Management of preoperative anaemia.
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Anemia↗
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[Preoperative care in neurosurgery; general].
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Humans↗
Blood ordering habits for elective surgery: time for change.
A prospective study was carried out for 6 months to determine the efficacy of blood ordering routines for elective surgery. It was found that only 23% of procedures needed preoperative crossmatching of blood (transfusion index 'TI' greater than 0.5). There was an excessive over-ordering of blood for 77% of the operations (crossmatch/transfusion ratio greater than 2.5). In addition, the transfusion index for the latter group showed that there was no need to prepare blood preoperatively (TI less than 0.5). A transfusion tariff is worked out which abandons crossmatching for the majority of procedures (cholecystectomy, thyroidectomy and surgery for duodenal ulcer excluding gastrectomy). Instead a 'group and screen' policy is suggested.
Blood Grouping and Crossmatching↗
[Intraoperative echoencephalography in neurosurgery].
Intraoperative ultrasonography with real time sonographic imaging equipment is widely used and, in the neurosurgical operating room, has been really successful, initially in the brain and subsequently in the spinal cord as well. Its main applications i.e. accurate needle biopsies, localization of intracerebral masses, placement of ventricular and cyst shunts, can diminish the amount of potential damage to normal brain tissue. Moreover results of tumor resection may be intraoperatively confirmed and the end results are more accurate. No intraoperative complications and no postoperative infections result from use of ultrasound in the operating room. No evidence is given that the small amount of mechanical vibration emitted by the transducer damages the brain or the spinal cord. Surgical procedures, as a result, are faster, safer and better planned by virtue of informations obtained by ultrasonographic intraoperative examination, instead of simple preoperative imaging procedures.
Brain↗
Utility of magnetic resonance arteriography for distal lower extremity revascularization.
PURPOSE: Magnetic resonance arteriography (MRA) of the lower extremities affords several possible advantages over conventional contrast arteriography (CA). We hypothesized that MRA of the infrageniculate vessels was sufficiently accurate to replace CA before revascularization procedures in patients with limb-threatening ischemia. METHODS: Fifty-three extremities in 49 patients were prospectively evaluated before attempted infrageniculate revascularization procedures with preoperative infrageniculate time-of-flight MRA (cost, $170/study) and standard contrast arteriography (cost, $1310/study) of the aortoiliac and runoff vessels. Independent operative plans were formulated based on the MRA and CA results before the revascularization procedure. Intraoperative, prebypass arteriograms (IOA; cost, $46/study) were obtained in all patients to confirm the adequacy of the distal runoff. The preoperative plans formulated by the results of MRA and CA were compared with the actual procedure performed based on the IOA. All arteriograms (CA, MRA, IOA) were reviewed after the operation by two independent reviewers, and the number of patent vessel segments and those with < 50% stenosis was determined. RESULTS: Revascularization procedures were performed in 44 of 53 extremities (83%), and amputation was performed in nine extremities (17%) because of an absence of a suitable bypass target. The CA and MRA were equally effective in predicting the optimal operative plans as determined from IOA (CA, 42 of 53 [77%] vs MRA, 40 of 53 [75%]; p = 0.79). More patent vessel segments were seen on CA than MRA (reviewer A, 229 vs 174, kappa = 0.32; reviewer B, 321 vs 314, kappa = 0.46); however, a comparable number of segments were seen if the vessels of the foot were excluded. The accuracy (reviewer A, 78% vs 68%, p = 0.003; reviewer B, 75% vs 67%, p = 0.003) and sensitivity (reviewer A, 69% vs 51%, p = 0.001; reviewer B, 68% vs 46%, p = 0.0001) of CA relative to IOA were superior to those of MRA, although the specificity was comparable (reviewer A, 86% vs 90%, p = 0.31; reviewer B, 82% vs 87%, p = 0.52). The combination of MRA and IOA would have resulted in the optimal operative plan in 51 of the 53 cases (96%) and was comparable with CA and IOA (53 of 53; 100%; p = 0.50). Substitution of MRA and IOA for CA and IOA could potentially have saved an estimated $60,420. CONCLUSIONS: The combination of MRA and IOA provides an accurate, cost-efficient strategy for visualization of the infrageniculate vessels before revascularization procedures.
Aged↗
Recent advances in preoperative and intraoperative nuclear medicine procedures in patients with primary hyperparathyroidism.
