[Surgical indications in small cell bronchial cancer].
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Carcinoma, Bronchogenic↗
Biomedical subjects
T Naruke
Publications and source records attributed to T Naruke.
[Lung cancer screening--present status and the problems].
For the counter measure having been indicated against increasing mortality rate in lung cancer cases, indication of lung cancer screening was started in 1987 in line with the law of insurance established for old aged people. In order to decrease the death rate in cases with lung cancer, methods of the counter measure were established for early detection of lung cancer by Chest X-ray and sputum cytology as well as early operative indication. Although results of these procedures have suggested effectiveness attained by mass screening, standard of efficiency have not been same in all the areas, where the screening having been performed, but there has been difference between respective areas, therefore, in order to make the every result of mass screening carried out in areas similar, it is necessary to make the indication of mass screening being done with careful attention for lung cancer cases.
Female↗
[Operation for preservation of lung function in lung cancer cases--study on bronchoplasty].
In the period between 1962 and 1989, there were 2,279 resected cases of primary lung cancer, out of which 134 cases (21 cases in stage I; 29 cases in stage II; 66 cases in stage IIIA; 9 cases in stage IIIB; 9 cases in stage IV) underwent bronchoplasty excluding carinal resection. Survival rate was 38.2% in these cases including one operative death. Five year survival rate was significantly better than 22.5% in 453 cases which underwent pneumonectomy. To preserve pulmonary function, enhance curability and extend scope of operative indication, bronchoplasty is a safe and valuable procedure for selected cases of squamous carcinoma and low-grade malignancy.
Bronchi↗
[Bronchopleural fistulas developing after pulmonary resections for lung cancer predisposing factors, management, and prognosis].
During the past 28 years, 55 bronchopleural fistulas (BPFs) have developed after pulmonary resections for 52 primary and 3 recurrent lung cancers at the National Cancer Center Hospital, Tokyo. During the same period, there were 2446 pulmonary resections for primary lung cancer, the incidence of BPF being 2.1%. As an operative mode of initial resections, pneumonectomy (26 cases) was most common, followed by lobectomy (20 cases), bronchoplasty (8 cases), and stump resection for recurrence (1 case). The following predisposing risk factors for BPF development were identified: resection for locally advanced lung cancer (80.8%); residual carcinomatous tissue at the resected end of bronchus or anastomosis line (29.1%); hypoalbuminemia, diabetes, or steroid administration (20%); pre- and postoperative adjuvant therapy (49.1%). Seven cases received no treatment for BPF because of sudden deaths by massive airway bleeding (5 cases), worsening pneumonia (1 case), and spontaneous recovery (1 case). Remaining 48 cases underwent treatment; tube thoracostomy only in 7 cases and surgical interventions in 41 cases, one case of which was lost during rethoracotomy due to vascular rupture. Initial surgical interventions were composed of combinations of the following procedures; direct re-suture of fistula (16 cases); amputation of the stump and re-closure (3 cases); completion pneumonectomy (6 cases); reinforcement and wrapping of fistula (27 cases); thoracoplasty (29 case). Among these 40 surgical repairs, fistula was successfully closed in 11 cases. In 5 cases, the fistula closure could be achieved after subsequent surgical procedures. Direct re-suture was successful only in 4 cases. In spite of various kinds of treatment, overall prognosis was quite poor; 37 cases died of BPF-related complications (67.3% mortality).(ABSTRACT TRUNCATED AT 250 WORDS)
Adult↗
Population-based case-control study on cancer screening.
Matched case-control studies have recently been used to evaluate the effectiveness of cancer screening. They enable us to estimate the odds ratios of dying of cancer or of getting invasive cancer. The study compares people with various patterns of screening history with those who were not screened. Criteria for eligible cases, controls, and screening histories that are compared as exposures are discussed. The results from a case-control study for evaluating screening for cervical cancer are shown as an example. Also, a study design of a case-control study for evaluating lung cancer screening in Japan is discussed, along with biases and applications of case-control studies in evaluating cancer screening.
Adult↗
Endoscopic ultrasound examination for mediastinal lymph node metastases of lung cancer.
