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S. Mizuguchi



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

    • Event: WCLC 2013
    • Type: Poster Session
    • Track: Surgery
    • Presentations: 1
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      P2.07-017 - Pulmonary Resection for Lung Cancer Patients with Cerebrovascular and Cardiovascular Comorbidities (ID 1509)

      09:30 - 09:30  |  Author(s): S. Mizuguchi

      • Abstract

      Background
      Patients with cerebro- and cardio-vascular comorbidities (CCVC) who undergo surgery represent a high-risk group and require careful perioperative management. In the present study, we aimed to retrospectively analyze the postoperative complications (POC) of patients with CCVC who had undergone pulmonary resection for lung cancer. Patients with cerebro- and cardio-vascular comorbidities (CCVC) who undergo surgery represent a high-risk group and require careful perioperative management. In the present study, we aimed to retrospectively analyze the postoperative complications (POC) of patients with CCVC who had undergone pulmonary resection for lung cancer.

      Methods
      Among 288 patients who underwent pulmonary resection at our institution from January 2009 to December 2011, we examined the records of 51 patients with CCVC (17.7%) to identify the risk factors for developing POC. Among the analyzed patients, we noted the presence of 34 POC, including tachyarrhythmia in 9, prolonged pulmonary fistula in 9, pyothorax in 2, cerebral infarction in 2, requirement of long-term oxygen therapy in 2, interstitial pneumonia in 2, delirium in 2, and other POC in 4. Several patients had multiple POC.

      Results
      We examined 43 male patients (84.3%); the median age was 72 years and the median preoperative forced expired volume in 1s (FEV~1~) was 2200 mL (range, 1120–3420). The patients with CCVC included 12 with cerebral infarction, 2 with transient cerebral ischemic attacks, 2 with cerebral hemorrhage, 1 with subarachnoid hemorrhage, 4 with cerebral aneurysm, 10 with arrhythmia, 17 with ischemic heart disease, 1 with valvular heart disease, 8 with aortic aneurysm/dissection, 11 with peripheral arterial disease, and 1 with a left atrial myxoma; several of these patients had multiple CCVC. Moreover, 2 patients underwent pneumonectomy, 37 underwent lobectomy, 3 underwent segmentectomy, and 9 underwent wedge resection. Postoperative morbidity rates were 21.4% in cerebrovascular comorbidity patients (p = 0.015), 53.5% in the cardiovascular comorbidity patients (p < 0.0001), 71.4% in CCVC patients (p = 0.0028), and 12.3% in patients without CCVC. No operative or in-hospital mortality was noted. Gender, age, smoking status, and smoking index were not found to be significantly related to the incidence of POC. However, patients with an FEV~1~ < 2200 mL were found to be significantly more likely to develop POC (p = 0.036).

      Conclusion
      We noted that patients with CCVC and low FEV~1 ~were more likely to develop POC.

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    P3.12 - Poster Session 3 - NSCLC Early Stage (ID 206)

    • Event: WCLC 2013
    • Type: Poster Session
    • Track: Medical Oncology
    • Presentations: 1
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      P3.12-005 - Clinical Significance of preoperative arterial blood gas in patients with stage I non-small cell lung cancer (ID 1391)

      09:30 - 09:30  |  Author(s): S. Mizuguchi

      • Abstract

      Background
      Surgical treatment is the most efficient therapy for early non-small cell lung cancer (NSCLC). For surgical treatment, oncological and physiological indications may be considered. For physiological indication, cardiopulmonary function evaluation, such as a general respiratory function test, arterial-blood-gas (ABG) analysis, an electrocardiogram, and echocardiogram are important to be determined. In ABG analysis, PaCO2>45 Torr and hypoxemia (< 90% of SaO2) have been reported as risk factors of complications after surgery. This study aimed to establish the clinical significance of preoperative ABG analysis in patients with stage I NSCLC in aspect of long-term risk.

      Methods
      The study involved 253 patients (154 male, 99 female; median age 68 years) who underwent lobectomy/bilobectomy with radical mediastinal lymph node dissection in patients with stage I NSCLC in our institution between January 1998 and December 2008. One hundred and seventy six patients had adenocarcinoma, 68 had squamous cell carcinoma, five had large cell carcinoma, and four had adenosquamous carcinoma. On pathologic staging, 129 patients were in stage IA, and 124 in stage IB. Predicted postoperative values of FEV~1~ and DLCO less than 40% is defined as high risk in pulmonary function tests. Concerning ABG parameters, the normal range for 1) PaO2 is over 75 Torr, 2) PaCO2 is 36-45 Torr and 3) pH is 7.36-7.45. The patients were divided into two groups according to ABG analysis: normal ABG group (n=167) and abnormal ABG group (n=86). The abnormal ABG group includes those whose 1)PaO2 is less than 75Torr (n=39, median 73, range, 63-74.9), 2)PaCO2 is less than 36 Torr (n=21, median 35.4, range, 32.7-35.9) or over 45 Torr (n=33, median 46.2, range, 45.0-50.6) and 3)PH is less than 7.36 (n=5, median 7.338, range, 7.332-7.356) or over 7.45 (n=8, median 7.454, range, 7.451-7.463).

      Results
      There were no significant differences in gender, performance status, Hugh-Jones classification, pathological stage, tumor histology, tumor location, surgical procedure, blood loss, operative time, and postoperative complications between the two groups. The age of patients in the normal ABG group (mean 68 years old) was significantly lower than those in the abnormal ABG group (mean 71 years old, p = 0.026). The mean follow-up period for the entire study population was 5.8 years (range 123-5201 days). No operative death occurred. The 3-, 5-, and 10-year survival rates in the normal and abnormal ABG groups were 87%, 76%, and 62%, and 78%, 64%, and 42%, respectively (p = 0.029). A log-rank test using physiological factors revealed that gender, age (>70 years old), performance status (0-1 vs 2), Hugh-Jones classification (1-2 vs 3), postoperative prediction pulmonary function test, and ABG were associated with a significant survival rate. By multivariate analysis, age, gender, and ABG (risk ratio, 4.03) were independent prognostic factors.

      Conclusion
      Preoperative ABG was a prognostic marker for stage I NSCLC. We should consider surgical strategies for patients with abnormal ABG analysis not only for immediate or short-term risk, which refers to perioperative morbidity and mortality, but also long-term survival risk.