Author of

• 12495

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  P3.07 - Poster Session 3 - Surgery (ID 193)

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

  • 12505

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    P3.07-010 - Thoracoscopic Pneumonectomy - An 11 year experience (ID 931)

    09:30 - 09:30  |  Author(s): T.L. Demmy
    • Abstract

    Background
    While VATS lobectomy yields enhanced recovery and fewer complications than open approaches, outcomes for thoracoscopic pneumonectomy are understood less well.

    Methods
    107 consecutive pneumonectomy cases performed at a comprehensive cancer center from 1/2002 to 12/2012 were studied retrospectively. 40 cases were open, while 50 Successful and 17 VATS conversions were grouped together for an intent-to-treat analysis.

    Results
    Preoperative characteristics were similar except for greater age (64±10 vs. 60±10, p=0.07), female sex (57 vs. 30% p=0.007) and preoperative comorbidities in the VATS group (Table 1). Right side was similar (46% vs. 45% open, p=0.9) as was disease extent (Early Stage 1&2, 72 vs. 61% open, p = 0.24). Neoadjuvant chemotherapy use also was similar (34 vs. 40% open). All VATS pneumonectomy pulmonary arteries were controlled safely and there were no intraoperative deaths from bleeding or other technical mishaps. Pursuing a VATS approach yielded a similar number of complications (3.1±2.6 vs. 3.0±2.6, p=0.8). Completion pneumonectomy (13%VATS/8% open) patients stayed longer (median 7.5 vs. 5 days, p=0.05) but had better survival (median not reached vs 27 months, p=0.05) largely because of more favorable stage distribution. A learning curve was evident as the rate of successful VATS pneumonectomy rose from 26% to 63% by the second half of the series (p<0.001). VATS patients started adjuvant chemotherapy an average of 39 days earlier. Excluded from long-term analyses were 7 pneumonectomies (3% VATS/13% open) for emergent indications like hemoptysis that led to 3 deaths. Stage-matched pneumonectomy cases had similar survival curves between the two groups. Multivariate logistic regression analyses found only age and pathologic stage as independent predictors of overall and disease-free survival. While the subset of patients who required conversion from VATS stayed longer (7 vs. 6 days, p=0.07), their survival curves were superimposable on open operations for all stages. In fact, achieving a successful VATS pneumonectomy demonstrated a trend toward improved survival compared to open/converted cases for early stage patients (median survival 80 vs. 27 months, p=0.07).

    Procedure	VATS n=67	Open n =40	p
    Predicted Post-resection Diffusing Capacity	38±10%	36±12%	0.6
    Comorbidities (number)	3.2±1.7	2.3±1.3	0.001
    Nodes retrieved	25±14	24±11	0.87
    OR time (min -median)	289	225	0.001
    EBL (ml -median)	400	325	0.84
    ICU (days -median)	3	2	0.24
    Hospital Stay (days -median)	5	6	0.2
    Non-Emergent Case Hospital Death	8%	6%	0.7
    Stage 1&2 Survival (mo -median)	26	26	0.74

    Conclusion
    Attempting VATS pneumonectomy appears to be a safe strategy that does not compromise short-term or long-term oncologic goals.