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Tracheal tumour is rare but can lead to upper airway obstruction and acute respiratory distress. Its management includes surgical resection, radiotherapy or interventional bronchoscopy. Ventilation or difficulties with tracheal intubation can occur during the peri‐operative course resulting in serious adverse consequences. We report the case of an 83‐year‐old man with an obstructive tracheal chondrosarcoma resected by rigid bronchoscopy undergoing veno‐venous extracorporeal membrane oxygenation. Such support should be considered when the patient's airway patency cannot be ensured by conventional methods.

Resume Les programmes de Recuperation Acceleree Apres Chirurgie (RAAC) ont ete initialement developpes en chirurgie colorectale d’apres les travaux du Dr Khelet. La RAAC est la protocolisation complete du chemin clinique du patient, basee sur des preuves scientifiques. Son but est, en reduisant la reponse au stress chirurgical, d’ameliorer la recuperation des patients. Des recommandations ont ete emises specifiquement pour la chirurgie thoracique. Le but de ce papier est de presenter quels sont les elements pour mener un programme de RAAC et discuter des elements du chemin clinique. © 2021 SPLF. Publie par Elsevier Masson SAS. Tous droits reserves.

BACKGROUND: Surgical resection is the best treatment for stage I and II non-small cell lung cancer. Despite an improvement in the perioperative management of cancer patients and specialization of surgical teams, morbidity and mortality remains significant. Non-invasive ventilation (NIV) is an effective therapeutic option in hypercapnic respiratory failure. It also improves functional and gasometric parameters when undertaken before surgery. The objective of the preOVNI study is to demonstrate that preoperative non-invasive ventilation for 7 days, at home, reduces the postoperative respiratory and cardiovascular complications of lung resection surgery, in a high-risk population. METHODS: A prospective, randomized, controlled open-labelled multicentric French study, under the supervision of the Groupe Francais de Pneumocancerologie (GFPC), comparing 7 days of preoperative non-invasive ventilation with standard treatment. Inclusion criteria are: patients suitable for lobectomy or segmentectomy for primary bronchial carcinoma and presenting with obstructive or restrictive lung disease, obesity or chronic cardiac insufficiency. The primary criterion is a composite one, including all respiratory and cardiac complications. The number of patients is 150 in each treatment arm, 300 in total. EXPECTED RESULTS: We think that preoperative NIV will be able to reduce the rate of postoperative complications. If this objective is achieved, the management of these patients could be changed.

Resume Introduction Etudier la faisabilite et l’efficacite d’un programme de rehabilitation respiratoire en institution (RR-i) chez des patients ayant subi une resection pulmonaire (RP) pour tumeur. Methode Entre janvier 2007 et decembre 2009, nous avions mene une etude observationnelle prospective sur les patients admis dans notre etablissement. Une RR-i etait proposee a tous les patients. Ils realisaient des epreuves fonctionnelles respiratoires et remplissaient un questionnaire de qualite de vie (QdV) au debut et a la fin du stage. Resultats Au cours de l’etude, 154 des 175 patients ayant subi une RP ont suivi cette RR-i. Les 21 patients restants ont ete exclus en raison de re-hospitalisations d’urgence (dix), departs anticipes (six) ou de refus de participer (cinq). Les parametres fonctionnels des 154 patients ayant suivi cette RR-i s’amelioraient entre le debut et la fin de leur sejour : CVF (69,9 % contre 79,6 % ; p p p p p Conclusion La RR-i postoperatoire apparaissait sure et influencait positivement les parametres fonctionnels respiratoires et la QdV de ces patients.

