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Purpose: Curative lobectomy and systematic lymph node dissection for lung cancer in elderly patients are often associated with increased risk of postoperative morbidity and decreased quality of life. Conversely, avoiding surgery may mean not curing the cancer. We retrospectively examined data on surgery for octogenarians with clinical stage I non-small-cell lung cancer (NSCLC) to assess the safety and prognosis for patients who underwent radical or limited surgery., Methods: Subjects comprised 44 octogenarians who underwent surgery for clinical stage I NSCLC from 1996 to 2008. Preoperative co-morbidities, surgical procedures, postoperative morbidity, and prognoses were compared between radical and limited surgery., Results: A total of 14 patients (32%) underwent complete lobectomy and systematic lymph node dissection (radical surgery), and 30 patients (68%) underwent segmentectomy or wedge resection or limited lymph node dissection (limited surgery). No significant differences in preoperative clinicopathological features were seen between groups except that significantly more clinical stage IA patients were in the limited surgery group than in the radical group. Surgical time was significantly shorter with limited surgery. Frequencies of postoperative morbidity and recurrence were similar for each type of surgery. Overall and disease-specific 5-year survival rates did not differ significantly between groups., Conclusion: Limited surgery is less invasive and is associated with the same prognosis as radical surgery for octogenarians with NSCLC. Limited surgery for this cohort thus appears reasonable to prevent postoperative morbidity, particularly for patients with poor pulmonary reserve.

It is known that patients with idiopathic interstitial pneumonias (IIPs) have an increased incidence of lung cancer. The purpose of this study was to evaluate the outcome of surgical treatment and to establish the surgical strategy for lung cancer with IIPs. Twenty-five patients with lung cancer and IIPs who were admitted in our hospital from 1996 to 2004 were examined. Eight patients underwent lobectomy with mediastinal lymph node dissection, while 17 patients underwent limited resection. The actuarial 3-year survival rate was 43%. There were no postoperative acute exacerbation of IIPs. We considered most patients were in a stable state of IIPs preoperatively, and we made effort to treat IIPs with limited resection. The prognosis of IIPs was poor. It is difficult to decide whether to carry out limited resection.

Objective: The aim of this study was to assess the adequacy of our intentional limited resection for small peripheral lung cancer based on intraoperative pathologic exploration., Methods: Patients who had stage IA non-small cell lung cancer (NSCLC) with a maximum tumor diameter of 2 cm or less were candidates for limited resection. If bronchioloalveolar carcinoma (BAC) was suspected on computed tomography and intraoperative pathologic exploration revealed the lesion as BAC without foci of active fibroblastic proliferation (Noguchi type A and B), wedge resection was performed. If the tumor was not suspected of being Noguchi type A or B, extended segmentectomy with intraoperative lymph node exploration was performed., Results: Limited resection was performed in 34 patients, wedge resection in 14, and extended segmentectomy in 20. The median follow-up period after wedge resection was 36 months, and all patients are alive with no signs of recurrence. The median follow-up period after extended segmentectomy was 54 months. No local recurrences were found, but distant metastasis was diagnosed in one patient. The 5-year survival rate after extended segmentectomy was 93%. In the same period, lobectomy was performed in 57 patients with stage IA NSCLC with a maximum tumor diameter of 2 cm or less, and the 5-year survival rate was 84%. There were no significant differences in 5-year survival between extended segmentectomy and lobectomy., Conclusions: Careful selection of patients based on high-resolution computed tomography findings and intraoperative pathologic exploration makes intentional limited resection an acceptable option for the treatment of small peripheral NSCLC.

Objectives: Our registration of surgically treated lung cancer patients in Niigata Prefecture began in 2001. The purpose of this study was to identify the characteristics of patients and surgical treatment of lung cancer., Methods: All patients who underwent resection for lung cancer in Niigata Prefecture from January 2001 to December 2002 were eligible for registration. A total of 31 medical data for each patient were registered., Results: During the 2-year period, 1,211 patients were registered. A total of 605 cases (50%) were detected by mass screening, and 874 cases (72%) were diagnosed preoperatively. There were 718 (59%) c-stage IA cases and 317 (26%) c-stage IB cases. The most common operative procedure was lobectomy; 850 patients underwent single lobectomy. Limited resection was performed in 301 patients (25%), and video-assisted thoracoscopic surgery in 193 (16%). The most common histological type was adenocarcinoma in 860 cases (71%), followed by squamous cell carcinoma in 273 (23%). Pathologic staging yielded stage IA in 635 cases (52%) and stage IB in 262 (22%)., Conclusions: The results of our registration demonstrate a very high ratio of surgically treated stage IA cases in Niigata Prefecture and that limited resection was performed in many patients. Accumulation of these data will reveal the characteristics of lung cancer surgically treated in Niigata Prefecture and will provide a basis for determining the future course of surgical treatment for lung cancer. Registration is continuing, and it will provide new and useful information about lung cancer, eventually including 5-year survival data.

