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S. Yoshida



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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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      P2.07-011 - A pilot study on the effects of perioperartive administration of the neutrophil elastase inhibitor, Sivelestat, to non-small cell lung cancer patients with preoperative risk factors of acute respiratory distress syndrome after pulmonary resection (ID 1217)

      09:30 - 09:30  |  Author(s): S. Yoshida

      • Abstract

      Background
      Postoperative acute respiratory distress syndrome (ARDS) is a recognized complication of pulmonary resection. ARDS following lung resection has a miserable prognosis, with overall hospital mortality rates over 25%. Previous studies demonstrated that there were risk factors of ARDS after pulmonary resection including age, chronic obstructive pulmonary disease (COPD), interstitial pneumonia, concurrent cardiac disease, prior therapy, remaining lung perfusion, duration of operation, increased blood loss and so on. Neutrophils and neutrophil elastase (NE) are believed to play a key role in the endothelial injury and increased vascular permeability characteristic of ARDS. Sivelestat sodium hydrate is a selective NE inhibitor and has been shown to improve respiratory status in cases of ARDS. It has not been well known whether or not NE inhibitors are beneficial for prevention of ARDS after lung resection.

      Methods
      We conducted a pilot study to investigate the efficacy of perioperative administration of sivelestat sodium hydrate to prevent postoperative ARDS in 34 non-small cell lung cancer (NSCLC) patients who had the various preoperative risk factors of the incidence of ARDS after pulmonary resection in Chiba University between 2009 and 2011. They received sivelestat sodium hydrate (5mg/kg/day) intravenously for 7 days starting at the beginning of operation.

      Results
      The patient demographics were as follows: median age, 68 years of age (range 47 to 83 years), male/female ratio, 31/3, clinical stage I/II/III, 9/6/19. The histology was adenocarcinoma (n =19), squamous cell carcinoma (n=10) and others (n =5). Risk factors of ARDS included induction chemotherapy (n=3), induction chemoradiotherapy (n=17), interstitial pneumonia (n=10), COPD (n=3) and medical history of ARDS (n=1). All 34 patients underwent complete resection. The operations included 2 partial resections, 31 lobectomies, and 1 pneumonectomy. Of the 31 patients who received lobectomy, bronchial or arterial plasty was performed in 9 patients. The postoperative mortality rate was 2.9%. One patient died of heart failure on the nineth postoperative day. There was no incidence of ARDS after pulmonary resection in all patients.

      Conclusion
      Perioperative administration of sivelestat sodium hydrate can be beneficial to prevent postoperative ARDS in NSCLC patients. Prospective studies are required.

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    P3.21 - Poster Session 3 - Diagnosis and Staging (ID 171)

    • Event: WCLC 2013
    • Type: Poster Session
    • Track: Prevention & Epidemiology
    • Presentations: 1
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      P3.21-008 - Effective Diagnosis of Postoperative Mediastinal Recurrence of Lung Cancer by Endobronchial Ultrasound-guided Transbronchial Needle Aspiration (ID 2057)

      09:30 - 09:30  |  Author(s): S. Yoshida

      • Abstract

      Background
      Diagnosis of postoperative recurrence of lung cancer usually depends on radiologic examinations. However, the diagnostic yield of radiological examination is limited and it often times show false-positive result. Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) is well accepted modality for the pre-operative lymph node staging in patients with lung cancer; however, the efficacy of diagnosis for post-operative recurrence still remains unclear. In this study, usefulness of EBUS-TBNA pathologic confirmation of regional node metastasis was investigated in comparison with 18F-fluorodeoxyglucose positron emission tomography (FDG-PET).

      Methods
      The patients who were suspected to have lymph node recurrence by routine chest CT follow-up after radical surgery for lung cancer were retrospectively investigated, and diagnostic yields of FDG-PET and EBUS-TBNA for the recurrence were compared. The cut-off value for positive results by PET was standard uptake value (SUV max) more than 2.5. Rapid on-site cytological evaluation was performed during the procedure of EBUS-TBNA for convenience and pathological diagnosis was employed by independent pathologist. A dedicated 22-gauge needle was used for TBNA. Final decision of presence of nodal recurrence was made based on pathological findings of cancer recurrence for EBUS-TBNA sample, and that of absence of the recurrence was made based on radiologic follow-up for more than 6 month.

      Results
      A total of 40 patients were eligible for this study. The mean duration between thoracotomy and EBUS-TBNA was 23.5 months, and the median follow-up period after EBUS-TBNA was 21.8 months. Diagnostic sensitivity, specificity and accuracy of EBUS-TBNA was 100% for each whereas those of FDG-PET were 95.8%, 12.5%, and 62.5%, respectively. 24 patients with metastatic lymph node confirmed by EBUS-TBNA showed significantly unfavorable prognosis than 16 patients with negative result by EBUS-TBNA (p=0.024). 22 out of the 24 patients who diagnosed as recurrence received anti-cancer treatments properly. 14 patients with positive results by FDG-PET but negative by EBUS-TBNA were determined as negative (false positive) since no deterioration of the nodal status was confirmed by radiological follow-up. Pathological findings of these false-positive lymph nodes showed 12 anthracosis and 2 non-specific granuloma.

      Conclusion
      Minimally-invasive diagnosis by EBUS-TBNA should be indicated when regional lymph node recurrence is suspected since radiologic modalities frequently recognize benign lesions as positive. The accurate diagnosis by EBUS-TBNA reduces fertile cancer treatment and improves patient management. Figure 1