Virtual Library

 x 
My Library Virtual Library FAQ

Start Your Search

T. Hashimoto



Author of

  • +

    MO02 - General Thoracic and Minimally Invasive Surgery (ID 99)

    • Event: WCLC 2013
    • Type: Mini Oral Abstract Session
    • Track: Surgery
    • Presentations: 1
    • +

      MO02.04 - Safety and long term outcome of repeated lung resection for ipsilateral second primary lung cancer (ID 3048)

      10:45 - 10:50  |  Author(s): T. Hashimoto

      • Abstract
      • Presentation
      • Slides

      Background
      Repeated lung resection for second primary lung cancer is indicated as an effective treatment in properly selected patients. Among repeated lung resections, surgery for ipsilateral lesion is a challenging modality for thoracic surgeons. We report our experience of repeated lung resection, especially focused on ipsilateral reoperation after anatomical major lung resection.

      Methods
      We retrospectively reviewed patients who had undergone a second lung resection for ipsilateral second primary lung cancer at the 3 institutions between 2000 and 2012. The diagnosis of the second primary lung cancer was based on the criteria from Martini. Variables analysis included clinical and pathologic data including age, sex, c-stage, surgical procedure, p-stage, histology, time interval between the two operations, operative findings, operative morbidity and mortality, as well as long term outcomes. Overall survival was calculated using the Kaplan-Meier method.

      Results
      There were 52 reoperations in 50 patients. Of the 50 patients, 35 were male and 15 were female. The median age at the time of a second operation was 69.9 years (range 51 to 85). The first lung resection was lobectomy in 48 patients and segmentectomy in 2 patients. According to the current TNM classification, p-stage of the first lung cancer was IA in 20, IB in 24, IIA in 3, IIB in 1, IIIA in 1, and IV in 1. The mean value of %vital capacity and forced expiratory capacity in one second /forced vital capacity obtained before the second surgery was 94.7% and 72.3% respectively. The second operation was wedge resection in 28, segmentectomy in 9, right middle lobectomy in 4, right upper lobectomy after lower lobectomy in one, and completion pneumonectomy in 7. The mean interval time between the two operations was 64 months (range, 15-156 months). During second surgery, vascular injury was occurred in 2 patients. Mean volume of blood loss during surgery was 354ml (range, 0 to 3440 ml), and blood transfusion was necessary in 6 patients. Intrapericaridial exposure of the main pulmonary artery was employed in 9 patients due to dense vascular adhesions. There was no operative death.　Complications occurred in 9 patients (prolonged air leakage in 5, empyema in 2, heart failure in 1, and delirium in 1). One patient died of pneumonia 5 months after the second operation. Therefore morbidity and hospital mortality was 18% and 2%, respectively. Pathological diagnosis of the second primary lung cancer was adenocarcinoma in 41, squamous cell carcinoma in 9, and sarcoma in 1. P-stage of the second lung cancer was IA in 37, IB in 8, IIA in 1, IIB in 2, IIIA in 1, and IV in 1. The 5-year overall survival after the second operation was 67 %, and more favorable 5-year survival of 77% was observed in p-stage IA.

      Conclusion
      Most second primary lung cancer in this retrospective study was treated in p-stage I. Reoperations for a second primary lung cancer on the same side of the first surgery shows an acceptable morbidity and mortality rate, and provides favorable survival in selected patients with adequate physiologic pulmonary reserve.

      Only Members that have purchased this event or have registered via an access code will be able to view this content. To view this presentation, please login, select "Add to Cart" and proceed to checkout. If you would like to become a member of IASLC, please click here.

      Only Active Members that have purchased this event or have registered via an access code will be able to view this content. To view this presentation, please login or select "Add to Cart" and proceed to checkout.

  • +

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

    • Event: WCLC 2013
    • Type: Poster Session
    • Track: Surgery
    • Presentations: 1
    • +

      P1.07-034 - Number of Metastatic Lymph Nodes and Metastatic Lymph Node Ratio Predict Patient Survival in Resected Non-small Cell Lung Cancer (ID 2265)

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

      • Abstract

      Background
      The non-small cell lung cancer TNM classification system uses the anatomic extent of lymph node (LN) metastases to define the N category. However, the TNM classification system for breast, gastric, and colorectal cancer has been updated to include number of metastatic lymph nodes (MLNs) in the N staging. In these cancers, the number of MLNs has been shown to be a more effective prognostic factor than the anatomic location of MLNs. Moreover, it has been suggested the ratio of MLNs to total number of LNs examined (lymph node ratio [LNR]) in breast, bladder, gastric, and colorectal cancer is a better prognostic factor. Here, we evaluated the effect of these factors on the disease-free-survival (DFS) of non-small cell lung cancer.

