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Lung cancer and other malignancies

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Lung cancer and other malignancies Powered By Docstoc
					Thematic Poster Session                                                                                   Hall B2-25 - 12:50-14:40
                                     T UESDAY, S EPTEMBER 5 TH 2006




                                                             365. Lung cancer and other malignancies


                                                           P4120
                                                           Pulmonary rehabilitation after lobectomy for lung cancer. Exercise
                                                           programme vs. conventional approach
                                                           Hande Kiziltas 1 , Dilsad Sindel 1 , Alper Toker 2 , Sedat Ziyade 2 , Osman Coban 3 ,
                                                           Goksel Kalayci 2 . 1 Physical Medicine and Rehabilitation, Istanbul Faculty of
                                                           Medicine, Istanbul, Turkey; 2 Thoracic Surgery, Istanbul Faculty of Medicine,
                                                           Istanbul, Turkey; 3 School of Physical Therapy and Rehabilitation, Istanbul
                                                           University, Istanbul, Turkey

                                                           Objective: The aim of this study is to define the effects of pulmonary rehabilitation
                                                           applied to patients with non-small cell lung cancer who underwent lobectomy.
                                                           Methods: This prospective, randomized and controlled study included 30 patients
                                                           with non-small cell lung cancer who underwent lobectomy. During the first post-
                                                           operative week, the study group (15 patients) had pulmonary rehabilitation. After
                                                           discharge, the rehabilitation continued 3 days a week for 2 months. Pulmonary
                                                           rehabilitation programme consisted of postural, shoulder, respiratory and aerobic
                                                           exercises. Control Group (15 patients) underwent a conventional postoperative
                                                           rehabilitation mainly applied with incentive spirometer in hospital. All patients
                                                           were assessed for pulmonary functions (FEV, FEV1), exercise tolerance (6 minutes
                                                           walk test and stair climbing test) preoperatively and in the postoperative second
                                                           month. Postoperative complications were analyzed for both groups.
                                                           Results: Groups were similar in terms of pulmonary function tests preoperatively
                                                           and postoperative second month (p>0.05). Six minutes walk test and stair climbing
                                                           tests results were statistically better in study group which had higher scores in the
                                                           postoperative second month than in preoperative period (p<0.05). Two patients in
                                                           the control group had frozen shoulder after the lobectomy within 6 months, while
                                                           the study group had none.
                                                           Conclusions: In our study, pulmonary rehabilitation had no effect in pulmonary
                                                           function tests This study showed that the patients who underwent pulmonary
                                                           rehabilitation program after lobectomy had better aerobic capacity and physical
                                                           function. This program can reduce postoperative shoulder dysfunction.


                                                           P4121
                                                           COPD and resectable bronchogenic carcinoma: worse quality of life after
                                                           surgery?
                                                           Nuria Castejón 1 , Luis Hernández 1 , Santos Asensio 1 , José M.R. Paniagua 2 ,
                                                           Santiago Romero 1 . 1 Neumología, HGU de Alicante, Alicante, Spain; 2 Cirugía
                                                           Torácica, HGU de Alicante, Alicante, Spain

                                                           Objective: To evaluate the influence of COPD in the health-related quality of life
                                                           (HRQL) after lung cancer resection.
                                                           Methods: Prospective study of 164 consecutive patients operated of lung cancer
                                                           during 3-years. According to GOLD criteria, 83(33%) were COPD. We included
                                                           COPD and lung cancer patients followed with a protocol pathway (evaluations


                                                     717s

                Abstract printing supported by Nonin Medical, Inc. Visit Nonin Medical, Inc. at stand C09
         Thematic Poster Session                                                                                                       Hall B2-25 - 12:50-14:40
                                                              T UESDAY, S EPTEMBER 5 TH 2006

