Hirofumi Noto

Survival and Prognosis After Pneumonectomy for Lung Cancer in the Elderly

BACKGROUND The number of elderly patients with lung cancer is increasing. This study was undertaken to assess the validity of pneumonectomy for the treatment of lung cancer in this patient group. METHODS Twenty-seven patients 70 years old or older (elderly group) and 95 patients younger than 70 years (younger group) who underwent pneumonectomy between January 1985 and March 1996 formed the study group. In the elderly group, 22 patients had squamous cell carcinoma, 2 had adenocarcinoma and 3, small cell carcinoma; 1 patient was in postoperative stage I, 4 patients were in stage II, 14 in stage IIIA, 5 in stage IIIB, and 3 in stage IV of the disease. The only significant differences in patient characteristics between the two groups were the percentage of patients undergoing right pneumonectomy and the percentage of patients receiving chemotherapy or radiotherapy within 3 months before or after operation or both times. RESULTS The prognosis for the elderly group was comparable to that of the younger group for all stages of the disease; the overall 5-year survival rate was 30.5% for the younger group and 11.5% for the elderly group. However, operation-associated mortality was significantly higher in the elderly group (22.2% versus 3.2%; p < 0.005). The prognosis was better for patients with a centrally located tumor than a peripheral tumor in both groups [13.5% versus 2.0% in the elderly group and 46.7% versus 5.2% (p < 0.01) in the younger group] and significantly better for patients having a left pneumonectomy than a right pneumonectomy in the younger group (46.7% versus 5.2%; p < 0.01) but not in the elderly group (13.7% versus 22.2%). Adjuvant treatment did not have any beneficial effect on the prognosis in either group. CONCLUSIONS Pneumonectomy for lung cancer in elderly patients appears to be justified because the outcome in our study was comparable with that for the younger patients. However, it should be performed only in carefully selected patients because of the increased operative risk.

Studies on Clinicopathological Features of Lung Cancer Patients with K-ras/p53 Gene Alterations: Comparison between Younger and Older Groups

In order to define the roles of the K-ras and p53 genes in the development of lung cancer, especially in young adults, we compared the clinicopathological features of the patients between younger (< or = 45 years, n = 47) and older (< 55 years, n = 50) groups. The gene alterations were examined by the polymerase chain reaction-single strand conformation polymorphism (PCR-SSCP) method. The K-ras gene alterations were detected only in adenocarcinomas, and the p53 gene alterations in all histologic types of lung cancer. There were no significant differences in the frequency of both K-ras and p53 gene alterations between the younger and older groups (9 vs. 11%, 36 vs. 32%). In the younger group, but not in the older one, the percentage for smokers was significantly higher in the p53 gene alteration-positive group than for the negative group (65 vs. 30%). As to the prognosis, there were no significant differences between the p53 gene alteration-positive and -negative cases in both the younger and older groups as well as in all subjects, while a tendency of poorer prognosis was observed in K-ras gene alteration-positive cases than for the -negative ones with adenocarcinomas. These results suggest that (1) the K-ras and p53 gene alterations would have no special roles in terms of the lung carcinogenesis in young adults; (2) a positive relationship between smoking and p53 gene alteration would exist in young adults with lung cancer, and (3) K-ras gene alteration would become a prognostic factor in lung cancer.

Results of Pneumonectomy for Non-Small Cell Lung Cancer

To assess the role of pneumonectomy for lung cancer and the factors affecting the prognosis, 107 patients who had undergone pneumonectomy for non-small cell lung cancer (NSCLC) between January, 1985 and March, 1996, were analyzed. They included 81 squamous cell carcinoma, 22 adenocarcinoma, 3 large cell carcinoma, and one adenosquamous cell carcinoma, with 8 patients in post-operative stage I, 15 in stage II, 51 in stage IIIA, and 33 in stage IIIB of the disease. The 5-year survival rate was 54.7% in stages I + II, 38.0% in stage IIIA, and <4% in stage IIIB. In stages I-IIIA, the patients with squamous cell carcinoma showed a significantly better prognosis than those with adenocarcinoma (50.6 vs. 0%, p < 0.01). The prognosis was also better, but not statistically significant, for patients with central type compared with those with peripheral type in both all histologic types (58.0 vs. 8.4%) and only squamous cell type (59.3 vs. 18.8%). A better prognosis observed in squamous histologic type or central type seemed to be related to a better N factor. Pneumonectomy remains the treatment of choice for lung cancer, but seems not to be justified for patients with stage IIIB due to their poor prognosis.

A case of short bowel syndrome managed by home elemental enteral hyperalimentation.

はじめに 小腸広範切除後に発症する短腸症候群においては栄 養管理は重要な問題である。以前は残存小腸の長さが 40cm以 下では管理は困難であるとされ1ち最近では経 静脈的高カロリー輸液 (intravenOus hyperalimenta― tion,以下 IVH)や 成分栄養剤(elemetal diet以下 ED) による経腸栄養法などの栄養管理法の進歩によりその 生命的予後は次第に改善されてきたものの,家 庭生活 への復帰はいまだ困難である。われわれは自己挿管に よる経鼻チュープを通 して夜間のみ EDを 注入する在 宅経腸栄養法の実施により,家 庭生活への復帰が可能 であった短腸症候群の 1例 を経験 したので報告する。 症 例 症fllは71歳の男性で,昭 和55年に上行結腸癌のため 結腸右半切除術の既往を有 し,家 族歴には特記すべき ことはない。昭和60年 7月 上旬よリイレウス症状のた め他院に入院していたが,腹 膜刺激症状が出現してき たため 7月 14日に当科へ紹介され,絞 施性イレウスの 診断にて緊急手術が実施された。 正中切開で開腹するに,腹 腔内に中等量の血性腹水 を認め,小 腸間膜の軸捻転のため Treitz観常の約25

EFFECT OF INTRAVENOUSHYPERALIMENTATION ON ANASTOMOTIC FAILURE OF GASTROINTESTINAL TRACT

縫合不全に対する高カロリー輸液 (IVH) の治療効果を検討した.縫合不全症例147例を, IVH (+) 69例, IVH (-) 78例の2群に分け, それぞれを重症度別にI度からIV度に分類した.全体の治癒率ではIVH (+) 58.0%, IVH (-) 44.9%で大差はなかったが, 重症度に応じた治癒率では, I度100%: 100%, II度100%: 91.3%, III度52.6%: 24.3%, IV度38.9%: 0%で重症例において明らかにIVHの効果がみられた.II度とIII度について, 自然治癒までの期間を比較したところ, II度14日: 40日, III度22日62日とIVH (+) で治療期間の著明な短縮を認めた.敗血症の発生, インシュリンの使用頻度では重症, 軽症間に差はなく, 縫合不全に対するIVHの効果が確認された.