Carcinoma of the Lung 1941

Our plain-English summary of Carcinoma of the Lung 1941, by A. Ochsner, M. DeBakey (1941).

The study

• Authors: A. Ochsner, M. DeBakey
• Published: Archives of Surgery, Volume 42 PP.209-258, February 1941
• Type of article: Journal article
• Our copy: from Johns-Manville's own medical library. The article is still under copyright, so we describe it here rather than post it.

In plain English

This article by Tulane University surgeons in New Orleans, first presented at the International Cancer Congress in 1939, reviewed published reports on lung cancer and added some of the authors' own data. It was not a study of asbestos exposure. Its silicosis section cited works on asbestosis, but a sentence about them is cut off in the scan. It covered autopsy frequency, suspected causes, symptoms, diagnosis and surgery. At Charity Hospital in New Orleans, lung carcinoma was found in 3 of 633 necropsies (0.47 per cent) in 1931 and in 17 of 825 (2 per cent) in 1938. United States records showed lung cancer deaths rising from 956 in 1920 to 4,648 in 1936. The authors judged that the role of pneumonoconiosis and silicosis was not definitely established. As their belief, they stated a definite conviction that the rise was due largely to increased smoking, particularly cigarette smoking with inhalation. Of their own 15 patients who had a whole lung removed, 7 recovered and 8 died. The authors concluded that tying off each lung vessel and the bronchus separately gave a lower death rate than tying them all together.

We wrote this plain-English summary from the full article with the help of AI, and a second AI model checked each sentence against the article. It is not the authors' wording; the abstract and the article are their own account.

What the study did and found

• Design: Literature review of lung carcinoma, with the authors' own hospital necropsy figures, a review of United States mortality statistics, and a collected series of total pneumonectomies that includes their own cases
• Who was studied: Published cases and series from many countries; necropsies at Charity Hospital, New Orleans, 1931 to 1938; United States deaths from lung cancer, 1920 to 1936; 116 total pneumonectomies for neoplastic lung disease (101 reported by others and 15 done by the authors)
• Exposure: No asbestos exposure was studied. The suspected causes of lung cancer that were reviewed included influenza, tuberculosis, syphilis, chronic lung inflammation, tar and road dust, radioactive mine dust (Schneeberg and Joachimsthal miners), pneumonoconiosis and silicosis, and tobacco smoking. In the pneumonoconiosis and silicosis discussion, the authors cited works whose titles concern pulmonary asbestosis: Lynch and Smith in the text, and Egbert and Gerger, Gloyne, Horning and Nordmann in a footnote. The sentence giving Lynch and Smith's findings is cut off in the scanned text.
• Main results:
  • At Charity Hospital necropsies in 1931, 3 of 633 (0.47 per cent) were carcinomas of the lung
  • At Charity Hospital necropsies in 1938, 17 of 825 (2 per cent) were carcinomas of the lung, compared with 16 (1.9 per cent) carcinomas of the stomach
  • In United States mortality statistics, deaths from lung cancer rose from 956 in 1920 to 4,648 in 1936, and the death rate per hundred thousand of population rose from 1.1 to 3.6
  • Of the authors' own 15 pneumonectomy patients, 7 recovered and 8 (53.3 per cent) died
  • Of 94 pneumonectomy cases collected from other reports in which the outcome was stated, 38 patients recovered and 56 (59.5 per cent) died
  • In 24 pneumonectomy cases with massive ligation of the lung root, 5 patients (20.8 per cent) recovered from the operation and 19 (79.1 per cent) died
  • In 54 pneumonectomy cases with individual ligation of the hilar structures, 25 patients (46.2 per cent) recovered and 29 (53.7 per cent) died
  • After reviewing conflicting reports, the authors judged that the role of pneumonoconiosis and silicosis in causing bronchogenic carcinoma was not definitely established
  • The authors stated their definite conviction that the increase in lung carcinoma was due largely to the increase in smoking, particularly cigarette smoking, which they described as universally associated with inhalation. This is their stated belief, not a finding the review demonstrated.
• The authors' conclusion: The authors concluded that individual ligation of the hilar structures should be used in total pneumonectomy, because it allows a more radical operation and the mortality rate is lower. In their view, any procedure short of total removal of the involved lung is irrational for lung carcinoma.
• Limitations the authors state:
  • The authors noted that the high rates of metastasis came from autopsy cases in which the tumors were already advanced
  • The authors noted that the younger age of pneumonectomy patients reflected selection: younger patients were chosen for the operation and older patients were not considered suitable

Topics

Medical terms in this study, explained in our Lexicon: Carcinoma, Lung Cancer, Asbestos Exposure, Silicosis, Autopsy, Bronchus.

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