Pulmonary blastomas represent about 0.5% of primary pulmonary malignancies. The prognosis is poor. Standard treatment consists of surgical excision. There are no published series on which to judge the efficacy of chemotherapy or radiation therapy. We describe an unusual case of classic biphasic pulmonary blastoma (CBPC), with long-term survival despite numerous and varied cancer-related events and review the literature. Our 71-year-old Caucasian woman presented with history of blood in sputum in 2009. Right lower lobectomy yielded a diagnosis of sarcomatoid carcinoma (pneumoblastoma). Unusually, our patient is still alive 7 years after initial surgery, despite metastatic first relapse after 2 years. Metastatic progression was confirmed histologically on three separate occasions during the disease course. The patient received a combination of cisplatin (or carboplatin) and etoposide on three separate occasions. Molecular biology studies of CBPC are needed to identify effective treatments, and a patient registry should be created.

Background The benefit of neoadjuvant chemotherapy (NCT) for early-stage oesophageal cancer is unknown. The aim of this study was to assess whether NCT improves the outcome of patients with stage I or II disease. Methods Data were collected from 30 European centres from 2000 to 2010. Patients who received NCT for stage I or II oesophageal cancer were compared with patients who underwent primary surgery with regard to postoperative morbidity, mortality, and overall and disease-free survival. Propensity score matching was used to adjust for differences in baseline characteristics. Results Of 1173 patients recruited (181 NCT, 992 primary surgery), 651 (55·5 per cent) had clinical stage I disease and 522 (44·5 per cent) had stage II disease. Comparisons of the NCT and primary surgery groups in the matched population (181 patients in each group) revealed in-hospital mortality rates of 4·4 and 5·5 per cent respectively (P = 0·660), R0 resection rates of 91·7 and 86·7 per cent (P = 0·338), 5-year overall survival rates of 47·7 and 38·6 per cent (hazard ratio (HR) 0·68, 95 per cent c.i. 0·49 to 0·93; P = 0·016), and 5-year disease-free survival rates of 44·9 and 36·1 per cent (HR 0·68, 0·50 to 0·93; P = 0·017). Conclusion NCT was associated with better overall and disease-free survival in patients with stage I or II oesophageal cancer, without increasing postoperative morbidity.

Concurrent chemoradiotherapy (CHRT) is the standard of care for unresectable locally advanced stage III non-small cell lung cancer. However, the optimal combination remains unclear. The aim of this study was to evaluate the efficacy of 2 induction chemotherapy cycles (days 1 and 22) with docetaxel 75 mg/m2 and cisplatin 75 mg/m2 followed by concurrent chemotherapy (weekly docetaxel-cisplatin, 20 mg/m2) and 3-D conformal radiotherapy for 6 weeks (66 Gy/5 fractions per week/2 Gy per fraction). The primary endpoint was the response rate. Secondary objectives were toxicity, time to progression, and overall survival. Forty-four patients were included and 40 were eligible. The mean age was 60.5 years (range 40.7–72.1), and 75% had stage IIIB disease. Six patients underwent complete R0 resection including 2 pathologic complete responses after a planned intermediate evaluation. Thirty-three patients completed CHRT. The objective response rate was 65% (95% CI 50.2–79.8). Grade 3–4 hematologic and digestive toxicities were observed mainly during the induction phase. Grade 3 esophagitis (5%) was experienced during CHRT. With a median follow-up of 38.7 months, the median progression-free survival was 28.3 months (95% CI 11.0–35.0) and the median survival rate was 31.4 months. Cisplatin-docetaxel induction followed by concurrent 3-D conformal radiotherapy and weekly chemotherapy is a feasible protocol associated with a promising response rate and acceptable toxicity.

