Surgical Considerations of Primary Carcinoma of the Lung

Our plain-English summary of Surgical Considerations of Primary Carcinoma of the Lung, by A. Ochsner, M. DeBakey (1940).

The study

• Authors: A. Ochsner, M. DeBakey
• Published: Surgery 8:992-1023 November (1940)
• 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 1940 article from Tulane University, New Orleans, does not mention asbestos. It discussed surgery for primary lung cancer, described methods for removing a whole lung (total pneumonectomy), and analysed 139 cases collected from the medical literature plus 19 of the authors' own pneumonectomies for lung tumours. In a separate comparison, 49 per cent of 139 collected lung cancer cases were judged operable, against 19 of 30 cases (63.3 per cent) in the authors' own series. Of 134 pneumonectomy cases with the tumour type stated, 126 (94 per cent) were primary carcinoma. Of 151 pneumonectomy cases with an operative result stated, 45 per cent died after operation; later deaths were reported separately. Empyema, cardiac failure and pneumonia were the most frequent causes of death. Mortality was lower when the vessels and airway at the root of the lung were tied off one by one rather than all together. Of 67 collected recovered patients with follow-up, 47 were still living, as were seven of the authors' 10. The authors concluded that removing the whole lung and mediastinal lymph nodes was the most rational operation, and said it was too early to judge long-term results.

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: Review of surgical treatment and operative technique, with an analysis of cases collected from the literature plus the authors' own cases
• Who was studied: 139 published cases collected from the literature and 19 of the authors' own cases of total pneumonectomy for tumours of the lung (Department of Surgery, Tulane University, New Orleans). Sex was stated for 92 cases: 23 female and 69 male. A separate operability comparison used 139 collected lung cancer cases and the authors' series of 30 cases.
• Exposure: No asbestos or other occupational exposure was studied. The subject was surgical removal of the entire lung (total pneumonectomy) for tumours of the lung.
• Main results:
  • Operability among lung cancer cases assessed for surgery: 49 per cent of 139 collected cases were operable, compared with 19 of 30 cases (63.3 per cent) in the authors' own series
  • Tumour type, stated in 134 pneumonectomy cases: 126 (94 per cent) primary carcinoma and 4 (2.9 per cent) sarcoma; the rest were metastatic tumours
  • Operative mortality was 45 per cent among the 151 pneumonectomy cases (all tumour types) in which the result of the operation was stated; deaths during later follow-up were reported separately
  • Empyema, cardiac failure and pneumonia were the most frequent causes of death in the collected series, including the authors' cases
  • Mortality was lower when the hilar structures were tied individually (86 collected cases) than when mass ligation was used (29 collected cases); the authors took this to show the superiority of individual ligation
  • Follow-up data were available for 67 of 83 collected patients who recovered from operation; 47 of the 67 (about 70 per cent) were still living
  • In the authors' own series, 7 of the 10 patients who recovered from operation were still living
• The authors' conclusion: The authors concluded that total removal of the involved lung and the mediastinal lymph nodes is the most rational surgical procedure, that it can be done adequately only by individual ligation of the hilar structures, and that irradiation therapy is of little, if any, value.
• Limitations the authors state:
  • The authors stated that surgery for primary lung cancer was too recent to allow adequate evaluation through large statistical analyses

Topics

Medical terms in this study, explained in our Lexicon: Carcinoma, Lung Cancer, Pneumonectomy, Empyema, Mediastinal Lymph Nodes.

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