Although bilateral neck exploration is traditionally considered as the treatment of choice in patients with primary hyperparathyroidism (HPT), several surgical techniques of limited neck exploration have been proposed over the last 10 years in primary HPT patients with a high probability to be affected by a solitary parathyroid adenoma. The availability in recent years of highly sensitive and accurate preoperative imaging modalities, particularly the parathyroid scintigraphy with 99mTc-MIBI and high resolution neck ultrasonography, allowed to increase the rate of primary HPT patients as candidates to a selective parathyroidectomy. One of the most innovative techniques for limited surgery is the minimally invasive radio-guided parathyroidectomy that is based on the intraoperative detection of the parathyroid adenoma under the guidance of a gamma probe allowing the removal of the parathyroid adenoma through a small 2-cm skin incision. However, if a minimally invasive parathyroidectomy is taken into consideration, accurate preoperative imaging is mandatory not only to distinguish patients with a solitary parathyroid adenoma from those with multi-glandular disease but also to diagnose patients with concomitant thyroid nodule(s) that can cause false-positive results at radio-guided surgery. In the present study the most recent advances reached with preoperative localizing imaging of parathyroid adenomas are reviewed and the techniques proposed to perform a minimally invasive radio-guided surgery are discussed with particular regard to the therapeutic efficacy and cost-effectiveness analysis.
Humans↗
Baerveldt implant surgery in the treatment of advanced childhood glaucoma.
BACKGROUND: The efficacy of Baerveldt implant (Pharmacia & Upjohn, Inc., Kalamazoo, Mich.) surgery in the treatment of advanced childhood glaucoma is unknown. METHODS: We reviewed the results of 23 consecutive 350 mm Baerveldt implants in 20 eyes of 17 children. Results were classified as follows: (1) success; no further reoperation, no decrease in vision, and intraocular pressure at last follow-up less than 21 mm Hg with no medications; (2) qualified success; medication necessary to bring intraocular pressure to less than 21 mm Hg or complication not associated with tube failure; and (3) failure; intraocular pressure >20 mm Hg, tube failure complication or reoperation causing tube removal, phthisis, or enucleation. RESULTS: Original glaucoma types were bilateral aphakic (five), unilateral aphakic or persistent hyperplastic primary vitreous (four), primary infantile (four), juvenile (three), secondary(two), Peter syndrome (one), and Lowe syndrome (one). Patients had undergone a mean of 2.8 previous intraocular procedures. Mean preoperative intraocular pressure was 33.6 mm Hg; average number of preoperative glaucoma medications was 3.0. Mean follow-up was 19 months (range, 6 to 32 months). Eight procedures were considered successful (mean intraocular pressure 15.5 mm Hg), six were qualified successes (mean number of medications 0.8; mean intraocular pressure 16 mm Hg), and nine failed. Two eyes in the qualified success group do not have useful vision as a result of complications. Complications included retinal detachment (five), corneal decompensation (five), corneal graft rejection in five of six grafts; dislocated tubes (three), and recurrent uveitis (two). One of these eyes is phthisic and one has been enucleated. Only two of nine procedures in eyes with a history of one or no previous intraocular operations failed,whereas seven of 13 procedures in eyes with a history of three or more previous procedures failed. Only seven of 13 procedures in aphakic eyes were successes or qualified successes, whereas seven of 10 procedures in phakic eyes had good results. CONCLUSION: Baerveldt implants can produce good short-term results, especially in phakic eyes. Aphakic eyes and eyes that have undergone multiple procedures are at a much higher risk for devastating complications.
Adolescent↗
Fate of excluded popliteal artery aneurysms.