Objectifs Connaitre les principes et l’evolution de la chirurgie en cancerologie pulmonaire. Connaitre la place de la pleuropneumonectomie elargie dans le traitement du mesotheliome. Connaitre les differentes procedures chirurgicales dans la prise en charge des tumeurs du mediastin. Points cles La chirurgie du cancer du poumon s’oriente vers une chirurgie d’epargne parenchymateuse, ses indications sont en cours de codification. La chirurgie du mesotheliome est a nouveau envisagee grâce a la maitrise du risque operatoire et a son association a des traitements peri-operatoires voire per-operatoires comme la chimiohyperthermie. La videothoracoscopie appliquee aux tumeurs du mediastin permet dans la majorite des cas d’obtenir un diagnostic et peut etre proposee pour le traitement des lesions benignes. Resume La pneumonectomie est en regression, elle ne represente que 10 a 20 % des exereses au profit de la lobectomie (70 a 80 %) eventuellement elargie a des structures de voisinage (veine cave, paroi, diaphragme…). Le curage ganglionnaire est mieux codifie avec au minimum 3 sites ganglionnaires. A cote de cette approche traditionnelle la chirurgie d’epargne parenchymateuse apparait comme une alternative pour des petites lesions (segmentectomie) ou grâce aux lobectomies associees a des procedes de reconstruction bronchique (bronchoplastie) et/ou arterielle (angioplastie) sans alterer la valeur carcinologique du geste. L’augmentation d’incidence du mesotheliome et une meilleure maitrise des risques ont remis en avant l’interet de la pleuro-pneumonectomie elargie au pericarde et au diaphragme. La lourdeur de cette intervention necessite une evaluation rigoureuse du statut tumoral et des capacites des patients. L’approche des tumeurs mediastinales a beneficie de l’essor de la videothoracoscopie (VT). Elle permet le diagnostic mais aussi l’exerese de certaines d’entre elles. La VT est devenue une procedure habituelle pour le traitement des lesions benignes : kyste mesothelial, bronchogenique, tumeur neurogene. Les tumeurs malignes, volumineuses et/ou invasives relevent generalement d’une chirurgie traditionnelle.

We report the case of a 49-year-old man who was admitted for progressive behaviorial disorders with frontal elements. There was no sensorial nor motor deficiency. Clinical examination revealed android obesity, cutaneous and mucous paleness, pubic and axillary depilation and gynecomastia. Encephalic MRI found a lesion of the left amygdalian region with high T2 intensity and low T1 intensity associated with gadolinium-enhancement. Cerebrospinal fluid analysis showed a lymphocytic meningitis. Panhypopituitarism was found on the endocrine investigations. Anti-RI antibodies were positive, leading to the diagnosis of paraneoplastic limbic encephalitis. The CT-scan showed a node of the lower part of the thymic area. Surgical resection revealed an ectopic mediastinal seminoma. The evolution consisted of paraneoplastic fever and crossed-syndrome with right hemiparesia and left common oculomotor nerve paralysis. Treatment was completed by two cycles of carboplatin, corticosteroids and substitutive opotherapy. Paraneoplastic fever disappeared, but behavioral disorders and palsy remain unchanged. The patient died two years later in a bedridden state. This case of paraneoplastic limbic encephalitis associated with positive anti-RI antibodies and mediastinal seminoma is exceptional and has not to our knowledge been described in the literature. Cancers usually associated with anti-RI antibody are breast and lung cancer. Paraneoplastic limbic encephalitis is not the classical clinical presentation, which usually is brainstem encephalitis. Hypothalamic involvement, uncommon in paraneoplastic limbic encephalitis is mainly associated with positive antineuronal anti-Ma2 antibodies. Finally, the gadolinium enhancement on encephalic MRI is unusual in paraneoplastic limbic encephalitis.

