[Surgical treatment of bronchial carcinoma]

Surgical resection of the primary tumor along with regional lymph nodes offers the best chance for cure in lung cancer. Progress in thoracic surgery in the past decade has resulted above all from the reduction of operative risk in the elderly, allowing radical operations to be carried out in older patients as well as from better planning of the extent of surgical intervention and avoiding radical intervention where it was not likely to be beneficial. Surgery is indicated as a rule up to tumor stage T3N2M0 , but account must be taken of the patient's functional reserves. Lobectomy, appears to be the method of choice. Segmental resection or tumorectomy may be indicated in patients with limited pulmonary function. Since prognosis depends largely on the tumor's histologic type, more generous indications for surgery are appropriate in the case of squamous cell carcinoma and narrower surgical indications are called for in cases of small-cell carcinoma. Mediastinoscopy allows assessment of regional metastatic spread. Remote metastases should be excluded by liver and one scintigraphy. From 1949 to 1982 a total of 2000 patients with bronchial carcinomas have undergone surgery in the Robert-R ossle -Clinic, with resections having been performed in 1,510 patients. Pneumectomy was performed in 63%, lobectomy in 35% and segmental resection in 2%. Despite broadened indications for surgery post-operative lethality was reduced to 3% during this period. In resected patients who where detected by systematic x-ray screening programs, 5 year survival rates of 38% have been achieved by surgical treatment. Asymptomatic small-cell bronchial carcinomas are cured by operation in 20% of cases. Postoperative empyemas are treated conservatively in our clinic. Further improvements in the prognosis of bronchial carcinoma can be achieved only by early diagnosis and adequate resection.