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M. Tanahashi



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    O13 - Limited Resections (ID 101)

    • Event: WCLC 2013
    • Type: Oral Abstract Session
    • Track: Surgery
    • Presentations: 1
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      O13.03 - Survival of 1963 lobectomy-tolerable patients who underwent limited resection for cStage I non-small cell lung cancer (ID 1030)

      10:50 - 11:00  |  Author(s): M. Tanahashi

      • Abstract
      • Presentation
      • Slides

      Background
      Although the standard operation for lung cancer is lobectomy, precise preoperative diagnosis of the “very early” lung carcinomas may identify patients that can be treated by limited resection. Previous reports on limited resection included patients who were not candidates for lobectomy. The survival of non-small cell lung cancer (NSCLC) patients who were fit for lobectomy and underwent limited resection has not been studied in a large enough scale.

      Methods
      A nationwide multi-institutional project collected clinical data of patients who underwent limited resection (segmentectomy or partial resection) for clinical T1-2N0M0 non-small cell lung carcinoma, who were 75 years old or younger at the time of operation and were considered fit for lobectomy by the physician. Overall and disease free survival, freedom from recurrence were analyzed and factors affecting survival or recurrence were identified.

      Results
      The median age of 1963 patients was 63 years. The mean maximal diameter of the tumor was 1.4 ± 0.6 cm. The overall and recurrence free survival after limited lung resection was 93.7 % and 90.4 % at 5 years, respectively. The recurrence free proportion and local recurrence free proportion were 93.3 % and 98.4 % at 5 years, respectively. Prognostic factors in overall survival were pathologically proven lymph node metastasis, interstitial pneumonia, male gender, older age, complications (cardiac disease, diabetes etc.), radiological invasive cancer, and multiple lesions. The consolidation/tumor ratio on CT of ≤ 0.25 predicted good outcome especially in cT1aN0M0 disease. Prognosis and recurrence was not affected by the method of limited resection (segmentectomy (n=1225) or partial resection (n=738)).

      Conclusion
      If the patient was 75 years old or younger and was judged fit for lobectomy, the result of limited resection for cStage I NSCLC was excellent and was not inferior to the reported result of lobectomy for small sized NSCLC. The radiological noninvasive carcinomas rarely recur and are especially good candidates for limited resection.

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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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      P3.07-007 - Induction treatment for locally advanced lung cancer deteriorates pulmonary function (ID 366)

      09:30 - 09:30  |  Author(s): M. Tanahashi

      • Abstract

      Background
      Preoperative induction treatment combining chemotherapy or chemoradiotherapy with surgical treatment may improve the prognosis of locally advanced lung cancer patients. On the other hand, induction treatment is associated with a higher incidence of postoperative pulmonary complications. We investigated the patients who received preoperative induction treatment to assess the respiratory function before and after induction treatment, and association with postoperative respiratory complications.

      Methods
      Preoperative induction therapy followed by surgery was performed for cT3-4 or cN2-3 locally advanced lung cancer in 118 of the 1,820 patients undergoing lung cancer resection between January 1997 and December 2012. Sixty-nine patients with complete data on the respiratory function before and after preoperative induction therapy were analyzed. Pulmonary functions before and after induction therapy were analyzed. Predicted postoperative those pulmonary functions also analyzed in the patients with pulmonary complication (group PORC) and without pulmonary complications (group NPORC). Independent group t tests were performed and p value<0.05 was considered statistically significant.

      Results
      There were 58 males and 11 females and median age was 61 years old. There were 38 adenocarcinomas, 20 squamous cell carcinomas, and 11 other pathologies. There were 11 stage IIB patients, 41 stage IIIA, and 17 stage IIIB. All patients received multidisciplinary induction treatment. Forty-three patients received induction chemoradiotherapy and 26 patients received induction chemotherapy. There was no significant change in %VC, %FEV1 before and after induction therapy. %DLCO (p<0.05) and DLCO/VA (p<0.01) were significantly decreased after induction treatment. More decrease of %DLCO was observed after induction chemoradiotherapy than chemotherapy (p<0.03). After the induction treatment lobectomy was performed in 51 patients, bi-lobectomy in 7, pneumonectomy in 10, and segmentectomy in 1. Combined resection of chest wall was performed in 16 patients, vertebra in 5, left atrium in 5, superior vena cava in 2, and diaphragm in 1. Sleeve lobectomy performed in 6 patients, sleeve bi-lobectomy in 3 and sleeve pneumonectomy in 1. Complete excision rate was 91.3%. Pathological analysis revealed that the ratio of patients obtained Ef 2-3 response were 56% after chemo-radiotherapy and 27% after chemotherapy (p<0.01). Median survival rate was 44.7 months and 5-year survival rate was 36％ for all patients. Especially 5-year survival rate of patients who obtained Ef 2-3 response after chemo-radiotherapy was 67%. There was no operative death and morbidity rate was 35%. Respiratory complications occurred in 12 patients. There were 8 pneumonia patients and 4 persistent hypoxemia patients. Ppo%VC, ppo%FEV1, ppo%DLCO, and ppoDLCO/VA were significantly low in the PORC group.

      Conclusion
      Higher proportion of patients obtained Ef 2-3 response after induction chemoradiotherapy and these patients showed a more favorable prognosis. DLCO should be evaluated to select candidates for induction therapy. Predicted postoperative pulmonary function should be assessed before surgery to select patients and to avoid critical pulmonary complications.