Author of

• 11595

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

  • Event: WCLC 2013
  • Type: Poster Session
  • Track: Surgery
  • Presentations: 2
  • Moderators:
  • Coordinates: 10/29/2013, 09:30 - 16:30, Exhibit Hall, Ground Level

  • 11607

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    P2.07-012 - Long-term results of limited resection for small adenocarcinoma showing ground-glass opacity (ID 1269)

    09:30 - 09:30  |  Author(s): A. Okada
    • Abstract

    Background
    In 2005, we reported the study of intentional limited resection for small peripheral lung cancer based on intraoperative pathologic exploration. At that time, only 14 patients with a small adenocarcinoma showing ground-glass opacity (GGO) had undergone limited resection. After that, we have continued limited resection and follow-up. The median follow-up time from the operation has reached 80 months, so we analyze the long-term results of this procedure.

    Methods
    Between 1996 and 2013, we enrolled 56 patients in this study. Entry criteria were: 1) cT1aN0M0 peripheral adenocarcinoma, 2) High resolution computed tomography (HRCT) findings suspected of having a Noguchi type A or B adenocarcinoma, and 3) pulmonary function adequate to permit lobectomy. When the tumor consisted of GGO only or GGO with a solid component that accounted for less than 50% of the surface area on HRCT, the tumor was suspected to be Noguchi type A or B adenocarcinoma. Wedge resection or segmentectomy was performed, and was followed by an intraoperative pathologic exploration. After confirming the diagnosis of Noguchi type A or B by intraoperative pathologic exploration, operation was completed. No systematic lymph node dissection or sampling was performed. If the lesion was not Noguchi type A or B, extended segmentectomy or lobectomy with systematic lymph node dissection was performed instead.

    Results
    Between 1996 and 2013, we enrolled 56 patients in this study. Limited resection was performed in all patients, wedge resection in 52, and segmentectomy in 4. Intraoperative pathologic exploration revealed that the lesion was not Noguchi type A or B in 11 patients. In these 11patients, we underwent extended segmentectomy in 2 and lobectomy in 9 with systematic lymph node dissection. Intentional limited resection was completed in 45 patients. Of these, 7 had Noguchi type A tumors, and 38 had Noguchi Type B tumors based on intraoperative pathologic exploration. Postoperative pathologic examination revealed 10 patients with Noguchi type A, 31 patients with Noguchi type B, and 4 patients with Noguchi type C. We recommended reoperation to 4 patients with Noguchi type C, but all refused reoperation and has been carefully followed at 3-month intervals. There was no postoperative and 30-day mortality or in-hospital mortality. There were no morbidities. All patients but one are alive without recurrence of lung cancer at the time of writing. Only one patient died of malignant lymphoma without recurrence. The follow-up periods have ranged from 6 to 195 months, and median follow-up period is 80 months. The overall 5- and 10-year survival rates were 96% and 96%, respectively. The 5- and 10-year recurrence –free proportions were 100% and 100%, respectively.

    Conclusion
    When patients are carefully selected by preoperative HRCT and intraoperative pathologic exploration, limited resection can be an acceptable option for the treatment of T1aN0M0 adenocarcinoma showing GGO lesion.

  • 11614

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    P2.07-019 - Postoperative Outcome of Patients with Pulmonary Large-cell Neuroendocrine Carcinoma (ID 1725)

    09:30 - 09:30  |  Author(s): A. Okada
    • Abstract

    Background
    Although large-cell neuroendocrine carcinoma (LCNEC) was categorized as a variant of large cell carcinoma on the WHO histologic classification of lung carcinomas, the clinical and biological features of LCNEC resemble those of small cell lung carcinoma. Therefore, there is no consensus on the treatment strategy for LCNEC, and an indication of surgical treatment for LCNEC is still controversial. Even though preoperative accurate diagnosis of LCNEC is difficult, the aim of this study was investigating patients with pulmonary LCNEC in whom better postoperative outcome is expected.

    Methods
    We retrospectively reviewed patients with pulmonary LCNEC on permanent pathologic diagnosis who underwent pulmonary resection at the 3 institutions between 1999 and 2011. We reviewed the medical records of each patient for demographic, clinical, and pathologic data including age, sex, smoking status, preoperative serum CEA, radiologic tumor size, c-stage, surgical procedure, extent of lymphadenectomy, p-stage, lymph node metastasis, visceral pleural invasion, lymphatic permeation, vascular invasion, and adjuvant chemotherapy. Disease-free survival (DFS) was calculated using the Kaplan-Meier method, and factors associated with DFS were analyzed with the log-rank test.

    Results
    Of the 18 patients eligible for this study, 14 were male and 4 were female. The median age was 74 years (range, 53 to 85). According to the current TNM classification, 12 patients had c-stage I disease, 4 had c-stage II disease, and 2 had c-stage IIIA disease. The majority of patients (13 patients, 72%) underwent lobectomy, 1 underwent pneumonectomy, 1 underwent bilobectomy, and 3 underwent wedge resection. On pathologic diagnosis, 8 patients had p-stage I disease, 5 had p-stage II disease, and 5 had p-stage IIIA disease. Following surgical treatment, cisplatin-based adjuvant chemotherapy was applied for 3 patients. The 1-year and 2-year DFS were 39% and 39%, respectively, with the median follow-up period of 9 months (range, 2 to 80). During the follow-up period, 10 patients (56%) developed recurrence, and the recurrence was identified within the first year post-resection in all the 10 patients. By the log-rank test, smoking status (non- or former, vs. current) and surgical procedure (lobectomy or greater, vs. limited resection) were identified as significant factors associated with DFS.Figure 1

    Conclusion
    Of patients with pulmonary LCNEC undergoing surgical treatment, a long-term prognosis might be expected if no recurrence is identified within the first year post-resection. If diagnosis of LCNEC is preoperatively obtained, surgical treatment is recommended for patients without current smoking status, and lobectomy or greater resection should be the surgical procedure of first choice.