De Giacomo T

Ambulatory mediastinal biopsy for hematologic malignancies

OBJECTIVE We retrospectively evaluated our experience with outpatient surgical biopsy of mediastinal lesions in patients with hematologic malignancies, its cost-effectiveness and ability to allow diagnosis. METHODS Eighty patients underwent outpatient surgical biopsy of mediastinal lesions related to hematologic malignancies (50 cervical mediastinoscopies, 24 anterior mediastinotomies and six video-assisted thoracoscopies). Eight patients had a superior vena cava syndrome, five had lesions residuing or relapsing after chemo-radiotherapy and six and had been treated with steroids before diagnosis; in five cases the biopsy had been previously performed at other hospitals without achieving a positive diagnosis. RESULTS Ambulatory mediastinal biopsy allowed diagnosis in all cases. Fifty-one patients had Hodgkin disease, 28 had non-Hodgkin lymphoma and one had chronic lymphatic leukemia. There was no operative mortality. Complications were: pneumothorax and bleeding during mediastinoscopy and wound infection after anterior mediastinotomy. CONCLUSIONS Mediastinal biopsy can be safely performed on an outpatient basis in selected patients with mediastinal involvement due to hematologic malignancies. Costs were markedly reduced with respect to in-hospital procedures.

Low grade neuroendocrine tumours of the lung (bronchial carcinoids) — 25 years experience

From 1960 to 1986, 69 patients with low grade neuroendocrine tumours (LGNT) of the lung were admitted to our institution. Of these, 36 were male and 33 were female. The mean age was 43 years with a range of 9-76 years. Sixty-eight patients were operated upon of whom 11 had metastatic mediastinal lymphnodes. A complete follow-up ranging from 3 to 25 years was obtained in 61 patients. Actuarial survival was 95% at 5 years and 87% at 10 years. The most important factor influencing the prognosis was mediastinal lymph node involvement. In 9 patients with mediastinal lymph node metastases at operation, the survival at 5 and 10 years was 75% and 46%, respectively, with highly significant difference (P less than 0.0001) as compared with the nonmetastatic group. In conclusion, bronchial LGNT are generally benign, but encompass a potential for malignancy. The prognosis depends on the presence of regional lymph node metastases. The choice of adequate surgical treatment depends on the size, location and aggressiveness of the tumour and the status of the mediastinal lymph nodes. The condition of the lung parenchyma distal to the lesion must be taken into account.

Preoperative chemotherapy and immunochemotherapy for locally advanced stage IIIA and IIIB non small cell lung cancer: preliminary results

From January 1991 to November 1993, 110 patients with histologically confirmed stage IIIA and IIIB non-small cell lung cancer (NSCLC), were seen at our Institution. Our study was designed to evaluate whether redirection to surgery of otherwise unresectable patients may be obtained by preoperative therapy. Forty-nine patients were considered eligible for neoadjuvant treatment. Thirty-two (Group I) were treated with two or three cycles of cisplatin, vinblastine and mitomycin C and 17 (Group II) received two cycles of cisplatin, VP16, alpha 1 timosine and interferon. The overall response rate was 81.2% for Group I and 88.7% for Group II. Downstaging was predictive of resectability (P < 0.05). Forty-one patients (83.6%) underwent thoracotomy with 37 (75.5%) radical resections. Conservative techniques (bronchovascular reconstruction) (22 cases) were preferred over pneumonectomy (2 cases). The resectability rate was 84% for Group I and 87% for Group II (P = NS). Treatment-related complications were minor, with no deaths. Postoperative complications occurred in two cases in each group (7.4% and 14.3%). There was no histologic evidence of tumor in three patients. Two-year survival was 75% for Group I and 55% for Group II (P = NS). To date 35 patients who had complete resection are alive, and free of disease. We conclude that preoperative chemotherapy produces high response and resectability rates in both stage IIIA and IIIB unresectable NSCLC; radical resection using a conservative technique is possible in patients who are otherwise unresectable; no local recurrence occurred after radical resection; no significant differences were demonstrated between the two protocols.