pre-surgery (preQx), 3rd and 6th months post-surgery) which included HRQL               group, 35±8% in control group (p=0.080). FEV1 was 47±15% and 36±7%
measured by St George’s Respiratory Questionnaire (SGRQ).                               respectively (p=0.0449). Serious, life-threatening complications of TEA were not
Results: Finally 70/164 patients complied with the conditions of the study; 34          observed.
of them were COPD (49%). The table shows the main results (mean ±SD) at                 Conclusions: We conclude that the TEA is a safe method, which provides a better
different follow-up moments (paired t-test) and their statistical significance respect   quality of life for the patient, decreases the postoperative complication rate and
non-COPD group. (*=p <0,05 between FEV1/FVC< or > 70%)                                  improves the ventilation function after the lung operations.
                                                                                        Acknowledgements: This study is supported in part by European Social Founda-
                                                                                        tion (ESF).
SGRQ              PreQx   PreQx-3rd m 3rd month 3rdm- 6th m 6th month PreQX-6th m
SYMPTOMS
FEV1/FVC<70%     30±21*     p=0,94      29±17       p=0,46     33±19*      p=0,58       P4124
FEV1/FVC>70%     20±12*     p=0,04      16±13*      p=0,90     18±12*      p=0,40       Survival and recurrences following surgical treatment of N2 NSCLC
ACTIVITY                                                                                Andrei Akopov, Ivetta Dvorakovskaya, Vladimir Varlamov, Yuri Levashev. Lung
FEV1/FVC<70%      30±21     p=0,00       50±29      p=0,39     52±26*      p=0,00       Surgery, Research Institute of Pulmonology, Pavlov’ Medical University,
FEV1/FVC>70%      24±29     p=0,02       38±28      p=0,99     37±31*      p=0,07       Saint-Petersbourg, Russia
IMPACT
FEV1/FVC<70%      16±15     p=0,03       23±18      p=0,66     26±17       p=0,00
                                                                                        The study included 110 patients (89 men and 21 women; median age of 64
FEV1/FVC>70%      12±12     p=0,11       18±16      p=0,63     21±19       p=0,04
TOTAL
                                                                                        years, range from 36 to 73 years) with N2 NSCLC who underwent thoracotomy
FEV1/FVC<70%      23±15     p=0,01       31±18      p=0,82     35±18       p=0,00       and pulmonary resection from January 1986 to December 2000 and in whom
FEV1/FVC>70%      17±13     p=0,12       23±15      p=0,93     27±19       p=0,04       complete follow-up Including results of postmortem examination at died were
                                                                                        done. 16 patients had T1 primary tumor (15%), 23 - T2 (20%), 60 - T3 (55%),
                                                                                        11 - T4 primary tumor (10%). The histologic types were squamous cell cancer
Conclusions: The differences in COPD group respect Non-COPD group were a                in 75 patients (68%), adenocarcinoma in 21 (19%), large cell cancer in 3 (3%),
worse puntuation in symptoms subscale which persisted in all evolutive moments          adenosquamous in 11 (10%). Pneumonectomy was done in 78 patients, lobectomy
and in the activity subscale at 6th month.                                              – in 32 patients. Multiple N2 nodal stages disease was found in 86 patients (78%),
Study founded by Fundación J. Gil Albert.                                               single - in 24 patients (22%). The median overall survival was 16 months. Overall
                                                                                        survival at 5 and 10 years were 14% and 11%, respectively. Median survival for
                                                                                        patients with single N2 nodal stage disease were 19 months, and for patients with
P4122                                                                                   multiple N2 disease - 14 months (p>0,05). At the time of first relapse, 17% of
Influence of the lung resection to small airways function in patients with               patients presented with a local relapse, 39% of patients had a distant metastases
limited and normal lung function and primary non-small cell lung cancer                 and 12% of patients had both a local and distant relapse. The incidence rates
Branka M. Bulajic 1 , Dragan R. Subotic 1 , Dragan V. Mandaric 1 , Tatjana              for relapse at postmortem examination were 15% with local disease, 45% distant
M. Eminovic 1 , Milan M. Gajic 2 . 1 Clinic for Thoracic Surgery and Intensive Care     disease and 28% local and distant disease, remaining died patients had no lung
Unit, Institute for Lung Diseases, Belgrade, Serbia, Serbia & Montenegro;               cancer relapses. 12% of patients were relapse-free at 5-year and 11% of 10-year
2
  Institute for Medical Statistics, University of Belgrade Medical School,              time period. Histologic type of tumor, T status, number of N2 level involved, the
Belgrade, Serbia, Serbia & Montenegro                                                   volume of resection did not influence survival and recurrences. Long-term survival
                                                                                        in patients with surgically treated N2 NSCLC is possible. For surgical selection
Objective: Small airways function changes after lung resection are rarely analysed.     investigation of biological prognostic factors is important.
Aims: to assess differences in small airways function after lung resection between
lung cancer patients with limited and normal lung function.
Methods: the study included 33 patients with limited lung function who under-           P4125
went lung resection (23 lobectomies, 10 pneumonectomies) for lung cancer in a           Limits of opportunities in palliative surgery in cases of the inoperable
one-year period. Forced expiratory flows at low lung volumes (FEF50 and FEF              malignant tracheal stenosis
