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

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

  • 12497

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    P3.07-002 - Pleural lymph flows exceeding the lung segment (ID 65)

    09:30 - 09:30  |  Author(s): M. Umehara
    • Abstract

    Background
    Limited pulmonary resections including lung segmentectomy for peripheral small lung cancer have attracted attention in recent years. However, a surgical consensus has not been established. It has been pointed out that there are not only lymph flows to pulmonary hilum along pulmonary vessels or bronchi but also pleural lymph flows directory into the mediastinum or adjacent lung lobe. There are some lung cancer cases with pleural indentation less than twenty millimeters. In these cases, it is concerned that lymph flows carry metastases from the pulmonary segment directly into the mediastinal lymph nodes without passing through the hilar lymph nodes. In other words, skip metastases might be caused. However, there have been few reports investigating pleural lymph flows exceeding the lung segment. The present study was designed to evaluate whether pleural lymph flows exceeding the lung segment could be detected using indocyanine green (ICG) and a fluorescence imaging system intraoperatively.

    Methods
    Fourteen patients undergoing lung segmentectomy or lobectomy for a tumor were enrolled in this study. A jet ventilation is selectively applied under bronchofiberscopy to the burdened bronchus to develop an anatomic border between the inflated segment to be evaluated and the deflated area. A 1.0 ml solution containing the fluorescent dye ICG (2.5 mg/ml) was injected into three to five subpleural sites of the segment. Fluorescence imaging device (HyperEye Medical System, MIZUHO IKAKOGYO CO.,LTD. Tokyo, Japan) was used to monitor the ICG-containing lymph flows from the injection site for five minutes. We evaluated the presence of pleural lymph flows exceeding the lung segment.

    Results
    We observed pleural lymph flows in eight of fourteen cases (57.1%), and pleural lymph flows exceeding the lung segment in seven of fourteen cases (50.0%). There is no pleural lymph flow from superior segment of bilateral lower lobe exceeding the segment in studies of several segments. Figure 1

    Conclusion
    Pleural lymph flows exceeding the lung segment can be observed in vivo. Skip metastases may occur through subpleural lymph channels in subpleural lung cancer cases. We should pay attention to skip metastases when we perform limited pulmonary resections for such cases.