Background. In contrast to the use of the stomach as an esophageal substitute, the use of the colon is becoming uncommon.Methods. From 1985 to 1995, 60 patients underwent colon interposition for esophageal cancer (n = 37), benign stricture (n = 13), iatrogenic fistula (n = 5), achalasia (n = 3), or necrosis of a previous substitute (n = 2). A long isoperistaltic conduit based on the left colonic artery could be used in 52 patients (86.7%). The surgical route used was through the esophageal bed in 38 patients (63.3%), under the sternum in 21 patients, and under the skin in 1 patient.Results. Colon interposition represented 18.5% of all operations performed for esophageal substitution during the study period. The choice of the colon resulted from an inadequate stomach in 33 cases (55%). The operative mortality rate was 8.3%. Seven patients (13.5%) required dilation of the esophagocolonic anastomosis. At last follow-up, 34 patients (65.4%) had no difficulty eating. Multivariate analysis identified the conduit position in the posterior mediastinum as the sole independent predictor of a good functional result (p = 0.002).Conclusions. Colon interposition for esophageal substitution, usually performed when the stomach is not available, provides satisfactory function when placed in the esophageal bed.

From 1985 to 1995, 60 patients with a mean age of 52 +/- 12 years [24-78] underwent colon interposition for esophageal replacement. Indications were esophageal cancer (n = 37), benign stricture (n = 13), iatrogenic esophageal fistula (n = 5), achalasia with megaesophagus (n = 3), and necrosis of a previous substitute (n = 2). Colon interposition represented only 18.5% of all operations performed for oesophageal replacement during the same period. The colon was selected because of inadequate stomach in 33 cases (55%). Long-segment conduit based on the ascending branch of the left colonic artery was the preferred method and could be used in 52 patients (86.7%). The colon was placed in the esophageal bed in 38 patients (63.3%), substernally in 21 (35%), and subcutaneously in 1. Overall operative mortality and morbidity were 8.3% and 65% respectively. Five-year survival rate was 9% in the 37 patients with esophageal cancer. Seven patients (13.5%) required one or more dilatations of the esophagocolonic anastomosis. At last follow-up, 34 patients (65.4%) had no difficulty eating. Multivariate analysis identified the conduit position in the posterior mediastinum as an independent predictor of good functional result (p = 0.0018). We conclude that colon interposition for esophageal replacement provides satisfactory and durable function; however, early mortality and morbidity are substantial.

As the population continues to age, septuagenarian patients with esophageal cancer are frequently referred for surgical treatment. The aim of this study was to analyze with respect to their age the outcome of 386 patients who underwent esophagectomy and simultaneous reconstruction from 1979 to 1994. The portion of patients of 70 years of age and older (14.5%) has slightly increased during the period. Location to the lower third of the esophagus and adenocarcinoma type were prevalent in the 56 elderly patients (Group I), but postsurgical TNM staging was identical to that of the 330 younger patients (Group II). Other clinical features, i.e., preoperative weight loss and presence of co-morbid diseases, however, were comparable in both groups. Pulmonary function, as assessed by spirometry, was significantly worse among the older patients, but blood gas determinations were not different. Operative mortality was comparable among the 2 groups (10.7% vs 11.2%). Major morbidity included anastomotic leak (10.7% vs 13.6%) and pulmonary complications (17.9% vs 20.6%) in both groups. Long term survival was not different in elderly patents (5-year rate: 17%) when compared with that of younger patients (18.9%). These data suggest that 1) esophagectomy can be performed in selected septuagenarian patients with an acceptable risk, and 2) long-term survival with excellent functional status is attainable in this age group in a portion of these patients.

