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T. Oikawa



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    P1.07 - Poster Session 1 - Surgery (ID 184)

    • Event: WCLC 2013
    • Type: Poster Session
    • Track: Surgery
    • Presentations: 1
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      P1.07-009 - Preoperative simulation and navigation using the combination of high-speed 3D-image analysis system and Robotic surgery increase the efficacy and accuracy in thoracic surgery (ID 980)

      09:30 - 09:30  |  Author(s): T. Oikawa

      • Abstract

      Background
      Previously, we reported the utility of the da Vinci[®] Surgical System (dVS: Intuitive Surgical, Inc., Sunnyvale, CA) for various types of anterior and middle mediastinal tumors in clinical practice. We evaluated the feasibility, safety and appropriate settings of this system for the surgical treatment of these tumors. One review reports about the importance of the appropriate settings according to tumor location in robot-assisted thoracic surgery (RATS), because no target always exists in the same location within the thoracic cavity. In this report, we evaluated the efficacy of a high-speed three-dimensional (3D) image analysis system (SYNAPSE VINCENT; Fuji Photo Film Co., Ltd.) for preoperative simulation and navigation during a RATS procedure.

      Methods
      In this study, a high-speed 3D-image analysis system was used to decide the best positioning of robotic-arms and instruments preoperatively. Moreover, this system has capable of detecting the tumor location and extracting surrounding tissues quickly, accurately and safely. Accurate and speedy set-up of the da Vinci S[® ]Surgical System was possible for this operation. Synapse Vincent facilitated determining the best positioning of robot arms and instruments, and was an excellent device for navigation in real time. All patients who underwent RATS in our institution provided written informed consent to receive robotic surgery using the dVS, and the institutional review committees of each institution gave their permission. In this report, a representative mediastinal tumor which was located in the upper thoracic cavity was selected to establish the merits of this procedure.

      Results
      The patient, a 38-year-old woman, had a posterior mediastinal tumor located at the upper level of Th 1 to 3. Accurate and speedy set-up of the dVS was capable on this operation. It was feasible to decide the best positioning of robot-arms and instruments, and excellent device for the navigation on real time. The total operation time was 270 minutes, the time of the dVS setting was 21 minutes, and the console time (the dVS working time) was 132 minutes. The amount of bleeding was 167 mL and the drainage time was 2 days after the operation and this patient had no complications. The pathological report revealed a schwannoma (85 × 42 × 20 mm) with no malignancy.

      Conclusion
      For the optimal performance of RATS, the positioning of all units and the locations of instrument ports need suitable directional setting. Preoperative simulation and navigation during of operation using SYNAPSE VINCENT for the RATS has efficacy for planning the setting, especially in deciding the points of instrument ports and the angle of robot arms, and very useful as a device of the navigation software and education use operating on it.

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    P2.10 - Poster Session 2 - Chemotherapy (ID 207)

    • Event: WCLC 2013
    • Type: Poster Session
    • Track: Medical Oncology
    • Presentations: 1
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      P2.10-048 - Therapeutic efficacy of gefitinib for postoperative recurrent cancer in patient with EGFR mutation (ID 3134)

      09:30 - 09:30  |  Author(s): T. Oikawa

      • Abstract

      Background
      Epidermal growth factor receptor (EGFR) -tyrosine kinase inhibitor (TKI) responds to approximately 80% of the non-small cell lung cancer (NSCLC) patients with EGFR mutation. In other words, about 20% of the patients with EGFR mutations don’t respond. It was reported that resistance to EGFR-TKI is caused by secondary mutation at codon 790 (exon 20 mutation), Met amplification and hepatocyte growth factor (HGF)-MET signaling. The aim of this study is to explore the type of EGFR mutation, phosphorylated MET and HGF expression in tissues surgically removed for NSCLC with EGFR mutation impact on the sensitivity to gefitinib.

      Methods
      We studied 44 surgically resected NSCLC from 2001 to 2012. 43 cases were adenocarcinoma and 1 case was large cell neuroendocrine carcinoma. These surgical resections were taken from patients who were treated with gefitinib as first or second or third line therapy for postoperative recurrent cancer. The patients’ age ranged from 27 to 78years old (average 63.1 years old). There were 19 male and 25 female patients. There was 1 case of exon 18 point mutation, 23 cases of exon 19 deletion, 2 cases of exon 20 point mutation, 16 cases of exon 21 point mutation, and 2 cases of both exon 20 and 21 point mutation. We assessed non-responders progression within 2 months. Intermediate responders were considered as being effectively treated (at least stable disease) with gefitinib between 3 and 11 months. And long-term responders were considered to be effectively treated with gefitinib for over 12 months.

      Results
      Non-responders were 4 cases. Intermediate responders were 26 cases (including 11 cases of ongoing treatment). Long-term responders were 14 cases (including 1 case of ongoing treatment). Non-responders had two secondary mutation, one exon 19 deletion and exon 21 mutation. Intermediate responders had one exon 18 mutation, 14 exon 19 deletion, 10 exon 21 mutation and one both exon 20 and 21 mutation. long-term responder had eight exon 19 deletion, five exon 21 mutation and one both exon 20 and 21 mutation.

      Conclusion
      In our data, NSCLC with exon 20 mutaiton will respond to gefitinib if this NCCLC with another EGFR mutation. We will report the findings of non-responders excluding analyzed exon 20 mutation phosphorylated MET and HGF expression.