Modern thirty-day operative mortality for surgical resections in lung cancer

Modern postoperative mortality rates for resectional operations for lung cancer are not readily available. In recent publications estimating the risk factors for surgical resection, mortality rates of 10% to 15% for pneumonectomy and 5% to 7% for lobectomy are frequently quoted. In order to determine modern operative mortality rates (up to 30 days postoperatively), the Lung Cancer Study Group (LCSG) analyzed the surgical mortality rates of the various participating centers during the years 1979 to 1981. A total of 2,200 resections for lung cancer were available for analysis. Of the 2,220 resections performed, 1,058 were lobectomies, 569 were pneumonectomies, and 143 were lesser resections (segmental or wedge). Eighty-one postoperative deaths occurred from among the 2,220 resections (3.7%). The mortality rate for pneumonectomy was 6.2% and for lobectomy, 2.9%. Lesser resections carried a 1.4% mortality rate, not statistically different from lobectomy. In patients under the age of 60 years, the mortality rate was 1.3%, 60 to 69 years, 4.1%, and over 70 years, 7.1%, all significantly different (p less than 0.01). The postoperative mortality rate for patients 70 years or older was 7.1% (pneumonectomy 5.9% and lobectomy 7.3%). It is obvious that greater care was taken in selection among the older pneumonectomy patients. The striking similarity of postoperative mortality rates for resectional operations for lung cancer among the various centers of the LCSG and among the various institutions within these centers suggest that these data are a reasonably accurate analysis of modern surgical mortality rates in the treatment of lung cancer.

Lung cancer patients' autoimmune responses to Thomsen-Friedenreich (T) antigen: diagnostic utility

The usefulness of T antigen in the diagnosis of lung cancer (LCA), including early, was assessed by determining the in vitro delayed type hypersensitivity response to T(DTHR-T), and by measuring with a solid phase immunofluorescent assay the serum anti-T IgM response. Sensitivity of DTHR-T was 89% for 73 patients with LCA including 8/9 with Stage T1N0M0 disease, overall specificity was 95% for 212 healthy persons and those with non-CA disease. The humoral immune assay detected 31/35 (89%) LCA patients including 4/5 Stage T1N0M0 patients. Overall specificity was greater than 90% among 116 persons without CA.

Patients' immune response to breast and lung carcinoma-associated Thomsen-Friedenreich (T) specificity

We report here sensitive and specific measurement of immune responses of patients with certain kinds of carcinoma toward the physically and chemically well defined T antigen isolated from healthy human erythrocytes. Over 90% of adenocarcinoma tissues tested possess T-specific immunoreactive structures as determined with human antisera, in contrast to healthy tissues and benign lesions. Adenocarcinoma patients recognize the carcinoma-associated T antigen as foreign. Delayed-type skin hypersensitivity reaction to T antigen (DTHR-T) was positive in all 25 lung adenocarcinoma patients tested, in 88% of 101 patients with ductal, in 43% of 30 patients with lobular or tubular breast carcinoma and in 9/9 patients with adenocarcinoma of body cavities. Patients of all Stages reacted positively. All 7 patients with small cell lung carcinoma and 3/5 with malignant melanoma had a positive DTHR-T. None of 17 patients with malignant brain tumors, leukemia or Hodgkin's disease, sarcoma or thyroid carcinoma reacted. The DTHR-T was specific in that all 77 healthy persons and 48/49 with other diseases, including 23/24 with non-cancer lung disease were negative; one patient with organizing interstitial pneumonitis was positive. This points to a possible source of false positive reactions. 91% of 149 patients with histologically benign breast disease had a negative DTHR-T; the histology of some of the positive ones was reexamined, 2 proved to have carcinoma in situ.

Site of recurrence in patients with stages I and II carcinoma of the lung resected for cure

Ninety-nine patients with Stage I or II lung carcinoma that was other than the small cell type and who survived for more than 30 days after a "curative" resection were followed for five years or until death if it occurred prior to the five-year anniversary. Recurrent disease developed in 44 patients. Clinical data and data from postmortem examination were reviewed in these 44 patients in an attempt to classify each recurrence as either initially local or distinct metastatic disease. The site of the first documented recurrence was local in 18 patients and distance metastases in 26. When the patients with recurrence were separated into TNM categories, it was apparent that in those patients without lymph nodes metastases demonstrated in the resected specimen (N0), the initial recurrence tended to be a distant metastases, whereas in those with such involvement (N1), the initial occurrence was more often local. In light of these data, selection of appropriate initial adjuvant therapeutic modalities may be different for each type of patient.

Angiogenic nature of the "intravascular bronchioloalveolar tumor" of the lung: an electron microscopic study

An intravascular bronchioloalveolar tumor of lung (IVBAT) was studied with electron microscopy. Based on ultrastructural evidence and information obtained from the literature, we propose the following: (1) IVBAT is a true pulmonary neoplasm with distinctive morphologic features; (2) it consists of cells with endothelial characteristics and is probably derived from multipotential mesenchymal reserve cells; (3) it is not related to the typical bronchioloalveolar tumor of lung; (4) a more appropriate designation for this unusual pulmonary neoplasm is "sclerosing angiogenic tumor."

Intraoperative fine needle aspiration biopsy of thoracic lesions

Forty-one intraoperative fine needle aspiration biopsies were performed on 35 patients during exploratory thoracotomy (33 patients) or mediastinoscopy (2 patients). Each biopsy was done with a 22 gauge needle. Smears were prepared at the operating table, air-dried, sent directly to the laboratory, stained, and interpreted immediately by the pathologist. Preparation and reporting time averaged ten minutes. Surgical decisions were made on the basis of the pathologist's reports. Intraoperative fine needle aspiration biopsy was 100% accurate in differentiating inflammatory from neoplastic lesions. Ninety-five percent diagnostic accuracy for malignancy (39 out of 41 specimens) was obtained. It permitted quick biopsy of lesions deep within the lung parenchyma without the need to cut across uninvolved tissue, thus permitting appropriate resection in each patient. There were no deaths related to the procedure.

Inhalation injury: evaluation and management in a burn unit

In the period from 1974 through 1976, there were 243 patients treated in the Evanston Hospital Burn Unit. Seventy-eight of these patients, representing 33% of the total admissions, sustained significant inhalation injury. The overall mortality of the Burn Unit for the three-year period was 19%. The mortality rate for patients sustaining inhalation injury was 42%. House fires were the most common cause of inhalation injury, and the history of sustaining a flame burn in an enclosed space is most important. Physical assessment emphasizes singeing of the nasal hairs, the presence of soot in the mouth and hypopharynx, and the finding of wheezing on auscultation of the chest. Elevated blood carboxyhemoglobin (HbCO) values can signal the extent of exposure. Our current policy is to perform flexible fiberoptic bronchoscopy on all patients with known or suspected inhalation injury immediately upon admission to the Burn Unit. Endoscopic findings are of great value in defining the degree of inhalation injury, in predicting the course of the individual patient, and in planning patient management. Intravenous amino-phylline is administered to those patients with wheezing. If gross ulceration, significant edema about the glottis, or large quantities of soot are noted on admission, then pharmacologic doses of corticosteroids are given intravenously for up to 48 hours. Tracheal intubation is performed if edema about the glottis threatens airway obstruction. Those patients who required ventilator support and/or tracheostomy did poorly. Major emphasis is placed on adequate respiratory support with vigorous care directed toward mobilizing tracheobronchial secretions. Nasotracheal intubation is preferred over tracheostomy, and such intubation can usually be performed with an adequate diameter tube to permit proper tracheobronchial toilet, if the flexible fiberoptic bronchoscope is used.