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H.S. Kim



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    O09 - General Thoracic Surgery (ID 100)

    • Event: WCLC 2013
    • Type: Oral Abstract Session
    • Track: Surgery
    • Presentations: 1
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      O09.06 - Prognostic factors for long-term survival in non-small cell lung cancer patients with interstitial lung disease (ID 3453)

      17:10 - 17:20  |  Author(s): H.S. Kim

      • Abstract
      • Presentation
      • Slides

      Background
      There is little information about prognosis after pulmonary resections for non-small cell lung cancer (NSCLC) in patients with interstitial lung disease (ILD). In this study, we examined the long-term outcome and the factors that affect long-term survival after resection for NSCLC in patients with ILD.

      Methods
      Between September 1996 and May 2011, 71 NSCLC patients were diagnosed as having ILD based on the CT and pathological findings. The extent of ILD on CT was scored visually at the level of 3 cm above the diaphragm as follows: minimal, <2 cm from the subpleura at the base of the lungs; moderate, >2 cm from the subpleura, but less than one-third of the lung area at the base of the lungs; severe, more than one-third of the lung area at the base of the lungs. Various clinical values such as gender, age, preoperative chemotherapy, severity of ILD on CT, preoperative pulmonary function test results, arterial blood gas studies, operative procedure, pathologic stage, cell type, and adjuvant treatment were evaluated using univariate and multivariate analysis.

      Results
      The mean age was 65.9 years, and the majority of patients were male(65:91.5%). In-hospital mortality was 9.9% (7/71). The causes of early mortality included pneumonia (n=4), acute respiratory distress syndrome (n=2), and acute exacerbation of ILD (n=1). The 5-year overall survival rate was 43.1% (stage I: 59.4%, stage II: 41.3%, stage III: 35.0%, respectively). In univariate analysis, the risk factors for long-term mortality were lower preoperative FEV~1~, FVC, severe ILD on CT, presence of pathologic pulmonary fibrosis, and non-squamous cell type. In multivariate analysis, severity of ILD on CT and non-squamous cell type remained as poor prognostic factors.Figure 1

      Conclusion
      Although patients with ILD undergoing pulmonary resection for NSCLC has resulted in a high in-hospital mortality, long-term survival can be expected in highly selected patients. NSCLC patients with severe ILD on CT findings and those with non-squamous cell type should be carefully selected for major pulmonary resection.

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    P3.07 - Poster Session 3 - Surgery (ID 193)

    • Event: WCLC 2013
    • Type: Poster Session
    • Track: Surgery
    • Presentations: 1
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      P3.07-028 - Long-term result of robot-assisted esophagectomy for esophageal cancer: Technical feasibility and oncological reliability. (ID 2229)

      09:30 - 09:30  |  Author(s): H.S. Kim

      • Abstract

      Background
      Whether robot-assisted esophagectomy is a technically feasible and oncologically reliable operation for esophageal cancer has not been proven. This study aimed to evaluate short-term and long-term outcomes of robot-assisted esophagectomy.

      Methods
      Robot-assisted esophagectomy was performed in prone position for cervical anastomosis or lateral position for intrathoracic anastomosis. Thoracic procedures were performed by totally robotic technique and abdominal procedures were performed by robot or laparotomy. Two field lymph node dissection was performed in all patients and dissection along both recurrent laryngeal nerves was performed in the patients with T1b or more stages. Retrospective review on short-term and long-term outcomes for robot-assisted esophagectomy was performed.

      Results
      Robot-assisted esophagectomy was performed in 46 patients between 2008 and 2013, which was 16% of total esophagectomy cases during the same period. There were 43 men and 3 women and mean age was 63.9 ± 8.2 years. Preoperative clinical stages were IA in 19 patients (41%), IB in 8 (17%), IIA in 6 (13%), IIB in 9 (20%), and IIIA in 4 (9%). Neoadjuvant chemoradiation was performed in 5 patients (11%). Abdominal procedures were performed by robot in 29 patients (63%) and by laparotomy in 16 (35%). R0 resection was accomplished in 45 patients (98%) and mean operation time including robot docking time were 512 ± 104 minutes. Total 2-field lymph node dissection along bilateral recurrent laryngeal nerve was performed in 32 patients (70%) and mean number of dissected lymph nodes were 29.1 ± 14.1. Cell types of esophageal cancer were squamous cell carcinoma in 45 patients (98%) and melanoma in 1 patient (2%). Pathologic stages were IA in 9 patients (20%), IB in 19 (41%), IIA in 2 (4%), IIB in 11 (24%), IIIA in 4 (9%), and IIIB in 1 (2%). There were one 30-day mortality (2%) and postoperative complication occurred in 15 patients (33%); respiratory complication in 5 patients (11%), anastomosis site leakage in 5 (11%), and vocal cord palsy requiring treatment in 3 (7%). Overall 5-year survival was 88% and 5-year freedom from recurrence was 73%. Locations of recurrence were regional in 4 patients (9%), distant in 4 (9%), and there was no local recurrence.

      Conclusion
      Robot-assisted esophagectomy was technically feasible and oncologically reliable surgery in this study. Further studies based on large series of data are necessary to prove advantages of robot-assisted esophagectomy.