Postoperative death used to be an important complication of resections for lung cancer, especially in elderly patients. To support decision making in a general situation, contemporary results and prognostic factors were evaluated.The computer records of 7899 lung cancer patients, diagnosed from 1984 until 1992 in hospitals connected to the Rotterdam Cancer Registry, were analysed to evaluate resection rates and 30 day postoperative mortality.Resections were carried out in 20% of all patients. In patients 70 yrs of age and older, the resection rate was 14%, and in younger patients 26%. The postoperative mortality was 3.1%; 3.6% for males and 0.4% for females. According to multivariate analysis, age and extent of surgery were the major determinants of operative risk. For patients aged 0-59, 60-69 and ≥70, postoperative mortality rates were 1.4, 3.5 and 4.0%, respectively. The operative risk was 5.7% after pneumonectomy, 4.4% after bilobectomy, and 1.4% after lesser resections. Pneumonectomies were performed less often in elderly patients: 27% of operations in patients ≥70 yrs versus 37% of operations in younger patients.Age appears to be related to treatment choice and postoperative mortality in patients with lung cancer. However, even in patients over 70 yrs of age, resections can be performed at acceptable risk, implying that chronological age should not automatically determine treatment decisions.

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Long-term treatment with 6-thioguanine (6-TG) for pediatric acute lymphoblastic leukemia (ALL) is associated with high rates of hepatic sinusoidal obstruction syndrome (SOS). Nevertheless, current treatment continues to use short-term applications of 6-TG with only sparse information on toxicity. 6-TG is metabolized by thiopurine methyltransferase (TPMT) which underlies clinically relevant genetic polymorphism. We analyzed the association between hepatic SOS reported as a serious adverse event (SAE) and short-term 6-TG application in 3983 pediatric ALL patients treated on trial AIEOP-BFM ALL 2000 (derivation cohort) and defined the role of TPMT genotype in this relationship. We identified 17 patients (0.43%) with hepatic SOS, 13 of which with short-term exposure to 6-TG (P < 0.0001). Eight of the 13 patients were heterozygous for low-activity TPMT variants, resulting in a 22.4-fold (95% confidence interval 7.1–70.7; P ≤ 0.0001) increased risk of hepatic SOS for heterozygotes in comparison to TPMT wild-type patients. Results were supported by independent replication analysis. All patients with hepatic SOS after short-term 6-TG recovered and did not demonstrate residual symptoms. Thus, hepatic SOS is associated with short-term exposure to 6-TG during treatment of pediatric ALL and SOS risk is increased for patients with low-activity TPMT genotypes.

Bronchopulmonary sequestration is a rare malformation of the lower respiratory tract. Several methods of treatment have been described since the first publication. We present two cases of female adult patients with bronchopulmonary sequestration. In the first patient an unsuccessful attempt to treat the bronchopulmonary sequestration by means of arterial embolization is described. She was subsequently treated by means of surgical resection, which was the primary treatment for the second patient. Although endovascular techniques are becoming promising, in our opinion surgical resection remains the unique treatment for bronchopulmonary sequestration.