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Y. Tsushima



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    O13 - Limited Resections (ID 101)

    • Event: WCLC 2013
    • Type: Oral Abstract Session
    • Track: Surgery
    • Presentations: 1
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      O13.02 - Is the Limited Surgical Resection Appropriate for Non-Small Cell Lung Cancers More than 2 cm in a Diameter? - Proposed Surgical Indication by the Presence of Ground-glass Opacity of The Tumor on Thin-section CT scan (ID 3266)

      10:40 - 10:50  |  Author(s): Y. Tsushima

      • Abstract
      • Presentation
      • Slides

      Background
      The size of solid component is much more important for predicting survival than maximum tumor dimension on thin-section CT scan in lung cancer. Moreover, the presence of ground-glass nodule (GGN) is the other significant predictor of pathologic lymph node-positive status. Our previous study showed that tumors with the absence of GGN, i.e. pure-solid, have more pathologically invasive nature than tumors with the presence of GGN, i.e. part-solid, even if both tumors have the same size of solid component on thin section CT. Therefore, it could be estimated that part-solid tumors with the small size of solid component have less frequency of nodal involvement, regardless of the maximum tumor dimension for resectable lung cancer patients.

      Methods
      Between February 2008 and April 2013, 306 consecutive patients with part-solid tumors that measured less than 30 mm in diameter of solid component and had clinically negative nodal involvement (cN0) on thin-section CT underwent surgical resection at our hospital. The findings of preoperative thin-section CT scan were reviewed for all 306 patients and part-solid tumors were defined as a tumor containing both solid and GGN component. Consolidation tumor ration (CTR) of those tumors showed 0 < CTR <1.0 and both pure GGN and pure solid tumors were excluded from this study. Univariate and multivariate analyses were performed by the logistic regression procedure to determine the relationship between pathological lymph node positive status and clinical or radiological findings.

      Results
      Of the 306 patients, 14 (4.6%) had pathological lymph node metastasis. Nodal involvement was observed in 3(1.9%) out of 156 patients with the maximum tumor dimension less than 20mm, i.e. cT1a tumors, 5 (4.4%) out of 113 cT1b tumors and 6 (16.2%) out of 37 cT2a tumors. The size of solid component on thin-section CT scan and consolidation tumor ratio (CTR) were significant predictors of pathological nodal involvement in both univariate and multivariate analysis (p<0.05, respectively). Part-solid tumors with the size of solid component ≤ 17mm and CTR ≤ 0.7, which were obtained as cutoff values of predicting pathological lymph node metastasis based on the result of Receiver operating characteristics curves, 1(1.4%) in 73 patients with these criteria had pathological lymph node positive status even in the c-T1b and c-T2a part-solid tumors on thin-section CT scan.

      Conclusion
      Among part-solid tumors with cN0 status, even cT1b and cT2a tumors with small size of solid component on thin-section CT scan have less frequency of nodal involvement and less invasive nature on pathological examination. These tumors could be candidates for limited surgical resection such as segmentectomy with nodal dissection only when enough surgical margin is warranted.

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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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      P2.07-050 - Short term preoperative efficacy of tiotropium for patients with resectable lung cancer and chronic obstractive pulmonary disease: Preliminary results of one arm prospective study (ID 3472)

      09:30 - 09:30  |  Author(s): Y. Tsushima

      • Abstract

      Background
      It was reported that in chronic obstructive pulmonary disease (COPD) patients, tiotropium improves lung function. However diagnosis of COPD is often made during evaluation of patients with lung cancer for surgical intervention and the efficacy of tiotropium for these patients is unclear. Thus a prospective study is needed to investigate it.

      Methods
      A prospective study was conducted on patients undergoing pulmonary resection for lung cancer with COPD (ratio of forced expiratory volume in 1 second (FEV~1~)/ forced vital capacity (FVC) less than 70%) between July 2011 and January 2012. Patients with a known history of asthma, chronic respiratory disease other than COPD were excluded. Primary endpoint was evaluating the incidence of postoperative complication. Secondary endpoints were improvement of pulmonary function tests after more than 1-week treatment using tiotropium preoperatively.