      Methods
      We retrospectively reviewed 428 patients who underwent with pathological examination of resected LNs from 2001 through 2010. The prognostic value of number of MLNs, LNR, or current pN classification was assessed using a multivariate Cox proportional hazards model for DFS, with sex, age, smoking history, tumor size, histology, histological grade. The number of MLNs and LNR were analyzed as a categorical variable, and the patients were divided into 4 groups by the number of MLNs (n[0]: no MLNs, n[1-3]: 1-3 MLNs, n[4-6]: 4-6 MLNs, and n[≧7]: 7 or more MLNs), or by the LNR (n[none]: 0%, n[low]: 1%-9%, n[moderate]: 10-24%, and n[high]: 25% or higher).

      Results
      At least one nodal metastasis was found in 100 patients (23%), represented by n[0] in 328 cases, n[1-3 ]in 77 cases, n[4-6] in 15 cases, and n[≧7] in 8 cases. By the LNR, 328, 55, 25, and 20 cases were assigned to n[none], n[low], n[moderate], and n[high] groups, respectively. The 5-year DFS rate of n[0], n[1-3], n[4-6], and n[≧7] groups were 83%, 48%, 24%, and 0%, respectively, and the 5-year DFS rate of n[none], n[low], n[moderate], and n[high] groups were 83%, 51%, 38%, and 9%, respectively. Multivariate analysis showed the number of MLNs and LNR were significant independent prognostic factor, equal to the current pN classification. Hazard ratios for pN1 and pN2 with respect to pN0 were 2.07 and 5.04. In contrast, hazard ratios were 2.70, 4.03, and 14.7 for n[1-3], n[4-6], and n[≧7] with respect to n[0]; and 2.16, 3.62, and 9.95 for, n[low], n[moderate], and n[high] with respect to n[none].

      Conclusion
      The number of MLN and LNR are strong independent prognostic factor in non-small cell lung cancer. They may add new information to the pN categories of the current TNM classification.

  • +

    P2.07 - Poster Session 2 - Surgery (ID 190)

    • Event: WCLC 2013
    • Type: Poster Session
    • Track: Surgery
    • Presentations: 1
    • +

      P2.07-019 - Postoperative Outcome of Patients with Pulmonary Large-cell Neuroendocrine Carcinoma (ID 1725)

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

      • Abstract

      Background
      Although large-cell neuroendocrine carcinoma (LCNEC) was categorized as a variant of large cell carcinoma on the WHO histologic classification of lung carcinomas, the clinical and biological features of LCNEC resemble those of small cell lung carcinoma. Therefore, there is no consensus on the treatment strategy for LCNEC, and an indication of surgical treatment for LCNEC is still controversial. Even though preoperative accurate diagnosis of LCNEC is difficult, the aim of this study was investigating patients with pulmonary LCNEC in whom better postoperative outcome is expected.

      Methods
      We retrospectively reviewed patients with pulmonary LCNEC on permanent pathologic diagnosis who underwent pulmonary resection at the 3 institutions between 1999 and 2011. We reviewed the medical records of each patient for demographic, clinical, and pathologic data including age, sex, smoking status, preoperative serum CEA, radiologic tumor size, c-stage, surgical procedure, extent of lymphadenectomy, p-stage, lymph node metastasis, visceral pleural invasion, lymphatic permeation, vascular invasion, and adjuvant chemotherapy. Disease-free survival (DFS) was calculated using the Kaplan-Meier method, and factors associated with DFS were analyzed with the log-rank test.

      Results
      Of the 18 patients eligible for this study, 14 were male and 4 were female. The median age was 74 years (range, 53 to 85). According to the current TNM classification, 12 patients had c-stage I disease, 4 had c-stage II disease, and 2 had c-stage IIIA disease. The majority of patients (13 patients, 72%) underwent lobectomy, 1 underwent pneumonectomy, 1 underwent bilobectomy, and 3 underwent wedge resection. On pathologic diagnosis, 8 patients had p-stage I disease, 5 had p-stage II disease, and 5 had p-stage IIIA disease. Following surgical treatment, cisplatin-based adjuvant chemotherapy was applied for 3 patients. The 1-year and 2-year DFS were 39% and 39%, respectively, with the median follow-up period of 9 months (range, 2 to 80). During the follow-up period, 10 patients (56%) developed recurrence, and the recurrence was identified within the first year post-resection in all the 10 patients. By the log-rank test, smoking status (non- or former, vs. current) and surgical procedure (lobectomy or greater, vs. limited resection) were identified as significant factors associated with DFS.Figure 1

      Conclusion
      Of patients with pulmonary LCNEC undergoing surgical treatment, a long-term prognosis might be expected if no recurrence is identified within the first year post-resection. If diagnosis of LCNEC is preoperatively obtained, surgical treatment is recommended for patients without current smoking status, and lobectomy or greater resection should be the surgical procedure of first choice.