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I. Alkoudmani



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    P1.24 - Poster Session 1 - Clinical Care (ID 146)

    • Event: WCLC 2013
    • Type: Poster Session
    • Track: Supportive Care
    • Presentations: 1
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      P1.24-051 - Video-Assisted Thoracoscopic Surgery (VATS) for diagnosis and therapy in primary and secondary pleuro-pulmonary angiosarcoma (ID 3410)

      09:30 - 09:30  |  Author(s): I. Alkoudmani

      • Abstract

      Background
      Angiosarcoma is a rare (1-2% of all soft-tissue tumors) but highly-malignant tumor deriving from the endothelia of small vessels. It primarily affects the skin, mamma, liver and spleen and the lung is the predominant organ of metastatic spread. Symptoms as well as radiologic characteristics are unspecific and diagnosis is made by biopsy and histopathological assessment.

      Methods
      Single-center case series focusing on the role of VATS in diagnosis and (palliative) therapy of primary and secondary pleuro-pulmonary angiosarcoma.

      Results
      From 11/2012 to 04/2013 three male patients (77 (74-78) y/o) underwent VATS for diagnosis and therapy of primary disseminated pleuro-pulmonary angiosarcoma (n=2) or bilateral pulmonary metastases of a cutan angiosarcoma. All patients presented with unspecific symptoms like dyspnoea and chest pain. Primary angiosarcoma was associated with severe and recurrent hemorrhagic pleural effusion, while bilateral pulmonary angiosarcoma metastases led to a bilateral pneumothorax under systemic chemotherapy. Two patients suffered from recurrent hemoptysis. Indication for VATS was diagnosis (pleural biopsies, n=3) and palliative therapy (talcum pleurodesis [n=3] and apical wedge resection with pleurectomy [n=1]). Mean operating time was 62 (31-117) min. Following VATS (and diagnosis) all patient received chemotherapy. One patient died 4 month after primary diagnosis, the two others are alive with stable disease.

      Conclusion
      Multiple unspecific pleural lesions on CT in patients presenting with hemoptysis and recurrent hemothorax may indicate a primary or secondary pleuro-pulmonary angiosarcoma. VATS is a safe minimally invasive single step procedure for both diagnosis and palliative therapy in this highly malignant soft tissue tumor.

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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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      P2.07-048 - Causes, predictors and consequences of conversions in VATS lobectomy for NSCLC (ID 3408)

      09:30 - 09:30  |  Author(s): I. Alkoudmani

      • Abstract

      Background
      To analyze causes, predictors and consequences of conversions to open surgery in VATS lobectomy.

      Methods
      Retrospective analysis of a prospectively maintained database.

      Results
      Since February 2009, 297 patients with NSCLC were scheduled for VATS anatomical resections. Conversion to open surgery was necessary in 22 patients (7.4%). Reasons for conversion were bleeding in 10, oncologic reason in 8 and technical considerations in 4 patients (adhesions after pleuritis or radiotherapy for other tumors: 3, limited space: 1). In univariate analysis, conversion rate was significantly higher in patients after neoadjuvant therapy (21% vs 4.3%, p=0.002). There was a statistical trend for higher conversion rate in patients during the first half of the series (9.5% vs 3.4%, p=0.062) and larger tumor size (T1 vs >T1, 4.8% vs 12.9%, p=0.098). The conversion rate was not influenced by age of the patient, nodal stage (pN0 vs pN+), body mass index, COPD, FEV1, or benign disease. Conversion did not translate into higher overall postoperative complication rates (33.3% vs 29.5%), longer chest drain duration (median 5 vs 5 days), or mortality (0% vs 2%). However, length of hospital stay was significantly longer in the conversion group (median 10 vs 6 days, p=0.0066).

      Conclusion
      Neoadjuvant therapy is an independent risk factor for conversion to thoracotomy in this VATS lobectomy series. Patients after neoadjuvant therapy should be selected carefully for a VATS approach. Conversion to thoracotomy did not increase the postoperative complication or mortality rate, but significantly increased the length of stay.

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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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      P3.07-048 - VATS lobectomy for NSCLC in Germany - results of a nationwide survey (ID 3412)

      09:30 - 09:30  |  Author(s): I. Alkoudmani

      • Abstract

      Background
      Despite increasing evidence of safety and efficacy of VATS lobectomy for early stage NSCLC, there has been persistent reluctance for this technique among thoracic surgeons in central Europe. Concerns have existed with regard to oncologic safety and the feasibility and accuracy of hilar and mediastinal lymph node dissection. Only recently the VATS approach has gained some increasing acceptance but no data exist regarding application and indication of the VATS approach for NSCLC in Germany.

      Methods
      A survey (12 questions) was performed among the thoracic surgical units in Germany. Questions focused on volume, indication, technique and distribution of VATS lobectomy for NSCLC.

      Results
      The response rate was 65% (25 units). Most units started the VATS lobectomy program only within the last 5 years and sofar performed up to 100 procedures, only 4 centers performed more than 300 procedures. Most centers consider NSCLC stages IA-IIB for a VATS approach, 4 units (16%) approach tumors up to stage IIIA by VATS. All units operate via an anterior approach, most (80%) use 3 incisions. In addition to standard lobectomies, 15 (60%) units also perform anatomical segmentectomies, 2 (8%) centers bronchial sleeve resections and 1 (4%) center pneumonectomies by VATS. 24 (96%) units perform systematic lymph node dissection, 3 centers perform VAMLA (Video Assisted Mediastinal LympAdenectomy). In most units (14, 56%) 2-3 surgeons participate in the VATS lobectomy program.

      Conclusion
      In Germany, the VATS approach for anatomical resections for NSCLC has been increasingly adopted only within the last 5 years. However, even in 2013, only approximately 15% of all lobectomies are performed by VATS, which is a low rate when compared to the US, Great Britain and some Asian countries.