OBJECTIVE: Popliteal artery aneurysms (PAA) are frequently treated with ligation and exclusion bypass grafting. It is assumed that these aneurysms will shrink and remain asymptomatic. This may not always be true. We sought to elucidate the fate of excluded PAA over time. METHODS: Data for all PAAs treated with ligation and exclusion bypass grafting between 1986 and 1999 were retrospectively reviewed. Computed tomography (CT) scans and duplex ultrasound scans provided aneurysm patency data and maximal transverse diameter measurements of the popliteal artery during late postoperative follow-up. This information was compared with that from similar preoperative studies. RESULTS: Forty-one patients (39 men, 2 women) underwent 57 ligation and exclusion bypass grafting procedures. Both preoperative and late postoperative (mean, 4.0 years; range, 0.43-13.5 years) CT scans or duplex ultrasound scans were available for review of 25 PAAs in 18 patients (ages 42-80 years; mean, 63 years). Preoperative PAA size ranged from 14 to 45 mm (mean, 28.7 mm). In late follow-up, 12 (48%) PAA had decreased in size (mean, 7.3 mm), 5 (20%) remained unchanged, and 8 (32%) increased in mean transverse diameter (mean, 5.9 mm). One large aneurysm increased by 50%. Contrast material enhancement was identified in the excluded sac in 11 aneurysms. CONCLUSIONS: PAA treated with ligation and exclusion bypass grafting often expand and can become symptomatic. This may be analogous to type II endoleak or endotension noted after aortic endovascular repair. We recommend PAA excision or endoaneurysmorrhaphy when feasible.
Adult↗
[Function-sparing surgery in the combined therapy of laryngeal cancer].
The reports deals with the principle and methods of making a two-stage diagnosis of laryngeal tumor evolved on the basis of the data on two calibrated groups of 250 patients each and a computer-supported procedure of mathematical analysis. Two programs for a MC-52 microcalculator are suggested to select the scope of surgical intervention. Such procedures of preoperative radiation therapy as exposure under hyperbaric oxygenation conditions, cutting down the preoperative radiation dosage and shortening the interval between ir radiation course and surgery have been improved. Five improved procedures of saving therapy for tumors of the supraglottic area and four--for glottic cancer were used in 142 patients. The functional and oncological results of saving surgery were evaluated in 458 patients receiving combined treatment for laryngeal tumors. Said results were found to be beneficial.
Combined Modality Therapy↗
[Diagnosis of solitary thyroid gland nodules].
Solitary thyroid gland nodes have presented an entity in thyroid surgery and endocrinology for a long period of years mostly due to frequent occurrence of malignomas and other changes of thyroid gland as well as to insufficient and uncertain clinical diagnostics. The only certain diagnostics is still the intraoperative exploration and ex tempore biopsy of the change, which means that surgery presents both a diagnostic and therapeutic procedure. At the Clinical-Hospital Center "Dr Dragisa Milosevic" in Belgrade, Department of Surgery, 100 patients with preoperatively diagnosed solitary thyroid gland nodes underwent surgery during a 4 year period. In all patients a uniform clinical diagnostics was performed, and then, on the basis of intraoperative findings and ex tempore biopsy, gathered results were compared and reliability of certain preoperative diagnostic procedures was considered in regard to intraoperative findings. The aim of this study was to point to necessity of application of all relevant indexes in diagnostics with a special review on the intraoperative finding as the most relevant in making the decision about the range of surgery and further postoperative treatment.
Adult↗
Preoperative visceral angiography alters intraoperative strategy during the Whipple procedure.
To determine the importance of preoperative visceral angiography prior to pancreaticoduodenectomy, all Whipple procedures performed between 1985 and 1991 at the Virginia Mason Medical Center were retrospectively reviewed. During this period, 77 pancreaticoduodenectomies were performed for both neoplastic disease (n = 54, 70%) and chronic pancreatitis (n = 23, 30%). Sixty-four preoperative angiograms were obtained, of which 39 (61%) were abnormal findings. Thirty percent (19 of 64) of the angiograms revealed a significant vascular abnormality that required specific preoperative or intraoperative measures that might not have been performed without knowledge of these findings. Examples include celiac axis revascularization for celiac occlusion, hepatic artery preservation for replaced vessels, preoperative embolization for pseudoaneurysm or arteriovenous fistula, and splenectomy for splenic vein thrombosis. Because of the high percentage of significant findings requiring an intraoperative or preoperative technical change, we recommend the use of angiography in order to diminish morbidity in all patients preparing to undergo pancreaticoduodenectomy.
Angiography↗
Laparoscopic ultrasonography for staging of gastrointestinal malignancy.
