Pulmonary hamartoma and malignancy.

Sixty-five patients, aged 15 to 65 years, including 48 men (73.8%), were operated on for pulmonary (60) or endobronchial (5) hamartoma: there were 36 enucleations, 17 lobectomies (1 sleeve resection), 7 wedge resections, 4 segmentectomies, and 1 pneumonectomy. The average tumor diameter was between 2 and 4 cm; 15 were calcified. All were benign. Two were parts of an incomplete Carney's triad. Eight were associated with carcinomas, and three of these were bronchial carcinomas. Concerning these latter three tumors, a study of the incidence tables for northern France and of the standardized mortality ratio showed that the risk of bronchial cancer developing in patients with hamartoma, after a sufficient follow-up (61 patients), was multiplied by 6.66, and the chi 2 test showed a significant difference of incidence compared with that in the general population (p < 0.001). It is concluded that patients with hamartoma should be submitted to a complete evaluation and to a regular follow-up.

[Value of iliac direct-view retroperitoneoscopy (or "extraperitoneal pelvioscopy") in the assessment of lymph node invasion by pelvic cancer]. / Valeur de la rétropéritonéoscopie iliaque à vision directe (ou "pelvioscopie extrapéritonéale") dans le bilan d'extension ganglionnaire des cancers pelviens.

Iliac retroperitoneoscopy, also called extraperitoneal pelviscopy (EPP), is a form of direct vision endoscopy derived from mediastinoscopy; It allows biopsies of pelvic lymph nodes. In view of the poor accuracy of radiological investigations for pelvic lymph node metastasis (N+) detection, EPP was performed in 210 patients with apparently resectable neoplasms (bladder n = 116, prostate n = 81, cervix n = 12, endometrium n = 1). Among 174 patients without radiologic evidence of metastasis (N-), EPP assessed 47 N+ patients and failed in 1 case, requiring a laparotomy (one N+ patient). Among 36 N+ patients after radiologic examinations, EPP assessed 20 N- patients and failed in 1 case, requiring a laparotomy (one N+ patient). Among 124 N- patients after EPP, a further laparotomy showed 8 N+ cases (false negative). Thus, out of 210 patients, EPP corrected the radiologic findings in 67 cases and drastically modified the therapeutic indications. Considering its absence of contraindications, EPP can be performed more often than laparoscopic pelvic lymphadenectomy techniques. Furthermore, its exploration field is not limited to the interiliac area. Its overall reliability is 95% in staging lymph node involvement of pelvic neoplasms.

[Is endoscopy of the respiratory-digestive tract under general anesthesia useful in the screening for cancer of the superior respiratory-digestive tract synchronous with lung cancer?]. / L'endoscopie des voies aéro-digestives sous anesthésie générale est-elle utile au dépistage des cancers des voies aéro-digestives supérieures synchrones des cancers bronchiques?

The frequency of lung cancers associated with synchronous head and neck malignancies can be evaluated between 1.5 to 2%. The purpose of our work was to determine if complete endoscopic head and neck examination performed under general anesthesia was superior than clinical head and neck examination for the diagnosis of these synchronous additional tumors. From july 1991 to august 1992, we realised a prospective study on 58 consecutive patients suffering from pulmonary removable lung cancers. All the patients had a clinical head and neck examination during the preoperative period. Immediately before thoracotomy a complete endoscopy of head and neck aerian and digestive tract was performed. During this last examination 18 new macroscopical lesions were discovered in 13 patients: benign lesions (n = 17), oral cavity and laryngeal dysplasia (n = 1). The one gingivolingual sulcus carcinoma, already discovered by the clinical examination, was confirmed. This study suggests that complete head and neck endoscopy is not superior than clinical examination for the diagnosis of synchronous malignancies before lung cancers removal.

Ten-year experience with extraperitoneal pelvioscopy for the lymph node staging of pelvic cancers.

BACKGROUND: In view of the surgical lymphadenectomy morbidity and of the low accuracy of the preoperatory radiological investigations, minimal access surgery procedures are needed to assess lymph node involvement in pelvic cancers. METHODS: Extraperitoneal pelvioscopy (EPP) is a direct vision endoscopy permitting the exploration of the retroperitoneal space of the pelvic area. Beginning 1/05/1995, 235 patients with apparently resectable tumors underwent EPP for lymph node staging of 133 bladder, 89 prostate, 12 cervix, and one endometrium cancers. RESULTS: Lymph node involvement was discovered in 68 cases; the absence of lymph node involvement was demonstrated in 155 cases; and there were 12 false-negative results of the procedure. The feasibility was of 98.3%. The global sensitivity and accuracy were, respectively, 85% and 94%. CONCLUSION: This study demonstrates that EPP is a safe and accurate procedure to evaluate the lymph node status of pelvic cancers.

Retroperitoneoscopy for the diagnosis of infiltrating retroperitoneal lymphadenopathy and masses.

BACKGROUND: Retroperitoneoscopy (RPS) is a form of direct vision endoscopy, used to explore the retroperitoneal space, and was first described by Bartel in 1969. METHODS: RPS was performed prospectively to diagnose infiltrating retroperitoneal lymphadenopathy or masses when needle aspiration biopsy under computed tomographic guidance (NABCT) failed to establish a definite diagnosis. RESULTS: From May 1985 to August 1995, RPS was performed in 118 patients (121 procedures). Mean hospital stay was 2.4 (range 2-5) days. The peroperative and perioperative morbidity rate was 6.6 per cent of the procedures. A precise diagnosis was obtained in 108 of the 118 patients. The sensitivity was 84 per cent for malignant lymphoma, 94 per cent for Hodgkin's lymphoma, 95 per cent for metastatic lymph nodes of carcinomas and 100 per cent for primary retroperitoneal tumours. The overall sensitivity was 91.5 per cent. CONCLUSION: RPS is an alternative procedure to NABCT when aspiration biopsy is not technically feasible because a lesion is too small to sample or failed to establish a precise histopathological diagnosis.

[Diagnosis of adenopathies and retroperitoneal masses by surgical endoscopy. Apropos of 93 cases]. / Diagnostic des adénopathies et masses rétro-péritonéales par la lomboscopie chirurgicale. A propos de 93 cas.

Lumboscopy is an endoscopic surgical technique providing direct visualization of the retroperitoneal space from the kidney hilium to the iliac bifurcation. We report our 10-year experience with this technique used to diagnose masses in the retroperitoneal space. This method is not very invasive and the morbidity is low. The sensitivity is greater than needle biopsy under CT guidance.