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A.M. Abdelrahman
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P2.08 - Poster Session/ Thymoma, Mesothelioma and Other Thoracic Malignancies (ID 225)
- Event: WCLC 2015
- Type: Poster
- Track: Thymoma, Mesothelioma and Other Thoracic Malignancies
- Presentations: 1
- Moderators:
- Coordinates: 9/08/2015, 09:30 - 17:00, Exhibit Hall (Hall B+C)
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P2.08-025 - Contributing Factors to the Outcome of Primary Malignant Chest Wall Tumors (ID 611)
09:30 - 09:30 | Author(s): A.M. Abdelrahman
- Abstract
Background:
Primary malignant chest wall tumors are a heterogeneous group of tumors. They require special experience in designing resection and reconstruction. They account for less than 1% of all primary malignant tumors. This study is designed to clarify different factors contributing to the outcome of patients with primary malignant chest wall tumors in our institution.
Methods:
A retrospective study included 97 patients with pathology proven primary malignant chest wall tumors, treated at the national cancer institute, Cairo University, Egypt, during the period from 2002 to 2012. Computed tomography scan of the chest and upper abdomen was considered the primary staging tool for all patients. Magnetic resonance imaging was requested whenever indicated. Surgical resection and reconstruction was designed according to the site and extent of the lesion. resected. Adjuvant and neo-adjuvant therapy was given according to thoracic oncology committee decision. This study was approved by the ethical committee of our institution and informed patient consent was taken.
Results:
Primary malignant chest wall tumors represented 10.5% of all thoracic malignanciesin our institution. There were 46 males and 51 females, the median age was 41 years. Chondrosarcoma was the commonest tumor histology (20.6%). The mean tumor size was 9.3x6.2cm. Tumor multiplicity was found in 15.4% of patients. Bone resection was performed in 76 patients (78.3%), ribs resection was performed in 62 patients and the average number of resected ribs per patient was 2.57 ribs. Sternal resection was done in 9 patients. R0 resection was achieved in 73% of patients. There was one operative related mortality and 23% of patients suffered procedure related complications. Local recurrence developed in 45.3% of patients. The overall survival for the whole group at 1, 3 and 5 years was 67.1%, 37.2% and 26.1 % respectively and the median survival time was 26 months. Different prognostic variables were used to assess better survival including : age , sex, site , size pathologic subtype , tumor grade,, safety margin Good prognostic factors include female sex, age ≤ 40years, no rib resection, safety margin ≥ 1cm, when the least safety margin involve the soft tissue and not the bone, tumor size ≤ 6cm in diameter.
Conclusion:
rimary malignant chest wall tumors should be treated with highly qualified thoracic surgeon and achieving wide resection margins is of great importance to minimize local tumor recurrence that will have an impact on long-term survival.
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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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P3.08-003 - Incidence and Management of Malignant Pleural Mesothelioma Related Empyema (ID 990)
09:30 - 09:30 | Author(s): A.M. Abdelrahman
- Abstract
Background:
Empyema in relation to malignant pleural mesothelioma is a serious complication that may stop or delay the planned treatment. It may be secondary to surgery or non surgical , both are difficult to treat and are challenging to the thoracic surgeon as patients are usually too ill to tolerate therapy.
Methods:
We retrospectively reviewed the data of 443 patients with mesothelioma referred to the National Cancer Institute, Cairo between 2004 -2013. Extra pleural pnuemonectomy (EPP) was performed in 93 patients and radical pleurectomy / decortication in 12 . The remaining 338 patients received palliative chemotherapy or best supportive care. The frequency of empyema among those patients was 5.86% (26 cases). Full history and clinical examination was done for all patients, culture from the chest tube and or sputum culture was ordered for all, Computed tomography of the chest was done to evaluate empyema in all patients and bronchoscopy and biopsy to exclude stump recurrence was requested for patients with empyema secondary to EPP.
Results:
There were 23 males and 3 females , the right side was affected in 17 patients. Of the 338 patients with non operative therapy, 17(5%) developed empyema , 5 following repeated tapping of effusion ,8 with prolonged chest tube insertion and 4 after pleurodesis. Palliative pleurectomy was possible in 4 patients and was successful in 2. The remaining 13 patients were treated with second chest tube and repeated cavity irrigation with diluted bovidon iodine, 5 of them were improved within 2-3 weeks. Empyema secondary to EPP developed in 8 patients, 2 had early post operative empyema, one with stump dehiscence and one secondary to tube thoracostomy in the post pneumonectomy space. Surgery was successful in both. Of the remaining 6 patients, 5 had delayed bronchial stump fistula 1-3 years post pleuro pneumonectomy, All were re explored. Two patients were cured, the remaining 4 died from persistent sepsis. The last patient had infected mesh 3 years after surgery and was treated by re surgery and mesh removal. We had one patient with empyema following radical pleurectomy/ decortication due to residual space, wound depridement was done and the procedure was successful.
Conclusion:
Treatment of mesothelioma patients with empyema is challenging, every patient should be and evaluated and treated separately. In spite of high failure rate with surgery, it's considered the only treatment option, great effort by high volume thoracic surgeon should be offered to this group of patients.