BACKGROUND: Diagnostic laparoscopy has been used frequently as a preoperative staging procedure for different gastrointestinal malignancies. The assessment of solid abdominal organs and retroperitoneal ingrowth or detection of lymph-node metastasis is limited, however. A recent development, laparoscopic ultrasonography, will probably increase the preoperative evaluation of these lesions and thus further improve the preoperative staging. METHOD: Since 1993 diagnostic laparoscopy combined with laparoscopic ultrasonography has been performed as an additional diagnostic procedure in patients who have already been selected for curative resection of different GI malignancies. In this prospective study, staging after conventional work-up is compared with the tumour stage after laparoscopy. All patients underwent exploratory laparotomy except those with histologically proven metastases/ingrowth. RESULTS: For patients with cancer of the esophagus and gastric cardia (n = 56) the preoperative stage was altered in 17% but laparotomy could only be avoided in 5% (for a subgroup of patients with a tumour of the gastric cardia laparotomy was avoided in 11%). Additional findings during laparoscopy showed that laparotomy could be avoided in 55% of the patients (n = 44) with primary liver tumours, liver metastasis or proximal bile duct tumours. For patients with pancreatic head tumours (n = 73) the preoperative stage of the tumor changed in 40%; the strategy of treatment was changed in 26% and laparotomy could be avoided in 20%. CONCLUSIONS: Laparoscopy combined with laparoscopic ultrasonography is effective (more accurate) in the staging of gastrointestinal malignancies, in particular for patients with liver, biliary and pancreatic tumours. The preoperative tumour stage changed between 15 and 60% for the different gastrointestinal malignancies and laparotomy could be avoided in 5-55%. The procedure is highly operator-dependent and has a learning curve.
Endosonography↗
[Annual study of perioperative mortality and morbidity for the year of 1999 in Japan: the outlines--report of the Japan Society of Anesthesiologists Committee on Operating Room Safety].
Anesthetic mortality and morbidity in Japan Society of Anesthesiologists (JSA) Certified Training Hospitals (CTH) for the year 1999 were reported as continuation of annual studies started in 1993. The JSA Committee on Operating Room Safety (CORS) sent confidential questionnaires to 774 CTH and received valid responses from 60.3% of hospitals. A total number of 793,840 anesthetics were documented. The respondents were asked to report all cases of cardiac arrests and other critical incidents (serious hypotension, serious hypoxemia and others), and their outcomes (death in operating room, death within 7 days, transfer to vegetative state and rescue without sequelae) as well as one principal cause for each incident from list of 52 items. They were also requested to submit the tabulation of patients by ASA physical status, age distribution, surgery sites and anesthetic methods. Analysis was made by total incidents under anesthesia/surgery, and also by incidents totally attributable to anesthetic management (AM), due to preoperative complications (PC), due to intraoperative pathological events (IP) and due to surgery (SG), with special reference to each of four tabulation groups and the whole group of patients. This paper focused analysis on all patients, as analyses with special reference to ASA physical status, age distribution, surgery sites and anesthetic methods were previously reported. Total incidence of cardiac arrest under anesthesia/surgery was 6.53 per 10,000 anesthetics. PC, IP and SG represented principal causes in 42.9%, 22.0% and 21.4% causes of total cardiac arrest cases, respectively. AM was noted as the principal cause in 12.0% of cases, with an incidence rate of 0.78 per 10,000. In 52 more detailed classification of principal causes, the most frequent cause of cardiac arrest was preoperative hemorrhagic shock, 20.3% of all cardiac arrests. The second cause was massive hemorrhage and/or hypovolemia due to surgical procedures (13.1%), and the third was intraoperative myocardial infarction/coronary ischemia/coronary spasm (9.5%). Prognoses of cardiac arrest cases declined due to PC: 71.1% of cardiac arrests died in the operating room or within 7 days after surgery and only 19.8% survived without sequelae. The best prognoses were found in cardiac arrest cases due to AM: 69.4% survived without sequelae and 12.9% died. The mortality rate post-cardiac arrest was 3.44 per 10,000 anesthetics, of those 0.10 due to AM, 0.57 due to IP, 1.99 due to PC and 0.76 due to SG. The mortality rate after critical incidents other than cardiac arrest such as severe hypotension and severe hypoxemia was 3.75, of those 0.03 due to AM, 0.28 due to IP, 2.31 due to PC and 1.13 due to SG. The final mortality rate attributable to anesthesia/surgery including deaths post-cardiac arrest and after other critical incidents was 7.19 per 10,000 anesthetics and very close to 7.18 [6.22, 8.13], that of mean [95% C.I.] in 1994-1998. The final mortality rate totally attributable to anesthesia was 0.13 per 10,000 anesthetics, which was significantly improved from 0.21 [0.15, 0.27], that of mean [95% C.I.] in 1994-1998. IP, PC and SG showed the final mortality rate of 0.84, 4.30 and 1.89, respectively. Five major causes of all critical incidents were massive hemorrhage due to surgical procedures (20.8%), preoperative hemorrhagic shock (10.7%), surgical technique (8.0%), inappropriate airway management (5.2%) and intraoperative myocardial infarction and coronary ischemia (4.5%). Drug overdose or selection error (3.9%) and overdose of main anesthetic (2.9%) as a result of human error occupied the 7th and 10th places. As far as anesthetic management to reduce mortality and morbidity related to anesthesia is concerned, we should increase vigilance to avoid human errors in addition to improving preanesthetic preparations and assessment of cardiovascular status as well as intraoperative management of cardiovascular events.
