[Recurrence and survival after surgical treatment of lung cancer]. / Residiv og overlevelse etter kirurgisk behandling for lungekreft.

BACKGROUND: 2500 new cases of lung cancer are diagnosed in Norway annually. Patients with limited disease can be operated, but many will die from the disease despite surgical treatment. The aim of the study was to review survival and recurrence, and factors which affect survival, in patients operated for lung cancer. MATERIAL AND METHODS: The risk of death and recurrence of disease was assessed retrospectively in patients who had non-small lung cancer and were operated at St. Olavs University Hospital, Trondheim in the period 1994-2001. Patient data were retrieved from medical records and a database with records from thoracosurgical procedures. RESULTS: 190 patients (30 % women) were included in the study. Average observation time after surgery was 58.3 months (range 21-99). Adenocarcinoma was the most common histological cancer type and occurred in 57.9 % of women and 39.1 % of the men (p = 0.02). The 30-day mortality rate was 3.2 % and the 60-day rate was 4.7 %. Recurrence of the disease was found in 45.8 %, among them median time to recurrence was 9 months after the operation. 5-year survival was 42 %, as analysed by the Kaplan-Meier estimate, and survival was best for early stages of the disease. 5-year survival was better for women (53.3 %) than men (36.8 %), p = 0.05. Prognostic factors for survival, estimated by Hazard ratio for death with Cox multiple regression analysis, were sex, age at the time of operation, type of operation, tumour diameter and postoperative N-stage. INTERPRETATION: Postoperative mortality and survival corresponded to data in the literature. Early stage lung cancer can be cured with surgical treatment. Our study confirms an increase in the incidence of adenocarcinoma among lung cancer patients during the last decades. Female sex is a positive prognostic factor for survival, as is young age, small tumor size, standard lobectomy, and absence of lymph node metastases.

[Nine years' experience with endovascular treatment of abdominal aortic aneurysms]. / Ni års erfaring med endovaskulaer behandling av abdominale aortaaneurismer.

BACKGROUND: Endovascular repair of abdominal aortic aneurysm was started nine years ago at our institution. Our purpose was to evaluate the results over this period. MATERIAL AND METHODS: From 1995 to 2003, a total of 148 patients were treated for infrarenal abdominal aortic aneurysms by endovascular repair. The material includes 31 patients (21%) who were unfit for open surgery because of comorbidity or poor general condition. The patients have been followed up at regular intervals with clinical investigation, plain abdominal X-ray, and CT scans. Regional anaesthesia was used for 143 procedures; 5 were carried out under general anaesthesia. RESULTS: 30-day mortality following elective procedures was 2.3%. 31 endo-leaks were observed, 16 early and 15 late. Furthermore, 22 graft limb occlusions were diagnosed and thirteen of them repaired with femoro-femoral bypass. Secondary procedures were necessary in 42 (28.4%) of the patients, including 7 late conversions to open surgery. Some patients had more than one secondary procedure. With better stent grafts, the incidence of complications and secondary procedures has decreased significantly. During the last 4.5 years, only 4 secondary procedures (5.8%) have been necessary in 69 patients. In the total material the accumulated five-year survival rate was about 60%. INTERPRETATION: Results from endovascular repair of abdominal aortic aneurysm have improved in recent years. Ongoing prospective randomised studies could give us the information we need in order to establish what role this treatment should have.

Combined open and endovascular treatment of complex aortic disease.

The purpose of this article is to report whether combined open and endovascular treatment could be applied in patients with complex aortic disease. A retrospective study including four patients with complex aortic disease was undertaken. In all patients, extra-anatomic bypass to the visceral arteries was made through a laparotomy while the aortic lesion was repaired by stent grafting. One patient died on the first postoperative day and another died 3 months after treatment from a myocardial infarction. The other two patients were alive 13 and 34 months after treatment, respectively. However, a patient treated for a ruptured thoracoabdominal type 2 aneurysm on the basis of a dissection suffers from postoperative paraplegia. The combination of open surgery with extra-anatomic bypass to visceral arteries and stent grafting could be an option for the treatment of patients with complex aortic disease, especially in high-risk cases in which more extensive open surgery is contraindicated.

[Interventional radiology in Norwegian hospitals]. / Intervensjonsradiologisk aktivitet ved norske sykehus.

BACKGROUND: In recent years, interventional radiology has gained in importance in patient treatment. In order to assess the impact of this trend, the executive committee of the Norwegian Society for Interventional Radiology made a registration of all interventional procedures in Norwegian hospitals in the year 2000. MATERIAL AND METHODS: Data were collected by a questionnaire sent to all Norwegian hospitals. Coronary interventions were not included. RESULTS: Forty-four out of 58 departments returned the questionnaire; 33 stated that they performed interventional procedures. A total of 18 135 procedures were performed in Norway in 2000; we present data on the distribution of types of procedures on different categories of hospitals. INTERPRETATION: A large number of interventional radiological procedures were performed in Norwegian hospitals in the year 2000, types of intervention that are considered very important in patient management in small hospitals, too.

Type III endoleak from a thoracic aortic stent-graft.

PURPOSE: To present an as yet unreported late complication of an Excluder thoracic endograft. CASE REPORT: A 78-year-old man underwent surgery for a ruptured type V thoracoabdominal aortic aneurysm in 1996. Four years later, an aneurysm was detected in the proximal thoracic aorta and repaired with 2 Excluder endoprostheses. At 12 months, computed tomography showed an increase in the aneurysm sac diameter and a type III endoleak, which was traced to a hole in the stent-graft fabric on arteriography. No fracture of the metal components was detected in the stent-grafts. Another Excluder device was implanted within the distal endograft. Satisfactory exclusion of the leak has been maintained for 6 months. CONCLUSIONS: The risk of type III leaks must be minimized before stent-grafting can be regarded as a routine procedure in the treatment of thoracic aortic aneurysms.