Wednesday Afternoon, April 22, 1959

2:00 P.M. Executive Session (Limited to Active and Senior Members). Pacific Ballroom.

3:00 P.M. Scientific Session: REGULAR PROGRAM -Pacific Ballroom.

ADDRESS BY THE PRESIDENT

MICHAEL E. DE BAKEY, Houston, Texas

29. Surgical Treatment of Cylindroma of the Bronchus (Adenoid Cystic Carcinoma).

W. Spencer Payne (by invitation), F. Henry Ellis, Jr.

Lewis B. Woolner (by invitation), and Herman J. Moersch,

Rochester, Minn.

Cylindromas of the bronchus are sufficiently rare to warrant a critical review in an effort to assess the nature of the tumor and to determine the efficacy of treatment.

In 21 of 157 cases of adenoma of the bronchus encountered at the Mayo Clinic from 1927 through 1957, a microscopic diagnosis of cylindroma was made. Analysis of this group includes data relative to age, sex, symptomatology, x-ray appearance, anatomic distribution, bronchoscopic appearance, gross and microscopic pathology, treatment, and prognosis. At the time of writing this abstract, follow-up data for periods of 1 to 20 years are available on all but two of the 21 patients. Necropsy data, which are available for half of the patients who died, attest to the malignant course of this disease as well as to the ability of these tumors to metastasize distantly.

Eleven of the 21 patients received primary resective therapy (nine pneumonectomies and two lobectomies) without operative mortality. The other patients had either a combination of irradiation and endoscopic resection or no treatment at all.

The data suggest that pulmonary resection offers the best chance for cure when the tumor is totally resectable. Pulmonary resection also seems to offer excellent palliation in those patients in whom tumor must be left behind.

30. Bronchogenic Carcinoma: An Aggressive Surgical Attitude.

J. Maxwell Chamberlain, Thomas M. McNeill (by invitation),

John R. Edsall (by invitation), and Peter Parnassa

(by invitation), New York, N.Y.

A thoracotomy for bronchogenic carcinoma usually implies that the surgeon considers the lesion resectable. During the last ten years we have made a determined effort in every case to resect the carcinoma, even though it was necessary to include with the specimen a portion of the left atrial wall, the tracheal carina or the muscular wall of the esophagus. In several patients whose respiratory reserve was critically low, an upper lobectomy was performed with sleeve resection of involved main bronchus, thus permitting preservation of the lower lobe by anastamosis of its bronchus to the trachea.

The resectability rate was 80% in 240 cases operated upon. Preferential selection of cases was not a factor in the high resectability rate, as attested to by the large number of cases upon whom a "palliative" resection was performed (50%). A "radical" en bloc mediastinal dissection was not done, but an extended effort was made routinely to expose 6-7 cm. of the opposite bronchus, to resect the subcarinal nodes at the bifurcation of the trachea and any suspicious nodes in the upper mediastinum and along the course of the aorta and the esophagus.

There was histologic proof of carcinomatous involvement of pericardium, auricle or deep mediastinal nodes among a sufficient number of long-term survivors to indicate that these surgical efforts were crucial factors in their survival.

7:00 P.M. Banquet and Dancing. Pacific Ballroom.

Attendance limited to Members of the Association and their ladies, Invited Speakers and their ladies.

Dinner dress preferred.