Anesthesia↗
Surgical experience with diseases of the tricuspid valve. Cross-sectional and Doppler echocardiographic evaluation following DeVega's repair.
Seventy-eight patients undergoing mitral valve surgery with or without replacement of the aortic valve also underwent procedures on the tricuspid valve over a period of 10 years. All patients were in functional class III or IV preoperatively. The procedures were performed in all patients with organic disease of the tricuspid valve (N = 44) and in those with moderate or severe functional tricuspid valvar regurgitation (N = 34). Seventy-one patients underwent DeVega's annuloplasty with or without commissurotomy. The overall mortality was 11.5%. 65 long-term survivors were followed up for a period of 6 months to 10 years (mean 5.3 years). Sixty-three patients were in functional class I or II at the last follow-up. Six patients had clinical evidence of mild to moderate tricuspid regurgitation. Regression of cardiomegaly (as judged by the chest radiograph and right ventricular hypertrophy seen in the electrocardiogram) was evident in most cases. Fifty-one of 54 patients evaluated by cross-sectional echocardiography were reported to have a functionally normal tricuspid valve. Doppler echocardiography in 28 patients showed no significant tricuspid regurgitation or stenosis in 26 patients. Eleven consecutive patients undergoing DeVega's annuloplasty were studied prospectively with pre- and postoperative Doppler echocardiography. Good correlation existed between right ventricular systolic pressures predicted by Doppler with those obtained preoperatively at cardiac catheterization. Postoperative Doppler echocardiography in these 11 patients showed complete restoration of competence of the tricuspid valve as well as normalisation of the right ventricular systolic pressure in 10 patients.
Adult↗
Rectus femoris surgery in children with cerebral palsy. Part II: A comparison between the effect of transfer and release of the distal rectus femoris on knee motion.
Rectus femoris muscle (RF) surgery was performed in 98 children (136 sides) with cerebral palsy (CP). RF transfer was performed in 105 lower limbs, and distal RF release was performed in 31. Eleven (20 sides) similarly affected children had no RF procedure and are included for comparison. Gait analysis was performed just before and approximately 1 year after surgery. All children underwent other orthopaedic surgery at the time of the RF procedure. When preoperative knee range of motion (ROM) was > 80% of normal, there were no significant changes in knee motion in either the RF transfer or distal release groups. In patients with < 80% of normal knee ROM preoperatively, RF transfer was followed by maintained knee flexion in swing; patients who underwent distal RF release or no RF procedure showed a decrease (10 degrees and 6 degrees, respectively) in knee flexion postoperatively. These results suggest that the RF should be transferred and not released when knee ROM is < 80%.
Adolescent↗
[Multidisciplinary therapy of colorectal cancer].
A multidisciplinary program for the treatment of colorectal cancer is described. The main objective of the authors has been to define uniform up to date guidelines based on recent progress in the treatment of colorectal cancer. Preoperative diagnostic procedures are summarized which advance determination of clinical stage and prognosis. These information essentially determine care. Sequences of surgical methods, preoperative and postoperative radiotherapy and medical treatments are discussed according to tumor stages. Guidelines for surveillance following active treatment and recommendation for the screening of population at high risk for colorectal cancer are presented.
Algorithms↗
[Annual study of anesthesia-related mortality and morbidity in the year 2000 in Japan: the outlines--report of Japanese Society of Anesthesiologists Committee on Operating Room Safety].