25) were compared with the same parameters in the control group of 56 patients          Boris B. Shafirovsky 1 , Igor V. Vasilyev 2,3 , Andrey R. Kozak 3 , Victor F. Mous 4 ,
with normal lung function. The main and the control groups were also compared           Sergey V. Orlov 5 , Peter K. Yablonsky 2,3 . 1 Miniinvasive Surgery, Mechnikov’s
in terms of FEF50 and FEF25 changes after lung resection.                               Academy, Saint-Petersburg, Russia; 2 Hospital Surgery, Medical Faculty, State
Results: in the lobectomy group, preoperative FEF50 values in patients with limited     University, Saint-Petersburg, Russia; 3 Thoracic Surgery, Hospital 2,
and normal lung function were 24.31±11.05% and 61.11±19.59% respectively                Saint-Petersburg, Russia; 4 Thoracic Radiology, CNIRRI, Saint-Petersburg,
(P<0.01); in the sams group, preoperative FEF25 values were 26.74±13.38% and            Russia; 5 Thoracis Oncology, Pavlov’s Medical University, Saint-Petersburg,
54.39±15.96% for patients with limited and normal lung function respectively.           Russia
After combined desobstructive treatment, in patients with limited lung function un-
dergoing lobectomy, only FEF50 became significantly improved (23.46±12.25%               There is quite enough information in contemporary scientific literature about
vs 28.1±10.82%), whilst in patients undergoing pneumonectomy, both FEF50                treatment options in cases of inoperable malignant tracheal stenosis. However,
and FEF25 significantly improved. In the main group, neither FEF50 nor FEF25             where is a rational limit? Aim: to study the prognostic factors of the lethality
significantly changed after the operation, whilst in the control group both FEF50        in perioperative period in cases of the malignant tracheal stenosis. Materials: 50
and FEF25 significantly decreased independently on the extent of lung resection.         patients were included in this retrospective study with inoperable tracheal cancer
Conclusion: in patients with limited lung function, small airways function is less      who were treated in SPb CIPiTH and Pavlov’s medical university from 1995 to
impaired after resection vs. patients with normal function. This finding influences       2006. Patients were diagnosed with 19 primary tracheal cancers and 31 cancers
patient selection.                                                                      of adjacent organs. In this study the cases of metastatic tracheal stenosis were
                                                                                        excluded. In all these cases we used rigid bronchoscopy with different methods
                                                                                        of palliative surgery. In this study we funded 6 lethal outcomes in perioperative
P4123                                                                                   period. We used statistical analysis: ANOVA method.
Effects of the epidural analgesia on the complication rate after the lung               Results: we used multifactorial Anova analysis and find, that choice of method of
cancer surgery                                                                          palliative surgery is not important for prognosis of lethal outcome. All character-
Uldis Kopeika 1 , Sanita Udre 2 , Natalja Jakushenko 1 , Immanuels Taivans 1 ,          istics of tracheal tumor-it is not important too.However, we find that patients with
Jazeps Basko 2 . 1 Faculty of Medicine, University of Latvia, Riga, Latvia;             poor functional status by Karnofsky scale – have major function for prognosis of
2
  Thoracic Surgery Centre, Pauls Stradins University Hospital, Riga, Latvia             lethal outcome.In second we use monofactorial Anova analysis and find, that all
                                                                                        patients with functional status by Karnofsky scale equal or less, than 50% had
Background and Goal of Study: TEA is considered to show a good anaesthetic              lethal outcome.
efficacy and to decrease the postoperative complication rate, but its effects upon       Conclusion: the functional status by Karnofsky scale equal or less, than 50% -
the ventilation function is the topic of many clinical researches.                      is may be rational limit for any method of the palliative surgery. However, all
Materials and Methods We analyzed all patient data, operated on for lung cancer         patients had to get all less invasive methods of relief of respiratory failure, such as
during last 5 years. There were 453 patients, their mean age was 61±8 years.            tracheostomy and intubation.
Postoperatively 80 patients received TEA, other 373- opioids intramuscularly. We
recorded postoperative complication rate, SaO2 , FEV1, FVC and the efficacy of
analgesia using visual- analog pain scale.                                              P4126
Results and Discussions: A better statistically significant efficacy of analgesia         Surgical treatment of lung cancer after polyhemothetapy/radiotherapy
was observed in the TEA group, VAS 2.3 against 5.4 in the control group                 down-staging in patients initially assessed as inoperable
(p<0.05). There was also a statistically significant lower incidence of postopera-       Danail Petrov 1 , Eluar Goranov 1 , Samuel Danon 2 , Mihail Plochev 1 . 1 Thoracic
tive complications - 20% against 38.8% in the control group. TEA is a factor of         Surgery, Saint Sophia University Hospital of Pulmonary Diseases, Sofia,
decreasing the relative risk of complications (RR= 0.53, 95% CI= 0.37-0.79; p=          Bulgaria; 2 National Cancer Registry, National Oncological Hospital, Sofia,
0.0233). In lobectomy group, 24 hours after surgery, FVC was 61±12% in TEA              Bulgaria
group, 45±13% in control group (p=0.0152). FEV1 was 56±17% and 41±11%
respectively (p=0.0308).                                                                Between 2002 and 2006 a total of 13 patients (mean age of 57.8 years) were
In pneumonectomy group, 24 hours after surgery, FVC was 47±16% in TEA                   operated on. Initially they were defined to be inoperable because of a local cancer


