Author of

• 10643

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

  • Event: WCLC 2013
  • Type: Poster Session
  • Track: Surgery
  • Presentations: 1
  • Moderators:
  • Coordinates: 10/28/2013, 09:30 - 16:30, Exhibit Hall, Ground Level

  • 10653

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    P1.07-010 - Preoperative Flourodeoxyglucose-Positron Emission Tomography Scan with Positive N1 Disease Does Not Predict Worse Survival in Pathologic Stage II Patients (ID 1070)

    09:30 - 09:30  |  Author(s): W. Hofstetter
    • Abstract

    Background
    The rate of fluorodeoxyglucose uptake measured as standardized uptake value (SUV) on positron emission tomography (PET) of the primary tumor has been correlated with tumor aggressiveness and poor survival in patients with lung cancer. A retrospective review of patients with lung cancer who were treated with surgical resection at MD Anderson Cancer Center (MDACC) was performed to determine if the pre-operative SUV uptake of N1 disease has any prognostic significance in patients with pathologic stage II lung cancer.

    Methods
    We reviewed all patients who underwent surgical resection for lung cancer at MDACC from 1998 to 2011. We evaluated non-small cell lung cancer patients who had at least a lobectomy at MDACC as first mode of surgical therapy who had pathologic stage T1-2 and N1 disease and pre-operative PET-CT scan. We determined the clinicopathologic characteristics of patients who had PET-positive N1 disease and compared them to patients who had PET-negative N1 disease. We also performed Kaplan Meier analysis to determine the survival between the two groups.

    Results
    Among patients who underwent surgical resection for lung cancer at MDACC during this time period, 120 patients met the inclusion criteria for the study. There were 100 stage IIA or T1aN1, T1bN1 or T2aN1 and 20 stage IIB or T2bN1 patients in the study. There were 62 patients (50% of the patients) who had a primary tumor in the periphery of the lung and 58 patients (50% of the patients) who had a primary tumor in the central portion of the lung. Within this group of 120 patients, only 29 patients (24% of the patients) had PET-positive N1 disease. Only 16 out of 58 patients (28%) in the central group and only 13 out of 62 patients (21%) in the peripheral group had PET-positive N1 disease. There was no clinical or pathological difference between the patients who had PET-positive N1 disease and PET-negative N1 disease. The average maxSUV of the primary tumor was 13 ± 10.7 and average maxSUV of the PET-positive N1 disease was 6.3 ± 4.1. Kaplan Meier analysis showed that there was no significant difference in survival between the patients who had PET-positive N1 disease and PET-negative N1 disease.

    Conclusion
    Among patients with pathologic stage II non-small cell lung cancer, preoperative PET scan was very poor at predicting positive pathologic N1 disease. Since it is difficult to predict pN1 disease, operative patients with clinical stage I non-small cell lung cancer should have surgical resection oppose to ablative therapy. Moreover, SUV uptake of N1 disease in patients with pathologic stage II lung cancer did not predict worse survival in pathologic stage II patients. Thus, patients with cN1 disease should undergo surgical resection after appropriate mediastinal staging.

• 12495

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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

  • 12498

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    P3.07-003 - Functional Outcomes in Reconstruction of Massive Chest Wall Defects: A 17-Year Experience (ID 117)

    09:30 - 09:30  |  Author(s): W. Hofstetter
    • Abstract

    Background
    Large chest wall resections with significant loss of the skeletal framework can result in flail chest, prolonged ventilator dependence, and major respiratory impairment. Limited case reports address the extreme situation of massive chest wall defects, defined as oncologic resection of 5 or more ribs. We review our institutional experience and compare patient demographics, surgical techniques, and clinical outcomes to evaluate which factors are predictive or protective of complications.

    Methods
    Patients information was prospectively entered into a departmental database and then retrospectively reviewed. All consecutive patients who underwent immediate reconstruction of massive thoracic neoplastic or oncologic-related defects (≥5 ribs resected) between 1994 – 2011 were included. Tumor defect and reconstructive factors were evaluated for possible relationships with complications. Logistic regression analysis evaluated predictive factors for surgical outcomes.

    Results
    A total of 59 patients (median age 53) were available for review. Rib resections ranged from 5 to 10 ribs (defect area 80-690cm[2]). Indications included lung malignancy (52.5%), sarcoma (33.9%), and squamous cell carcinoma (5.9%). Types of rigid and semi-rigid reconstruction included use of prosthetic implants (83%), methylmethacrylate (25.4%), bioprosthetic mesh (5.1%). Soft tissue reconstruction required free tissue transfer (6.8%) and local muscle flaps (45.7%). Diaphragm reconstruction was required in 18.6% patients. The overall complication rate was 62%; which was subdivided into pulmonary complications (48%), cardiac complications (12%), and wound complications (17%). On average, patients were ventilator dependent for 3.9 days, required ICU monitoring for 4.9 days, and were discharged after 15.6 days. Mean follow-up time was 36 months. The 90-day overall survival rate of patients after initial procedure was 89.4%; all deaths occurred within superior resections (p=.03). Average postoperative decreases in FEV1 and FVC were 6.8% and 5.3%, respectively. Patients with superior resections and those older than 60 years were more likely to have post-operative complications.

    Conclusion
    In patients with massive oncologic thoracic defects, complex reconstructions are associated with a high rate of complications. However, creation of a stable construct is possible to prevent debilitating respiratory impairment and minimize pleural complications. Frequently, massive defects may be reconstructed with local muscle flaps obviating the need for free flaps. Prospective multicenter trials are warranted to differentiate and establish superiority of specific techniques and implant devices within these rare but challenging cases.