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SURGICAL TREATMENT OF PATIENTS WITH LUNG CANCER INVOLVING LEFT ATRIUM. Q.H. Zho”, L.X. Li”, Y.I. Ho, Z.H. Yang. Department of Thoraccardiic Surgery, The First Universdy Hospital, Wesf China University of Medical Sciences, Chengd”, Sichuau 6lM)41, People’s Republic of China.

If is not rare that pulmonary carcinoma involve left atrium either along pulmonary veins or penetrating through the pericardium directly. In the past, these cases were regarded as contraindication for surgery and they could only have chemotherapy whether $e diagnosis was established preoperatively or during operation. With the application of modern cardiovascular surgical techniques in the field of pulmonary surgery, lobectomy 01 pneumonectomy combined with resection of a part of left atrium wall is the choice for such cases. Twenty-five padents with lung cancer involving leh atrium were admitted to our deparuuent from April, 1984 to April, 1993. Of these patients, 10 cases had only explorarory operation, with an average survival time of I12 days. The other 15 cases had lobectomy (5 cases) or pneumonectomy (10 cases) combined with partial resection of left atrium (PRLA). 2 of the pneumouectomy cases also had partial resection of cariua. The resection of the leh atrium wall ranged from 12 m 22 square centimeter. All the patients were given perioperative intensive chemotherapy. There was neither operative complication nor operative death in this group. These patients have been followed up from 6 months t” 78 months. Twelve patients have survived from 6 tu 72 months without metastasis or ~ecurreuce of the cancer postoperatively. Of these 12 patients, 1 case have survived more than 6 years: 1 for 4 years, 2 for 2 years, 2 over 16 mouths, 2 for 12 months, and the other 4 cases more than 6 months. There were 3 late deaths in this group, I died of kidney cauce~ at 4 years and IO months, 1 distanf metastasis at 2 years and 8 months and the third one brain metastasis at 10 months postoperatively.

The indication of this operation in such patients should be scmpulous because of the tendency of blood metastasis. The author’s criteria of case selection includes: 1) The function of heart, lung, liver and kidney should be able to stand the operation; 2) Clinical examination and CT or/and MRI scans reveal thaf the tumor is confined in one side of the chest, without remote or contralateral media&al lymph node metastasis; 3) No malignant effusion in the pericardial cavity; 4) Non-small cell lung cancer: 5) The estimated resection of lefl atrium should not be over 113 of it.

The results showed that lobecromy or pneumouectomy combined with partial resection of left atrium could remarkably improve the survival time of patients with lung cancer involving the atrium. Therefore, the authors propose that if the patients are properly selected by this criteria, especially “on-small cell lung cancer, they would be good candidates for this operation

654

VIDEOTHORACOSCOPY: DIAGNOSIS AND TREATMENT OF THORACIC DISEASES. Ratto G.B.“, Tassara E.‘. Mereu C.“, Verna A.“, Nlcosia F.A, Zappi L.‘L. Mignone L.A, Carossino D.” ‘Cattedra di Chirurgia Toracica - Universita di Genova, ltalia “1st. di Oncologia Clinica e Sperimentale - UniversitP di Genova. ltalia “Servizio di Anestesia e Rianimazione - IST, Genova, Italia.

Advances in surgical instruments and training have expanded the use of videothoracoscopy in the diagnosis and therapy of many thoracic diseases.

Between January 1993 and November 1993 72 patients (45 men and 27 women; mean age 58 years, range 23-79) underwent video- assisted thoracoscopy. The following interventions were applied: bullectomy and /or pleurodesis (talcage and/or mechanical abrasion) in 21 pneumothoraces, pleurodesis (talcage) in 27 malignant pleural effusion% wedge-resection in 5 lung malignant nodules, lung biopsy in 7 diffuse lung diseases, pleural biopsy in 11 malignant pleural diseases, pericardiectomy in 1 malignant pericardial effusion.

Procedures were performed under general anesthesia. Patients being in antero-lateral thoracotomy position; if necessary, selective intubation was carried out.

2-3 trocar of various size were placed in variable position along the axillary lines.

In 5 cases, an utility minithoracotomy. for palpation and extraction of lung neoplasm, was performed. Chest drenaiges were removed between the second and the sixth post-op. day.

There were no major complications; conversion to thoracotomy was only needed in 2 cases.

In our experience, the video-assisted thoracoscopy proved to be an excellent and safe technical option in an increased number of thoracic diseases, avoiding thoracotomy.

BRONCHOPLASTIC PROCEDURES AND PULMONARY ARTERY RECONSTRUC~ON IN THE TREATMENT OF BRONCHOGENIC CARCINOMA. @H. Zhau, L.X. Liu, I.1 Yary, H.B. zhaug, Z.H. Yang. Depamm”f of liloracocardm Surgery. nlc Fusf “Nwslly Hospml, v&f China Uruvsrsw of Medical Sciences, Chcngdu. Szhum 61@?41. People’s Republic of Cldna

655

TREATMENT OF III LUNG CANCER BY ENLARGED RESECTION AND SCAVENING LYMPH NODES. Wu Xi, Department of Surgery, Nanjing Railway Medical College, Nanjing, Jiangsu 210009, P.R. China.

III lung cancer is considered to be of late stage of the disease. Resection with supplemental chemotherapy and radiotherapy remains the main treatment measure.

In recent 8 years, enlarged resection and scavening lymph nodes were performed on 48 patients with III lung cancer in our hospital. They had a survivorship of 18 to 88 months. The 3 and 5 year survival rate for them was 18% and 12%, respectively. It was higher than that of the patients in exploratmy group in which no one had a survivorship of more than 11 months.

28 patients were diagnosed as having central type of lung cancer and 18 as having peripheral type. Asymptomatic lung cancer was found in 8 cases during physical examination. They accounted for 17% of the total. 6 patients underwent emergency operation due to airway obstruction, severe hemoptysis or life-threatening condition.

Pneumonectomy was performed on 29 patients, pulmonary and bronchoplasty on 8, total pneumonectomy on 8, resection and reconstruction of carine on 3. The accompanied enlarged operation included partial excision of pulmonary trunk on 9 patients, partial pericardiectomy on 12, partial excision of pericardium and left atrium on 6, removal of partial pleura on 12, costatectomy on 5, and resection of superior/inferior vena cava on tangential position on 4.

The patients with III lung cancer treated surgically, their life quality improved after removal of the cancer. Elimination of the influence of cancer-released immunosuppressant factors and breakthrough in an immunologically closed condition should create favorable conditions for the treatment of III lung cancer.