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Y. Ishikawa



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

    • Event: WCLC 2013
    • Type: Mini Oral Abstract Session
    • Track: Surgery
    • Presentations: 1
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      MO02.09 - Needle scopic surgery for primary lung cancer: Reduced port surgery in thoracic surgery using fine scope and forceps (ID 1856)

      11:10 - 11:15  |  Author(s): Y. Ishikawa

      • Abstract
      • Presentation
      • Slides

      Background
      If a surgical approach is less invasive than a conventional method and can maintain a sufficient technical level equal to a conventional one, it will bring more benefits to patients. We have performed thoracoscopic anatomical segmentectomy and lobectomy for primary lung cancer for more than fifteen years. First we use and slide a 5mm-diameter scope through three or four ports. Then we start the needle scopic surgery（1 port+ 3 punctures method）using a 3mm-diameter scope, which we have used since September 2012. Now we would like to explain this operative procedure and effectiveness.

      Methods
      【Patients】Forty one patients underwent the needle scopic anatomical segmentectomy and lobectomy of the lung between September 2012 to May 2013. They had clinical stage IA or IB lung cancer. We compared the operation time, blood loss volume, post-operative creatinine phosphokinase (CK) and other peri-operative parameters of this method with those of the conventional method using a 5mm-diameter scope which were performed on 73 patients from January 2012 to August 2012. 【Operative procedure】1. We make a 2.5 to 3 cm length skin incision on the 4th or 6th intercostal space of the chest trunk and set the polyurethane-made retractor. We use it as the main port. 2. We puncture the skin with three 3mm-diameter trocars. Then we insert and slide a 3mm-diameter scope and fine forceps through them. We observe thoracic lumen and perform various manipulations using them. 3. Endostaplers, energy devices and electric cautery of which diameters are larger than 3mm go into the thoracic lumen through the main port. 4. Finally we set the chest tube within the main port incision at the end of surgery.

      Results
      We performed 8 segmentectomies and 33 lobectomies of the lung using this method in forty-one cases for the lung cancer. We dissected mediastinal nodes in all cases. We had no cases that were converted to the conventional method. However we elongated the incision of one puncture from 3 mm to 10mm in three cases in order to insert endostaplers for dissecting pulmonary veins and arteries. Mean operation time was 219±49 minutes. Mean blood loss volume was 20.5±28.4 ml. They were not significantly different from those of the conventional method. Post-operative peak titers of CK of this method were significantly lower than that of the conventional method. We had no severe intraoperative accidents or postoperative complications. All patients were smoothly discharged.

      Conclusion
      We were able to successfully perform the needle scopic surgery for lung cancer as well as conventional thoracoscopic surgery. Though some surgeons have tried the single port method for thoracic surgery as another less invasive surgery, we think the needle scopic method is more suitable for thoracic surgery. Because thoracic surgery needs observations and manipulations which are in the wider range of the inner space than that of the abdomen. This method would be the optimal and optional method if we appropriately select cases.

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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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      P1.07-035 - Uncertain Resection due to incomplete intraoperative nodal assessment (ID 2321)

      09:30 - 09:30  |  Author(s): Y. Ishikawa

      • Abstract

      Background
      The standard surgical approach for non-small-cell lung cancer is lobectomy with systematic hilar and mediastinal lymph node dissection. The purpose of lymph node dissection is considered to be improvement of prognosis and intraoperative staging. Although improvement of prognosis is controversial, it is clear that intraoperative nodal assessment is important for identifying N2 disease and making postoperative therapeutic decisions． For complete resection (CR), at least three mediastinal nodes including subcarinal nodes and three hilar/ intrapulmonary nodes had to be retrieved. Otherwise It is defined as uncertain resection(UR). The objective of this study is to clarify the difference of prognosis between CR and UR.

      Methods
      The medical records and the follow-up data of the patients operated for NSCLC(c-stage I to III) between January 2005 and December 2006 in Yokohama City University Hospital and 8 associate hospitals were analyzed retrospectively. Four hundred-eighty-four patients with NSCLC who underwent lung resections (lobectomy or pneumonectomy) with negative surgical margins were included in this study. Complete resection (CR) was performed in 198 patients. And in 286 patients, uncertain resection was done. We compared these 2 groups.

      Results
      There were no statistically difference between the both groups for age, gender, pathological stage( IA:CR n=69/UR n=153，IB 59/71，IIA 4/12，IIB 27/21，IIIA 36/24，IIIB 3/5), and histology (adenocarcinoma: CR n=122/UR n=185，squamous carcinoma:51/68，large cell carcinoma:15/14，others:14/20 respectively). Five-year disease-free-survival rate in the CR group was 58.1% compared with 63.3% in the UR group. Among patients with p-stage I, the 5-year disease-free-survival rate was significantly lower in UR group (78.1%) than in CR group (88.0%, p=0.027).

      Conclusion
      Uncertain resection might not be enough for accurate intraoprerative staging to determine pN0 status. However whether the accurate intraoperative staging leads to good prognosis was unclear.