Tuesday Afternoon, March 30, 1965

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

3:00 P.M. Scientific Session: REGULAR PROGRAM

International Room

Address by the President

John C. Jones, Los Angeles

Address by Honored Guest

Dr. A. Gerard Brom

Professor in Thoracic Surgery

University Hospital, Leiden

"Narrowing of the Aortic Isthmus and Enlargement of the Mind"

28. Tracheal and Tracheobronchial Resections: Technic and Results (20 Cases)

J. Mathey*, J. P. Binet*, J. J. Galey*, C. Evrard*,

G. Lemoine*, and B. Denis*, Paris, France

Sponsored by O. Theron Clagett

This communication reports on 20 cases of tracheal and tracheobronchial resections. The study period extends from 1951 until 1964. In 16 cases, annular resection was elected and repair completed by end to end tracheal or bronchotracheal anastomosis. Four technical points are emphasized: 1) at the time of resection, ventilation and anesthesia must be provided through the distal airway, 2) annular resection with end to end anastomosis is to be preferred when technically feasible, 3) following resection of the tracheal bifurcation, reconstruction of the bronchial tree is essential, and 4) when dealing with malignant lesions, complete removal of the tumor must always be controlled by quick section. Two additional technical aids, extracorporeal circulation and the Marlex mesh prosthesis are currently fashionable. They are discussed in relation to our results. Lateral as opposed to annular resection is only used when the latter is technically impossible. The choice of incision resides between a lateral and anterior sternum-splitting incision. The latter affords broad exposure of the trachea and its bifurcation. Immediate results are as follows: 10 high and 6 low (including the bifurcation) tracheal annular resections with end to end anastomosis - 3 hospital deaths. 3 high and 1 low lateral resections - 2 hospital deaths. Late results with follow up from 8 months to 5 years will be presented.

29. Non-metastatic Neurological Complications of Bronchogenic Carcinoma: The Carcinomatous Neuromyopathies

Donald L. Morton*, Hideo Itabashi*, and Orville F. Grimes,

San Francisco, Calif.

The carcinomatous neuromyopathies are a group of neurological syndromes which occur in association with carcinoma and may involve almost any level of the neuromuscular system, but are unrelated to the presence of metastases. These neurological syndromes are probably the most frequent non-metastatic manifestations of bronchogenic carcinoma, but they have received little attention in the thoracic surgical literature. However, the recognition of these neuromyopathies and their differentiation from metasta-tjc lesions deserves special emphasis when considering the surgical treatment of bronchogenic neoplasms. The experience of the University of California Hospitals (San Francisco) and the Langley Porter Neuropsychiatric Institute with this syndrome will be reviewed. Patients with bronchogenic carcinoma may have a wide variety of non-metastatic neurological lesions, including cortical cerebellar degeneration, peripheral neuropathies, encephalomyelitis, polymyositis and myasthenia-like syndromes. The frequency, clinical picture, differential diagnosis and neuropathological findings of these lesions will be discussed. Sixteen cases of this syndrome which were proved at autopsy will be presented. The severity of the syndrome has no relationship to the size or growth rate of the tumor. A surgical approach to the treatment of carcinoma is indicated in these patients, especially since the carcinomatous neuropathy may undergo remission following removal of the primary neoplasm.

30. Preoperative Irradiation in Patients Undergoing Pneumo-nectomy for Carcinoma of the Lung: Incidence of Postoperative Cardiac Complications

James B. D. Mark, San Jose, Calif.,

Edward P. Call*, and Carl F. Von Essen*, New Haven, Conn.

In recent years, preoperative irradiation as part of the treatment plan for patients with carcinoma of the lung has undergone critical appraisal at several institutions. Emphasis has been on long-term cure. No evaluation of postoperative complications in previously irradiated patients has been undertaken. During the past six years, 60 patients have undergone pneumonectomy for carcinoma of the lung at the Yale-New Haven Medical Center. Twenty of these patients received planned preoperative irradiation under a selective protocol. Patients in the irradiated and non-irradiated groups were found to be comparable relative to age, sex, stage of disease (TNM classification) and preoperative cardiac status. Postoperative bronchopleural fistula did not occur in either group. The incidence of postoperative cardiac complications in the irradiated group was found to be more than twice as great as that in the non-irradiated group. Operative mortality in the irradiated group was eight times that in the non-irradiated group (4/20 vs. 1/40). Additional correlations with postoperative morbidity, length of survival and post-mortem findings have been carried out. Based on this data, it appears that preoperative irradiation in patients undergoing pneumonectomy for lung cancer is associated with a higher incidence of postoperative cardiac complications and mortality.

*By Invitation

Tuesday Evening, March 30, 1965

7:00 P.M. Reception

International Room

8:00 P.M. Banquet and Dancing

International Room

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

Dinner dress preferred