Robert J. McKenna

PURPOSE: To evaluate the technical feasibility and safety of video-assisted thoracic surgery (VATS) lobectomy for small lung cancers. PATIENTS AND METHODS: The Cancer and Leukemia Group B 39802 trial was a prospective, multi-institutional study designed to elucidate the technical feasibility of VATS in early non-small-cell lung cancer (NSCLC) using a standard definition for VATS lobectomy (one 4- to 8-cm access and two 0.5-cm port incisions) that mandated videoscopic guidance and a traditional hilar dissection without rib spreading. Between 1998 and 2001, 128 patients with peripheral lung nodules < or = 3 cm in size with suspected NSCLC were prospectively registered for VATS lobectomy. RESULTS: One hundred twenty-seven patients (66 males and 61 females; median age, 66 years; range, 37 to 86 years), with a performance status of 0 (74%) or 1 (26%), underwent surgery. Patients with lymph nodes more than 1 cm by computed tomography scan underwent mediastinal lymph node sampling to rule out N2 disease. One hundred eleven patients (87%) had stage I lung cancer, and 96 (86.5%) of these 111 patients underwent successful VATS lobectomies. The median procedure length was 130 minutes (range, 47 to 428 minutes), and median chest tube duration was 3 days (range, 1 to 14 days). Fifty-eight (60%) of 97 patients underwent diagnostic biopsy at lobectomy. Within 30 days, three (2.7%) of 111 patient deaths occurred, none of which were directly related to VATS technique; seven (7.4%) of 95 patients had grade 3 or greater complications, with only one case of bleeding. CONCLUSION: A standardized approach to VATS lobectomy as specifically defined with avoidance of rib spreading is feasible.

Osteogenic sarcoma is a convenient and generically correct designation for all skeletal conective-tissue neoplasms of mesenchymal origin including: osteosarcoma, chondrosarcoma, fibrosarcoma, parosteal osteogenic sarcoma, and osteogenic sarcomata arising in Paget's disease, irradiated bone, Osteochondroma, fibrous dysplasia, or other bone disease. This report is summary of the clinical, histopathological, and roentgenographic findings, and of the treatment and end-results of treatment in 552 cases of osteogenic sarcoma. Factors which have no influence on prognosis are age, sex, bone of origin, trauma, and the occurrence of fracture. Factors which do influence prognosis include: histological type of sarcoma, tumor size, preoperative and postoperative serum alkaline Phosphatase elevations, lymph-node involvement, and treatment. Absolute five-year survival figures varied from 0.0 per cent for osteogenic sarcoma arising in Paget's disease to 82 per cent for parosteal osteogenic sarcoma; the figures for the other types were as follows: osteosarcoma, 13.2 per cent; chondrosarcoma, 28.1 per cent; fibrosarcoma, 31.7 per cent; and secondary chondrosarcoma, 67 per cent. Only in chondrosarcoma did grading correlate with prognosis; the patients with low-grade and medium-grade chondrosarcoma having considerably better survival rates than those with high-grade tumors. The incidence of late failures (patients dying of sarcoma more than five years after diagnosis) showed an inverse relationship to five-year survival. Prognosis varied directly with tumnor size, and no patient with an osteosarcoma or fibrosarcoma greater than 15.0 centimeters in greatest dimension was cured. When examination of the surgical specimen revealed lymph-node metastases, the outcome was always fatal. Radical ablative surgery is the only curative therapy for osteogenic sarcoma. Irradiation as the sole therapy did not cure a single patient. Preoperative irradiation followed by radical ablative surgical therapy was attended by a worse prognosis than surgery alone. Two patients with unilateral lung metastasis were cured by lobectomy. Adjuvant chemotherapy by perfusion administered prior to radical ablative surgery might be considered for future investigative protocols.