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The localization of small lung masses at thoracoscopic operation is very difficult. A 67-year-old female with tiny pulmonary metastases of renal cell carcinoma primary was successfully treated by pulmonary thoracoscopic resection after transbronchial localization using a dye.

Objective: The feasibility of systematic node dissection (SND) for stage I primary lung cancer by video-assisted thoracic surgery (VATS) remains controversial. The aim of this study was to assess the feasibility of SND by VATS., Methods: Four hundred and eleven patients with clinical stage I primary lung cancer were enrolled in this study. Two hundred and twenty-one patients, VATS group, underwent a major pulmonary resection with SND by VATS through a minithoracotomy (30-70mm) and two access ports; 190 patients, open thoracotomy (OT) group, did so through anterolateral thoracotomy. The two groups were compared regarding clinical data including number of dissected nodes in each nodal station for evaluating the feasibility of SND by VATS., Results: In the right side, the total number (N) of nodes dissected (VATS 31 vs OT 31, P=0.899), N of mediastinal nodes dissected (20 vs 21, P=0.553), and N of dissected nodes in each nodal station were similar between the two groups. In the left side, total N of nodes dissected (28 vs 27, P=0.714), N of mediastinal nodes dissected (16 vs 17, P=0.333), and N of dissected nodes in each nodal station were similar between the two groups. There were three (1.4%) and five (2.6%) operation related deaths in the VATS group and OT group, respectively (P=0.48). Chest tube duration was shorter in the VATS group than the OT group (5.8 vs 7.6 days, P=0.001). The incidences of chylothorax, recurrent laryngeal nerve injury and pleural effusion requiring thoracentesis after surgery were similar between the two groups (3 vs 4, P=0.709; 5 vs 3, P=0.480, 3 vs 8, P=0.122). The 5-year actuarial recurrence-free survival rate and cumulative survival rate of pathological stage IA cases were similar between the two groups (88.6 vs 92.4%, P=0.698; 92.9 vs 86.5%, P=0.358)., Conclusions: The SND by VATS was as technically feasible as SND through OT regarding number of dissected nodes and morbidity. It seems acceptable as an oncological treatment for clinical stage I lung cancer.

We report on 86 cases (112 operations) who underwent surgery for metastatic lung tumors at our department during the last 10 years. The study subjects comprised 53 men and 33 women, and the average age was 51 (+/- 19) years. Of the 112 metastatectomies performed, 53 were conducted by video-assisted thoracic surgery (VATS), and 59 were performed via thoracotomy. The procedures employed for metastatectomy were lobectomy (22 cases), segmentectomy (4 cases), and partial resection. wedge resection (86 cases). The primary origin of the metastatic tumors was colorectal carcinoma in 22 cases, osteosarcoma in 13 cases, renal carcinoma in 10 cases, and breast carcinoma in 6 cases. The 5-year survival rates in subjects undergoing first and second resection for pulmonary metastases were 46% and 44%. Metastatectomy was performed 1, 2, 3, 4, 5, and 7 times in 73, 7, 1, 2, 2, 1 cases, respectively. The average number and maximum diameter of the metastatic pulmonary lesions at first metastatectomy were 1.9 and 27.6 mm. Metastatectomy is performed, as a rule, by VATS at our department, because the more highly invasive thoracotomy procedure influences the activity of the cancer cells in a suspended phase in an unfavorable manner. Furthermore, we believe that to the maximum extent possible, re-metastatectomy should also be performed by VATS. The survival rates at our institution have been satisfactory, and we attribute this to our following strict indications for metastatectomy. Re-metastatectomy should always be considered, as the survival rates are as favorable as those following the first metastatectomy.

We have experienced a very rare case of hepatoid adenocarcinoma in the lung. A 55-year-old male with a history of smoking was diagnosed as adenocarcinoma of the right S2, and underwent resection of the right upper lobe and dissection of the hilum and mediastinal lymph nodes (complete resection). Pathological examination revealed cuboid atypical cells arranged in a papillary or trabecular fashion, and a proliferating pattern in most part of the tumor resembling that of hepatocellular carcinoma. Immunohistochemistry study showed alpha-fetoprotein (AFP)-positive tumor cells, hence the diagnosis of hepatoid adenocarcinoma was confirmed. Postoperative pathological staging classified the patient as having as p-T2NOMO, p-stage I B disease. The serum AFP level was not determined before surgery, but the value decreased gradually after surgery and has since remained within the normal range. At present, 32 months after the operation, no signs of recurrence have been observed. Hepatoid adenocarcinoma in the lung has been reported in eight patients with the present one being the ninth case. All were males, the tumor diameter was large and the patient prognoses were mostly poor, but at early stage two cases of long-term survival have been reported indicating that the stage is the most important prognostic factor also for rare tumor., (Copyright 2002 Elsevier Science Ireland Ltd.)

A 64-year-old male, who had received successful radiotherapy for the previous laryngeal cancer, was admitted to our department for the treatment of a peripheral pulmonary tumor in the right upper lobe and an endotracheal tumor in the carina. The endotracheal biopsy of the carinal tumor demonstrated squamous cell carcinoma, though preoperative examination of the intrapulmonary tumor was unable to clarify it's pathological type. The intrapulmonary tumor required right upper lobectomy and R2 lymph node dissection as a measure against the possibility of primary lung cancer. Since the endotracheal cancer was diagnosed as an intra mucosal tumor by the preoperative computed tomography (CT) scans and the bronchoscopic examination, laser abrasion therapy to the endotracheal tumor was performed 4 days before the lobectomy of the intrapulmonary tumor. After the pulmonary operation, the intrapulmonary tumor was diagnosed as squamous cell carcinoma without lymph node metastasis, and it was suggested to be a metastatic tumor of the previous laryngeal cancer. Both radiotherapy to the carina and general chemotherapy with docetaxel hydrate and carboplatin were used as adjuvant therapies 36 days after the lobectomy. One year after the pulmonary surgery, there is no recurrence of the tumor in the lung or carina. Laser abrasion therapy to the endotracheal tumor is very useful and safe for the patient, who should then receive pulmonary resection soon after the therapy.

A 53-year-old male was admitted to our department with a chest tumor due to infiltration of lung cancer. Right upper lobectomy and a wide en bloc excision of the right upper chest wall were performed, including the 2nd, 3rd, 4th, and 5th ribs with upper lobectomy of right lung. The defect was replaced with three A-O metal plates, which joined both stumps of the ribs, from the third to the fifth rib. These metal plates were very useful because it was easy to bent and twist them to fit the defect in operation. And curved metal plates preserved a cone from of chest cage. Postoperative course was favourable without mechanical ventilation and wound infection.