We studied the relationship between age, type of surgical procedure and preoperative cardiopulmonary function and postoperative pulmonary complications and cardiac arrhythmias in 369 cases that underwent thoracotomy for bronchogenic carcinoma. The following results were obtained.
Pulmonary Complications:
1) Postoperative pulmonary complications occured in 73 (19.8%) of 369 patients. The incidence increased with age: 3.8% below 50 years of age, 16.0% between 50 and 59, 22.6% between 60 and 69, and 40.5% in the over 70 age group.
2) Lower %FVC, FEV_1.0/FVC and PO₂ and higher %RV and RV/TLC ratio were. observed in cases with pulmonary complications, compared to cases without complications. Of these tests, the most sensitive test was FEV_1.0/FVC. The incidence of postoperative pulmonary complications when FEV_1.0/FVC was below 60% was 43.5% compared with 17.6% when FEV_1.0/FVC was normal.
3) Cigarette smokers had double the incidence of postoperative pulmonary complications of nonsmoker.
Cardiac Arrhythmia:
1) Cardiac arrhythmias were documented in 67 (18.2%) of 369 patients postoperatively. The incidence was 3.8% below 50 years of age, 10.9% between 50 and 59, 21.9% between 60 and 69 and 42.9% in the over 70 age group.
2) Postoperative arrhythmias were seen in 15.9% lobectomy and 30.6% of pneumonectomy cases.
3) Pre-existing cardiovascular disease was a factor strongly associated with a high incidence of cardiac arrhythmias. The incidence of postoperative arrhythmia in patients with abnormal ECG and hypertension was 34.9% and 31.4% respectively compared with 13.4% and 16.5% in patients without these abnormalities. Furthermore, ECG after exercise was studied preoperatively in 170 cases. Arrhythmias developed in 40% of cases with abnormal ECG after exercise, versus 20% in those with a normal ECG after exercise.

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In order to assess the accuracy and limitations of clinical and surgical TNM classification in lung cancer, we compared clinical and surgical with pathological TNM classifications in 48 cases. T-factor was diagnosed the most accurately whereas the N-factor was the least accurate.
The estimation of extrapulmonary invasion was most difficult in terms of the evaluation of T-factor. In the classification of N-factor it was recognized that evaluation of the size of lymph nodes either on chest X-ray or during surgery did not yield satisfactory results.
The rate of adequate diagnosis of M-factor was unexpectedly low because of microscopic lung metastasis.

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In 1958, Nash and Stout reported an unusual pathological variety of primary carcinomas of the lung and they named it giant cell carcinoma of the lung. Eight cases of a giant cell variety of carcinoma of the lung were identified clinically and pathologically among about 500 cases of primary carcinomas of the lung seen in our hospital since 1972.
In terms of prognosis, giant cell carcinoma of the lung is more malignant than small cell carcinoma of the lung, and the average interval from clinical recognition of the tumor to death was only 7.7 months. Only one patient of the eight with giant cell carcinoma of the lung is surviving 4 years and 6 months after operation. The mean age was 55, ranging from 41 to 70.
Laboratory data showed marked elavation of WBC and ESR in the eight patients, and four of them also developed general symptoms such as high fever and malaise.
On X-ray the eight cases were nodular in shape and peripheral in location.Histological findings showed three cellular components, i.e. giant carcinoma cells, round mononuclear cells, and spindle cells. The tumor, in addition, is usually infiltrated by inflammatory cells, and acdenonlatous and squamous patterns are variously mixed.

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Ninety seven cases of patients with lung cancer were examined with 4 types of delayed hypersensitive skin tests (PPD, PHA, Candida and SK-SD), and their nutritional status was evaluated by hemoglobulin, lymphocyte, serum albumin and ratio of weight to height before operation. The Skin Test Index was calculated by the following equation: STI= logDT + logDP + logDC + logDS -0.4/ 4 (DT, DP, DC, DS: mean diameter of PPD, PHA, Candida and SK-SD).
1. STI was significantly depressed in T₃ and N₂ cases.
2. STI was significantly depressed in patients with non-curative operation.
3. Nutritional status was significantly depressed in cases with an STI lower than 1.0.
4. The majority of cases with an STI of 1.0 or higher survived 2 years or more.

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Thirty patients were treated with COM chemotherapy, receiving 500mg/m² CPA, 1mg VCR, and 20mg/m² MTX intravenously on days 1 and 5. The regimens were repeated every 21 days.
After two courses of COM, irradiation of the primary lesion, mediastinum and clinically involved cervical nodes was performed in 23 patients.
The response rate was 70%(CR 27%, PR 43%) in 30 cases treated with COM alone and 91%(CR 56%, PR 35%) in 23 cases treated with COM + radiotheraphy. Relapse of the primary lesion was recognized in 4 of the responders in the chemotherapy only group and 1 of the responders in the combined group. The median survival was 8 months (range 3-24 months). Severe toxicity of COM was not observed. Combined therapy (COM+R) favorably influences the prognosis of small cell carcinoma of the lung, especially in those patients with limited disease, favorable performance status and continuous chemotheraphy.

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The clinical and pathological findings of double primary cancer involving lung cancer are important in terms of carcinogenesis, cancer immunity and surgical therapy.
Seven cases out of 156 cases involving lung cancer were asynchronous, and another seven cases were synchronous double primary cancer of the lung. In the metachronous double cancer cases, the site of the initial tumor was the stomach in three, the uterine cervix in two and the larynx and breast in one each. All were operated on two to twenty-six year previously.
The other primary tumors in cases of synchronous double cancer were located in the prostate in two cases and there was one each in the one hepatic duct, stomach, skin, liver, and lung. In these seven cases only two were diagnosed clinically, and five were detected at autopsy.
Synchronous and asynchronous double primary cancer cases involving lung cancer constituted 14 cases out of 156, 7 cases were synchronous (4.5%), and 5 cases (11%) out of 45 autopsy cases were synchronous detected at autopsy.
These incidence rates are higher than those previously reported and higher than the occurrence of cancer in normal adults.