      Results
      Of 168 lung cancer patients for six months, 21 (12.5%) patients with COPD were enrolled. Pulmonary complications (prolonged air leak; 4 (19.0%), sputum retention; 2 (9.5%), hypoxia needing transient home oxygen therapy; 2 (9.5%)) were observed in seven (33.3%), although there was no critical complication such as acute respiratory failure and no side-effect related tiotropium. Treatment of tiotropium resulted in a significant improvement of FVC (pre-FVC 2.96±0.70 vs post-FVC 3.18±0.58; p=0.005) and FEV1 (pre-FEV~1~ 1.78±0.44 vs post FEV~1~ 1.91±0.18; p=0.0003), but there was no significant difference between pre-RV (residual volume) / TLC (total lung capacity)% and post-RV/TLC% ( 108.8±20.1 vs 102.4±16.1; p=0.237).

      Conclusion
      In this prospective study, we were safely able to use tiotropium without critical complication and it improved FVC and FEV~1~ in patients with COPD. But it did not improve RV/TLC% statistically and there remains doubt about efficacy of titropium. We thought that there is a problem of compliance in inhalation drug and need to reveal the population in which tiotropium was effective, and then we should perform a prospective randomized control trial.

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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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      P3.07-043 - Pneumonectomy, bronchoplasty, pulmonary arterioplasty, and combined resections of the superior vena cava are feasible even in salvage surgery after treated lung cancer (ID 3084)

      09:30 - 09:30  |  Author(s): Y. Tsushima

      • Abstract

      Background
      Salvage therapy could be indicated for residual tumor and local recurrence of treated lung cancer. However, there is no report of the meaning of making full use of bronchoplasty, pulmonary arterioplasty, and combined resections of superior vena cava (SVC) in salvage surgery for lung cancer. In this study, we investigated perioperative complications of the salvage surgery for lung cancer according to the mode of operations.

      Methods
      We retrospectively reviewed 1320 consecutive patients who underwent lung resection for lung cancer at our institution from January 2008 to May 2013 and surveyed 18 salvage surgery cases among them. The mode of operation, perioperative complication and long-term outcome were investigated in detail.

      Results
      Twelve salvage surgical therapies were indicated for residual tumor after 10 chemotherapy and two chemoradiotherapy cases, and another six salvage surgeries were indicated for local recurrence after chemoradiotherapy. Radiation dose was 45 – 66Gy in seven chemoradiotherapy cases and 140Gy of proton therapy in one case. The number of mode of operation was as follows; one pneumonectomy with carinal resection, three pneumonectomies, one lobectomy with bronchoplasty and pulmonary arterioplasty and combined resection of the SVC (triple plasty), one lobectomy with bronchoplasty and combined resection of the SVC (double plasty), one sleeve bilobectomy, two sleeve lobectomies, eight lobectomies and one wedge resection(Table 1). Median operation time was 178.5 minutes (range 80-395). Median intra-operative blood loss was 130ml (range 5-1720). Average duration of hospitalization days after salvage surgery was 10.5 days. Regarding to operation time, intra-operative blood loss, and hospitalization days after operation, there was no significant difference between salvage surgery and conventional lung resection at our institute. Post-operative complications were as follows; three empyemas, three pneumonias, two pleural fistulas, and one chylothorax. We had to make an open window for one empyema case, but another complications were recovered safely and there was no 30-day mortality. Median follow-up was 9.5 months. There was no local recurrence but there were three distant metastases cases after salvage surgery. The longest survivor without recurrence after salvage surgery survives for 31 months.Figure 1

      Conclusion
      There were no critical complications and mortality in salvage surgeries after chemotherapy and chemoradiotherapy for lung cancer. Pneumonectomy, bronchoplasty, pulmonary arterioplasty and combined resections of the SVC are feasible even in salvage surgery for treated lung cancer.