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D. Tian



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    MO14 - Mesothelioma II - Surgery and Multimodality (ID 121)

    • Event: WCLC 2013
    • Type: Mini Oral Abstract Session
    • Track: Mesothelioma
    • Presentations: 2
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      MO14.03 - Meta-analysis of extrapleural pneumonectomy versus radical pleurectomy for patients with resectable malignant pleural mesothelioma (ID 3467)

      10:40 - 10:45  |  Author(s): D. Tian

      • Abstract
      • Presentation
      • Slides

      Background
      Malignant pleural mesothelioma (MPM) is an aggressive disease of the pleural lining with a dismal prognosis of 6 – 12 months from the time of diagnosis. Surgical treatment of MPM includes extrapleural pneumonectomy and pleurectomy/decortication (P/D). Recently, IASLC has reclassified P/D according to therapeutic intent and surgical technique into partial P/D, P/D, and radical P/D. The present meta-analysis aimed to compare the perioperative and long-term outcomes of EPP and radical P/D for patients with resectable MPM.

      Methods
      A systematic review of the literature was performed on five electronic databases to identify all relevant data on comparative outcomes of radical P/D and EPP. Endpoints included perioperative mortality and overall morbidity, as well as long-term overall survival.

      Results
      Six relevant studies with comparative data of EPP (n= 601) versus radical P/D (n=493) were identified from the current literature. Comparison of these two groups demonstrated significantly lower perioperative mortality (3.0% vs 6.5%, p=0.04) and overall morbidity (30.4% vs 64.3%, p<0.0001) for patients who underwent radical P/D compared to EPP. Median overall survival ranged between 13 – 29 months for radical P/D and 12 – 22 months for EPP, with a strong trend favouring radical P/D. Figure 1Figure 2

      Conclusion
      Although it must be emphasized that patient selection and treatment strategies differ between EPP and radical P/D, a number of comparative studies have recently been conducted to compare these two surgical techniques for patients with resectable MPM. The present study indicated that appropriately selected patients who underwent radical P/D had lower perioperative morbidity and mortality with similar, if not superior, long-term survival compared to EPP.

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      MO14.04 - Current evidence of pleurectomy in the treatment of malignant pleural mesothelioma (ID 2226)

      10:45 - 10:50  |  Author(s): D. Tian

      • Abstract
      • Slides

      Background
      Pleurectomy/decortication (P/D) in the treatment of malignant pleural mesothelioma includes a number of procedures with different clinical indications and therapeutic intents. To unify the nomenclature, IMIG and IASLC recently defined P/D-related procedures according to surgical technique, including ‘extended P/D’, ‘P/D’ and ‘partial pleurectomy’. The present systematic review aimed to assess the safety and efficacy of these techniques.

      Methods
      A systematic review of relevant studies was performed by electronic search of five online databases from 1985 to 2012 by two independent reviewers according to predefined selection criteria.

      Results
      Thirty-four studies involving 1916 patients who underwent pleurectomy were included for quantitative analysis. These included 12 studies on ‘extended P/D’, 8 studies on ‘P/D’ and 14 studies on ‘partial P/D’. Perioperative mortality ranged from 0% - 11% and perioperative morbidity ranged from 13% - 43%. Median overall survival ranged from 7.1 – 31.7 months and disease-free survival ranged from 6 – 16 months. One study reported on quality-of-life outcomes using a standardized questionnaire suggesting superior outcomes for ‘extended P/D’ compared to extrapleural pneumonectomy. Figure 1Figure 2

      Conclusion
      Results of the present systematic review suggested similar perioperative mortality outcomes between different P/D techniques but a trend towards higher morbidity and length of hospitalization for patients who underwent ‘extended P/D’. However, overall and disease-free survival appeared to favour ‘extended P/D’ compared to less aggressive techniques. Future studies on P/D should adhere to recent definitions to enable accurate analysis of similar procedures. Direct comparisons of pleurectomy to extrapleural pneumonectomy remain challenging, and should be restricted to ‘extended P/D’ procedures only.

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    P1.12 - Poster Session 1 - NSCLC Early Stage (ID 203)

    • Event: WCLC 2013
    • Type: Poster Session
    • Track: Medical Oncology
    • Presentations: 1
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      P1.12-020 - Cross-sectional Survey on Lobectomy Approach (X-SOLA) (ID 2809)

      09:30 - 09:30  |  Author(s): D. Tian

      • Abstract

      Background
      To improve the understanding of current attitudes of the thoracic community to video-assisted thoracoscopic surgery (VATS) lobectomy, the Collaborative Research Group conducted the Cross-sectional Survey On Lobectomy Approach (X-SOLA) study. The aim was three-fold: to assess the practice of lobectomy in the current clinical setting, to identify potential reasons that may inhibit the popularization of the VATS lobectomy technique, and to hypothesize potential strategies that can advance this field in the future.

      Methods
      Participants included thoracic surgeons identified through an index search from the Web of Science and the cardiothoracic surgery network. A confidential questionnaire was emailed in June, 2012. Non-responders were given two reminder emails at monthly intervals.

      Results
      838 thoracic surgeons completed the questionnaire within a three-month period, including 416 surgeons who only performed lobectomy through open thoracotomy and 422 surgeons who performed VATS or robotic-VATS. Two sets of standardized questionnaires were completed by these two groups. Ninety-five percent of VATS surgeons agreed with the definition of ‘true’ VATS lobectomy according to the CALGB trial. Ninety-two percent of surgeons who did not perform VATS lobectomy were prepared to learn this technique, but were hindered by limited resources, exposure and mentoring. Both groups believed VATS lobectomy should be incorporated into thoracic surgical training and for more standardized workshops to be made available. Figure 1 Figure 1. Survey responses for surgeons who performed video-assisted thoracoscopic surgery lobectomy (n=422) Figure 2

      Conclusion
      The X-SOLA study represents the largest cross-sectional report within the thoracic community to date, demonstrating the current status of clinical practice of lobectomy approach for NSCLC worldwide and identifying areas in need of further development.