The Development of Pulmonary Surgery with Special Emphasis on Carcinoma and Bronchiectasis

Our plain-English summary of The Development of Pulmonary Surgery with Special Emphasis on Carcinoma and Bronchiectasis, by A. Ochsner (1978).

The study

• Author: A. Ochsner
• Published: The American Journal of Surgery 135:732-746 June (1978)
• 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 was a historical review and personal account by one surgeon of how lung surgery developed, focused on lung cancer and bronchiectasis. It did not concern asbestos. The author recalled seeing nine cases of lung cancer in six months in 1936, all in men who smoked heavily, and said the author had then proposed cigarette smoking as the probable cause. The author described a total lung removal performed in 1936 on a nineteen-year-old boy for a fibrosarcoma in the bronchus, not a carcinoma; he was still well decades later. In one comparison of five-year survival, the surgeon Overholt's lobectomy patients had 27 per cent survival and pneumonectomy patients 19 per cent. Among university students given bronchography, many with chronic bronchitis had unexpected widening of the airways. In one patient, sputum bacteria fell from 4,200,000 to 200,000 per cubic millimeter after iodized oil was instilled. The author stated that, at the time of writing, death rates after lung resection for bronchiectasis did not exceed 1 per cent. The author concluded that most lung cancer is preventable by not smoking.

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: Historical review and personal narrative by a single surgeon (not an original study); covers the development of surgery for lung cancer and bronchiectasis
• Who was studied: Published historical cases and series on lung cancer and bronchiectasis, plus the author's own patients, including nine lung cancer cases seen in 1936, one nineteen-year-old pneumonectomy patient, and University of Wisconsin students who underwent bronchography
• Exposure: No asbestos exposure is discussed. The article discusses cigarette smoking as the main cause of lung cancer, and mentions radioactive substances in the Schneeberg mines as another known cause
• Main results:
  • The nine lung cancer patients the author saw in 1936 were all men who smoked heavily. The author postulated that cigarette smoking was the probable cause of the rise in lung cancer.
  • A nineteen-year-old boy had a total left pneumonectomy in 1936 for a tumor in the bronchus. On microscopic examination the tumor was a fibrosarcoma, not a carcinoma. He developed empyema but recovered, and was reported healthy more than thirty-six years later.
  • In a comparison of resections, five-year survival in Overholt's series was 27 per cent after lobectomy and 19 per cent after pneumonectomy. The author's own pneumonectomy survival figure is not legible in the scanned text. The author stated that results after lobectomy were better, although the difference was not great.
  • The author reported less morbidity after lobectomy than after pneumonectomy
  • Two colleagues in the author's organization found tumor cells in the peripheral arterial blood of 30 per cent of patients with proven carcinoma, and none in patients without malignant disease. The author took this as evidence that lung cancer invades the pulmonary vessels early.
  • Among approximately 700 university students examined by bronchography, the author reports that 90 per cent of those with constant chronic bronchitis had unanticipated bronchial dilatation. This passage is partly illegible in the scan.
  • In one typical student case, the sputum bacterial count was 4,200,000 per cubic millimeter before iodized oil (lipiodol) was introduced, and 200,000 two days after the injection
  • The author stated that, at the present time, the mortality for resection in bronchiectasis does not exceed 1 per cent
• The authors' conclusion: The author concluded that treatment of lung cancer remained unsatisfactory because of early spread through the blood vessels. The author also concluded that most lung cancers are preventable by avoiding smoking, and that physicians should persuade themselves and their patients to stop smoking.

Topics

Medical terms in this study, explained in our Lexicon: Carcinoma, Lung Cancer, Bronchus, Pneumonectomy, Sputum.

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