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D. Kato



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    MO04 - Lung Cancer Biology I (ID 86)

    • Event: WCLC 2013
    • Type: Mini Oral Abstract Session
    • Track: Biology
    • Presentations: 1
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      MO04.02 - Paclitaxel resistance is associated with drug accumulation in intracellular compartments and paclitaxel-binding proteins in human lung cancer cell lines (ID 75)

      16:20 - 16:25  |  Author(s): D. Kato

      • Abstract
      • Presentation
      • Slides

      Background
      Several mechanisms have been suggested for paclitaxel resistance in cancer cells, including overexpression of the multidrug transporter gene, ATP-binding cassette, sub-family B, member 1 (ABCB1), and the presence of a point mutation in the β-tubulin gene at the paclitaxel-binding site. However, the mechanisms underlying resistance to this agent have not yet been completely elucidated.

      Methods
      Three human lung cancer cell lines, II18, A549, and RERF-LC-KJ, were analyzed; their 50% inhibitory concentrations of paclitaxel were -8.33, -7.69, and -4.51 logM, respectively. The cell lines did not have any β-tubulin mutation. We evaluated the expression levels of ABCB1, intracellular accumulation of paclitaxel, paclitaxel-induced stabilization of microtubules, and intracellular localization of Oregon Green[®] 488-conjugated paclitaxel in these cell lines. Moreover, we prepared paclitaxel conjugated ferriteglycidyl metacrylate (FG) beads to purify paclitaxel-binding proteins from whole cell lysates of these cells.

      Results
      The ABCB1 expression level was strongly correlated to intracellular [[3]H]-paclitaxel accumulation (r[2] = -0.804) but was not related with paclitaxel resistance. The changes in the quantities of polymerized tubulin and acetylated tubulin after paclitaxel exposure were not related to paclitaxel resistance. Differences were observed between the intracellular localization of paclitaxel in RERF-LC-KJ, the most resistant cell line, and in the other 2 cell lines. The use of Oregon Green[®] 488-conjugated paclitaxel enabled visualization of not only the normal microtubule formation in the partial cells but also the aggregated vesicle formation in RERF-LC-KJ cells; aggregated vesicle formation was not remarkable in the other cell lines. Affinity purification by paclitaxel immobilized beads revealed several specific bands in RERF-LC-KJ; these bands were not revealed in the other cell lines.

      Conclusion
      We propose that paclitaxel resistance is associated with intracellular compartments in which paclitaxel accumulates and paclitaxel-binding proteins expressed specifically in resistant cell line.

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    P2.03 - Poster Session 2 - Technology and Novel Development (ID 151)

    • Event: WCLC 2013
    • Type: Poster Session
    • Track: Biology
    • Presentations: 1
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      P2.03-005 - Rotary Dissector: Frictional force achieved by using the porous polypropylene Rotary Dissector in clinical settings (ID 2482)

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

      • Abstract

      Background
      Figure 1During thoracoscopic surgery, rounded cotton-tip dissectors (Blunt Cherry Dissectors[®]) have been used to maintain the position of the lungs. However, moistening of cotton tips due to blood or pleural effusion often makes it difficult for surgeons to maintain the lung position when using this equipment. Therefore, we developed a polygonal-shaped tip dissector using porous polypropylene, called the Rotary Dissector, in order to achieve a greater amount of frictional force against the lung. In the present study, we assessed the difference in the rotational frictional force between the Blunt Cherry Dissector and Rotary Dissector, as well as the usefulness of the Rotary Dissector in thoracic surgery.

      Methods
      The rotational frictional force of the Rotary Dissector and the Blunt Cherry Dissector was estimated using a gel. We measured the weight and volume of gel that was scooped and pushed out in one direction by each dissector. Furthermore, we used the newly developed Rotary Dissectors for video-assisted thoracic surgery (VATS), and assessed the usefulness of this equipment.

      Results
      The weight and volume of gel pushed out was 1.14 g and 948.4 mm[3] with the Rotary Dissector and 0.34 g and 270.6 mm[3] with the Cherry Dissector, respectively. Moreover, the Rotary Dissector had 3 times the frictional force compared to that of the Cherry Dissector. During VATS, we used the Rotary Dissector and successfully detached the pleural adhesion without causing any lung injuries and could maintain the lung position to obtain a clear surgical field.

