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Pulmonary metastasectomy of renal cell carcinomas (RCC) remains controversial. Thoracic lymph node involvement (LNI) is a known prognostic factor. The aim of our analysis is to evaluate whether patients with LNI, and particularly N2 patients, should be excluded from surgical treatment.We retrospectively reviewed data from 122 patients who underwent operations at two French thoracic surgery departments between 1993 and 2011 for RCC lung metastases.The population consisted of 38 women and 84 men; the average age at time of metastasectomy was 63.3 years (min: 43, max: 82). LNI was identified as a prognostic factor using univariate and multivariate analysis (median survival: 107 months vs. 37 months, P = 0.003; HR = 0.384 (0.179; 0.825), P = 0.01, respectively). Although differences in survival between metastases at the hilar and mediastinal locations were not significant (median survival: 74 months vs. 32 months, respectively, P = 0.75), length of survival time was associated with disease-free interval less than 12 months (median survival: 23 months vs. 94 months, P 0.0001; HR = 3.081 (1.193; 7.957), P = 0.02).Although LNI has an adverse effect on survival; long-term survival can be achieved in pN+ patients. Consequently, these patients should not be excluded from surgery. Systematic lymphadenectomy should be performed to obtain more accurate staging and to determine appropriate adjuvant treatment.

A 36-year-old man presented with a pleural tumor. The first pathologic analysis diagnosed biphasic pleural malignant mesothelioma. However, the atypical clinical course, the early development of lung metastases and a new reading of histologic documents led to the diagnosis of primary pleural synovial sarcoma. The literature review is limited, as only nine other cases have been reported to date. Chest pain is the only constant clinical feature. Misleading interpretation of histologic material is frequent (6 of 10 cases). Only a complete immuno-histochemical study confronted with the clinical course can lead to the correct diagnosis. Because the efficacy of chemotherapy and/or radiotherapy is poor, surgery remains the basis of treatment, whenever possible. Evolution is mainly intra-thoracic, with multiple local recurrences and lung metastases. Prognostic is poor, a survival rate is similar to that of primary pulmonary sarcomas.

More and more elderly subjects are offered for pulmonary resection. The object of this study was to review the results of excision for cancer in octogenarians.51 consecutive patients (44 men, 7 women) with a mean age of 82 years (80-91) were operated on. 31 lobectomies, 2 bilobectomies, 13 pneumonectomies, 1 segmental resection and 4 exploratory thoracotomies were carried out. 17 tumours were classed as stage I, 15 as stage II and 15 as stage III.38 patients (75%) had uncomplicated post-operative periods; the predicted factors for complication were the existence of weight loss and alteration of respiratory function. 2 patients (4%) died in the post-operative phase. Neither the type of operation, the staging or the existence of cardiovascular dysfunction had any influence on the post-operative phase. The level of the survival at 3 and 5 years was 39% and 16% respectively. 30% of the late deaths were related to intercurrent events.Pulmonary excision may be envisaged in an octogenarian who is in good physical and intellectual state with a limited tumour. This surgery in general is applied to a population which probably only marginally consists of octogenarians but the results here justify their inclusion in the indications for selection.

In a number of cases, surgery is carried out as the initial procedure in Stage III non small cell carcinoma. For those with Stage IIIA surgery is the initial procedure performed by practically all teams for Stage T3 chest wall and T2 bronchial stump in patients who have non evidence of N2. In Stage IIIA N2 which is histologically confirmed by mediastinoscopy or thoracoscopy surgery is the initial procedure in certain cases if the local conditions are "favourable". The majority of surgical teams however prefer to operate after neo-adjuvant therapy whose long term efficacy still remains to be shown in a formal study. Stage IIIB consists of a very heterogeneous group in whom surgery can be carried out as an initial procedure in a limited number of cases such as involvement of the left auricle, the proximal pulmonary artery, the superior vena cava, the oesophageal muscle as well as at the carina. In all the other cases of IIIB on the CT scanner or MRI scanner where the cancer seems to be non resectable, or resectable in a poor clinical situation, one would envisage surgery only after a re-evaluation secondary to neo-adjuvant therapy.

To determine the long-term results after surgical treatment of bronchioloalveolar lung carcinoma (BALC) and to identify prognostic factors.A retrospective study of 70 patients (49 men, 21 women), mean age 61+/-10 years, was carried out. Their carcinomas were classified into three clinicopathologic types: nodular or tumoral, pneumonic, and diffuse types. All the diagnosed BALC cases were reviewed and were classified into histologic types: mucinous, nonmucinous (including fibrotic center), and mixed tumors. Univariate and multivariate analyses were carried out.The nodular or tumoral type was identified in 42 patients, pneumonic in 21, and diffuse in seven. Histologically, there were 36 mucinous, 25 nonmucinous, and nine mixed tumors. Resection was complete in 61 instances (87%) and incomplete in five. The 5-year survival rate was 34% in patients with curative resections. Five prognostic factors were identified by univariate analysis, but in multivariate analysis, only three factors remained significant: the absence of symptoms, the TNM stage, and completeness of resection. Thirty-six patients with curative resection (59%) developed recurrences (in the lung in 26 patients; mediastinal lymph nodes, four; distant metastases, nine). The frequency of recurrence was significantly greater in patients with pneumonic-type BALC than in nodular or tumoral types (p0.01), and pulmonary recurrences were significantly more frequent in pneumonic than in tumoral types (p0.02).This study confirmed that the overall prognosis of BALC is not significantly different from that of the other non-small cell lung cancers. We found that the lungs are the predominant site of recurrence in BALC, especially in the pneumonic types. The complete surgical resection of localized BALC offers the best chances of long-term survival.

