Replacement of the superior vena cava with polytetrafluoroethylene grafts combined with resection of mediastinal-pulmonary malignant tumors. Report of thirteen cases.

From 1979 to 1986, we replaced the superior vena cava with polytetrafluoroethylene grafts in 13 patients to enable resection of malignant mediastinal or pulmonary tumors. Five prostheses could be interposed between a tumor-free proximal superior vena cava and right atrium while eight required separate innominate anastomoses (Y grafts constructed intraoperatively). There were no deaths. Phlebograms obtained 15 to 30 days after the operation demonstrated patency in 12 of 13 patients. Long-term (average 24 months) patency was evident in eight. Five patients are alive at 1, 3, 40, 49, and 60 months, a cumulative survival rate of 27% at 3 years.

[Surgery in small cell anaplastic cancer of the lung]. / La chirurgie dans le cancer anaplasique a petites cellules du poumon.

Surgery has few indications in the treatment of small lung carcinoma. It is currently being evaluated for combined radiotherapeutic/chemotherapeutic treatment strategies.

[Anatomo-clinical calssification of primary tumors of the pleura and possibility of their surgical treatment]. / Classification anatomo-clinique des tumeurs primitives de la plèvre et possibilités du traitement chirurgical

A distinction is drawn between first category includes peduncolates, giant seslocal and diffuse primary tumours of the pleura on anatomopathological grounds. The first category includes peduncolated, giant sessile, and "deceptive" forms; the latter those in which the lung is surrounded by a "pleural" and "serous" mantle. Treatment is discussed and the soundness of surgical management is stressed.

[Floating clot in the suprarenal inferior vena cava. Surgical extraction without extracorporeal circulation]. / Caillot flottant de la veine cave inférieure sus-rénale. Extraction chirurgicale sans circulation extra-corporelle.

A new technique for extracting floating clots from the suprarenal segment of the inferior vena cava is presented in which the vein is obliterated by a Fogarty catheter, thus preventing the risk of embolism by migration of the clot. This simple technique avoids both the mixed thoracic and abdominal approach and the use of cardiopulmonary bypass.

[Long-term survival of patients operated on for primary bronchial cancers (excluding anaplastic cancers)]. / Les survies lointaines des cancers bronchiques primitifs opérés (cancers anaplasiques exclus).

The results of a retrospective study of patients operated upon for primary bronchial carcinoma (small-cell type excluded) are reported. The survival rates of 1285 patients who underwent tumoral excision between 1960 and 1973 were calculated by the actuarial method after exclusion of post-operative deaths. The overall survivals at 5 years' intervals were 31%, 18%, 11% and 8%. The excess mortality due to cancer was significant up to 15 years. Among 159 patients who survived for more than 10 years, relapses or new growths, sometimes amenable to surgical treatment, were relatively common. The cardiorespiratory status, living conditions and social rehabilitation of 149 patients who survived for more than 5 years showed good adaptation in most cases. The long-term prognosis was unrelated to age, sex or side of the tumour. The influence of the histological type depended on differentiation. Among surgical operations, lobectomy had the best prognosis. In patients who had simple pneumonectomy there was no significant difference between pneumonectomies performed on account of tumour of the main bronchus and the others. The place of enlarged pneumonectomy is defined. Of paramount importance for survival are the T.N.M. classification (UICC coding modified by Renault in 1975) and Carr's grading into 3 stages of increasing severity, notably the size and site of the tumour (T1 to T3) and the presence of pedicular or mediastinal lymph node involvement (N1-N2-N3). Early diagnosis is essential. Prospective studies involving several parameters (especially treatments combined with surgery) appear to be needed.

[Thymomas and associated diseases. Apropos of a series of 255 surgically treated thymomas]. / Thymomes et maladies associées. A propos d'une série de 255 thymomes opérés.

The authors report on a series of 255 thymomas and the associated diseases most often auto-immune, myasthenia is the disease most frequently encountered (61% of cases). Next, but with a much reduced frequency of around 2%, come other diseases such as hypogammaglobulinaemia, erythroblastopenic anaemia, and disseminated lupus erythematosis. The authors analyse the effect of ablating the thymoma on the associated disease; those with myasthenia are the principal beneficiaries of thymic ablation, 83% in this series experiencing a good response. Besides myasthenia only erythroblastopenic anaemia obtained some benefit from thymic ablation; in all the other cases surgery to the thymic tumour had no benefit on the associated disease. In the light of their own experience the authors made a review of the literature of the different diseases associated with thymomas and made the point of the efficacy of thymectomy in the different diseases.

