[Bronchoplasty, with special reference to suture technics and postoperative management].
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Biomedical subjects
Publications and source records attributed to T Naruke.
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By means of lymph mapping, the prognosis significance of lymph node metastasis in lung cancer was studied in 270 patients who had undergone radical operations--pulmonary resection combined with complete mediastinal lymph node disection, which is used for patients in whom all cancer could thereby be ablated. Mediastinal lymph node metastasis was found in 64 patients, and 12 patients lived 5 years or more (an absolute 5 year survival rate of 18.8 percent). After radical surgery, there was a significant difference between the prognosis for patients who had metastases to the subcrainal lymph nodes as compared to the prognosis for those who did not. The 5 years survival rates were 9.1 percent and 29.0 percent, respectively. On the other hand, prognosis was not significantly affected by involvement or noninvolvement of the superior mediastinal, paratracheal, tracheobronchial, pretracheal, and the subaortic and para-aortic lymph nodes. No significant difference in survival was detected between patients who were given adjuvant therapy and those who were not. Lymph node mapping gives valuable prognostic information.
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Twenty patients with lung cancer have undergone bronchoplastic procedures September, 1965, to June, 1976 in our hospital. Bronchoplastic procedures are considered to be indicated for early cases of hilar lung cancer rather than for somewhat advanced cases. Endoscopic examination and roentgenograms of the bronchial arteries are needed to delineate resectional lines of bronchus, the former for deciding the mucosal extent and the latter the intrabronchial extent of the tumor. The bronchoplastic procedures we adopted were free from the risks and dangers generally accompanying the operation, and there were no postoperative deaths. For the prevention of postoperative complications, careful attention to suture technique is needed, and postoperative bronchoscopic suction of intrabronchial secretions is absolutely necessary. These procedures assure good quality of life postoperatively and improvement in the survival rate by preserving pulmonary function, enhancing curability, and increasing the operative indications. These advantages warrant high evaluation of the operation.
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Forty-six cases of primary bronchogenic carcinoma occurring in patients with other unilateral pleuropulmonary diseases were studied. In 37 cases (80-4%) carcinoma developed in the previously healthy lung. All but one squamous-cell carcinoma and all of five undifferentiated small-cell carcinomas developed in the previously healthy lung while 7 of 15 adenocarcinomas were in the lung with impaired ventilation. It is suggested that the bronchial epithelium of the healthy lung is more exposed to exogenous carcinogens than that of the diseased, underventilated lung, resulting in a higher risk of development of squamous-cell and undifferentiated small-cell carcinoma.
A series of cases of lung cancer were analyzed, with particular attention to the relationship between the presence of lymph node metastases and the prognosis for surgical intervention. The cases are classified into four clinical stages and a detailed classification of histologically proved lymph node metastasis and pleural involvement is presented. Results indicate that the presence of mediastinal lymph node metastasis, especially in cases with squamous-cell carcinoma and negative subcarinal lymph node, does not contraindicate surgical treatment.
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