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A total of 292 cancer patients were treated in our department from April, 1973, through April, 1980. Resection of tumor was performed on 206 of the cases. Operative death occurred in two cases.
The disease was at stage III in 135, of which 74.0% had T3 lesions and 66.7% had N₂ disease. Tumor resection was performed on 103 of the stage III cancer patients. Surgery for the T₃ lesions consisted of combined resection of the surroundirig structures and, for the N₂ lesions, extended operation with extensive dissection of the mediastinal lymph nodes. Chemo-and immunotherapeutic agents were administered pre-and postoperatively as adjuvant therapy.
The five-year survival rate was 13.6% in the stage III patients who had had complete or incomplete tumor resection. For only those patients who had complete tumor resection, the survival rate was 22.4%. The three-year survival rate was 12.9% in 75 patients with combined resection of the adjacent structures, but it was 18.9% if the patients with incomplete resection were excluded.
The prognosis was favourable in cases of combined chest wall resection. Relatively longer survival was experienced in cases of adenocarcinoma with No or N1 lesions and in cases undergoing chest wall resection. It was confirmed that postoperative treatment with OK-432, a streptococcal preparation for immunotherapy, is effective in prolonging survival of cases undergoing extended operation.
Although the survival rate of stage III patients is low compared to that of the patients in stages I and II, these results encourage us to perform aggressive surgery with the aid of pre-and postoperative adjuvant therapy in selected cases of advanced lung cancer.

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A laser photoradiation system for the localization of lung cancer by detection of fluorescence emitted by hematoporphyrin derivative (HpD) was tested in experimentally induced malignant tumors in dogs. Canine lung cancer was induced by means of repeated submucosal injections of 20-methylcholanthrene at the bifurcation of the right apical and cardiac lobe bronchi. Four dogs with squamous cell carcinoma were used in this experiment and 5 dogs (4 dogs with cancer and 1 normal dog) were used as controls. 2.5-5.0 mg/kg body weight of HpD was administered intravenously in each dog 48 hours prior td examination for fluorescence. HpD is known to be retained longer by malignant tissue than by normal tissue and to emit fluorescence when stimultated by violet light. A krypton ion laser was used as a violet light source to excite the HpD, and an image intensifier and fiberoptic bronchoscope were used to detect fluorescence from the tumors. The cancer focus showed positive fluorescence in all cases. On the contrary, the control group which did not receive HpD injection showed no fluorescence.
The resuts of this study indicate that this system involving intravenous administration of HpD and laser photoradiation could have clinical value in the diagnosis of lung cancer.

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During the past five years (1975-1979) we have performed mass surveys to detect lung cancer in 178, 259 subjects initially participating in surveys performed by various institutions. On the basis of results of chest X-ray and a questionnaire, a high risk group of 23% of the total was selected. Sputum cytology tests were performed in 6.5% of all cases.
74 lung cancers were detected, 16 cases of which were early stage lung cancer, but 48.6% of the 74 cases were in advanced stages. Even among stage I and stage II lung cancers, 2.7% were non-curatively resected and 21.6% were not treated surgically.
We have re-evaluated our results epidemiologically and feel that our five-year experience has yielded valuable info'rmation in terms of conducting more effective mass surveys for lung cancer in the future.

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We examined 3 patients with squamous cell carcinoma of the hilar type among chromate workers for assessment of its development. Diagnosis of the cases was confirmed. by fiberoptic bronchoscopy. We reviewed changes in the bronchial mucosa by fiberoptic bronchoscopy and also successive changes of sputum cytology. The duration between the first bronchoscopic examination which revealed almost normal findings and the second one which revealed carcinoma was 15, 30 and 43 months. By histopathological examination, their stages were defined as carcinoma in situ, micro-invasion and advanced type. These findings strongly suggest that bronchoscopic examination at inter-vals of 15 months or less is the best method to detect in situ squamous cell carcinoma of hilar type.

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A 65-year-old male on chronic haemodialysis for 6 years underwent a right lower lobectomy and mediastinal lymph node dissection. Microscopically, the tumor was a well differentiated squamous cell carcinoma with metastasis to mediastinal lymph nodes. He was managed well with frequent daily haemodialyses for 4 days before and after operation respectively. Although immunotherapy with Nocardia rubra-CWS was begun after discharge, a symptom of cerebral metastasis appeared 3 months later, and he developed right hemiparesis. In spite of irradiation to the cerebral metastatic lesion and chemotherapy with Bleomycin, he died of cancer 6 months postoperatively.

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42 years old male who had undergone resection of a left mammary tumor 11 years previously, was admitted with bilateral nodular shadows. Three of them were in the right lower lobe, which was resected, yielding a diagnosis of a mucous carcinoma metastatic from breast cancer.
Following lobectomy, OK432, Fental and PSK have been administered for 14 months. The 2×2cm shadow in the left lower lobe has disappeared on routine chest film but on tomogram it appears as 0.5 cm in diameter. We are recommending wedge resection of the left lower lobe. We believe that this is the first case of bilateral pulmonary metastasis of a male mammary mucous carcinoma treated by lobectomy, Fental, OK432 and PSK with partial remission in Japan.

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