                                                                                    718s

                                     Abstract printing supported by Nonin Medical, Inc. Visit Nonin Medical, Inc. at stand C09
         Thematic Poster Session                                                                                                       Hall B2-25 - 12:50-14:40
                                                              T UESDAY, S EPTEMBER 5 TH 2006

advance in 9 patients, as well as of ipsilateral pleural (1), intrapulmonary (1)        P4129
and supraclavicular (2) metastases. Squamous cell carcinoma was verified in 8            Post operative dynamism of NSCLC tumor markers (CEA, CYFRA 21.1,
cases, followed by adenocarcinoma (3), bronchioalveolar (1) and mucoepidermoid          NSE, TK, TPS)
(1) carcinomas. Cisplatin and Gemzar (4 to 6 courses) were administrated in 10          Jarmil Safranek 1 , Ondrej Topolcan 2 , Jiri Klecka 1 , Vladimir Spidlen 1 ,
patients. In 2 patients polyshemotherapy was combined with radiotherapy. Reeval-        Josef Vodicka 1 , Vaclav Simanek 1 . 1 Department of Surgery, Charles University
uation revealed a “down-staging” ± in all of them and they were referred to surgery.    and Faculty Hospital, Pilsen, Czech Republic; 2 Second Internal Clinic, Charles
The following procedures were carried out: lobectomy (1), sleeve lobectomy (2)          University and Faculty Hospital, Pilsen, Czech Republic
extended lobectomy (3), and pneumonectomy (7) with systematic mediastinal
lymphadenectomy. No 30-day postoperative mortality was faced. Early postpneu-           Background: The aim of this study was to evaluate prospectively the relationship
monectomy empyema was observed in 2 (15%) patients, successfully treated with           between the tumor markers (CEA, CYFRA 21.1, NSE, TK, TPS) serum levels of
repeated VATS debridement (1) and open-window thoracostomy (1). Postoperative           non small cell lung carcinoma (epidermoid or adenocarcinoma) and the stage of
polychemo-/radiotherapy was administered in 2 patients. The overall cumulative          carcinoma.
3-year postoperative survival is 76±29%. Tree patients died 9, 12 and 39 months         Methods: The study comprised 43 new consecutive NSCLC patients (stage I-III),
postoperatively. Nine patients are disease free respectively 4 to 31 months after the   operated in year 2005 (29 epidermoid carcinomas and 14 adenocarcinomas). Tu-
operation. The last patient is still alive with recurrence 19 months postoperatively.   mor markers were assessed using immunoanalytical method 1 day before surgery,
In conclusion, carefully selected patients (initially judged to be inoperable) after    7 days and 6 months after surgery. The results were statistical processed.
a successful polychemotherapy and polychemo-/radiotherapy are indicated for             Results: Statistical significant dynamic differences (p<0,05) in post surgery fol-
surgery with acceptable early and long-term postoperative results.                      low up indicates (p-value): TK (p=0,0014) and TPS (p=0,0093). CYFRA 21.1
                                                                                        (p=0,1492), CEA (p=0,1642) and NSE (p=0,5779) do not indicate follow up sig-
                                                                                        nificant differences. The level of CEA is constantly higher with distinctive increase
P4127                                                                                   in the stage III of adenocarcinoma. The level of CYFRA 21.1 is also constantly
The study of effecting factors in acute respiratory emergencies in children             higher with distinctive increase in the stage III of epidermoid carcinoma. NSE is
with mediastinal tumors                                                                 not increased, it is without level variation. TK and TPS serum values significantly
Reza Bagheri, Ziaollah Haghi. Quaem Hospital Cardiothoracic Department,                 response in post operative course.
Mashhad University of Medical Science, Mashhad, Iran; Quaem Hospital                    Conclusions: CYFRA 21.1, TK and TPS are optimal for follow up monitoring
Cardiothoracic Department, Mashhad University of Medical Science, Mashhad,              markers of NCSLC epidermoid carcinoma, CEA, TK and TPS are optimal markers
Iran                                                                                    for adenocarcinoma. NSE is not suitable for following of NSCLC.

Intrathoracic tumors in children often occure in anterior mediastinum where the
rate of malignancy is high and may lead to acute respiratory emergency. In this         P4130
study we evaluated the effective factors that led to acute respiratory emergency in     Lung function estimation in patients with lung cancer qualified for surgical
children.                                                                               treatment
Material & Method: We studied 22 children under 15 years old with mediastinal           Monika Franczuk 1 , Mariusz Chabowski 2 , Stefan Wesolowski 1 , Piotr Boros 1 ,
tumor that had been treated with pathologic diagnosis and followed for at least         Tadeusz M. Orlowski 2 . 1 Lung Function Lab, National TB & Lung Diseases
6 months. (Between 1994-2004 in Mashad Quaem hospital). Besides me did a                Research Institute, Warsaw, Poland; 2 Department of Thoracic Surgery, National
comparing study between two (with and without airway obstruction) to show the           TB & Lung Diseases Research Institute, Warsaw, Poland
effective factors.
Results: 22 patients were included with 55% male, 13% of patients were asymp-           The criteria determining the treatment method of patients with NSCLC comprise
tomatic and 16% of them had minor respiratory symptoms and 27% of them had              the extent of the disease expressed by TNM classification and histopathology. The
more with acute respiratory emergencies. 45% of these tumors were in anterior           lung function assessment is one of the tools of perioperative risk estimation.
mediastinum. The most common method of diagnosis was anterior mediastinotomy            The aim of the study was the evaluation of lung function in patients with LC
(41.5%). 72% of these tumors were malignant and the most common malignancy              qualified to surgical treatment. 169 pts, including 114 men, of mean age 61.6 ±9.8),
was lymphoma (41%). Effective factors for acute respiratory emergencies included        of proven LC, were analysed. The spirometry according to ERS recommendation
being of tumor in anterior mediastinum, having the pathology of lymphoma, per-          was performed in all pts.
sisting of signs pressure on great vessels and airway and having pleural effusion,      Results: 93 pts were assigned to surgical treatment, and 51 of them had airway
signs of superior vencava syndrome. During our 6 months follow up, mortality            obstruction (16-mild, 29-moderate, 6-severe), enabling to diagnose COPD. In 45
was seen only in 9% of patients that all of them had acute respiratory emergency        pts with LC and airway obstruction lobectomy was performed, in 3 pts - pneu-
signs.                                                                                  monectomy and in 3 pts lung tissue sparing surgery, i.e. partial resection. 9 patients
Conclusion: According to high rate of malignancy in children with mediastinal           did not meet even the minimal criteria of BTS recommendation, i.e. FEV1≥ 1.5
tumor and probable acute respiratory emergency with high mortality rate in them,        for intented lobectomy, and FEV1 ≥ 2.0 for pneumonectomy. The postoperative
diagnostic evaluations seem necessary to find out predisposing factors to prevent        course in one patient was complicated by pneumonia and respiratory insufficiency.
acute respiratory complications.                                                        In the other cases of increased perioperative risk the postoperative period was
                                                                                        uneventful.
                                                                                        Conclusion: Almost 55% of pts with LC assigned to surgical treatment have
P4128                                                                                   an airway obstruction, requiring permanent therapy with bronchodilators. For
Possibilities of reconstruction during pleuropneumonectomy with resection of            majority of them (over 90%) preoperative spirometry was the first test revealing
pericardium and diaphragm in patients with malignant pleural mesothelioma               COPD. According to experts’ recommendation and our preliminary observation it
Dragan R. Subotic, Dragan V. Mandaric, Nikola D. Atanasijadis, Predtag                  is believed that administration of inhalation therapy, even shortly before surgery,
P. Dzeletovic, Ljiljana M. Andric. Clinic for Thoracic Surgery, Institute for Lung      improves the lung function parameters. It allows the patients with borderline lung
Diseases, Belgrade, Serbia, Serbia & Montenegro                                         function parameters to undergo the surgical procedures.