Resume But de l’etude. – Le but de ce travail etait d’etudier les indications actuelles et les resultats a long terme de la chirurgie des metastases pulmonaires d’origine colorectale. Patients et methode. – Entre 1985 et 2000, 42 patients avaient beneficie de 57 interventions thoraciques pour des metastases pulmonaires dans le service de chirurgie thoracique du CHU de Nice. Nous avons analyse la survie a long terme et l’importance des facteurs pronostiques. Resultats. – Il y avait 26 hommes et 16 femmes d’âge moyen 64,5 mois. Dans 36 cas les metastases pulmonaires etaient metachrones et l’intervalle libre de maladie etait de 28,7 mois en moyenne. Dix-huit patients avaient des metastases bilaterales. Dix patients avaient beneficie d’une metastasectomie hepatique avant l’intervention thoracique. Quarante-sept interventions etaient faites pour un premier episode de metastases pulmonaires (1 bilobectomie, 21 lobectomies, 4 segmentectomies et 38 resections atypiques). L’envahissement ganglionnaire mediastinal etait present dans six cas. La mortalite postoperatoire etait nulle et la morbidite de 6,25 %. Six patients avaient beneficie d’interventions iteratives, deux de ces malades decedaient en postoperatoire apres pneumonectomie de totalisation. La survie calculee a cinq et dix ans etait respectivement de 29,5 et 26,2 %. Le test de Log-Rank a identifie deux facteurs pronostiques : l’exerese complete (p = 0,0066) et l’intervalle libre de maladie superieur a deux ans (p = 0,0021). Conclusions. – Notre etude confirme que le controle local de metastases pulmonaires augmente la survie de ces patients si l’exerese est complete. Les criteres de selection peuvent etre ameliores dans le but d’exclure les malades presentant un risque de recidive eleve. Le Pet-scan devrait permettre de selectionner les patients qui beneficieront reellement d’une telle approche.

Resume Cette observation rapporte le cas d’un patient âge de 65 ans qui, hospitalise pour accident vasculaire de la fosse cerebrale posterieure, a brutalement presente un œdeme pulmonaire unilateral. Alors que la forme radiologique habituelle des œdemes pulmonaires neurogeniques (OPN) est associee a des opacites alveolaires bilaterales, la presentation unilaterale au cours de cette affection est extremement rare. Le diagnostic differentiel entre un OPN et un exces de remplissage vasculaire, une pneumopathie infectieuse, un œdeme pulmonaire secondaire a l’inhalation de liquide gastrique ou un œdeme pulmonaire cardiogenique, de meme que le mecanisme pouvant etre responsable de cette presentation, sont discutes.

Summary Fluoroscopic removal of radio-opaque foreign bodies from the stomach Fluoroscopic removal of smooth radioopaque foreign bodies from the stomach can be proposed to asymptomatic patients. The authors report the case of the removal of two foreign bodies from the stomach using a less invasive technique which requires a gastric feeding tube and a metallic guidewire.

e17503 Background: To evaluate the impact of early response after 40-46 Gy of RTCT on unresectable stage III NSCLC outcome. Methods: 71 patients (pts), treated from 2004 to 2010, were included in this study. Pts received 2 cycles of induction chemotherapy (CT): cisplatin (P) and docetaxel (D) followed by concurrent RTCT: 66-70 Gy, 6 weekly cycles of PD. An early evaluation by CT-scan was planned at 40-46 Gy. Pts with complete and partial response (RECIST criteria) were considered as early responders (ER) while pts with stable or progressive disease were considered as non responders (NR). Median follow-up was 13 months [2.8 -72.2]. Results: 45/71 of pts (63%) were male, 12/71(17%) were > 70 years., 36/71(51%), 27/71(38%) had adenocarcinoma or squamous cell histology respectively, 69/71 (97%) had performans status 0 or 1, 45/71 (63%) and 25/71 (35%) were stage IIIB or IIIA respectively. 68/71 (96%) received the planned 2 induction cycles, 57/71 (80%) completed > 4 concurrent cycles and mean radiation dose r...

2551 Background: A multimodal approach based on debulking surgery is beneficial in the treatment of pleural mesothelioma (PM). In addition, hyperthermic intra-thoracic chemotherapy significantly improves patient survival. Chemotherapeutic agents such as gemcitabin (Gem) have proven their efficacy in PM. The aim of this study was to assess the feasibility, tolerability and pharmacokinetics (PK) of gemcitabine (Gem)-cisplatine (Pt) both administered using this new intra-thoracic hyperthermic schedule. Methods: A phase II study was conducted in patients with T

7585 Background: Concurrent chemoradiotherapy (CT/RT) is a standard of care for pts with unresectable NSCLC. However, the optimal combination remains unclear in this setting. The aim of our study i...