Among patients with primary lung cancer who were admitted to the National Cancer Center Hospital from July 1987 to April 1988 for surgical treatments, 132 underwent preoperative transesophageal endoscopic ultrasound examination (EUS) on mediastinal lymph nodes. Of the 132 patients, 101 were pathologically evaluated and studied in this article. A GF-UM2 radial scanner with 7.5-MHz (Olympus Co Ltd) was used for image examination. The lymph nodes were diagnosed as positive for metastasis when they had thickened images, clear contours, and low echoing images of fusion or lobulation. The results obtained from 509 sites were as follows: sensitivity, 53.6 percent; specificity, 97.5 percent; positive predictive accuracy, 77.1 percent; negative predictive accuracy, 93.1 percent; and overall accuracy, 91.6 percent. The sensitivity rate was 80.6 percent excluding the result of the right superior mediastinal lymph nodes that were difficult to examine for anatomic reasons. Although EUS was considered to be an excellent method in diagnosing lymph node metastases, it had a blind angle in the field. More accurate diagnoses of mediastinal lymph node metastases could be achieved by using EUS and computed tomography (CT) together.
Adult↗
[Intraoperative pleural lavage cytology in patients with lung cancer].
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Adenocarcinoma↗
[Clinico-pathological study of primary malignant chest wall tumors].
Clinicopathological studies of primary malignant chest wall tumor on 16 cases operated between 1962 and 1988 were made. Of 9 osteogenic sarcomas, 8 cases were chondrosarcoma and 1 case was Ewing's sarcoma. Of 7 soft part sarcomas, 2 cases were fibrosarcoma, liposarcoma and neurogenic sarcoma respectively, and one case was hemangiosarcoma. Most of the cases had symptoms, such as chest mass and/or chest pain comprehend symptoms for more than one year. The intrathoracic growth of tumor is common, especially in osteogenic sarcoma. The maximum size of tumor was 8.2 cm in a mean diameter. Preoperative histological diagnosis is difficult to make even though various radiologic diagnosis or pathological technique as biopsy or cytology were assessed. And true rate of preoperative diagnosis is limited only 43.8%. Wide resection combined with the tissue distant more than 3 cm length from tumor is recommended and 6 cases underwent combined resection of diaphragm, pericardium or lung. 3 cases underwent chest wall reconstruction using the Marlex mesh and 10 cases were able to direct closure, in 13 cases with ribs resection. The 5 year survival rate of endurable cases was 62.2%, and that of soft tissue sarcoma (68.6%) is better than that of osteogenic sarcoma (41.7%). The recurrent or metastatic rate in high, 7 cases (43.8%), but reoperation was added for 5 cases of local recurrence or for a case of lung metastasis. 5 year survival rate of cases with recurrence or metastases is relatively good, 46.8%, especially excellent in 4 cases with recurred lesions after more than 2 years of tumor free interval.
Adult↗
Prognosis for resected lung cancer patients with tumors greater than ten centimeters in diameter.
During the period 1962-1986, 43 lung cancer patients, 2.3% of the 1,832 patients who underwent pulmonary resections at the National Cancer Center Hospital, Tokyo, had tumors greater than 10 cm in diameter. These 43 cancers were classified postsurgically according to the 1987 guidelines for TNM classification of malignant tumors established by Union Internationale Contre le Cancer (UICC), and included 35 cases (81.0%) in stages IIIA, IIIB and IV. The histological tumor types were adenocarcinoma in 18 cases (41.9%), squamous cell carcinoma in 13 (30.2%), large cell carcinoma in 11 (25.6%) and adenosquamous cell carcinoma in one (2.3%). Twenty-two patients underwent pneumonectomy and 21, lobectomy. In terms of the radical extent of surgery, 16 patients underwent a curative operation (37.2%) and 27 received non-curative surgery (62.8%). Excluding one patient who died of an unknown postoperative cause, the overall cumulative five-year survival rate was 19.7%. There was, however, no significant difference in five-year survival rates between the patients who underwent a curative operation (21.5%) and those who received non-curative surgery (18.8%). There was no significant difference in five-year survival rates between patients with adenocarcinoma (21.2%), those with squamous cell carcinoma (15.4%) and those with large cell carcinoma (27.3%). There was little difference in five-year survival rates between patients with postoperative stage I or stage II tumors (25.0%), patients with stage IIIA tumors (9.5%), patients with stage IIIB tumors (30.0%) and patients with stage IV tumors (20.0%), while the five-year survival rates for patients with postoperative N0 disease were 33.3%, N1 disease 28.9% and N2 disease 0%. Among the 42 patients the survival study, there were eight long-term survivors (greater than 5 yr), all of whom had been in N0 or N1 stage and four of whom had undergone curative surgery. Two were classified as being in stage T4 with malignant pleural effusions, and the other two as being in stage M1 with intrapulmonary metastasis. Patients with N2 disease have an unfavorable prognosis and may be considered suitable for studies on adjuvant therapy, although the relative influence of other prognostic factors must be considered. Classifying the tumors according to whether or not they had reached 10 cm in diameter was of no importance.
