[A case of completion pneumonectomy with carinal wedge resection after sleeve upper lobectomy for right lung cancer].

A 58-year-old man underwent sleeve upper lobectomy for squamous cell carcinoma of the right lung in April 1993. Eleven months after the operation, local recurrence at the bronchial suture line was detected by bronchoscopy. As the patient declined our proposal for performing reoperation, the recurrent tumor was treated with concurrent radiotherapy and chemotherapy, which resulted in only minimal response. After these treatment, the tumor was still localized at the right pulmonary hilus with no distant metastasis, and patient's pulmonary function was preserved good enough to undergo reoperation. Therefore, with a patient's consent to reoperation, we performed completion pneumonectomy with carinal wedge resection in September 1994. Pedicled serratus anterior muscle flap was applied to the suture line in order to prevent anastomotic complications. Postoperative course was uneventful except for pneumonia, and the anastomosis had healed well. As of March 1997 the patient is alive with no evidence of tumor recurrence. Completion pneumonectomy with carinal resection carries a high risk of operative morbidity and is seldom indicated. We reported a patient underwent this procedure for recurrent lung cancer and discussed about its indication and procedure.

[Primary hemangiopericytoma of the chest wall: a case report].

We describe a rare male case of malignant hemangiopericytoma of the chest wall. An extrapleural chest wall mass about 1.5 x 4 cm in size was detected along the right 3rd rib on a chest roentgenogram when the patient was 58 years old. The tumor did not enlarge for over 12 years thereafter. At the age of 73 years, the patient came to our hospital for chest pain after a traffic accident. A roentgenogram revealed the extrapleural tumor of the chest, which was enlarged to 8 x 12 x 7 cm, and right hemothorax. The tumor was resected together with the 3rd and 4th ribs. Light and electron microscopy and immunostaining studies led to a diagnosis of malignant hemangiopericytoma. The postoperative course was uneventful, and radiotherapy and chemotherapy were performed. The patient has been well without recurrence for 18 months after the operation. We also reviewed 9 cases of this tumor reported in Japan.

A clinical analysis of small-sized lung cancer with advanced disease.

A clinical analysis of small-sized lung cancers with advanced disease was conducted on a total of 58 patients: 34 diagnosed as T1N2, 6 as T1N3, 9 as T1M1, and 9 as T4 due to pleural dissemination. The cumulative 5-year survival rate after surgery for the 34 patients with a T1N2 lesion was 17.4%. Of these 34 patients, 24 underwent a curative operation resulting in a 5-year survival rate of 23.7%, but the remaining 10 patients, who underwent a non-curative operation, had a 5-year survival rate of 0%. Extended lymph node dissection for N3 disease has only been performed in recent years, so it is not yet clear whether it will affect the survival rate or not. T4 disease due to pleural dissemination and T1M1 disease associated with intrapulmonary metastasis encountered at thoracotomy could be expected to have relatively long-term survival with the combined use of systemic immunochemotherapy after surgery. In cases diagnosed as T4 due to pleural dissemination, we have recently employed resection of the primary lesion with parietal pleurectomy as the standard operative procedure. For cases of T1M1 with intrapulmonary metastasis confined to the same lobe as the primary lesion, a lobectomy is usually performed, while for cases with intrapulmonary metastasis extending to another lobe, a lobectomy with enucleation of metastatic nodules or pneumonectomy is most often performed instead of an exploratory thoracotomy.

Internal herniation through a broad ligament defect after obturator hernia repair.

A case of internal herniation into a broad ligament pouch 5 months after obturator herniorrhaphy is reported. We believe this to be the first reported postoperative case of internal herniation into such a defect in the broad ligament following obturator herniation repair. Computed tomography was useful in the preoperative diagnosis.

[Combined resection of the aortic wall in T4 lung cancer under the assistant devices].

Radical operation for T4 lung cancer is technically difficult. We report here 3 cases of T4N0M0 lung cancer involving aorta or left subclavian artery which was successfully operated on. We could carry out combined aortic resection more safely and speedy under the assistant devices, such as Anthrontube and Biomedicus Centrifugal Pump. Even T4 lung cancer having aortic invasion with N0 disease can be operated on and be expected long-term survival using these assistant devices.

[The value of omental pedicle flap method for postoperative intractable infection in the field of thoracic surgery].

We present a series of 8 consecutive patients who underwent the omental pedicle flap method in the field of thoracic surgery. Four of them had empyema with bronchopleural fistula and four had mediastinal infection. A pedicle of omentum containing the right gastroepiploic artery was passed through a tunnel in the diaphragm into the empyema cavity or the mediastinal abscess cavity. All eight patients were cured successfully by single-stage procedures. We think this series demonstrates the value of omental pedicle flap method which lacks in symptoms due to defected organ and offers an excellent therapeutic effect with easy operative procedure. And, this method produce a quality of life. Further active application of this method can be expected in the management of chest problems.

[Evaluation of surgical treatment in patients over 80 years of age with lung cancer].

Seventeen lung cancer patients over 80 years of age were treated surgically at Kanazawa University Hospital from 1973 to 1991. The operative procedures were lobectomy (six patients), segmentectomy (seven patients), partial resection (three patients) and exploratory thoracotomy (one patient). Absolutely curative resection was done in two patients, relatively curative resection in two, relatively non-curative resection in ten, absolutely non-curative resection in two. The three-year survival rate after operation for all seventeen patients was 60.2%. Postoperative complication developed in eleven patients (64.7%). Patients who had lobectomy with mediastinal lymph node dissection had a high incidence of postoperative complications. In recent years, pulmonary resections have been performed in patients over 80 years of age who have been managed with pulmonary rehabilitation, resulting in better course. It is concluded that the limited resections produce good prognosis in patients over 80 years of age with lung cancer.

[Surgical treatment of thymoma--clinical evaluation].

Sixty-seven patients with thymoma were surgically treated during the past 19 years in our department. The 5-year, 10-year and 15-year survival rates of total cases with thymomas were 69.2%, 59.6% and 59.6%, respectively. Survival rates of thymoma with MG and without MG were not significantly different. According to clinical stages in Masaoka's classification, there were significant difference between Stage I and Stag III (p < 0.05), Stage I and Stage IV a (p < 0.01), and Stage I and Stage IV b (p < 0.01). We can conclude that complete resection of thymomas lead to better prognosis, and immunochemotherapy using cyclophosphamide, vincristine and OK-432 are effective.

[Two cases of familial pulmonary arteriovenous fistula].

Two cases of familial pulmonary arteriovenous fistula are reported. Case 1: A 54-year-old woman was admitted with exertional dyspnea. An abnormal shadow on chest X-ray had been noted since the age of 37 years. Pulmonary angiography demonstrated bilateral pulmonary arteriovenous fistulas. Case 2: A 25-year-old man, the son of Case 1, was admitted for operation for the same disease. The mother and son both suffered from repeated epistaxis due to Rendu-Osler-Weber disease. In order to reserve pulmonary function, fistulectomy was performed in both cases, and their subsequent clinical courses were good.