This report contains anesthesia-related mortality and morbidity in Japanese Society of Anesthesiologists Certified Training Hospitals (JSACTH) in the year 2000, as a part of the second series of annual studies started in 1999. JSA Committee on Operating Room Safety (CORS) sent confidential questionnaires to 794 JSACTH and received effective answers from 65.5% of hospitals. A total number of 941,217 anesthetics were documented. The respondents were asked to report all cases of cardiac arrests and other critical incidents (serious hypotension, serious hypoxemia and others), and their outcomes (death in operating room, death within 7 days, transfer to vegetative state and rescue without sequelae) as well as one principal cause for each incident from the list of 52 items. They were also requested to submit the tabulation of patients by ASA physical status, age distribution, surgery sites and anesthetic methods. Analysis was made by total incidents under anesthesia/surgery, and also by incidents totally attributable to anesthetic management (AM), due to preoperative complications (PC), due to intraoperative pathological events (IP) and due to surgery (SG). This paper focused analysis on entire patients, since analyses with special reference to ASA physical status, age distribution, surgery sites and anesthetic methods were reported previously. Total incidence of cardiac arrest under anesthesia/surgery was 6.52 per 10,000 anesthetics. PC, IP and SG occupied 46.4%, 19.1% and 23.0% of principal causes of total cardiac arrest, respectively. AM occupied only 8.1% of the principal causes and the incidence was 0.53 per 10,000. The most frequent cause of cardiac arrest in 52 more detailed classification of principal causes was preoperative hemorrhagic shock that occupied 23.3% of all cardiac arrests. The second was massive hemorrhage and/or hypovolemia due to surgical procedures (10.6%), and the third was surgery itself (9.5%). Prognosis of the cardiac arrest was worst in that due to PC, 73.7% of cardiac arrests died in the operating room or within 7 days after surgery and only 20.4% survived without sequelae. The best prognosis was found in cardiac arrest due to AM, 76.0% survived without sequelae and 12.0% died. The mortality rate after cardiac arrest was 3.52 per 10,000 anesthetics, of them 0.06 was due to AM, 0.39 due to IP, 2.23 due to PC and 0.76 due to SG. The mortality rate after critical incidents other than cardiac arrest such as severe hypotension and severe hypoxemia was 3.48, and of them 0.03 was due to AM, 0.18 due to IP, 2.45 due to PC and 0.81 due to SG. The final mortality rate attributable to anesthesia/surgery including deaths after cardiac arrest and after other critical incidents was 7.00 per 10,000 anesthetics and very close to 7.18 [6.22, 8.13], that of mean [95%C.I.] in 1994-1998, and 7.19 in 1999. The final mortality rate totally attributable to AM was 0.10 per 10,000 anesthetics, which was significantly improved from 0.21 [0.15, 0.27], that of mean [95%C.I.] in 1994-1998, but not different from 0.13 in 1999. IP, PC and SG showed the final mortality rate of 0.56, 4.69 and 1.57, respectively. Five major causes of all critical incidents were massive hemorrhage due to surgical procedures (13.8%), preoperative hemorrhagic shock (13.1%), surgical technique (8.6%), inappropriate airway management (6.2%) and preoperative respiratory complication (5.7%). Drug overdose or wrong choice (2.7%) as a human error occupied the 10th. In conclusion, the obtained incidences as to death, other critical incidents and their outcomes as well as the occurrence of principal causes in 2000 study were remarkably close to those in 1999 study. We expect that this second series of annual studies for five-years should reveal precise and definite direction for us to reduce anesthesia-related mortality and morbidity.
Anesthesia↗
[Exploratory thoracotomy: causes of inoperability of non-small-cell lung cancer].
The investigation is concerned with evaluation of different procedures of preoperative examination as well as reasons for carrying out explorative thoracotomy for lung cancer. The data on examination and surgical treatment of 81 patients who underwent explorative thoracotomy for primary non-small cell cancer of the lung were analyzed. The procedure was performed in 9.3% of surgical patients. Assessment of preoperative clinical and macro- and microscopic findings as well as resected material was carried out for each patient. The X-ray, bronchological, functional, angiographic and computed tomography evidence identified involvement of the mediastinal systems (pulmonary artery, vena cava superior, myocardium, aorta and trachea) and dissemination of tumor to the pleura as the most common cause of inoperability. Radical surgery was contraindicated in 65% because of the involvement of several organs and tissues. In certain situations, explorative thoracotomy should be resorted to as the last method of diagnosis of primary lung cancer.
Carcinoma, Non-Small-Cell Lung↗