS) was performed. Subsequently, the large part of the tumor, in the central region, was diagnosed as a pulmonary adenocarcinoma, and the smaller part of the tumor, in the peripheral region, was found to consist of an adhesion of small nodules composed of pneumoconiosis due to the rushes. Multiple small nodules consisting of rush pneumoconiosis were histologically recognized surrounding this smaller part of the tumor. Although, at admission, we first suspected the presence of multicentric, metastatic lung cancer and an inflammatory tumor, the patient's occupational history also proved to be important, and we could not decide on the appropriate diagnosis before VATS because multiple small nodules consisting of rush pneumoconiosis overlapped the tumor.
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PMID:[A case of pulmonary adenocarcinoma coexistent with Igusa pneumoconiosis in one segment of the lung]. 1522 44


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