Prise en charge des carcinomes bronchiques selon le stade: le point de vue du chirurgien

Surgery is the treatment of choice for non-small cell lung carcinoma (NSCLC) stage I and II. However, adjuvant or neoadjuvant chemotherapy may prove to be of benefit for stages IB and II. Treatment of non-small cell lung carcinoma stage IIIA remains controversial. Recently, neoadjuvant chemotherapy has shown excellent results in patients with metastases to mediastinal lymph nodes discovered at mediastinoscopy and, therefore, seems to be the treatment of choice for these patients. Patients with non-small cell lung carcinoma stage IIIB and IV may benefit from surgery in rare and extremely well selected cases

Four decades of surgery for bronchogenic carcinoma in one centre

Since the authors' initial experience in the surgical management of bronchogenic carcinoma in 1956, more than 40 years have passed. The purpose of this report was to review the authors' data and compare the results by decade (1956-1966; 1967-1976; 1977-1986; and 1987-1996) in order to assess the changing patterns in bronchogenic carcinoma. A total of 1,597 thoracotomies have been performed. Between the first and last decades of the study, patients' mean age increased from 57 to 63 yrs, the ratio of males to females decreased from 19:1 to 3:1 and the proportion of adenocarcinoma cases increased from 10 to 34%. The operative mortality decreased from 10% in 1967- 1976 to 4% in 1987-1996 and the overall 5-yr survival improved from 27 to 36% during the same period. The rate of lobectomy progressively increased from 32% in 1956-1966 to 61% in 1987-1996, whereas that of pneumonectomy and exploratory thoracotomy decreased from 42 to 28% and from 20 to 4%, respectively. Changing patterns of patient characteristics, histology and type of surgery were associated with a constant improvement in the overall 5-yr survival. This improvement was particularly evident among patients with advanced-stage carcinoma

Factors influencing improvement and remission rates after thymectomy for myasthenia gravis

Thymectomy has become an accepted option in the treatment of myasthenia gravis (MG). However, the optimal selection of patients for surgery remains controversial

Muscle-sparing anterior thoracotomy for one-stage bilateral lung volume reduction operation

Bilateral lung volume reduction produces significant clinical and physiologic improvement in selected patients with end-stage emphysema. Current surgical approaches consist of median sternotomy and video-assisted thoracoscopy. This report describes an alternate technique of single-stage, bilateral lung volume reduction using muscle-sparing anterior thoracotomy in 18 patients with severe lung emphysema

Time trend in the surgical management of patients with lung carcinoma

The goal of the study was to analyze the histological and clinical trends in lung carcinoma and their influence upon the preoperative evaluation, surgical procedures and survival

Carcinomes pulmonaires primitifs et syndrome de Pancoast

Although the treatment of Pancoast tumours usually combines radiotherapy and surgery, poor prognosis has been reported. The influence of clinical signs and extension of surgical resection on long-term survival has not yet been systematically investigated

Early improvement of respiratory function after surgical plication for unilateral diaphragmatic paralysis

We reported an unusual case of symptomatic diaphragmatic paralysis in an elderly patient with progressive respiratory-dependent limitation of her daily activities. Surgical plication of the affected hemidiaphragm resulted in early clinical and physiological improvements

Incidence, risk factors and management of bronchopleural fistulae after pneumonectomy

Postpneumonectomy bronchopleural fistula (BPF) remains a serious and often life-threatening complication. Over a seven-year period, seven cases of BPF occurred in a series of 100 consecutive pneumonectomies performed for lung carcinoma by the same surgical team. The incidence increased from 3% (1/33) prior to 1993 to 9% (6/67) thereafter. The presence of tumour within the main stem bronchus and the need for postoperative mechanical ventilation correlated significantly with the occurrence of BPF. However, it is likely that other risk factors, such as the introduction of systematic mediastinal lymph nodes dissection since 1992 and bronchial stapling since 1993, were involved. In four patients, closure of BPF was achieved by transposition of pedicled latissimus dorsi (LD) muscle flap and closed-chest irrigaiton of the pleural cavity. Patients were discharged after a median stay of 19 d; fistula recurred in one case and was successfully treated with an omental flap. No complications related to the LD division were observed. In conclusion, mediastinal lymph node dissection may increase the risk of post-pneumonectomy BPF. Systematic bronchial stapling should be used cautiously, especially if the tumour is present within the main stem bronchus. Treatment with predicted LD muscle flap or omental flap associated with closed-chest irrigation proved to be simple, time-saving and efficient

Long-term survival after surgical resections of bronchogenic carcinoma and adrenal metastasis

There is some evidence that complete resection of both primary and metastatic sites of non-small cell lung carcinoma has more influence on survival than the locoregional stage of the lung cancer. We describe prolonged survival (>5 years) after complete surgical resection of a bronchogenic carcinoma (T3N0M1) and solitary adrenal metastasis