In order to test the validity of the new 1987-UICC classification (4th edn) for lung cancer, data from 456 patients who underwent pulmonary resection for bronchogenic carcinoma from 1980 to 1985 were analysed retrospectively. Overall survival rate was 32.7% at 5 years. Prognostic significance of the tumour formula (pTNM) was assessed by multivariate analysis: N lymph node involvement appeared to be the most pejorative factor (p less-than-or-equal-to 10(-5)), followed by the T factor (p less-than-or-equal-to 0.002) and the M factor (p less-than-or-equal-to 0.01). Respective survival curves were compared. Excluding the correlation between T1 and T2 tumours, the prognosis became significantly more unfavourable as the values for the pTNM classification criterion rose. Differences in prognosis between stages I and II, II and III A, III B and IV were not statistically significant for methodological reasons and inappropriate regroupings. Thus, our results partially confirm the prognostic value of the new international staging system. Meanwhile, this classification constitutes a prerequisite for the evaluation of end-results of therapy and the estimation of prognosis.

In order to test the validity of the new 1987-UICC classification (4th ed.) for lung cancer, data from 456 patients who underwent pulmonary resection for bronchogenic carcinoma from 1980 to 1985 were analysed retrospectively. Overall survival rate was 32.7% at 5 years. Prognostic significance of the tumour formula (pTNM) was assessed by multivariate analysis: N lymph node involvement appeared to be the most pejorative factor (p < or = 10(-5)), followed by the T factor (p < or = 0.002) and the M factor (p < or = 0.01). Respective survival curves were compared. Excluding the correlation between T1 and T2 tumours, the prognosis became significantly more unfavourable as the values for the pTNM classification criterion rose. Differences in prognosis between stages I and II, II and III A, III B and IV were not statistically significant for methodological reasons and inappropriate regroupings. Thus, our results partially confirm the prognostic value of the new international staging system. Meanwhile, this classification constitutes a prerequisite for the evaluation of end-results of therapy and the estimation of prognosis.

Between January 1980 and January 1985, 462 consecutive patients underwent lung resection for bronchogenic carcinoma. Eighty of these patients (17.3 percent) had atherosclerosis involving mainly the coronary arteries (40 percent). The mortality rate was significantly higher in patients with atherosclerosis (10 percent) than in those without it (4.7 percent), but the long-term survival was not affected with the presence of atherosclerosis. The lung carcinoma-atherosclerosis association raises two problems: what investigations should be carried out in this group of patients at risk, and what treatment should be given priority when vascular lesions are present and likely to become complicated by pulmonary surgery? However, the presence of atherosclerosis should not lead to a re-evaluation of the need for lung resection.

Data from 452 patients who underwent pulmonary resection for a non small cell bronchogenic carcinoma from 1980 to 1985 were analysed retrospectively. The operative mortality rate was 5,5%. Mortality was significantly increased in patients who underwent enlarged resections for T4 tumors (20%; p less-than-or-equal-to 0.05), and in patients who were 70 years and older (12.8%; p less-than-or-equal-to 0.05). The overall 5-years survival rate was 32.7% at 5 years. Prognosis in patients who were 70 years and older was similar to that in younger patients. No difference in survival was observed in patients with lymph node metastases with regard to the operative procedure (pneumonectomy versus lobectomy). Survival in patients . without lymph node metastases who underwent a lobectomy was similar to those who underwent a conservative resection. Prognostic significance of the histologic cell type and the tumor formula (pTNM) was assessed by multivariable analysis. There were statistically significant differences between squamous cell carcinoma and both adenocarcinoma (p less-than-or-equal-to 10(-5)) and undifferentiated carcinoma (p less-than-or-equal-to 0,01). This study confirmed the validity of the TNM classification (4th ed) for the accurate prognosis evaluation. Lymph node involvement appeared to be the most pejorative factor (p less-than-or-equal-to 10(-5)).

Between January 1980 and January 1985, 462 consecutive patients underwent lung resection for bronchogenic carcinoma. Eighty of these patients (17.3 percent) had atherosclerosis involving mainly the coronary arteries (40 percent). The mortality rate was significantly higher in patients with atherosclerosis (10 percent) than in those without it (4.7 percent), but the long-term survival was not affected with the presence of atherosclerosis. The lung carcinoma-atherosclerosis association raises two problems: what investigations should be carried out in this group of patients at risk, and what treatment should be given priority when vascular lesions are present and likely to become complicated by pulmonary surgery? However, the presence of atherosclerosis should not lead to a re-evaluation of the need for lung resection.