Adult↗
[Resection of chondrosarcoma of anterior chest wall with pleural dissemination].
A 52-year-old woman admitted with difficulty of breathing and had an anterior chest wall tumor. Primary lesion of the chest wall tumor invading the inferior one third of sternum, right third to sixth ribs, a part of the right middle lobe, the pericardium and a part of the diaphragma and small nodules on the parietal pleura were resected, and a diagnosis of chondrosarcoma of the right fifth or sixth rib and pleural dissemination of the tumor was established. The defect of pericardium was repaired with artificial dura mater and the defect of bony chest wall was repaired with a double layer of Marlex mesh. Although the resection was palliative because of pleural dissemination, she is now working as a housewife without difficulty of breathing.
Chondrosarcoma↗
[Completion pneumonectomy--a review of 29 cases].
From 1962 through 1988, a total of 29 consecutive patients had completion pneumonectomy (CP). Indications for initial pulmonary resection were primary lung cancer in 27 patients, metastatic lung tumor in 1, and mediastinal tumor with pulmonary invasion in 1. Indications for CP were lung cancer (including local recurrence, pulmonary metastasis from the first lung cancer, and second primary lung cancer) in 21 patients, complications after initial operations in 7, and pulmonary arterial injury during second operation in 1. Severe adhesion of the residual lung and the hilar structures made operative procedures extremely difficult. Injury of pulmonary arteries occurred in 6 patients. Especially, in cases the left upper lobe had been resected previously, deviation of the lower lobe and hilar adhesion lead to operative difficulty. Post-CP bronchial fistula occurred more frequently in what the bronchi had been dissected at more peripheral level than main bronchus, because of some severe hilar adhesions. Operative mortality was 13.8% (9.5% for second lung cancer, 28.5% for post-operative complication). Five-year survival for patients with lung cancer was 32.9% according to the Kaplan-Meier method. We conclude that the indications for CP are clinically resectable lung cancer and bronchial stenosis with residual pulmonary organic changes following bronhoplastic procedure. Postoperative bronchofistulae should be managed by other operative procedure.
Adenocarcinoma↗
Resection of tracheal carina for lung cancer. Procedure, complications, and mortality.
We studied 20 patients with lung cancer that invaded the tracheal carina who were operated on during a recent 12-year period. Fifteen patients underwent sleeve pneumonectomy, two had pneumonectomy, one had lobectomy with wedge resection of the carina, and two patients had sleeve resection of the carina followed by reconstruction of the carina. There were two patients with postsurgical stage IIIA lung cancer, 15 with stage IIIB, and three with stage IV disease that involved intrapulmonary metastases. However, the operations of 13 patients were curative resections in which the surgical margin was negative for disease. Sleeve pneumonectomy was performed only in the last 3 years of the study period, after we had confirmed the safety and good results of bronchoplastic surgery by our experience of 100 cases of sleeve lobectomy. Hence, the period of follow-up in this group is too short to assess long-term survival. Eleven patients are alive, three died within 1 month after operation (15%), three died in the hospital beyond 1 month after the operation, and three died after discharge from hospital. Nine of the 11 surviving patients have no evidence of disease 1 month to 2 1/2 years after the operation, but two are alive with supraclavicular lymph node metastases. The 1-year and 2-year survival rates for 17 cases (excluding the three operative deaths) were both 59% by the Kaplan-Meier method. Two different methods were used to adjust the difference of calibers of the trachea and the bronchus. The first method involved the shift of the edge of the cartilagonous portion of the bronchus against the edge of the cartilaginous portion of the trachea and the other involved cutting the tracheal wall as a wedge-shaped piece to shorten the diameter of the tracheal caliber. To prevent complications after resection of the tracheal carina in 11 recent cases with sleeve pneumonectomy, anastomoses were protected by a pedicle fat flap nourished by internal thoracic artery and vein. No postoperative complications of anastomoses developed in any of these cases.
