The spectrum of treatment and future diagnosis of early non-small cell lung carcinoma.

PURPOSE: Review the surgical treatment of 56 patients at a single institution of early stage non-small cell lung carcinoma (NSCLC). Briefly review the literature to report the current indications for limited pulmonary resection. Discuss newer methods of assessing early stage NSCLC. METHODS: We reviewed 56 lobectomies performed at the Biloxi Veterans Administration Medical Center from January 1992 to December 1997 for NSCLC to report the incidence of N1 positive lymph nodes and survival data. Additionally, a search of PubMed, Ovid, and MDConsult.com, using search parameters of non-small cell lung carcinoma, limited pulmonary resection, lobectomy, and comorbidity, were used to determine indications for treating non-small cell lung carcinoma. RESULTS: N1 positive lymph nodes occurred in 11 out of 56 patients; 4 were identified preoperatively. In this sample, 21 patients were Stage IA, 21 Stage IB, 6 Stage IIA, and 8 Stage IIB, and their 4-year median survival was as follows: (IA) greater than 44.80 months, (IB) greater than 48.0 months, (IIA) greater than 25.28 months, and (IIB) = 11.18 months. Four-year survival rates by stage were IA= 10/21 (47.62%), IB= 14/21 (66.67%), IIA= 2/6 (33.33%), and IIB= 0/8 (0.0%). CONCLUSIONS: The 4-year survival data we reviewed were less favorable than is reported by others. Patient medical comorbidity, patient age, and sample size are thought to account for this difference. According to our literature review, reasons for limited pulmonary resection include poor physical performance, marginal lung reserve, synchronous bilateral tumors, and superior sulcus tumors (T3) in which the tumor primarily invades the chest wall. Heavier consideration of these indications might have improved the outcomes seen in this population.

Horner's syndrome: a delayed complication after thoracostomy tube removal.

PURPOSE: Description of a complication from tube thoracostomy. METHODS: Case report from experience at an Air Force tertiary care hospital in a 50-year-old female smoker undergoing left upper lobectomy for lung cancer. RESULTS: Horner's syndrome resulted 18 hours after removal of an apical thoracostomy tube. CONCLUSIONS: Horner's syndrome caused by tube thoracostomy is a rare but real complication. One should avoid placing the tip of the tube in the medial thoracic apex with the intent of avoiding second-order sympathetic chain pathways. As evidenced by our patient with a delayed onset of presentation, malpositioned tubes should be repositioned before symptoms develop. Long-term prognosis is poor once Horner's syndrome develops.