Author of

• 11001

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  P1.24 - Poster Session 1 - Clinical Care (ID 146)

  • Event: WCLC 2013
  • Type: Poster Session
  • Track: Supportive Care
  • Presentations: 1
  • Moderators:
  • Coordinates: 10/28/2013, 09:30 - 16:30, Exhibit Hall, Ground Level

  • 11030

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    P1.24-029 - Metastatectomy for lung cancer and lung resection for metastases - our experience (ID 2165)

    09:30 - 09:30  |  Author(s): S. Krishnamurthy
    • Abstract

    Background
    Metastectomy for lung cancer had shown varied results some showing survival benefit and in some studies as only palliation. But unlike metastatectomy for lung cancer , lung resection for metastases had shown definitive role atleast in some selected cases like colorectal cancer, renal cell carcinoma, breast cancer , etc. Here we would like to share our experience considering the above mentioned topics.

    Methods
    Our study was a retrospective analysis of medical records from January 2006 to March 2012 in a single unit in a teritiary care center in India. Clinicopathological features, treatment, prognosis and disease free survival were assessed.

    Results
    Fourteen patients underwent metastatectomy in lung and five patients underwent metastatectomy for lung cancer (Fig.1). Results were described in Table 1 and 2. Among 14 patients who underwent lung resection for metastases, 5 cases were for osteosarcoma of extremity, 5 for soft tissue sarcoma of extremity, one for pyriform fossa cancer, one for breast cancer, one for gestational trophoblastic neoplasia and one for metastatic gaint cell tumor of bone (Table 1&2). Fig: 2: Clinicopathological features of patients: Figure 1 Figure 2

    Conclusion
    Stage IV disease in cancer though considered as incurable in adult solid malignancies, a selective group of patients can still be cured. The success of the surgery depends on disease free survival from the detection of primary, number of lesions, grade and stage of initial primary and site of primary. Metastatectomy for lung cancer in our study is done with a palliative intent.

• 11595

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  P2.07 - Poster Session 2 - Surgery (ID 190)

  • Event: WCLC 2013
  • Type: Poster Session
  • Track: Surgery
  • Presentations: 1
  • Moderators:
  • Coordinates: 10/29/2013, 09:30 - 16:30, Exhibit Hall, Ground Level

  • 11619

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    P2.07-024 - Predictive factors for postoperative morbidity in patients undergoing esophagectomy for esophageal cancer: (ID 2142)

    09:30 - 09:30  |  Author(s): S. Krishnamurthy
    • Abstract

    Background
    Oschner and DeBakey in 1940, reviewed the world literature of 191 esophageal resections with a 72% mortality rate. Later on with advent of better preoperative, intaoperative and postoperative management advances, the risk of mortality had decreased to less than 10%. Various radical resections were described both in resection of primary (Eg: Transhiatal esophagectomy(THE), transthoracic esophagectomy (TTE),enbloc esophagectomy,etc..,) and lymph node dissection (two field, three field , etc.,). The role of radical surgery is still controversial and its becomes necessary to decide which patient can tolerate a radical procedure in the preoperative setting itself.

    Methods
    We retrospectively analyzed surgical and medical records of 154 patients of carcinoma esophagus operated in a single unit at our center to assess the predictive factors for postoperative morbidity for the period 2006-2012.

    Results
    

    Table 1: Demographic profile of the Patients: Characteristics Number of patients ( Total N = 154) Age Mean Range 55.857 ± 10.3989 20-79 years Sex Male Female 92 62 Histopathological Examination Squamous cell carcinoma Adenocarcinoma Adenosquamous carcinoma 124 28 2 Site of lesion Middle third esophagus Lower third thoracic esophagus and Gastroesophageal tumors 36 118 Duration of symptoms ( Mean ± S.D) Preoperative albumin (gm/dl)( Mean ± S.D) Comorbidities Neoadjuvant treatment 2.481± 1.7684 (Range 1 -12) 3.938 ± 0.3684 (Range 3-4.9) 25 ( COPD-12, Diabetes Mellitus-10, Hypertension-8, Ischemic heart disease-3; Hypothyroidism-3, Previous history of pulmonary Koch’s-3) 10 (6 patients - NACTRT, 4 patients- NACT) Surgery performed Transhiatal esophagectomy Transthoracic esophagectomy 140 14 Complications Pulmonary complications Anastamotic leak Mortality Abdominal infection Chyle leak 18 11 12 ( 7 had pulmonary complication also) 3( All 3 had pulmonary complication ) 2 1( also had pulmonary complication)

    NACTRT- Neoadjuvant chemoradiotherapy, NACT-Neoadjuvant chemotherapy Of 154 patients who underwent esophagectomy at our center, 140 patients underwent THE and 14 underwent TTE. Mean duration of dysphagia was 2.4 months. One hundred and twenty four patients had squamous cell carcinoma and 30 patients had other histological types. Twenty five patients had comorbidities as described in Table.1. Eighteen patients developed postoperative complication of which three died - one case due to massive pulmonary embolism and two cases due topulmonary infection and septicaemia). Twelve patients had anastamotic leak (7.7%), all were managed conservatively. When multivariate regression analysis was performed for the predicted risk factors and development of complication, preop albumin ( less than 4gm/dl) and histological type (non squamous cell carcinoma) were associated significantly with increased post operative complications (Table.2). Abnormal pulmonary function tests though showed increased risk of complications it didn’t attain statistical significance. Table 2: Multivariate logistic regression analysis of predictive factors for early postoperative complications:

    Independent variables Coefficient Standard Error t P Albumin (Less than 4 gm/dl) -0.1505 0.07519 -2.001 0.0472*(significant) Comorbidity (Yes) 0.1012 0.06716 1.507 0.1339 Duration of dysphagia (Absolute dysphagia) 0.004364 0.01576 0.277 0.7823 Histopathological examination ( Non squamous cell carcinoma) -0.1877 0.07332 -2.559 0.0115*(Significant) Neoadjuvant treatment ( Yes) 0.1043 0.1147 0.910 0.3645 Site of lesion ( Middle 3rd) 0.06701 0.06641 1.009 0.3146 Pulmonary function tests (Abnormal) 0.04156 0.02232 1.862 0.0646

    Conclusion
    We achieved a 2% mortality rate during the study period. Preoperative serum albumin and histological subtype were associated with increased postoperative mortality. Neoadjuvant therapy was not associated with increased complication rate.