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aneuploidy. In these cases, tumor cells obtained by bronchoscopic bmshingwereso few that thesmall DNAaneuploidpeak was undetectable in the DNA histogram. But the tumor DNA ploidy was evaluated correftlyin9O%of2lcasesusingbronchoscopicsamples. Consequently, despitesomedrawbacks, theDNAploidydiagnosisu.singbronchoscopic samples in this relatively small study, was almost as reliable. as surgical samples.

Surgery

Second surgical intervention for recurrent and second primary broncbogenic carcinomas Watanabe Y, Shimizu J, Oda M, Tatsurawa Y, Hayashi Y, Iwa T. Deparfmenr of Surgery, Kanazawa UniversiTy, School of Medicine, Kanazawa. Stand J Thorac Cardiovasc Surg 1992;26:73-8.

Second operations were performed in 1961-1990 on 23 patients with non-small cell bmnchogenic carcinoma, constituting 2.5 I of 906 who had undergone pulmonary resection for such tumor and 3.6 96 of the 641 with apparently curative surgery. The second operation was performed for recurrent tumor in 15 cases and for second primary tumor in eight. Five-year survival after the first operation was 30% in the former group and 88% in the latter (significant difference). Among the total 23 patients, this survival rate was 51%. The study indicates that an aggressive attitude to second surgical intervention is warranted. For early detection of second lesions, follow-up at maximally 6-month intervals should be continued for more than 5 years after the first operation.

The effect of surgical treatment on survival from early lung cartcer; implications for screening Flehinger BJ, Kimmel M, Melamed MR. IBM T. J. Watson Research Center, Yorkmwn Hts, NY 10598. Chest 1992;101:1013-8.

We assessed the effect of surgery on survival from stage 1 non-small- cell lung cancer based on data collected in these screening programs. The majority of patients diagnosed in each program were treated by surgical resection, but 5 percent of the Sloan-Kettering group, 21 percent of the Hopkins group and 11 percent of the Mayo group failed to receive surgical treatment. Approximately 70 percent of tbe stage I patients in each program who were treated surgically survived more than five years, but there were only two five-year survivors among those who did not have surgery. We conclude that patients with lung cancers detected in stage I by chest x-ray film and treated surgically have a good chance of remaining free of disease for many years. Those stage I lung cancers which are not resected progress and lead to death within five years. Therefore, every effort should be made to detect and treat lung caucer early in high-risk populations.

Oxygen transport during incremental exercise load as a predictor of operative risk in lung cancer patients Nakagawa K, Nakahara K, Miyoshi S, Kawashima Y. 1st Depanmenr of Surgery. Osaka University Medical School, Fuksrrhima, Fukurhima- ku, Osaka 553. Chest 1992;101:1369-75.

To evaluate functional parameters related to the morbidity and mortality after thoracotomy, exercise loadiig was applied in 31 lung cancerpatientsunderrightheartcatheterization. Theroutinepulmonary function and predicted postoperativepuhnonary function (ppo) parameters were also evaluated. Patients were grouped according to postoperative complications: nocomplications(group 1, n = 17), nonfatal complications (group 2, n = lo), and fatal complications (group 3, n = 4). In all the patients %VCppo was above 40 percent and in patients undergoing pneumonectomy, pulmonary artery mean pressure during the unilateral pulmonary artery occlusion test was below 25 mm Hg. FEV, percent and MVV/BSA were statistically significant between groups 1 and 2 but

were not between groups 1 and 3 or groups 2 and 3. The %FEV, ppo was statistically significant between groups 1 and 2 and groups 1 and 3 but was not between groups 2 and 3. Thus, the. routine pulmonary function and predicted postoperative lung function tests, although they are mandatory for screening patients who are. at risk, did not deftitely discriminate between patients experiencing nonfatal and fatal complications after tharacotomy. VO,/BSA(La20), CI(LazO), O,D/ BSA(L20), and TPVRI(La20) were statistically significant between groups 1 and 3 and groups 2 and 3: in all the group 3 patients, as well as three patients of group 1 and one of group 2, VO,/BSA(L.a20) was below 350 mllminlm2. On the other hand, O,D/BSA(LaZO) was below 500 ml/min/n? in all the group 3 patients, while it was above 560 ml/ minim* in all patients in groups 1 and 2. O,D/BSA(L&?O) was the only parameter that definitely discriminated between experiencing nonfatal and fatal complications. We conclude that in addition to the generally accepted functional guidelines, VO,/BSA(LaZO) should be above 400 mllmin/m2 and O,DIBSA(La20) should be above 500 mllminln? in patients who will undergo thoracotomy.

Patient and hospital characteristics related to in-hospital mortality after long cancer resection Roman0 PS, Mark DH. Institutefor Health Policy Studies. Vniwrsily of California, San Francisco, CA. Chest 1992;101:1332-J+,

Several recent reports from academic centers have documented very low postoperative mortality after lung cancer surgery.. However, generalizing these studies to community hospitals is pdtentlally limited by reporting bias. From California hospital discharge Bbstracts, we identified 12,439 adults who underwent pulmonary resection for lung or bronchial tumors behveen January 1983 and December 1986. In- hospital mortality was 3.8 percent after wedge resection, 3.7 percent after segmental resection, 4.2 percent atIer lobe&my, and 11.6 percent afterpneumonectomy. In multivariate regression models, the significant predictors of in-hospital death included age 60 years or more, male gender, extended resection, chronic lung or heart disease, diabetes atxd hospital volume. High-volume hospitals experienced better outcomes than low-volumehospitals, although unmeasured severity of illness may be a confounder. The overall mortality in this community-based sample exceeds that reported by selectedcentenandprovidesabetterfoundation for advising patients.

Completion pneumonectomy after bronchial sleeve resection: Incidence, indications, and resulb Van Schil PE, Brute1 De La Riviere. A, Knaepen PI, Van Swieten HA, Defauw JJ, Van Den Bosch JM. Gerard Van Laethemlaan 3, B-2650 Edegem. AM Thorac Surg 1992;53:1042-45.

Durilig the years 1960 through 1989, 145 patients underwent sleeve lobectomy ot sleeve resection of a main bronchus. Completion pneumonectomy was performed in 19 patients (13.1 W). Indications were bronchostenosis without malignancy in 10 patients, positive resection margins in 3, recurrent tumor in 5, and anastomotic dehiscence in 1. Mean age at sleeve operation was 59.3 years. In 18 patients tbe histology was squamous cell carcinoma and in 1 patient, carcinoid tumor. The mean interval between sleeve resection and completion pneumodectomy was 5.7 months (range, 3 to 16 months) for the patients with stenosis and 6.6 months (range, 1 to 17 months) for the others. There were 3 operative deaths (15.8%). The mean follow-up was 53.2 months. Five-year and IO-year survival rates after completion pneumonectomy for the patients with stenosis were 54% and 41 R, respectively, and for the others, 52% and 52%.