Objective: pleuropneumonectomy with removal of pericardium and diaphragm
for malignant mesothelioma is a challenge both from the standpoint of patient           P4131
selection and surgical procedure. The operative technique is rarely adressed in the     Features of N-staging in left-sided non-small cell lung cancer
literature.                                                                             Peter K. Yablonsky, Vadim G. Pischik, Andrey S. Petrov. Hospital Surgery, State
Aims: to demonstrate some alternative technical possibilities in patients with this     University, Faculty of Medicine, Saint-Petersburg, Russia
pathology.
Methods: in the period 1996-2005, 12 patients underwent pleuropneumonectomy             Study objectives: Left-sided tumors frequently metastasize to lymph nodes (LN)
+ resection of the pericardium and diaphragm. By using the intraoperative videos,       #5, which are not accessible by standard mediastinoscopy (SM) and some authors
we present 3 possible technical solutions for dealing with the postpleuropneu-          suggest to use additional invasive procedures for N-staging.
monectomy space after removal of pericardium and diaphragm. Intraoperative              Aim: to evaluate the diagnostic value of SM in N-staging of left-sided non-small
videos are combined with schematic presentation of reconstructive procedures.           cell lung cancer (NSCLC) and to define the necessity of biopsiing LN#5 during
Results: in the analysed period, classical technique consisted of extrapleural pneu-    preoperative N-staging.
monectomy, removal of the pericardium and diaphragm and their replacement with          Materials and methods: 67 patients with potentially resectable left-sided NSCLC
protheses. First modification consists of the reduction of the pleural space by mesh     treated at our institution from Jan 2004 to Jan 2006 were included and divided
interposition from the medial diaphragmatic edge to the upper rib of the lower          into 2 groups: group I (n=40) where both SM and chest CT were used and group
thoracic incision. Second modification represents the use of the free inferior-lateral   II (n=27) where only chest CT was used for N-staging of NSCLC. Patients with
edge of the pericardium to cover the medial part of the diaphragmatic defect,           negative SM from group I and all patients from group II underwent subsequent
so that the rest of the defect could be directly reconstructed. The third modi-         thoracotomy.
fication combines complete desinsertion of the posterior part of diaphragmatic           Results: In 9 patients (23%) SM revealed N2-N3 disease. Accuracy, sensitivity
muscles, leaving the posterior part of the intact peritoneum unprotected and direct     and specificity of SM for N-staging (93%, 75%, 100%, respectively) were signifi-
suture/mesh of the rest of the diaphragm invaded by the tumour.                         cantly higher than those of CT (61%, 50%, 68% respectively). The percentage of
Conclusion: whatever technique is performed, the balance should exist between           “noncurative thoracotomies” (pN2) was lower in group I (10%) than in group II
potentialy curative resection and operative morbidity.                                  (37%), p=0,03. During the systematic LN dissection most frequently the metastasis
                                                                                        were observed in LN #5: in group II these LN were involved in 26% of patients,


