Alpaslan ÇAKAN, Sülün ERMETE, Şaban ÜNSAL, İbrahim TAYLAN, Mehmet AŞKIN, Teoman BUDUNELİ

Akciğer karsinomlu olgularda intraoperatif plevra yıkama sıvısında malign hücre saptanmasının sağkalıma etkisi

Akciğer karsinomlu hastaların intraoperatif plevra yıkama sıvısında (PYS) malign hücre varlığının, hasta sağkalımını, uygulanan cerrahi girişimin başarı ve sonuçlarını olumsuz yönde etkilediği bilinmektedir. Bu prospektif klinik çalışma, 49'u akciğer karsinomu ve 15'i akciğer karsinomu dışı bir neden ile torakotomi uygulanan 64 olguyu kapsamaktadır. Bu çalışmada, plevra açıldıktan hemen sonra ve cerrahi işlem bitiminde toraks kapanmadan önce olmak üzere, sitolojik inceleme için iki PYS örneği alınmış ve bu örneklerdeki malign hücre varlığının sağkalıma etkisi incelenmiştir. PYS' de malign hücre pozitifliğine, periferik yerleşimli, visseral plevra tutulumlu, ileri evreli ve adenokarsinomlu olgularda daha sık rastlanmıştır. Sonuç olarak, PYS'de malign hücre aranması, kolay uygulanabilen, hasta ve cerrahi ekibe yük getirmeyen, aynı zamanda %100 spesifisitesi ile prognostik değeri olan bir yöntemdir.

Effect of determining malignant cells in intraoperative pleural lavage fluid on survival in lung carcinoma

It is known that the patient's survival, the outcome and success rate of the surgical intervention are adversely affected by the presence of malignant cells in the intra-operative pleural lavage cytology (PLC) in patients with lung cancer. This prospective clinical trial includes 64 cases undergoing thoracotomy, of which 49 with lung cancer and 15 with other than lung cancer. Two samples of pleural lavage fluid were sent for cytological investigation, one immediately after opening the pleura and another one at the end of the procedure before closing the chest. The influence of the presence of malignant cells on the patient's survival was investigated. The positivity of PLC for malignant cells was more frequently encountered in patients with peripheral tumours, invasion of visceral pleura, advanced stages, and adenocarcinomas. In conclusion, PLC is an easily performed investigation that does not burden the patient and the surgical team. It also has a prognostic value with a specificity of 100%.

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1. Shields TW, Robinson PG, Radosevich JA. Lung cancer: Etiology, carsinogenesis, molecular biology, and pathology. In: Shields TW (ed). General thoracic surgery. Philadelphia: Williams & Wilkins 1994: 1095-117.
2. Martini N, Flehinger B. The role of surgery in N2 lung cancer. In: Martini N (ed).Surgical Clinics of North America. Philedelphia: W.B. Saunders 1987; 67(3): 1037-49.
3. Watanabe Y. Results of surgical treatment in patients with stage llla non small cell lung cancer. Thorac Cardiovasc Surg 1991; 39(1): 44-9.
4. Naruke T, Goya T, Tsuchiya R, Suemasu K. The importance of surgery to non small cell carcinoma of lung with mediastinal lymph node metastasis. Ann Thorac Surg 1993:55:951-6.
5. Spjut HJ. Carcinoma cells in pleural cavity washings. Cancer 1958; 11(6): 1222-5.
6. Kondo H. Prognostic significance of pleural lavage cytology immediately after thoracotomy in patients with lung cancer. J Thorac Cardiovasc Surg 1993; 106: 1092-7.
7. Eagan RT. Pleural lavage after pulmonary resection for bronchogenic carcinoma. J Thorac Cardiovasc Surg 1984; 88: 1000-3.
8. Buhr J. The prognostic significance of tumor cell detection in intraoperative pleural lavage and lung tissue cultures for patients with lung cancer.J Thorac Cardiovasc Surg 1997;113:683-90
9. Buhr J. Tumor cells in intraoperative pleural lavage:An indicator for poor prognosis of bronchogenic carcinoma.Canser 1990;65:1801.
10. Okumura M. Intraoperative pleural lavage cytology in lung cancer patients. Ann Thorac Surg 1991; 51:599.