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T.D. Yan



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

    • Event: WCLC 2013
    • Type: Mini Oral Abstract Session
    • Track: Mesothelioma
    • Presentations: 1
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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): T.D. Yan

      • 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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    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): T.D. Yan

      • 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.

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

    • Event: WCLC 2013
    • Type: Poster Session
    • Track: Surgery
    • Presentations: 1
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      P2.07-032 - Video-Assisted Thoracic Surgery versus Open Thoracotomy for Non-Small Cell Lung Cancer - A Meta-analysis of Propensity Score Matched Patients (ID 2816)

      09:30 - 09:30  |  Author(s): T.D. Yan

      • Abstract

      Background
      This meta-analysis aims to compare the perioperative outcomes of video-assisted thoracic surgery (VATS) versus open thoracotomy for propensity score-matched patients with early-stage non-small cell lung cancer (NSCLC).

      Methods
      Four relevant studies with propensity score-matched patients were identified from six electronic databases. Endpoints included perioperative mortality and morbidity, individual postoperative complications and duration of hospitalization.

      Results
      Results indicate that all-cause perioperative mortality was similar between VATS and open thoracotomy. However, patients who underwent VATS were found to have significantly fewer overall complications, and significantly lower rates of prolonged air leak, pneumonia, atrial arrhythmias and renal failure. In addition, patients who underwent VATS had a significantly shorter length of hospitalization compared to patients who underwent open thoracotomy. Figure 1 Figure 2

      Conclusion
      In view of a paucity of high level clinical evidence in the form of large, well-designed randomized controlled trials, propensity score matching may provide the highest level of evidence to compare VATS with open thoracotomy for patients with NSCLC. The present meta-analysis demonstrated superior perioperative outcomes for patients who underwent VATS, including overall complication rates and duration of hospitalization.

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    P3.07 - Poster Session 3 - Surgery (ID 193)

    • Event: WCLC 2013
    • Type: Poster Session
    • Track: Surgery
    • Presentations: 1
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      P3.07-037 - A Systematic Review and Meta-analysis on Pulmonary Resections by Robotic Video-Assisted Thoracic Surgery (ID 2822)

      09:30 - 09:30  |  Author(s): T.D. Yan

      • Abstract

      Background
      Pulmonary resection by robotic-video assisted thoracic surgery (RVATS) has been performed for selected patients in specialized centers over the past decade. Despite encouraging results from case-series reports, there remains a lack of robust clinical evidence for this relatively novel surgical technique. The present systematic review aimed to assess the short- and long-term safety and efficacy of RVATS.

      Methods
      Nine relevant and updated studies were identified from 12 institutions using five electronic databases. Endpoints included perioperative morbidity and mortality, conversion rate, operative time, length of hospitalization, intraoperative blood loss, duration of chest drainage, recurrence rate and long-term survival. In addition, cost analyses and quality of life assessments were also systematically evaluated. Comparative outcomes were meta-analyzed when data were available.

      Results
      All institutions used the same master-slave robotic system (da Vinci, Intuitive Surgical, Sunnyvale, California) and most patients underwent lobectomies for early-stage non-small cell lung cancers. Perioperative mortality rates for patients who underwent pulmonary resection by RVATS ranged from 0 – 3.8%, whilst overall morbidity rates ranged from 10 – 39%. Two propensity-score analyses compared patients with malignant disease who underwent pulmonary resection by RVATS or thoracotomy, and a meta-analysis was performed to identify a trend towards fewer complications after RVATS. In addition, one cost analysis and one quality of life study reported improved outcomes for RVATS when compared to open thoracotomy. Figure 1 Figure 2

      Conclusion
      Results of the present systematic review suggest that RVATS is feasible and can be performed safely for selected patients in specialized centers. Perioperative outcomes including postoperative complications were similar to historical accounts of conventional VATS. A steep learning curve for RVATS was identified in a number of institutional reports, which was most evident in the first 20 cases. Future studies should aim to present data with longer follow-up, clearly defined surgical outcomes, and through an intention-to-treat analysis.