Data from 452 patients who underwent pulmonary resection for a non small cell bronchogenic carcinoma from 1980 to 1985 were analysed retrospectively. The operative mortality rate was 5.5%. Mortality was significantly increased in patients who underwent enlarged resections for T4 tumors (20%; p < or = 0.05), and in patients who were 70 years and older (12.8%; p < or = 0.05). The overall 5-years survival rate was 32.7% at 5 years. Prognosis in patients who were 70 years and older was similar to that in younger patients. No difference in survival was observed in patients with lymph node metastases with regard to the operative procedure (pneumonectomy versus lobectomy). Survival in patients without lymph node metastases who underwent a lobectomy was similar to those who underwent a conservative resection. Prognostic significance of the histologic cell type and the tumor formula (pTNM) was assessed by multivariable analysis. There were statistically significant differences between squamous cell carcinoma and both adenocarcinoma (p < or = 10(-5)) and undifferentiated carcinoma (p < or = 0.01). This study confirmed the validity of the TNM classification (4th ed) for the accurate prognosis evaluation. Lymph node involvement appeared to be the most pejorative factor (p < or = 10(-5)).

The authors report one case of posterior mediastinal neurinoma with a Adamkiewicz artery arising at an atypical site. They stress the spinal cord complications following thoracic surgery. The value of spinal cord arteriography during preoperative examinations and for prevention of complications is discussed.

The authors report one case of posterior mediastinal neurinoma with a Adamkiewicz artery arising at an atypical site. They stress the spinal cord complications following thoracic surgery. The value of spinal cord arteriography during preoperative examinations and for prevention of complications is discussed.

In order to evaluate the reliability of medical imaging methods in the assessment of mediastinal invasion by lung cancers, a prospective study was conducted in 30 patients undergoing preoperative computed tomography (CT), magnetic resonance imaging (MRI) and pulmonary digital subtraction angiography. MRI improved the sensitivity of detection of surgically confirmed mediastinal lymphadenopathy, but its specificity in relation to histological results was poor and identical to that of CT. In terms of extension to vascular structures, MRI and CT gave comparable results for the pulmonary artery and vein with two false positives for the pulmonary veins and left atrium with the two methods. MRI was found to be superior to CT for the detection of invasion of the aortic arch. Digital subtraction angiography is not as reliable as the other two modalities, particularly for extension to the pulmonary vein for which it was found to be technically inappropriate. By means of sagittal and frontal scans, MRI was therefore found to be more effective than CT for examination of the subcarinal region and aorto-pulmonary window. In contrast, the persistence of false positives with the two methods and the impossibility of distinguishing between inflammatory lymph nodes and neoplastic lymph nodes means that thoracotomy can never be contraindicated on the basis of the results of imaging alone.

Between March 1982 and December 1987, 112 patients with oesophageal cancer were treated by gastroplasty following oesophagectomy to restore gastrointestinal continuity. This technique was used in all oesophageal cancers regardless of their site, with the exception of paryngo-oesophageal and oesophago-cardio-fundal cancers. The overall mortality of 12.5% fell to below 6% during the last two years. The postoperative course was straightforward in 54.5% of cases. The most frequent complications were respiratory tract complications (19 cases of ARDS out of 112 patients, i.e. 17%) and fistulae at the oesophago-gastric anastomosis (9 cases out of 112, i.e. 8%). The secondary complications were dominated by anastomotic stenoses (19/98, i.e. 19.3%).

The authors report a study of 140 patients presenting with a non-allergic respiratory tract disease (121 cases of asthma--19 cases of spasmodic cough). Gastro-oesophageal reflux was detected by 24-hour pHmetry in 86 of these patients. In 34 of them (i.e. 40% of cases), the gastro-oesophageal reflux appeared to be responsible for the initial respiratory tract symptoms. These 34 patients were submitted to a therapeutic trial of high dose anti-H2 therapy for at least two months. Only those patients in whom a marked improvement or even complete resolution of the respiratory tracts symptoms was observed underwent anti-reflux surgery. Out of the 13 patients undergoing surgery, there were two failures and 11 good results after a follow-up of more than 18 months.