From 1996 to 2002, we performed intentional limited resection for small peripheral lung cancer using intraoperative pathologic examination. Wedge resection was performed in patients who had small peripheral adenocarcinoma (< or = 20 mm), suspected of being Noguchi type A or B, and confirmed by intraoperative pathologic examination. Extended segmentectomy was performed in the rest of patients (tumor diameter < or = 20 mm), and not suspected of being Noguchi type A or B. Hilar and mediastinal lymph nodes sampling was performed in this group. If lymph node metastasis was detected by the intraoperative pathologic examination, the surgical procedures was converted into a lobectomy with lymph node dissection. Limited resection was performed in 27 patients, wedge resection in 8, and extended segmentectomy in 19. All patients received wedge resection are alive without sign of recurrence. In extended segmentectomy, 17 patients are alive with no evidence of disease, 1 patient died of non-pulmonary disease, and 1 patient is alive with recurrent disease. The overall survival rate at 5 years was 100% in wedge resection, 91% in extended segmentectomy, and 79% in standard lobectomy. We conclude that limited resection for small peripheral lung cancer using intraoperative pathologic examination may be safe and effective procedure.

From 1975 to July 1994, twenty patients underwent second or third pulmonary resections for 7 recurrent lung cancers and 14 second primary lung cancers. The initial surgical procedures were lobectomy in 18, pneumonectomy in 1 and bilateral segmentectomy in 1. The procedures at the second operation were completion pneumonectomy in 4, ipsilateral wedge resection in 3, contralateral lobectomy in 1, contralateral segmentectomy in 4, contralateral wedge resection in 7 and resection of left main bronchus in 1. At the third operation, wedge resection was done in one 28 months after completion pneumonectomy. There was no operative death following second and third operations. Five-year survival rate following second operation in 20 patients was 32.3%, and it was 28.6% for patients with recurrent lung cancers, and 31.2% for multiple primary lung cancers. In conclusion, an aggressive surgical approach for reappearing lung tumor should be performed. At the reoperation, wedge resection for recurrent lung cancers, completion pneumonectomy for ipsilateral primary lung cancers and segmentectomy for contralateral primary lung cancers should be chosen for the standard surgical procedure.

A 56-year-old woman was admitted to our hospital with the complaint of cough. She had a rt. supraclavicular lymph node swelling, and her chest X-ray showed masses at the rt. hilum and the mediastinum. On bronchofiberscopy, a tumor was detected at the orifice of the lt. B3b, and the biopsy revealed small cell lung cancer (SCLC). With the peroperative diagnosis of stage IIIB SCLC, a neoadjuvant chemotherapy followed by surgical resection was performed. Because of the presence of malignant cells in the pericardial effusion, the operation turned out to be an absolutely non-curative one. As the recurrence of mediastinal lymph node swelling occurred after the surgery, an intensive chemoradiotherapy was performed successfully. Then the patient has been free from disease for five years. This case indicates the possibility that some of SCLC patients can be long-term survivors by the treatment of an appropriate adjuvant therapy combined with radical resection, even if the clinical stage is advanced. Therefore an extended operative indication for SCLC should be considered.

By the end of 1988, seventy five cases after pulmonary resection for lung cancer and one case after pulmonary resection for basal cell hyperplasia were examined with fiberoptic bronchoscopy as postoperative follow up. Endobronchial tumor was detected in 14 cases. In seven cases, endobronchial tumor was located at site far from the surgical bronchial anastomosis. These tumors were suspected as second lung cancer as long as examined by fiberoptic bronchoscopy. Histological type of all of these was squamous cell carcinoma. Re-operations were performed in five cases and two of them were early lung cancer. In 6 cases (13.6%) among 44 cases examined with fiberoptic bronchoscopy after pulmonary resection for central type squamous cell carcinoma, second lung cancer was detected. In the case of central type squamous cell carcinoma, usually the tumor appears to be of same histological type and at same location. Among those cases those who smoke heavily should be separated as high risk group. If this group is followed with fiberoptic bronchoscopy or sputum cytological examination, it is more possible to detect second lung cancer at an early stage.

A 69 year-old man, who had undergone left pneumonectomy for squamous cell carcinoma of the lung 21 months ago, was admitted with a high temperature and chest pain. A diagnosis of empyema was made, and a chest tube was inserted for drainage. Bronchopleural fistula was not noted. Noticing that food was leaking through the drainage tube, a diagnosis of esophagopleural fistula was made radiologically. Surgery was done in October, 1987, after irrigating an empyema space for two months. The fistula was approximately 4 cm below the carina, and it was closed directly. The omentum was sutured around the closed site to reinforce and obliterate the empyema space. Furthermore, additional thoracoplasty was done because the cavity was too large to close only with the omentum. The postoperative course was uneventful. He was able to eat specially prepared foods within 4 weeks, and was discharged on the 60th day after the operation. This patient could possibly be the first case who had undergone an omental flap for the closure of a postpneumonectomy esophagopleural fistula.

From January 1975 to December 1986, 415 patients were operated for primary lung cancer. Postoperative pulmonary complications were observed in 83 patients and among them 48 patients (57.8%) suffered from difficulty in expectoration. Postoperative expectoration mostly depends on the ability of coughing. To evaluate cough dynamics, expiratory flow-rate and volume at voluntary maximal cough were measured. The more expiratory flow rate and volume a cough has, the more effective it is for expectoration. In those patients with decreased FEV1.0, or respiratory muscle weakness because of emaciation and aging, or severe pain in the wound, the cough dynamics was decreased. By cleaning retained secretions in the respiratory tract, postoperative pulmonary complications would be prevented. However in cases where the decrease in postoperative cough dynamics is predictable, application of limited resection should be considered as well.