[Neoadjuvant chemotherapy in non-small-cell lung cancer]. / Neoadjuverende kemoterapi ved ikke-småcellet lungekraeft.

Over the past 10 years, several studies of neoadjuvant chemotherapy for stage III Non Small Cell Lung Cancer (NSCLC) have been conducted. In eight Phase II studies, response rates of approximately 65% and resectability rates of approximately 50% have been achieved, with acceptable side effects. Two randomized trials with a total of 120 patients with stage IIIA cancer have been carried out to compare the effect of neoadjuvant chemotherapy plus surgery versus surgery alone. The trials were terminated early when interim analysis showed significantly increased survival in groups that received neoadjuvant chemotherapy. The incidences of treatment-related death did not differ significantly between the groups. Neoadjuvant chemotherapy for patients in stage III NSCLC is feasible and might prolong survival. However, the results of larger randomized trials must be awaited before firm general recommendations can be made.

[Thymectomy in myasthenia gravis]. / Tymektomi ved myasthenia gravis.

Thymectomy is in most cases the treatment of choice in myasthenia gravis (MG). In order to evaluate the Danish results, we investigated the outcome and patient satisfaction following thymectomy in Odense University Hospital from 1980 to 1994. Thirty-three patients were operated. Five (16%) were completely without symptoms or medication and 14 (44%) received less medication and had fewer symptoms than preoperatively. Sex, age, degree of illness, duration of symptoms, histology of the thymus and surgical approach had no significant (p > 0.05) influence on the result. Four patients died 2-29 months after surgery, three because of aggravation of MG and one of causes unrelated to the operation. Of the 29 patients still alive none had serious complications, 11 had minor complications and 23 were satisfied with the operation. Thymectomy is recommended for patients with symptomatic MG, but the effect of surgery should be evaluated in a prospective clinically controlled study.

[Video-assisted thoracic surgery--1]. / Videoassisteret thoraxkirurgi--1.

Due to the latest advances in video technology and endoscopic instruments, thoracoscopy has changed from being mainly diagnostic to include many threapeutic procedures in the thorax. The article reviews equipment and techniques as well as attempts to reflect current attitudes to indications for their use.

[Video-assisted thoracic surgery--2]. / Videoassisteret thoraxkirurgi--2.

The study presents our experience with video-assisted thoracoscopy and video-assisted thoracoscopic surgery (VATS) at the Dept. of Thoracic and Cardiovascular Surgery at Odense University Hospital. All VATS-procedures performed in the period 1/1 1993-30/9 1994 were prospectively registered. Sixty-seven procedures were undertaken on 63 patients with a median age of 35 years (range, 13-75 years). Twenty diagnostic and 47 combined diagnostic and therapeutic procedures were performed. The indications were spontaneous pneumothorax, pleural changes, diffuse interstitial lung disease, Raynaud's disease, localized lung lesion, and abnormal chest X-ray in patients with previous extrathoracic malignancy. In patients with pneumothorax, the most frequent procedures were pleurodesis with fibrin glue sealant, wedge resection with endostapler, and pleural abrasion. In the remaining groups, the most frequent procedures were pleural biopsy, wedge resection of lung parenchyma, and thoracic sympathectomy. The median time consumption during the surgical part of the VATS-procedures was 50 minutes (15-130 min.), and median hospitalization time after VATS was three days (1-10). Drains were left for more than two days after 13 procedures (22%), most often due to air leakage or persisting pneumothorax. Four VATS-procedures were converted to thoracotomy, and three had thoracotomy at a later stage during hospitalization. All thoracotomies were related to preexisting disease. No major procedure-related complications occurred. A diagnosis was achieved in every case where VATS was aimed at being purely diagnostic. Two patients had sympathectomy with good results. We conclude that VATS seems of advantage for diagnosis and therapy in many cases of benign intrathoracic disease. In addition, a histological diagnosis can be achieved and operability assessed in many cases of intrathoracic malignancy.(ABSTRACT TRUNCATED AT 250 WORDS)

[Esophageal resections in Denmark 1985-1988. A retrospective study of complications and early mortality]. / Esophagusresektioner i Danmark 1985-1988. En retrospektiv opgørelse af komplikationer og tidlig mortalitet.

In a retrospective investigation, 17 Danish Departments of Surgery reported on morbidity and mortality following surgical treatment of cancer of the oesophagus and cardia in the years 1985-1988. The study comprised 352 men and 112 women, representing 98% of the total number of resections performed in Departments of General Surgery (11%), Departments of Surgical Gastroenterology (24%) and Departments of Thoracic Surgery (65%). Nine departments performed less than five resections per year. Frequency of anastomotic leaks were 8.2%, and the mean hospital mortality was 16.6%. Mortality was significantly lower (median 9.6% and 7.0%) in departments performing more than 20 resections per year. It is concluded that in Denmark, surgical treatment of cancer of the oesophagus or cardia should be centralized to departments performing more than 20 resections per year.