Virtual Library
Start Your Search
D. Van Raemdonck
Author of
-
+
MS16 - ESTS/IASLC Thymic Session (ID 33)
- Event: WCLC 2013
- Type: Mini Symposia
- Track: Thymoma & Other Thoracic Malignancies
- Presentations: 1
- Moderators:P. Goldstraw, E. Lim
- Coordinates: 10/30/2013, 10:30 - 12:00, Bayside Gallery A, Level 1
-
+
MS16.3 - Surgery for Thymic Tumours: Outcomes from the ESTS Data Base (ID 532)
11:04 - 11:21 | Author(s): D. Van Raemdonck
- Abstract
- Presentation
Abstract
Introduction: Thymic tumors are rare malignancies and most of the current literature is composed of single-institutional series collecting small number of patients spanned over short time periods. The European Society of Thoracic Surgeons (ESTS) thymic working group developed a retrospective database among its members collecting patients with thymic tumors submitted to surgical resection between 1990 and 2010. Methods: A total of 2151 patients were collected from 35 Institutions, including 1798 thymomas, 191 thymic carcinomas (TC), and 41 Neuroendocrine Thymic Tumors (NETT)). 1709 patients (89%) received a complete resection. Myasthenia Gravis (MG) was present in 629 patients (35%). Different clinical-pathologic characteristics were analyzed for their impact on survival and recurrence. Primary outcome was overall survival (OS); secondary outcomes were the proportion of incomplete resections, disease-free survival (DFS) and the cumulative incidence of recurrence (CIR). Results: Ten-year OS and DFS rates were 73% and 70%. The risk of mortality increased with age and with the stage. It also increased in the presence of TC, NETT and incomplete resection. Ten-year CIR was 12%. Predictors of incomplete resection included male gender, tumor size, the absence of MG, non-thymoma categories (TC and NETT) and high-risk thymomas (B2-B3). The risk of recurrence increased with tumor size, increased stage and NETT. Finally, our analysis indicates that the overall effect of adjuvant therapy after complete resection on OS was significantly beneficial (p=0.05) using a propensity score. Conclusions: Masaoka stages III-IV, incomplete resection and non-thymoma histology showed a significant impact in increasing recurrence and in worsening survival. The administration of adjuvant therapy after complete resection is associated with improved survival.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.
-
+
P1.17 - Poster Session 1 - Bronchoscopy, Endoscopy (ID 182)
- Event: WCLC 2013
- Type: Poster Session
- Track: Pulmonology + Endoscopy/Pulmonary
- Presentations: 1
- Moderators:
- Coordinates: 10/28/2013, 09:30 - 16:30, Exhibit Hall, Ground Level
-
+
P1.17-003 - Endobronchial valve treatment for pulmonary air leak after anatomical resection for cancer. (ID 1125)
09:30 - 09:30 | Author(s): D. Van Raemdonck
- Abstract
Background
Around 50,000 patients undergo each year a surgical resection for early stage lung cancer in the United States. Their median hospital stay after a lobectomy is 4-7 days. The European Society of Thoracic Surgery database shows that the percentage of pulmonary air leak present on day 5 is 6.8% for segmentectomy and 8.3% for lobectomy. This postoperative pulmonary expiratory air leak is usually managed conservatively. However, this is independently associated with prolonged hospital length of stay, decreased patient satisfaction, increased morbidity or postoperative complications. The use of endobronchial valves is a minimal invasive method that may be effective for the treatment of such a persistent postoperative pulmonary air leak.Methods
In a prospective study, the efficacy of endobronchial valve treatment in 10 patients with a prolonged persistent pulmonary air leak after anatomic surgical resection for cancer was investigated. The primary study endpoint is the clinical efficacy on air leak cessation assessed using a digital thoracic drainage system and allowing chest tube removal. Other evaluations included avoidance of Heimlich valve, avoidance of additional surgical intervention, safety issues including complications related to endobronchial valve treatment, evaluation of consequences of airway closure on pulmonary function, and timing of endobronchial valve removal.Results
Of all included patients, 90% was scheduled for valve treatment. We demonstrated air leak cessation at a median of 2 days after endobronchial valve placement, which resulted in chest tube removal at a median of 4 days after valve placement. Three patients were discharged with a Heimlich valve despite a significant reduction of their air leak after valve implantation. No single patient required additional surgical intervention. No deaths or implant-related events (such as infection distal to the endobronchial valve, hemoptysis, persistent cough, pneumothorax or expectoration of a valve) did occur. A significant decrease in FEV1 was found at airway closure by valve implantation, as compared to the functional status after valve removal (mean FEV1 53% versus 61% of predicted; p=0.0002). A 5-10% decrease in FEV1 was observed in patients when a right upper lobe was treated with endobronchial valves, while a 10-15% decrease in FEV1 was observed when a lower lobe was treated with endobronchial valves. Elective removal of the endobronchial valves was safely performed at a median of 23 days (range 14-28) after valve implantation.Conclusion
Endobronchial valve treatment is an effective therapy for patients with a prolonged pulmonary air leak after anatomic resection for cancer. The aid of a digital thoracic drainage system is required as it guides endobronchial valve placement and allows a safe fast-tracking chest tube removal.
-
+
P2.19 - Poster Session 2 - Imaging (ID 180)
- Event: WCLC 2013
- Type: Poster Session
- Track: Imaging, Staging & Screening
- Presentations: 1
- Moderators:
- Coordinates: 10/29/2013, 09:30 - 16:30, Exhibit Hall, Ground Level
-
+
P2.19-004 - Characterization of solitary pulmonary lesions combining visual perfusion and quantitative diffusion MR imaging (ID 1000)
09:30 - 09:30 | Author(s): D. Van Raemdonck
- Abstract
Background
To evaluate the diagnostic accuracy of dynamic contrast enhanced (DCE)magnetic resonance (MR) and diffusion weighted imaging (DWI) sequences for defining benign or malignant character of solitary pulmonary lesion (SPL) in a preoperative setting.Methods
This study was approved by the local ethics committee; all patients provided written informed consent. First, 54 consecutive patients with SPL, clinically staged (CT and PET or integrated PET-CT) as N0M0, were included in this prospective study. An additional MR examination including DCE and DWI was performed one day before the surgical procedure. Histopathology of the surgical specimen served as standard of reference. Subsequently, this functional method for SPL characterization was validated with a second cohort of 54 patients.Results
In the feasibility group, 11 benign and 43 malignant SPL were included with a maximal diameter that varied from 3 to 71 mm (mean 23.2 mm). Using the conventional MR sequences with visual interpretation of DCE-MR curves sensitivity, specificity, accuracy were respectively 100%, 55% and 91%. By additional interpretation of quantitative apparent diffusion coefficient (ADC) values (with a cutoff value of 1.52x10-3 mm2/sec for ADC calculated from high b-values (ADChigh) these results improved to 98%, 82% and 94% respectively. In the validation group, with 14 benign and 40 malignant SPL (diameter ranged between 7 mm and 10 cm - mean 26.5 mm), these results were confirmed with a sensitivity, specificity and accuracy of 95%, 79%, and 91%, respectively.Conclusion
Visual DCE-MR-based curve interpretation can be used for initial differentiation of benign from malignant SPL, while additional quantitative DWI-based interpretation can further improve the specificity.