Adult↗
[Thin-slice CT analysis of localized inflammatory pulmonary lesions--pathologic-CT correlation].
In order to evaluate thin-slice CT findings of localized inflammatory pulmonary lesions, 5 granulomatous lesions without preoperative pathological diagnosis were examined. On thin-slice CT, fifth order bronchi and vessels were detected, and inflammatory lesions were observed in margins of pulmonary veins. Of involved bronchi, thick walls were detected in 3 cases, central convergence in 2 cases, mucoid impaction in 3 cases. The characteristics of inflammatory nodules, strand-like shadow and concave margin of lesion contiguous to normal lung, were demonstrated on thin-slice CT. Thin-slice CT can be effective to differentiate localized inflammatory pulmonary lesion.
Aged↗
Surgical resection of pulmonary metastases from colorectal cancer. 10-year follow-up.
Pulmonary resection of metastatic lesions from colorectal cancer was performed in 62 patients, and their cumulative 5-year and 10-year survival rates were 42% and 22%, respectively. The overall median survival was 24 months. The survival curve decrease even after 5 years after pulmonary resection; four of 13 patients who survived more than 5 years subsequently died of metastatic disease and only two patients survived more than 10 years. The number and size of the pulmonary metastases were significantly correlated with postthoracotomy survival. Solitary metastases less than 3.0 cm in diameter were good indicators of favorable postthoracotomy survival. There were no significant differences in survival based on Dukes' classification or location of the primary lesion. Sex, age, disease-free interval between the primary tumor and appearance of metastasis, and extent of pulmonary resection had no influence on survival. It is impossible to say from our experience that surgical resection of pulmonary metastases increased the cure rate. Presumably a good 5-year survival rate after thoracotomy would be a reflection of a length bias caused by the biologic behavior of the metastatic pulmonary lesions.
Colonic Neoplasms↗
Pleural lavage cytology immediately after thoracotomy as a prognostic factor for patients with lung cancer.
Pleural lavage cytology was examined in 230 lung cancer patients just after opening the chest. There were 16 cases (7.0%) of positive pleural lavage cytology, and the results of pleural lavage cytology were related to the presence of pleural involvement by cancer, microscopical pleural dissemination and lymphatic permeation of the cancer cells. If the cancer involves the pleura or lymphatics of the submesothelial layer, being covered with visceral mesothelium, positive cytology may still be obtained. Pleural lavage cytology at opening of the chest seems to be available as a premonitory indicator for exfoliation and dissemination into the pleural cavity or subpleural lymphatic extension of cancer cells, and it was suggested that positive pleural lavage cytology has an influence on postoperative survival.
Humans↗
Bronchoplastic and bronchovascular procedures of the tracheobronchial tree in the management of primary lung cancer.
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Adult↗
[A new diagnostic method of lung cancer by DNA-RFLP].
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Adult↗
An esophagobronchopleural fistula successfully treated by a surgical procedure combined with conservative therapy after resection for lung cancer.
The patient was a 43-year-old woman, who had undergone a right middle and lower lobectomy for adenocarcinoma of the lung. An esophagobronchopleural fistula developed two months after the operation. It was treated by a combined procedure consisting of pedicle flap closure of the fistula and thoracoplasty. The esophagobronchopleural fistula recurred two days later, however, and another pedicle flap closure with fenestration of the chest wall were performed in a third operation. A bronchopleural fistula then recurred, after which it was treated by conservative therapy including intravenous hyperalimentation, frequent dressing changes and systemic administration of appropriate antibiotics. It closed spontaneously 23 days after surgery, in spite of this being a very rare but serious complication very difficult to treat and cure. From our experience with this particular case, we recommend, for treating esophagobronchopleural fistulas, proper drainage, antibiotic therapy, intravenous hyperalimentation and packing of the empyema space, together with closure of the fistula using a muscle or pleural flap.
Adenocarcinoma↗