[Surgery of 19 bilateral simultaneous pulmonary metastases]. / A propos du traitement chirurgical de 19 métastases pulmonaires bilatérales et simultanées.

19 patients with bilateral simultaneous pulmonary metastases were operated on between 1954 and april 1976 at the Marie-Lannelongue surgical centre. Sarcomas were twice as common as carcinomas. In 10 cases the thoracotomy was only unilateral, either because thoracotomy was not attempted on the other side owing to the diffuse nature of the lesions (8 cases) or because prior chemotherapy had permitted complete reduction of the metastases on the opposite side (2 cases). This thoracotomy remained exploratory in 47 p. cent of cases, radical removal of all the tumour nodules was possible in 53 p. cent of cases (10 patients). Peripheral resections of the lesions were the rule. But in 4 cases, lobectomy was carried out on one side. 7 of the 9 bilateral operations were performed during the same stage. There were no operative deaths. The late results are encouraging considering the number of sarcomas in which the prognosis is usually poor. Bilateral lesions are thus not an absolute contra-indication, provided one remains within reasonable anatomical and functional limits, in the fields of well-conducted anti-cancer strategy.

[Right subphrenic abscess and bronchial fistula from late trans-diaphragmatic migration of a postoperative abdominal foreign body.(author's transl)]. / Abcés inter-hépato-diaphramatique avec fistule bronchique par migration tardive trans-diaphragmatique d'un corps étranger abdominal post-opératoire.

Late trans-diaphragmatic migration of a postoperative abdominal foreign body followed a left hepatectomy for injury. Operative treatment, by means of the low posterior thoracic approach consisted of partial resection of the right inferior lobe with immediate closure of the diaphragm and subphrenic drainage. The natural history of the course taken by this abdominal foreign body is used as a basis for discussing diagnostic and therapeutic factors, particularly the surgical route of approach.

[Leiomyomas of the esophagus. Report of 20 cases (author's transl)]. / Les leiomyomes de l'aesophage. A propos de 20 observations.

The authors report 20 cases of leiomyoma of the esophagus operated on between 1964 and 1976. The diagnosis depended on the existence of dysphagia without loss of weight, the integrity of the mucosa on endoscopy and the findings of the esophagogram, suggested the true origin of the mediastinal image. Surgical operation usually permits simple enucleation of the leiomyoma. Postoperative mortality was nil. The late postoperative period was uneventful. There was no relapse of the histologically benign leiomyoma.

[Surgical treatment of pulmonary metastases from rectocolic cancers. Apropos of 21 cases]. / Traitement chirurgical des métastases pulmonaires des cancers recto-coliques. A propos de 21 observations

The authors report 21 cases of pulmonary metastases from operated cases of rectal and colonic carcinoma. Half the patients were aged between 60 and 70 years. In all cases except one the primary tumour was known and treated surgically before the metastasis occurred. The authors emphasize the necessity of radiological supervision of the chest after operation and recall that neither chemotherapy nor radiotherapy should be undertaken without prior histological confirmation. It is possible to remove the metastases by surgery but a high percentage require pneumonectomy i.e. it is necessary to take the same precautions before operation as for primary carcinoma of the bronchus. The operative mortality was nil, and the five year survival rate 18 p. 100.

[Bronchopulmonary hamartochondroma (apropos of 136 cases, including a homogeneous series of 124 cases). Review of the literature]. / Les hamartochondromes broncho-pulmonaires (à propos de 136 cas, dont une série homogène de 124 cas). Revue de la littérature.

On the basis of a series of 136 hamartochondromas, the largest ever published, the authors review the clinical and paraclinical characteristics of bronchopulmonary hamartochondromas. After describing their pathological study, particular attention is paid to the controversial pathogenesis of these tumors before dealing with therapeutic aspects. Review of the literature.

[Late pulmonary metastases of uterine choriocarcinoma: apropos of a case occurring 19 years after hysterectomy for choriocarcinoma. Review of the literature]. / Les métastases pulmonaires tardives des chorio-carcinomes utérins: à propos d'un cas survenu 19 ans après une hystérectomie pour chorio-carcinome.

The authors report a case of pulmonary metastasis which exceptionally occurred 19 years after hysterectomy for uterine choriocarcinoma. They use this opportunity to take stock of our present knowledge concerning this subject by reviewing a vast literature. This case is of interest, as it provides a new element to the theoretical study of carcinogenesis.

[Results and prognostic factors in surgically treated thymoma. Apropos of a series of 194 cases]. / Résultats et facteurs pronostiques des thymomes opérés. A propos d'une série de 194 cas.

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.