                                                                                    719s

                                   Abstract printing supported by Nonin Medical, Inc. Visit Nonin Medical, Inc. at stand C09
         Thematic Poster Session                                                                                                      Hall B2-25 - 12:50-14:40
                                                              T UESDAY, S EPTEMBER 5 TH 2006

whereas in group I - only in 6%. Metastasis in LN #5 were found less than in 5%         technique and only in one case an anterior thoracotomy was needed to remove the
of patients with negative LN #4L or #7.                                                 huge mediastinal tumor. Total resection of tumors were done in all 3 patients and
Conclusions: SM has a high diagnostic value and helps to reduce the percentage          there were no severe injuries to great vessels and all patients were discharged from
of noncurative thoracotomies in patients with left-sided NSCLC. Metastasis in LN        hospital without any complications and are being observed for 6 months until now
#5 (N2 disease), can be rather accurately excluded in case of negative LN #4L /#7       without tumor recurring. The medium time for hospitalization was 5.5 days.
(which are to be biopsied during SM) without additional invasive procedures.            Conclusion: Due to good exposure of neck and mediastinal great vessels and
                                                                                        succeed in removing these tumors, we advise using this technique for approaching
                                                                                        them. Of course it is obvious that more studies are needed in future.
P4132
Mediastinal primary malignant melanoma
Serife T. Liman 1 , Salih Topcu 1 , Korkmaz Burc 1 , Huseyin Agirbas 2 ,                P4135
Sevgiye Ozkara 3 , Hasan T. Sarisoy 4 . 1 Thoracic Surgery, Kocaeli University The      Bilaterally thoracotomy in the treatment of pleuropulmonary blastoma
Faculty of Medicine, Kocaeli, Turkey; 2 Cardiovascular Surgery, Kocaeli                 Serife T. Liman 1 , Funda Corapcioglu 2 , Salih Topcu 1 , Korkmaz Burc 1 ,
University The Faculty of Medicine, Kocaeli, Turkey; 3 Pathology Department,            Sadan Yavuz 3 , Kursat Yildiz 4 . 1 Thoracic Surgery, Kocaeli University Medical
Kocaeli University The Faculty of Medicine, Kocaeli, Turkey; 4 Radiology                Faculty, Kocaeli, Turkey; 2 Pediatric Oncology, Kocaeli University Medical
Department, Kocaeli University The Faculty of Medicine, Kocaeli, Turkey                 Faculty, Kocaeli, Turkey; 3 Cardiovascular Surgery, Kocaeli University Medical
                                                                                        Faculty, Kocaeli, Turkey; 4 Pathology, Kocaeli University Medical Faculty,
Malign Melanoma (MM) may be rarely located in the mediaatinum as primary                Kocaeli, Turkey
or metastatic lesion. A case with primary mediastinal MM and pleural metastasis
was discussed here. A 65-year-old female patient was admitted to the hospital           Pleuropulmonary blastoma (PPB) is aggressive, rarely seen tumor of childhood.
with the complaints of dyspnea, cough which increased with exertion. Massive            Congenital cystic lesions may be precursors for PPB.
pleural effusion was detected in chest x-ray. Mediastinal mass was observed in          A 3-year-old child was admitted to the hospital with the complaints of cough,
second radiological examinations after thoracentesis. CT and MR examinations            dyspnea and wheezing. Chest x-ray showed complete homogeneous opasity of
revealed mediastinal mass 10x7x6 cm in dimention located in right mediastinum.          right hemithorax and mediastinal shift. Right huge mass contained both solid and
Mediastinal shift and tracheal displacement to left and multiple soft tissue masses     cystic components was detected in chest x-ray and CT after thoracentesis. Con-
in pleural space which involved right diaphragm and pleura were also observed.          genital lung cyst was detected in left lung. PPB was diagnosed via true-cut biopsy.
VATS was performed. Biopsy was taken from purple colured lesions in pleural             After giving 2 cures neoadjuvan chemotherapy (ICE-VAC), it was detected that
space. Pathological examinations revealed MM. There was no another primary              the fluid in cystic components was disappeared and solid component was getting
or metastatic focus f of MM in total body examination. Mediastinal MM was               smaller. The tumor was originated from medial segment of middle lobe but there
regarded as primary focus. In her second CT examination mediastinal involvement         was no invasion of adjacent structures in thoracotomy.I was excised together with
was detected and she underwent chemotherapy programme. MM is frequently seen            wedge resection of middle lobe. She was given 4 cures additional chemotherapy
in skin. But it can be seen in another tissues which have melanin cells. MM may be      (ICE-VAC). After 8 months from surgery, congenital cystic lesion of left lung was
primary or metastatic. Since there was no additional focus we regarded mediastinal      excised.
malignant melanoma as primary. But it shoud be kept in mind that Cutaneous
melanomas may spontaneously regress leaving only the metastatic lesion masking
as a primary lesion.


P4133
Giant tumors of the pleura: solitary fibrous tumors
Alpay Orki, Gökhan Haciibrahimoglu, Cagatay Tezel, Altug Kosar, Oral Akin,
Erdal Tasci. Thoracic Surgery, Sureyyapasa Center for Chest Disease and
Thoracic Surgery, Istanbul, Turkey

