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S. Kumar
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P2.03 - Poster Session/ Treatment of Locoregional Disease – NSCLC (ID 213)
- Event: WCLC 2015
- Type: Poster
- Track: Treatment of Locoregional Disease – NSCLC
- Presentations: 1
- Moderators:
- Coordinates: 9/08/2015, 09:30 - 17:00, Exhibit Hall (Hall B+C)
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P2.03-008 - Surgery for Primary Lung Tumors with Histology Other than Non-Small Cell Lung Cancer: A Single Center Experience (ID 1306)
09:30 - 09:30 | Author(s): S. Kumar
- Abstract
Background:
Primary lung tumors with histology other than small cell and non-small cell carcinoma are uncommon, and generally have a better prognosis and differing criteria of resectability. We present our experience of surgery in such tumors over the last three years at a tertiary cancer center in north India.
Methods:
This is an analysis of a prospective database of patients with primary lung tumors undergoing surgery in a three-year period between May 2012 and April 2015 at the Department of Surgical Oncology, All India Institute of Medical Sciences, New Delhi. We included the group of patients with histology other than non-small cell lung cancer (NSCLC). Details concerning the clinical presentation, preoperative therapy, operative procedure, postoperative complications and outcome were retrieved from the database.
Results:
Between May 2012 and April 2015, out of the 101 patients who underwent surgery for primary lung neoplasm, twenty eight (28) patients had histology other than NSCLC. There were 19 males and 9 females, with a median age of 36 (range 6 to 64). They included 18 patients with carcinoid tumor, 3 with mucoepidermoid tumor, 4 with adenoid cystic carcinomas, 2 with myofibroblastic tumor, and 1 with clear cell tumor. Four patients had been previously treated presumptively for pulmonary tuberculosis, and two had received chemotherapy elsewhere before presenting to us. Two patients had prior bronchoscopic debulking. The surgical procedures included lobectomy in 8, bilobectomy in 8, pneumonectomy in 10, and pneumonectomy with carinal resection in 2 patients. Bronchoplastic procedures or sleeve resections were performed in 5 patients. All these surgeries were performed using muscle-sparing thoracotomy approach, except in two patients who underwent left pneumonectomy with carinal resection and reconstruction using median sternotomy approach and cardiopulmonary bypass. Postoperative morbidity was observed in 5 patients (prolonged air leak in 2patients, postoperative lung collapse, pneumonia, and empyema in one patient each). There was one postoperative mortality; this patient had mucoepidermoid carcinoma of the left main bronchus for which he underwent left pneumonectomy with carinal resection under cardiopulmonary bypass through median sternotomy approach. He was re-explored for a pericardial bleed on the first postoperative day, subsequently developed postoperative pneumonia of the solitary lung, and succumbed on 9th]postoperative day. Although the follow-up period is short, there has been no recurrence so far; and all patients are surviving without evidence of disease, except the one patient who died due to postoperative complications.
Conclusion:
Patients with carcinoid tumor, minor salivary gland neoplasm, or other unusual histologies of the lung usually have a better prognosis than those with non-small cell carcinoma. Aggressive surgical approaches should be pursued in such tumors, even in face of advanced local disease that would preclude resection in NSCLC.
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P3.08 - Poster Session/ Thymoma, Mesothelioma and Other Thoracic Malignancies (ID 226)
- Event: WCLC 2015
- Type: Poster
- Track: Thymoma, Mesothelioma and Other Thoracic Malignancies
- Presentations: 1
- Moderators:
- Coordinates: 9/09/2015, 09:30 - 17:00, Exhibit Hall (Hall B+C)
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P3.08-021 - Bronchopulmonary Carcinoid: A Developing Nation Cancer Center's Perspective (ID 2765)
09:30 - 09:30 | Author(s): S. Kumar
- Abstract
Background:
Bronchopulmonary carcinoids are low grade malignant tumours and increased incidence has been noticed worldwide. Our aim was to study preoperative characteristics, surgical approaches and outcome in bronchopulmonary carcinoid patients treated at a institutional cancer center.
Methods:
Twenty patients with bronchopulmonary carcinoids were surgically treated at department of surgical oncology, IRCH, AIIMS between December 2006 and December 2014. Preoperative variables, postoperative outcome and histopathological features were analyzed retrospectively. All patients underwent a detailed clinical evaluation followed by CECT of chest and bronchoscopy with biopsy of the suspicious lesion. After preoperative optimization, all patients were treated with upfront surgery. Adjuvant chemotherapy was given in patients with lymph nodal metastasis. Patients were followed up at three monthly interval with Clinical examination, chest X ray and serum chromogranin in cases of suspected recurrence. Because of cost factors Dotanoc scans were done only in cases with radiological suspicion of recurrence.
Results:
Patient’s median age was 40 years (range 18-62 years). All patients were symptomatic and median duration of symptoms before presentation was 18 months (range 6-72 months). Eight patients were treated with antitubercular drugs after presumptive diagnosis outside based on symptoms and Xrays. All the patients had lobar or main bronchial involvement which was detected on bronchoscopy and biopsy. Ninteen patients underwent complete pulmonary resection with mediastinal nodal dissection and surgical approach included eight pneumonectomies, four bilobectomies, five lobectomies, two sleeve resections. After a median follow up of 15 months, all patients were alive with no local recurrence or distant metastasis. On Histopathology all the resections margins were free of tumor and lymph nodal involvement was found in one patient.
Conclusion:
Delayed presentation and misdiagnosis are major concern in our scenario because of high prevalence of tuberculosis and despite a small number of cases our study emphasises the need for early bronchoscopy in patients with persistent symptoms. Aggressive surgical resection with technical approach of lung preservation may provide optimal survival results
