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K. Itoh



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    P1.16 - Poster Session 1 - Other Thoracic Malignancies (ID 186)

    • Event: WCLC 2013
    • Type: Poster Session
    • Track: Thymoma & Other Thoracic Malignancies
    • Presentations: 1
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      P1.16-003 - Features of computed tomography images and tumor viability: 141 lesions of pulmonary metastasis of non-seminoma (ID 1863)

      09:30 - 09:30  |  Author(s): K. Itoh

      • Abstract

      Background
      The standard treatment for advanced non-seminoma is to excise all residual masses, including pulmonary metastatic lesions, in patients whose tumor markers return to normal after chemotherapy. However, too many regions and too great a volume of the patient’s lung are often resected. On the other hand, viable cells are frequently not present in the resected tissue. This study therefore tried to identify distinct features of viable lesions on computed tomography (CT).

      Methods
      Figure 1From January 2008 to December 2011, 17 cases of non-seminoma with lung metastasis underwent lung resection after normalization of tumor markers (α-fetoprotein and hCG). To excise all very small or impalpable lesions, we performed lipiodol marking under computed tomography, for a maximum of 8 sites in one operation. CT images of the 141 resected lesions were investigated for size and properties, and compared with pathological findings. Statistical analysis was performed using the chi-square test.

      Results
      We confirmed viable cells in 8 of 17 cases and 47 of 141 lesions. In those cases, viable cells were detected in both lungs. However, no significant relationship was found between average size and cell viability. The minimum diameter of tumor showing positive pathological change was 3 mm. No significant relation was observed between pathological findings and CT characteristics such as solid, cystic, scar-like or clear boundary.Figure 1

      Conclusion
      The ability to excise tissue from the lung is limited, and we would like to avoid excision of lesions against which chemotherapy has already been successful and which do not contain residual cells. However, the present results suggest the difficulty of specifying regions with viable cells based on CT. For this reason, minute lesions should still be excised, and marking has a very important role to play.

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    P2.25 - Poster Session 2 - Nurses (ID 249)

    • Event: WCLC 2013
    • Type: Poster Session
    • Track: Nurses
    • Presentations: 1
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      P2.25-001 - Workflow improvement and results of standardization of thoracic surgery procedures among six hospitals (ID 1133)

      09:30 - 09:30  |  Author(s): K. Itoh

      • Abstract

      Background
      Five full-time doctors are sent to 5 affiliated hospitals from University Hospital of Kyoto Prefectural University of Medicine. To conduct a surgery in the affiliated hospitals, a doctor is sent from the university, for ensuring an efficient and secure medical care with limited members. Until now, each hospital performed surgeries in its own way. However, to perform safer and efficient surgery with a limited number of operating room nurses and thoracic surgeons, they need to work as one team. We report the standardization of thoracic surgery procedures.

      Methods
      First, to understand the current situation at each affiliated hospital, we survey all aspects of surgical procedures. Subsequently, we held 5 meetings among the group and standardized the surgical procedures. A thoracic surgeon and 3–4 operating room nurses from each hospital joined in the discussion. The topics of the discussion covered all aspects of surgery and methods from each hospital were analyzed and standardized. We have already standardized the thoracoscopy system and energy device in all hospitals. We also standardized the main surgical instruments and methods in these meetings. The content of the standardized main surgical procedure was thoroughly explained in a video distributed to each hospital in DVD format. We evaluated the frequency of use of the surgical instruments and excluded rarely used items. To increase the understanding on automatic suture instruments and energy device, the important usage points were shared in the meeting. Nurses were trained on the usage. In the 6[th] affiliated hospital meeting, a questionnaire was conducted to survey the awareness of this approach.

      Results
      The amount of time required from entering the operating room to starting the surgery was shortened from 62 to 55.5 minutes (average). The time required from the end of surgery to exiting the operating room was also shortened from 46.1 to 38.7 minutes (average). The difference among hospitals was successfully reduced. Because the main surgical instruments and methods were standardized, almost the same level of surgery could be performed in each hospital. Surgical instruments were reduced from 48.3 to 41.1 types (average). Total number of surgical instruments was successfully reduced from 91.8 to 73.5 items (average). In the questionnaire, all members referred to other hospitals devices, and they will attempt productions of their own device. All members confirmed improved understanding on thoracic surgery and 88% confirmed increased interest in thoracic surgery．

      Conclusion
      Standardization of the surgical procedures improved the workflow, enabled safe and efficient surgery among the affiliated hospitals, and increased awareness of the importance of workflow improvement. Change in awareness toward thoracic surgery was observed among participating members, suggesting that the present approach is highly useful.