[Pancoast tumors ; modified surgical approaches and techniques].

The surgical treatment of Pancoast tumors is associated with difficulties related to its anatomical locations. Different surgical approaches have been reported but every approaches have some advantages and disadvantages. We report 2 Pancoast tumors cases with unique surgical approaches and our techniques. Case 1 : A 38-year-old man complained of face edema. The chest computed tomography (CT) revealed an right anterior apical tumor with direct invasion of the 1st and 2nd rib. Preoperative chemotherapy with 2 courses of carboplatin [area under the blood concentration-time curve (AUC) 6, day 1] and paclitaxel (80 mg/m2, day1, 8, 15) and concurrent extracorporeal radiation (70 Gy) was used to treat the adenocarcinoma. The skin incision was performed according to Masaoka's anterior approach, and a proximal median sternotomy communicated with an incision in the 4th intercostal space. The clavicula was freed by the L-shaped incision on the manubrium and the 1st cartilage section according to Grunenwald method to retract the section. Case 2 : A 65-year-old man complained back pain. The chest CT revealed an right superior sulcus tumor, displaced bronchus (B1+B3 tracheal bronchus, B2) and pulmonary arteries anomalies. Combined Shaw-Paulson incision and 4 intercostal lateral thoracotomy was performed to right upper lobectomy and systematic lymph nodes dissection.

[Inflammatory myofibroblastic tumor of the lung; report of a case].

A 24-year-old male admitted to our hospital with a pulmonary nodule detected by his chest X-ray and computed tomography (CT). His laboratory findings were within normal limits. Chest CT showed a 10 mm solitary nodule in the right lower lobe. Positron emission tomography showed moderately positive detection correspond to the nodule. We couldn't rule out a malignant tumor and performed partial resection of the right lower lobe. Pathological findings definitely revealed pulmonary inflammatory myofibroblastic tumor. This case was reported together with some reviews of the literature.

[Intractable pneumothorax secondary to pulmonary metastasis of angiosarcoma].

A 68-year-old male suffered from right pneumothorax and was admitted to our hospital. He had a previous history of angiosarcoma of the scalp, and had received local resection and chemoradiotherapy. Chest computed tomography (CT) on admission revealed right pneumothorax and bilateral multiple thin-walled cavities of the lung. We performed partial resection of right lung. Histopathological examination showed a small metastatic lesion around the thin-walled cavities of the lung. Four months after the 1st lung resection, he suffered left pneumothorax. We performed partial resection of the left lung. Ten days after the 2nd lung resection, left pneumothorax recurred. Nine days later, he also developed right pneumothorax. We performed the 3rd operation for right lung. Thoracoscopy demonstrated multiple bullas in right lung and it showed impossibility for radical surgery. Although surgical resection for pneumothorax secondary to metastatic lung cancer is usually efficient, it is very hard to manage the pneumothorax of metastatic angiosarcoma.

[Completion pneumonectomy after 4 times of resections for metastatic lung tumors from rectal carcinoma].

We report a case of completion pneumonectomy after 4 times of metastasectomy for metastatic lung tumors from rectal carcinoma. A 63-year-old man underwent Miles' operation for advanced rectal carcinoma. Forty-seven months after the operation, bilateral metastasis was appeared, and bilateral metastasectomy was performed. After the resection, 3 times of metastasectomy were performed during 40 months. Follow-up X-ray and computed tomography (CT) showed abnormal shadow in his left hilum of lung. Completion pneumonectomy with mediastinal lymph node sampling was performed. He is still alive without recurrence 4 years after first thoracotomy. Repeated pulmonary resection can lead to good outcome for selective patients with metastatic colorectal carcinoma, and repeated surgery can be useful for pulmonary recurrences after thoracotomy.

[Catamenial pneumothorax in a young patient diagnosed by thoracoscopic surgery; report of a case].

A 16-year-old woman presented with chest pain on 2 days before the onset of menstruation and was referred to our hospital because of a pneumothorax. She was diagnosed as spontaneous penumothorax and surgical treatment was performed. Thoracoscopy revealed the presence of multiple blueberry spots near central tendon of the diaphragm and little pleural effusion. No other abnormal lesions were found in the left pleural cavity and left lung. Thoracoscopic biopsy and coagulation of the lesions were successfully performed. Histological findings of biopsied specimen did not contradict as an endometoriosis and catamenial pneumothorax was diagnosed. CA 125 level of the pleural effusion had increased to 99.2 U/ml. Because she was young, she did not receive a systemic hormonal therapy.

[Perioperative targeting brachytherapy for lung cancer invading the chest wall].

We evaluated the efficacy of perioperative targeting brachytherapy for lung cancer invading the chest wall. Between 1998 and 2003, 7 patients underwent perioperative targeting brachytherapy for lung cancer invading the chest wall. There were 5 male and 2 female patients. The mean age was 63.3 years, with a range of 45 to 77 years. All patients underwent complete resection including the chest wall combined resection. During the operation, plastic afterloading catheters fixed on the Vicryl mesh at interval of 1 cm were placed on the site of chest wall resection. From the third to sixth day after the operation, 15 to 32 Gy of radiation was delivered over 3 or 4 days using a high dose rate remote afterloading system. The area targeted for brachytherapy was determined by a computed tomography (CT) scanner translator with a computer program for radiation planning. The median postoperative hospital stay was 35 days. Local recurrences were observed in 2 patients, but there was no evidence of recurrence in the margin of the resected chest wall. We believe that this short period of treatment and the low side effects enhances the quality of the patients. Prevention of local recurrence was achieved in short term follow-up.

Bronchial sleeve resection with complete preservation of the lung for carcinoma.

Conservative sleeve resection with complete preservation of the lung parenchyma is very rarely applicable for the treatment of bronchial carcinomas. We used this surgical procedure in four patients with bronchial carcinoma in various sites of the central airway, and we obtained successful results. The pathological types were two squamous cell carcinomas and two low-grade malignant tumors (mucoepidermoid carcinoma and adenoid cystic carcinoma). If patients are properly selected, this operative procedure appears to be a safe and radical therapeutic option for the treatment of bronchial neoplasms arising from major bronchi.