Surgical treatment of apical chest tumor in 27 patients / 中华外科杂志

<p><b>OBJECTIVE</b>To explore the "hemi-clamshell" approach to the resection of the apical chest tumors, and to evaluate its advantages of operative safety and completeness.</p><p><b>METHODS</b>We conducted a retrospective review of the records of 27 patients undergoing resection of the primary apical chest tumors from January 1995 to January 2001. Tumor type included NSCLC, sarcoma, neurofibromatosis, esophageal carcinoma. Data collected included clinical presentation, tumor type and involvement, type of resection, complication, and survival.</p><p><b>RESULTS</b>A clinical operation for gross-total resection of tumors and invaded structures was performed on six patients by means of a successful anterior approach. Among other 21 patients on whom a clinical operation was performed by posterior approach, only 13 patients obtained gross-total resection. There were significant difference between the two groups (P < 0.01). The mean duration for follow-up was 29 months, and the overall median survival was 21 months. Median survival in patients undergoing gross-total resection was 29 months, and this is significantly better than in incomplete resection group (P < 0.01).</p><p><b>CONCLUSIONS</b>The anterior "hemi-clamshell" approach is a successful technique for the exposure and resection of these tumors and invaded structures. Release of symptoms and long-term survival is acceptable if complete resection can be performed.</p>

Treatment of 40 patients with primary tracheal carcinoma / 中华肿瘤杂志

<p><b>OBJECTIVE</b>To study the efficacy of treatment in 40 patients with primary tracheal carcinoma.</p><p><b>METHODS</b>From 1970 to 2001, 40 patients with primary tracheal carcinoma treated in our hospital were retrospectively reviewed. Twenty-eight were male and 12 were female with median age of 47 years. The median interval from onset of symptoms to diagnosis was 10 months (1 - 60 months). Fifteen patients had adenoid cystic carcinoma, 14 squamous cell carcinoma, 8 adenocarcinoma, 2 small-cell carcinoma and 1 mucoepidermoid carcinoma. Thirty-two patients received operation plus adjuvant radiotherapy, 6 received radiotherapy alone and 2 received operation alone.</p><p><b>RESULTS</b>The median survival time for all patients was 40 months. The 1-, 5-, and 10-year survival rate was 86%, 59% and 29%, respectively. The 1-, 5-, and 10-year local control rate was 84%, 60% and 50%, respectively. Distant metastasis rate in 1, 5, and 10 years was 17%, 51% and 84%, respectively.</p><p><b>CONCLUSION</b>Surgical resection plus adjuvant radiotherapy is a reasonable mode of treatment. Despite late local recurrence after initial treatment, its intrinsic feature, excellent long-term palliation can be achieved after treatment.</p>

Ultrasound surveillance of cervical lymph node metastasis in thoracic esophageal carcinoma / 中华外科杂志

<p><b>OBJECTIVE</b>To improve the accuracy of preoperative evaluation of cervical lymph node metastasis in thoracic esophageal squamous carcinoma.</p><p><b>METHODS</b>Forty-two patients with thoracic esophageal squamous carcinoma underwent neck ultrasonography. Enlarged lymph nodes with their long axis greater than 10 mm and a short-to-long axis ratio greater than 0.5 were considered as metastatic.</p><p><b>RESULTS</b>Preoperative neck ultrasonography revealed the enlarged lymph nodes in 16 patients, but only in 5 (31%) cases the nodes were palpable. Among them 9 were classified as metastatic (cM(1-LN)), including 4 patients with palpable nodes. In 5 cM(1-LN) patients surgical intervention was canceled and the remaining 37 patients underwent trans-thoracic esophagectomy. Cervical node metastasis (pM(1-LN)) was confirmed pathologically in 6 surgical patients, 4 with tumors invading the adventitia (pT3) and the other 2 into the surrounding structure (pT(4)) (pT(1), pT(2) vs. pT(3), pT(4), P = 0.020). All 6 pM(1-LN) patients had concomitant mediastinal node metastasis and 4 of them had upper abdominal node metastasis. Statistically significant relationship was detected between cervical and abdominal nodal status (r = 0.536, P = 0.007). In comparison with the results of pathological examination and treatment response, the accuracy and sensitivity were 81% and 95% (P = 0.043), 36% and 82% (P = 0.081), respectively, for palpation and ultrasonography. Five out of 39 (13%) patients had their therapy changed due to ultrasonographic findings.</p><p><b>CONCLUSIONS</b>Neck ultrasonography for cervical lymphadenopathy is of high sensitivity and accuracy, which plays an important role in the preoperative evaluation and therapeutic decision-making.</p>