Objective: The aim of this study is to evaluate the clinical behavior of the solitary
fibrous tumors of pleura and the optimal surgical approach for these rare tumors.
Methods: We have reviewed the records of six patients who underwent tumor
resection in our clinic between 1997 and 2004 retrospectively.                          Complet surgery should be performed. Since PPB is originated from congenital
Results: Six patients were operated in this period and the mean age was 42.3            cystic lesions, excision of congenital cystic lesions of lung is the acceptable
years. None of them have been exposed to asbestosis. Symptoms were presented            management.
in five patients. All patients underwent thoracotomy. Tumor was originated from
visceral pleura in five patients and parietal pleura in one. All patients underwent
tumor excision. Mean diameter for tumor was 14cm (range 6 to 23). Pathology             P4136
results were reported as benign solitary fibrous tumor of the pleura for all the         Surgical treatment of lung carcinoid depending on its differentiation
six patients. Resection was complete in all patients. There was no post-operative       Miodrag Pavlicic, Ljiljana Vuckovic, Milana Panjkovic, Zivka Eri, Jelena Stanic.
mortality and major complications. No recurrence has been observed during the           Surgery Department, Clinical Center of Montenegro, Podgorica, Montenegro,
mean 53.5 months follow-up.                                                             Serbia & Montenegro; Pathology Department, Clinical Center of Montenegro,
Conclusion: Solitary fibrous tumors of the pleura are rare neoplasms and can             Podgorica, Montenegro, Serbia & Montenegro; Pathology Department, Institute
reach to giant diameters. Complete surgical resection is the optimal treatment for      for Pulmonary Diseases, Novi Sad, Serbia, Serbia & Montenegro; Pathology
these tumors and risk of malignancy in larger masses should be remembered.              Department, Institute for Pulmonary Diseases, Novi Sad, Serbia, Serbia &
                                                                                        Montenegro; Oncology Department, Institute for Pulmonary Diseases, Novi Sad,
                                                                                        Serbia, Serbia & Montenegro
P4134
Anterior trans cervicothoracic approach for complete resection of                       This combined retrospective- prospective study included 76 patients operated for
cervicothoracic mediastinal tumors                                                      lung carcinoid in the Medical Centre of Montenegro in Podgorica and at the Chest
Reza Bagheri, Mohammad Taghi Rajabi Mashhadi, Mohammad Mashhadinejad.                   Surgery Clinic of the Institute for Lung Diseases in Sremska Kamenica, over the
Quaem Hospital Cardiotoracic Surgery Department, Mashhad University of                  period from 1990-2003. The examined group consisted of 39 males at the mean
Medical Science, Mashhad, Iran; Quaem Hospital General Surgery Department,              age of 50,47yrs, and 37 females at the mean age of 47,08 years. Sixty-six patients
Mashhad University of Medical Science, Mashhad, Iran; Quaem Hospital                    (86,85%) reported syptoms, predominantly dyspnea and cough. In 96,05% of the
Neurosurgery Department, Mashhad University of Medical Science, Mashhad,                patients the disease was discovered by X-ray and/or CT screening. Sixty-eight
Iran                                                                                    (89,47%) operated patients had a typical and eight (10,35%) atypical bronchial
                                                                                        carcinoid. Lobectomy was the most common surgery applied in 55,26% of the
Mediastinal tumors consist of a wide spectrum of benign and malignant disease.          operated, followed by pneumonectomy (19,73%), bilobectomy (11,84%), middle
Some of these tumors which locate in the thoracic apex can produce many problems        lobe sleeve lobectomy (3 patients), right main bronchus sleeve lobectomy (1
in decision making due to developing to neck spaces, because with thoracotomy           patient) and wedge resection (3 patients). The peripheral carcinoid localization
approach most of these tumors cannot be resected totally due to close attachment        was registered in only 14 patients (19,45%), while the endoluminal one was
of these tumors with great vessels and removal of these tumors is with dangerous        found in rest 80,55% of the patients. The distal parenchyma was involved by
complications and massive hemohrrages during surgery.                                   obstructive pneumonitis and/or obstructive bronchiectasis in 59 patients (77,63%).
The goal of this study is to report the operated cases of these kinds of tumors with    The majority of the typical carcinoids had stage I disease (73,53%), while most
anterior trans cervical-thoracic approach.                                              atypical carcinoids were in stage II (37,50%). The five-year survivl was registered
Case reports: There were 3 patients in our study; all were females; and 9 and 10        in 86,76% and 12,5% of the patients in the typical and atypical carcinoids respec-
and 21 years old. Pathology reports of them were: one case ganglioneuroblastoma,        ticely. The ten-year survival was 77,94% of the typical carcinoids, only one patient
one case neurofibromatosis and the other, thyroid medullary carcinoma. Tumor             has now been living eight years after the surgical treatment. Limited resections
extenstion in neck spaces in 2 patients was at the left side and in one patient in      may be apllied in rare, strictly indicated cases.
right side. In all three patients tumors were completely removed by mentioned


                                                                                     720s

                                   Abstract printing supported by Nonin Medical, Inc. Visit Nonin Medical, Inc. at stand C09
         Thematic Poster Session                                                                                   Hall B2-25 - 12:50-14:40
                                                                T UESDAY, S EPTEMBER 5 TH 2006

P4137
Giant cell tumour originated from rib
Habil Tunc 1 , Turgut Isitmangil 1 , Saban Sebit 1 , Rauf Gorur 1 , Akin Yildizhan 1 ,
Erdogan Kunter 2 , Nurettin Yiyit 1 , Hakan Cermik 3 . 1 Thoracic Surgery, GMMA
Haydarpasa Training Hospital, Istanbul, Turkey; 2 Pulmonary Medicine, GMMA
Haydarpasa Training Hospital, Istanbul, Turkey; 3 Pathology, GMMA
Haydarpasa Training Hospital, Istanbul, Turkey

