J.Jpn. Surg. Soc.. 56(6): 695-719, 1955
宿題報告
Treatment of Pulmonary Cancer
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Surgical Department, Tiba Uinversity Medical School Naoji KAWAI |
Bases for the systemic condition were blood sedimentation rate, anemia, liver functions, and serum protein. The limits of resectability were determined from these factors.
The local findings were evaluated acording to a simplified classification patterned after that of Salzer, based on the extent of the tumor and its metastasis : Group I, radically resectable : Group III, unresectable : and Group II, intermediate between the other two grops and either unresectable or permitted a palliative resection.
In evaluating the extent of the tumor and localization of metastasis, some special procedures, such as the use of isotope, mediastinography, and angiocardiography, were used in addition to the usual methods.
Determination of indications during the operation : In cases where definitive diagnosis is not made pre-operatively, biopsy and rapid intraoperative diagnosis by means of P32 upon theracotomy are recommended in order to aid in the choice of operative procedures.
Evaluation of operative procedures: Since a radial operation with lymphalic dissection form the basis of the treatment, adequate knowledge of the lymphatic system is required.
In order to determine the extent of wide resection which is requried in radical resection, experiments were conducted in connection with measures necessary for resection of the chest wall, pericardium, diaphragm, large vessels, and tracheo-bronchial tree, and the limits of their resectability were outlined.
Experimental tumors in mice were studied in connection with palliative resection therapy. Palliative resection of fructose-sarcoma and chinone-carcinoma in mise produced a cure rate three times as high as that of control negative rate, while the addition of chemotherapy at an appropriate time, in an appropriate dosage, and for an appropriate duration, to the palliative resection produced a cure rate twice as high as that of the palliative reaction alone.
Disappearance of the remnant tumor tissue sfter a palliative resection can also be shown clinically. Surgery of lung cancer should, as a rule, be radical, but, under unavoidable circumstances, may be palliative with due consideration to the systemic condition. In these cases all efforts should be dircted post-operatively toward elimination of the remaining tumor tissue. This is considered possible.
Operative results and prognosis: Our exploratory thoractomy comprised 25% and resection, 42%, of the total. These figures are better than those of the foreign and previous Japanese reports. Analysis of resetability from different angels shows a certain degree of correlation, so that they should be evaluated pre-operatively.
Prognosis of resection : Operative mortality was 22%, about the same as that of foreign reports, despite the higher resection rate.
Prognosis of resected cases cannot be certain at this time. Out of 49 cases resected, half of them died wihin 4 months. The survival rate over 1 year was 21% and over 2 years only 9%.
The future of lung cancer treatment depends on how to realize the already well known, and yet difficult to carry out, early diagnosis and early operation. With that end in view, public education, mass examination, resection of the so-called pre-cancer states, social measures and measures for advanced cases are important.
(author's abstract)
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