Primary malignant melanoma of the esophagus, first recognized as a primary tumor by de la Pava et al. in 1963, is rare. It usually presents as an aggressive polypoidal darkly colored or non-pigmented tumor in the mid to lower esophagus which may be diagnosed preoperatively by the use of immunohistochemical stains such as HMB-45 (melanoma specific antigen). The treatment of choice is surgical resection however the overall prognosis is poor with only 4 per cent of patients surviving 5 years.

Aged↗

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Continued experience with thoracoscopic major pulmonary resection.

Between April 1992 and March 1995, 83 patients underwent video-assisted (VATS) thoracoscopic major pulmonary resection (lobectomy: 72, bilobectomy: 4, or pneumonectomy: 7). Conversion to open thoracotomy was required in a further 21 cases (rate=20.2%). There was no in unit mortality; 2 patients died within 30 days (1.9% overall). Analysis (median values) of the VATS lobectomy cases demonstrated; operation time - 135 minutes; blood loss - 80 mls; High Dependency stay - 38 hours; total postoperative stay - 7 days. Comparison between 70 VATS lobectomies and a simultaneous group of 110 open thoracotomy cases confirmed reduced postoperative morphine consumption (83 mg open vs 57 mg VATS; p<0.001). One pneumonectomy patient exhibited a transient sympathetic dysaesthesia and one lobectomy patient developed a mild post thoracotomy pain syndrome. Long-term follow-up of VATS lobectomy for patients with primary bronchogenic carcinoma (49) revealed 1 bronchogenic cancer related death during an overall mean follow-up of 16.5 months.

Adult↗