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C. Kang



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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): C. Kang

      • 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.

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    P3.19 - Poster Session 3 - Imaging (ID 181)

    • Event: WCLC 2013
    • Type: Poster Session
    • Track: Imaging, Staging & Screening
    • Presentations: 1
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      P3.19-014 - CT Morphologic Patterns, Pathologic Subtypes, and Genetic Phenotypes: A Correlation Study in 600 Nodular Lung Adenocarcinomas (ID 2094)

      09:30 - 09:30  |  Author(s): C. Kang

      • Abstract

      Background
      Genotype manifests itself as phenotype and that the one may inform the other. In terms of phenotype, imaging has the potential to assist in noninvasively characterizing the tumor, however, there are very few investigators who have pursued that potential connection between imaging features and the genetic characteristics of lung cancer. The purpose of this study was to retrospectively correlate the CT morphologic patterns of nodular lung adenocarcinomas (ADs) with pathological and molecular phenotypes in an East-Asian cohort of patients.

      Methods
      The institutional review board approved this retrospective study, and all patients provided informed consent. 600 primary lung ADs smaller than 3 cm in diameter that were surgically resected from 592 patients (M:F=257:335; mean age, 63) were included. CT morphologic pattern of ADs was evaluated by three board-certified thoracic radiologists and was classified into four patterns: pure GGN, GGO dominant part-solid nodule (PSN), solid dominant PSN, and pure solid nodule. EGFR mutation, ALK rearrangement, and KRAS mutation were evaluated using PCR-based direct DNA sequencing and FISH. Histologic subtype was classified according to IASLC/ATS/ERS classification of lung AD. The Fisher exact test and student t-test were used to assess statistical significance.

      Results
      Figure 1 In terms of CT morphologic patterns, 17.2%,15.2%, 31.8%, and 35.8% of tumors manifested as pure GGN, GGO dominant PSNs, solid dominant PSNs, and pure solid nodules, respectively. EGFR mutation was significantly more often found in ADs that manifested as subsolid nodules (69.9%, 269/385) than in ADs presented as pure solid nodules (46.7%, 100/214) (P<.0001). ALK rearrangement was more frequent in ADs that manifested as pure solid nodule (8.5%, 13/153) than in tumors presented as subsolid nodule (1.8%, 5/281) (P=.001). KRAS mutation showed no significant difference between subsolid nodules (6.6%, 8/121) and pure solid nodules (8.5%, 5/59) (P=.760). The ratio of subsolid nodule vs pure solid nodule was 72.7% vs 27.3% in ADs with EGFR mutation and was 27.8% vs 72.2% in ADs with ALK rearrangement. EGFR mutation was more frequent in minimally invasive ADs (P=.004) and lepidic predominant ADs (P=.018). ALK rearrangement was more frequent in solid predominant ADs (P=.002) and invasive mucinous ADs (P=.030). KRAS mutation was more frequent in invasive mucinous ADs (P=.001).

      Conclusion
      EGFR mutation was significantly more often found in ADs that manifested as subsolid nodules, and ALK rearrangement was more frequent in ADs that manifested as pure solid nodule.