      Conclusion
      Thus, we noted that Rotary Dissectors can yield a greater amount of frictional force as compared to conventional dissectors, and can be safely used in VATS.

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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): D. Kato

      • 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.

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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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      P3.07-022 - Preoperative lipiodol marking for small-sized lung tumors (ID 1861)

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

      • Abstract

      Background
      Recent advances in imaging modalities have enabled detection of small-sized lung tumors at earlier stages with resultant dramatic changes in therapeutic strategies. However, if preoperative pathological diagnosis is not possible, video-assisted thoracic surgery (VATS) for therapeutic resection as well as diagnostic excisional biopsies may be indicated. Small-sized lung tumors, such as bronchioloalveolar carcinoma, are difficult to localize during surgery by visualizing or palpating the lung surface because the lung is a soft and deformable organ and contains air. Accurate intraoperative localization of the tumor is critical to surgeons. We usually perform preoperative lipiodol marking for small-sized tumors, particularly those located deep in the lung, to create a “visible target” from an invisible and impalpable tumor. This visualization technique enables resection of marked lesions under X-ray fluoroscopy.

      Methods
      From May 2006 through March 2013, we performed preoperative lipiodol marking for 356 lesions in 215 cases in which unconfirmed lung tumors were less than 10 mm in diameter, located deep to the visceral pleura, or of ground-glass opacity. One to five markings with lipiodol were performed in each case. The mean diameter of the lesions was 7.7 ± 5.1 mm (2–33 mm), and they were located 10.1 ± 9.5 mm (0–54 mm) below the surface of the visceral pleura. CT-fluoroscopy guidance was used to inject 0.1–0.5 mL lipiodol in the vicinity of the tumor before surgery. During VATS, X-ray fluoroscopy was used to confirm lesion location and to guide resection of the lipiodol-marked lesion.

      Results
      The average duration of the marking procedure was 18.4 minutes per lesion. Regarding complications, pneumothorax occurred in 40 cases (18.6%), but there were no cases of air embolization and no histological modifications in or around lipiodol markings. Of the 356 lesions, 354 (99.4%) were detectable and safely resected. Pathological examinations revealed lung cancer in 54 lesions, atypical adenomatous hyperplasia in 8, metastatic lung tumor in 165, organized pneumonia in 115 and other benign lesions in 12.

      Conclusion
      Lipiodol marking with CT-fluoroscopy guidance before VATS is a useful technique for small and impalpable lung tumors.

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    P3.24 - Poster Session 3 - Supportive Care (ID 160)

    • Event: WCLC 2013
    • Type: Poster Session
    • Track: Supportive Care
    • Presentations: 1
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      P3.24-024 - Lymphangioma of the diaphragm (ID 1531)

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

      • Abstract

      Background
      Lymphangioma usually occurs in the head and neck area. We present a very rare case of cystic lymphangioma that originated from the diaphragm. Few cases were reported in the literature.

      Methods
      A 69-year-old woman was referred to our hospital for macrocytic anemia and weight loss. Pernicious anemia was diagnosed by the presence of the atrophic gastritis, the decreased serum vitamin B12 level, and the anti-parietal cell antibodies and anti-intrinsic factor antibodies in blood serum. In addition, on chest computed tomography (CT) she was found to have a multicystic mass, measuring 50 mm in diameter, which seemed located in the anterior mediastinum and abdominal cavity, across the diaphragm. The cranial part of the mass consisted of solid structure including fat components but no calcification, and the caudal part consisted of multicystic structure, of which septal wall was slightly enhanced. The mass did not appear to invade the liver but to compress. Fluorine-18-fluorodeoxyglucose positron emission tomography (PET) scan showed no abnormal uptake. The mass was suspected a cystic teratoma, a bronchial cyst, a lipoma, a thymoma, or Morgagni hernia. It was resected through right diagonal thoraco-laparotomy with short upper midline incision.

      Results
      Seen from intrathoracic side the mass did not invade the pericardium and seemed to have firm adhesion to the diaphragm, and from intraabdominal side did not perforate the peritoneum or invade the liver, and no hernia canal was seen. The mass was not able to apart from the diaphragm, and combined resection of the diaphragm was performed. Pathologically it was diagnosed as a lymphangioma.

      Conclusion
      Lymphangioma arising from diaphragm is a very rare tumor. It should be considered in the differential diagnosis of diaphragm tumor.