Author of

• 11595

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  P2.07 - Poster Session 2 - Surgery (ID 190)

  • Event: WCLC 2013
  • Type: Poster Session
  • Track: Surgery
  • Presentations: 1
  • Moderators:
  • Coordinates: 10/29/2013, 09:30 - 16:30, Exhibit Hall, Ground Level

  • 11618

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    P2.07-023 - Extended sleeve lobectomy after induction chemoradiotherapy for locally advanced non-small cell lung cancer (ID 2013)

    09:30 - 09:30  |  Author(s): H. Yamamoto
    • Abstract

    Background
    An extended sleeve lobectomy is a useful procedure so as to spare the lung parenchyma. However, the resection of the bronchus can cause an increment in the tension at the site of the anastomosis and mismatches in the size of the bronchial orifices. Induction chemoradiotherapy (CRT) followed by surgery is a therapeutic option for locally advanced non-small cell lung cancer (NSCLC). Induction CRT, especially radiotherapy, has a negative effect on bronchial healing in the bronchial stump or anastomosis in a pulmonary resection.

    Methods
    The medical records were reviewed for nine NSCLC patients who underwent extended sleeve lobectomy after CRT between December 2007 and January 2013. Disease stage was evaluated with imaging analyses, including enhanced chest computed tomography (CT) scan, brain magnetic resonance imaging, positron emission tomography-CT scan and bronchoscopy. Induction CRT was performed for eight cases using cisplatin and docetaxel with concurrent thoracic radiation. For one patient who had synchronous laryngeal cancer, 5-fluorouracil and nedaplatin were used as chemotherapy. The radiation dose was 46 or 40 Gy using a conventional fractionation (2 Gy/day). Patients without progressive disease or good general condition underwent surgery. The bronchial anastomosis was basically wrapped with an omental pedicled flap or pericardial fat pad with prophylactic intent. The pre- and postoperative first-second forced expiratory volume was measured. The overall survival (OS) and the disease-free survival (DFS) were calculated from the date of initialing induction CRT until the date of death or the last follow-up for OS and until confirmed death of any cause or recurrence at local or distant site for DFS. The survival curve was calculated by the Kaplan-Meier method.

    Results
    The median patient age was 60 years (range, 50 to 73 years). There were seven men and two women. The histological subtype was squamous cell carcinoma in six patients and adenocarcinoma in three patients. Five patients had clinical stage (c-stage) IIIA, two patients had c-stage IIIB, and two patients had c-stage IIB. The radiation dose was 46 Gy in seven patients and 40 Gy in two patients. An extended sleeve lobectomy was performed for the left lingular division and the lower lobe in four patients, the right upper lobe and trachea in one patient, the right upper lobe, carina and trachea in one patient, the right middle and lower lobe in one patient, the right upper and middle lobe and the carina in one patient, and the right upper lobe and superior segment of the lower lobe in one patient. While no postoperative 90-day deaths occurred in this series, one case developed a bronchopleural fistula on postoperative day (POD) 25 and one case developed a bronchovascular fistula on POD 163. No cases of local recurrence occurred. The first-second forced expiratory volume before surgery was 2.52 ± 0.58 L (mean ± standard deviation), while that after surgery was 1.80 ± 0.66 L. The 2-year overall survival and disease-free survival rates were 63.5% and 47.6%, respectively.

    Conclusion
    Our experience suggests that an extended sleeve lobectomy after induction CRT is feasible, but careful patient selection and perioperative management is mandatory.