To determine long-term survival and prognostic factors, 208 patients with primary tracheal tumors were evaluated in a retrospective multicenter study including 26 centers. Ninety-four patients had squamous cell carcinoma, four had adenocarcinoma, 65 had adenoid cystic carcinoma, and 45 patients had miscellaneous tumors. The following resections were performed: tracheal resection with primary anastomosis, 165; carinal resection, 24; and laryngotracheal resection, 19. Postoperative mortality rate was 10.5% and correlated with the length of the resection, the need for a laryngeal release, the type of resection, and the histologic type of the cancer. Fifty-nine percent of patients with tracheal cancer and 43% of patients with adenoid cystic carcinomas had postoperative radiotherapy. The 5- and 10-year survivals, respectively, were 73% and 57% for adenoid cystic carcinomas and 47% and 36% for tracheal cancers (p0.05). Among patients with tracheal cancers, survival was significantly longer for those with complete resections than for those with incomplete resections. On the other hand, the presence of positive lymph nodes did not seem to decrease survival. Postoperative radiotherapy increased survival only in the case of incompletely resected tracheal cancers. Long-term prognosis was worsened by the occurrence of second primary malignancies in patients with tracheal cancers and by the occurrence of late pulmonary metastases in patients with adenoid cystic carcinomas.

The indications for repeated excision for bronchial cancer may be raised in cases of a synchronous second (or subsequent cancer) or in the case of a local recurrence of the initial cancer which was operated upon. Ninety consecutive patients had a repeat operation for cancer over a 30 year period. There were 86 men and 4 women with a mean age of 59. The initial cancer had most often been treated with lobectomy or bilobectomy and was relatively localised (90% stage I or II). However, 7 patients had a pneumonectomy. The repeat operation was carried out for 30 recurrences and in 44 for secondary subsequent cancers and in 16 cases for a bilateral synchronous cancer. The second operative intervention led to 30 pneumonectomies, 29 lobectomies and 20 atypical excisions. On the otherhand 11 patients had an exploratory thoracotomy and on 10 occasions there was local regional recurrence. These secondary localisations were classified as 44 stage I, 9 stage II and 26 stage III. Eight patients had major loss of lung parenchyma with a pneumonectomy on one side and an atypical excision or a lobectomy on the other. Six patients (6.5%) died in the post-operative period (two from respiratory failure and two due to cardiovascular causes and two sepsis). The actual survival at 5 years was 20% in cases that had an excision. The prognosis was identical in cases having a resection for a recurrence or for secondary subsequent cancer or for bilateral synchronous cancers.(ABSTRACT TRUNCATED AT 250 WORDS)

The object of this enquiry was to group together a series of patients with a mediastinal germ cell tumour who were diagnosed and treated between 1983-1990 to specify their clinical characters and their prognostic factors and to evaluate the current therapeutic strategies. Out of a total of 87 cases that were analysed 23 had seminomas and 64 malignant dysembryomas. Amongst the 23 patients suffering from seminomas, 8 had first been treated by surgery, 13 by chemotherapy and 2 by radiotherapy. At the end of treatment 22 made a complete response and 4 patients relapsed after 4-13 months following a complete response. 3 patients had metastases at the outset and were alive and in complete response at 1,4 and 7 years respectively. The survival level at 2 years for seminomas was 84%. Of 64 patients suffering from a malignant dysembryoma, 19 were first treated with surgery (10 by complete resection) followed by chemotherapy in 17 cases. At the end of treatment 12 patients were in complete remission. Only one of these patients had a subsequent relapse. 45 patients were first treated by chemotherapy (10 complete responses, 26 partial responses) then secondary surgery was performed in 22 cases, allowing a complete remission in 21. Seven malignant dysembryomas relapsed after an initial complete remission. The patients treated for pure choriocarcinoma were 7 in number: 6 of these received primary chemotherapy. One patient underwent a secondary resection and was living at 26 months. The other 5 died rapidly. The 2 year survival for malignant dysembryomas was 52%. The median survival was 28 months. There was a significant difference in surviyal between dysembryomas in complete remission and those in partial remission.

The authors analyse a series of 194 thymomas (epithelial tumours of the thymus gland) which were operated over a period of about 25 years. The long term prognosis (70% 5 year survival and 60% 10 year survival) is examined in terms of the anatomo-surgical stage of the thymoma, the histological type of the tumour and the presence of associated auto-immune diseases. The authors recommend a more rigorous classification which takes into account both the anatomo-surgical and the histopathological findings so that the indications for post-operative mediastinal irradiation can be extended in a attempt to reduce the rate of distant recurrence of these tumours.

Two cases of malignant adrenal cortex tumors revealed by primary hyperaldosteronism with hypertension, and associated with a biological hypercortisonism, are reported. Diagnosis of this very rare affection depends on the finding of marked biological hyperaldosteronism associated with a large adrenal tumor. The outcome appears to be rapidly fatal for tumors exceeding 5 cm in diameter and associated with lymph node invasion. This raises the problem of the utility of surgery in these cases, operative intervention apparently accelerating progression of the lesion. In practice, however, a laparotomy is always justifiable, the most rational biopsy being excision of the tumor.