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C. Nwogu



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

      09:30 - 09:30  |  Author(s): C. Nwogu

      • 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.

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    P3.24 - Poster Session 3 - Supportive Care (ID 160)

    • Event: WCLC 2013
    • Type: Poster Session
    • Track: Supportive Care
    • Presentations: 1
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      P3.24-055 - Neo-adjuvant Versus Adjuvant Treatment for Non-small Cell Lung Cancer (NSCLC) Less Than Clinical N2 Disease (ID 829)

      09:30 - 09:30  |  Author(s): C. Nwogu

      • Abstract

      Background
      Increasingly, neoadjuvant therapy is being used for the treatment of NSCLC. While several randomized controlled trials have been performed to evaluate this approach in patients with N2 disease, limited data exists in patients less than N2 disease. We examined our experience with neoadjuvant therapy in our institution and compared it to patients receiving adjuvant therapy.

      Methods
      This retrospective analysis included patients with less than clinical N2 disease that underwent curative surgical resection and received either neoadjuvant or adjuvant chemotherapy with or without radiation therapy from 2005 to 2010. Patient characteristics, peri-operative outcomes and survival data were analyzed for patients receiving neoadjuvant vs. adjuvant therapy. Comparison of categorical, continuous and survival variables across groups were performed using chi-square, t-test and Kaplan-Meier methods respectively. Multivariate analyses were performed using Cox Regression analyses.

      Results
      130 patients fulfilled the inclusion criteria – 54 patients had neoadjuvant therapy and 76 patients had adjuvant therapy. Patient characteristics in both comparison groups are summarized in Table 1. No peri-operative deaths were seen in either group. There was no statistically significant difference between the comparison groups with respect to age, gender, race, histology and grade. Patients with neoadjuvant therapy had a higher clinical stage than those that had adjuvant therapy. At a median follow-up of 41.5 months, there was no difference in the overall survival and recurrence free survival of patients in both groups in univariate analyses and in multivariate analyses after adjusting for potentially confounding variables including stage. Patients treated with neoadjuvant therapy had a higher rate of empyema (11.1% vs. 0%; p=0.004) and a trend toward increased arrhythmia and pneumonia than those treated with adjuvant therapy.

      Conclusion
      For NSCLC less than N2 disease, neoadjuvant therapy increases peri-operative morbidity without an improvement in overall and recurrence free survival. For this patient population, the role of neo-adjuvant therapy is questionable. Figure 1Figure 2