The records of 193 patients (29 femals and 164 males) who undervent resection for lung cancer between gen. 1987 and sept. 1997 were reviewed. Mean age was 72,6 ys. (range 70 - 82 ys.). Associated diseases included: cardiovascular disease (86 patients), bronchopulmonary disease (46 pts), peptic ulcer (28 pts), diabetes mellitus (14 pts) other disease (48 pts). Fifty-two patients were free of relevant disease. Eight-two patients had a single associated disease and 59 had two or more associated disease. Surgical procedures included 9 pneumonectomies, 161 lobectomies and 23 lesser resections. Sixtythree complications were observed in 61 Fts (31%) There were atrial fibrillation (42), persistent air leakage (10) and acute respiratory failure (2). Five pts. needed ICU stay because of respiratory distress in the immediate postop. period: 3 were discharged on the Ist postop, day; 1 was mechanically ventilated till the 3rd postop. day and :I underwent tracheostomy and was discharged from ICU on the 10th postop. day. In 24 pts. the complications was related to the associated pathology. Mean postoperative stay was 10 days (range 5 - 30). Mortality rate was 0,54%. Age over 70 years has no longer to be considered a limiting factor in selected patients undergoing surgery for lung cancer.

Objective: We have analyzed our experience in a period ranging from January 1990 to December 1996, to confirm role of surgery in management of treatment of SCLC patients.Methods: The study was carried out on 55 patients(pts) undergone surgery for SCLC as resections or open lung biopsy. The median age of pts(49 males and 6 females) was 59 years(range 34 to 74 yrs). In 6 pts with pre-operatory diagnosis 3-5 cycles of neo-adjuvant chemotherapy(CEVE-CEV) were administered. In all remained pts adjuvant chemotherapy(CHT) after thoracic approach(3-5 cycles CEVE-CEV) and in few cases radiotherapy (RT)were performed. The surgical procedures included 7 pneumonectomy,28 lobectomy and 20 open lung biopsy and or segmental resections.Results: The median follow-up was 27.6 months(range 5-84mths). The 5 year actuarial survival rate was 23.3%(median 19.1 mths). Seventen pts are still alive(9 in stage I; il in stage II and 4 in stage III), 12 of them being disease free. No patients had a significantly better survival than N1-N2 patients.-Conclusions- Surgery,adjuvant CHT and RT represent a good option in treatment of limited SCLC desease. Neoadjuvant CHT consents to reconduce to surgery some excluded pts and permitts a satisfactory management also in extensive SCLC desease controll.

The aims of this report were: 1) to compare the strategy of bioptic approach in Italy during the last 4 yrs with a previous period; and 2) to compare efficacy and safety of video-assisted thorascopic lung biopsy (VTLB) versus OLB. We retrospectively evaluated: 1) the strategy of the bioptic approach in the Milan Sarcoid Clinic in the years 1992-1995 (201 patients) versus 1988-1991 (197 patients); and 2) data from 65 VTLB procedures in the years 1992-1995 versus 68 OLB procedures in the years 1988-1991 performed in patients with diffuse lung disease. It was found that the use of OLB (17-9%), mediastinoscopy (15-5%), and scalene node biopsy (20-7%) decreased, whereas transbronchial biopsy (TBB) increased (11-17%). VTLB biopsy is now performed in 17% of patients. VTLB compares favourably with OLB as there is less need for analgesia (7.5+/-7.5 versus 17.5+/-8.0 methadone mg i.m.: p<0.001), lower blood loss (61+/-58 versus 156+/-84 mL in the first postoperative day: p<0.001), and shorter postoperative stay (4.7+/-1.6 versus 5.7+/-1.4 days: p<0.001). Specimen adequacy (98.6 versus 985%) and diagnostic accuracy (86.1% VTLB, versus 92.6% OLB: p>0.05) were the same in the two groups. In conclusion, video-assisted thoracoscopic lung biopsy is replacing both mediastinoscopy and open lung biopsy. It is at present the best option when a surgical procedure is required for histological confirmation of diffuse lung disease.

In a period rancing from January 1995 to May 1997, 36 patients affected by pneumothorax (34 spontaneous, 2 post-traumatic) undergone Argon pleurodesis in video-assisted thoracoscopy (VATS), were admitted to this study.The enlisted patients were 5 females and 31 males with mean age of 29,3 years (range from 16 to 58 ys).The median operative time was 45 minutes (range from 30 to 60 minutes)The median length of ospitalization was 7 day (range from 4 to 27 days)..Two recidivous pneumothorax were registered.The antibiotic therapy (amoxycillin and clavulanic acid) was started tile day before operation and continued for 4 days after surgery approach.Haematological and radiological examination (Chest X ray) were performed in all treated patients.No side effects were registered with antibiotic therapy.

From January 1955 to April 1987 111 patients with bronchial carcinoid were operated on in our department. There were 62 males and 49 females with a mean age of 45.5 years. Preoperative histological diagnosis was achieved in 22 cases, while in five patients, a false positive diagnosis of small cell lung cancer was reported. Fifteen patients required pneumonectomy, 70 had lobectomy, 16 bilobectomy, and four segmentectomy. One patient required tracheal resection, while in another patient the tumour was removed through bronchotomy. Four patients were completely treated with YAG laser phototherapy. There were three postoperative deaths. The following variables were analysed and discussed in order to evaluate their influence on prognosis: (1) size of the tumour, (2) typical or atypical appearance, (3) endoluminal or extraluminal growth, (4) vascular invasion, (5) node metastases. Atypical onset, node metastases and extraluminal invasion are significant factors in worsening the prognosis.

Two patients with malignant airway obstruction and acute respiratory insufficiency were given emergency treatment with yttrium aluminum garnet (YAG) laser tissue vaporization under local anesthesia only. A mixture of oxygen and helium was administered to reduce the respiratory distress. This case emphasizes the rapidity and effectiveness of YAG laser treatment via fiberoptic bronchoscopy under local anesthesia in the management of acute malignant airway obstructions.

From January 1975 to April 1987, 27 patients underwent surgical resection of non oat cell lung cancer and a single brain metastasis. There were 25 men and 2 women ranging in age from 37 to 70 years. In 21 cases the brain metastasis was synchronous while in 6 cases the onset was metachronous. In 17 cases, the site of the brain metastasis was supratentorial and in 10 cases it was located in the posterior fossa. The chest X-ray confirmed the primary lung tumour in 24 cases. In 3 cases, only bronchoscopy and cytology revealed the primary focus of the tumour. The lung cancer was located in the upper lobe in 25 patients. Upper lobectomy was performed in 23 patients, pneumonectomy in 3, and lower lobectomy in 1. There were no operative deaths. The cell type was adenocarcinoma in 19 cases, squamous cell carcinoma in 4 patients and large cell carcinoma in 4. Only the tumour and nodes were used for staging at thoracotomy. The classification was: 12 patients in stage I, 2 in stage II, and 13 in stage III. At conclusion of the study the longest survival was 68 months after thoracotomy. There was no significant difference in the duration of survival in patients over or under 50 years old. Better results were obtained in patients without node metastases at thoracotomy (median survival of 30 months and an overall 5-year survival of 35%), and in patients with supratentorial metastases (median survival of 22 months and an overall 5-year survival of 23.4%). Our experience confirms that combined surgery prolongs survival and improves the quality of life.

Despite the recent advances in diagnostic techniques, most lung cancers are at an advanced stage when detected and are considered inoperable. We report a case in which neo- dymium yttrium-aluminium-garnet (Nd YAG) laser phototherapy permitted limited lung resection in a patient whose lung cancer had been diagnosed as inoperable.