Giant cell tumour originated from rib is a rarely seen semi-malign tumour. Giant
cell tumours are generally characterized with local relapses. In the literature, a few
cases with metastases and rapid course have been reported. Now, giant cell tumour
of rib is aimed to be presented since it is rarely seen.
In the physical examination of the patient who had a swelling in the back-left
during 6 months, a mass lesion rising over the skin with sizes 6X6 cm has been
found on the 12th rib. In computed tomography, a rough contour 6X5 cm size
mass lesion has been determined which originated from left 12th rib, leading to
expansion of bone structure and lytic appearance. It was pushing the kidney toward
anterior and attacking chest wall muscles in posterolateral region. In the operation
of the patient, tumoural lesion and left 12th rib had been excised together with
environmental tissue. In postoperative period there was not any complication and
it was written “giant cell tumour with low malignancy potential” in his pathology
report. This patient has been followed up by medical oncology clinic.
We think that surgical excision is the choice of therapy in giant cell tumour cases
and low malignancy potential patients should be followed up in regards of relapse
and metastases risk.


P4138
Primary mixoma of lung ang pleura, complicated pleural effusion
Nikolay S. Opanasenko 1 , Irina V. Liskina 2 . 1 Thoracic Surgery, 2 Pathology,
Institute of Tuberculosis and Pulmonology, Kiev, Ukraine

Myxoma is a rare mesenchymal tumor occurring mainly in the vulvar region
extending into the paravaginal and perirectal region. Histologically, this tumor is
rich in vascular structures and in collagen fibers and is of myxoid appearance.
We report a very rare case of primary myxoma of pleuro-pulmonary origin. We
present 45-years old white woman who was admitted to our department with left
pleural haemorragic effusion. She suffered from pain in the left hemythorax and
had mild hypertermia. Patient was sick during 5 months. Pleural fluid exami-
nation, bronchoscopy, common laboratory examination were not informative for
diagnosis. During thoracoskopy planty invasions (like incapsulated haematoma)
were found on parietal and visceral pleura (cytohistologic - myxoma). After CT
and sonography it was proved that pathology invasion have just been discov-
ered in the left hemythorax (parietal and visceral pleura, upper lobus of left lung).
Open thoracothomy, cytoreduction and postoperative intrapleural hypertermy (420 )
chemotherapy were performed. Pathologic examination showed myxoma without
malignancy. Patient had 3 courses of systemic chemotherapy (cisplatinum). Post-
operative period was univentful during 1, 3 and 6 months after operation. But after
1 year local recurrence of myxoma without Mts was found by CT. Pathologic
examination (transthoracic puncture) showed agressive malignant myxoma. In
spite of the systemic chemotherapy patient died 23 months after operation.
Conclusions: 1.Myxoma is very rare tumor of pleuro-pulmonary origin. 2. This
tumor is locally infiltrative and requires wide excision and follow up. 3. Behaviour
of myxoma is unclear (possibility to lose differentiation).


P4139
Primary pleural synovial sarcoma: a case report
Nikolay S. Opanasenko, Irina V. Liskina. Thoracic Surgery, Institute of
Tuberculosis and Pulmonology, Kiev, Ukraine; Pathology, Institute of
Tuberculosis and Pulmonology, Kiev, Ukraine

Synovial sarcoma (SS) is rare tumor of respiratory system. We present a 38-
years white old male non-smoker with no occupational exposure to asbestos who
suffered from dyspnoea (due to a large left persistent pleural effusion), periodic
rising of temperature and common weakness. He admitted to hospital where X-ray
revealed cyst arranged in left interlobar sulcus with pleural effusion. Investigation
of haemorragic pleural fluid suggested hydatic disease. The course of treatment
was carried out with temporary effect but later signs have appeared again. In
our department pleural fluid examination showed no scolies, no malignant cell.
Thoracocenthesis, closed pleural biopsy and thoracoscopy were uneffictive for
diagnosis. At open thoracotomy a different diameter cystic masses (150 mm max)
were presented in left interlobar sulcus and pleural space. Within the cysts several
hemorrhagic, necrotic and solid areas were noted. Possible total pleural decorti-
cation with removal of cystic mass was performed. Tumor did not invade lung
parenchyma. Histologically, a diagnosis of biphasic SS was made based on few
immunohistochemical stains. Postoperative period was complicated by toxic hep-
atitis with successfully overcome. Patient had 3 course of chemotherapy (gemzar)
and 2 course of radiotherapy. In spite of systemic chemotherapy after 4 months
just local recurrence of tumor was found by CT, 9 months - CT showed distant
Mts and after 15 moths – patient died.
Conclusions: 1.SS is very rare and agressive tumor of pleuro-pulmonary origin
with poor prognosis. 2. It has possibility for local recurrence and distant Mts. 3.
Wide tumor excision with next chemotherapy and radiotherapy is attempt to cure
these patients.


                                                                                         721s

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