Virtual Library
Start Your Search
Y. Shimada
Author of
-
+
P1.03 - Poster Session/ Treatment of Locoregional Disease – NSCLC (ID 212)
- Event: WCLC 2015
- Type: Poster
- Track: Treatment of Locoregional Disease – NSCLC
- Presentations: 1
- Moderators:
- Coordinates: 9/07/2015, 09:30 - 17:00, Exhibit Hall (Hall B+C)
-
+
P1.03-003 - A Clinicopathological Study of Resected Small-Sized Non-Small Cell Lung Cancer 2 cm or Less in Diameter with N2 Lymph Node Metastasis (ID 1348)
09:30 - 09:30 | Author(s): Y. Shimada
- Abstract
Background:
The detection of small-sized (≤ 2 cm) non-small cell lung cancer (NSCLC) has increased with the development of high-resolution computed tomography. The reported 5-year survival rate of T1a (≤ 2 cm) N0M0 patients is more than 80%, and that of p-T (≤ 2 cm) N2M0 patients has also steadily improved.
Methods:
Between January 1991 and December 2011, a total of 917 patients with small-sized NSCLC underwent curative pulmonary resection with systematic lymph node dissection by open thoracotomy or video-assisted thoracic surgery at our hospital. We retrospectively evaluated their postoperative clinical outcomes and survival rates. Survival was analyzed using the Kaplan-Meier method and log-rank test.
Results:
There were 57 (6.2%) patients with mediastinal lymph node metastasis (pN2 disease). The distributions of the histological types were adenocarcinoma 41 cases, squamous cell carcinoma 11, large cell carcinoma 4, and carcinoid 1. The procedures included lobectomy in 48 cases, segmentectomy in 6, and pneumonectomy in 3. The respectively status of lymph node metastasis was single station in 36 cases and multiple station in 21. Skip lymph node metastasis (no hilum lymph node metastasis) was observed in 13 cases. In 44 cases, there was both hilum lymph node and mediastinal lymph node metastases. There were 34 cases (59.6%) that were upstaged from preoperative clinical diagnosis (cN0 or N1). The median overall survival period and 5 year survival of the 57 patients with pN2 was 43.5 months and 41%. The recurrence rate was 70% (40/57) and the median disease-free interval was 41.3 months. Of the 18 patients without recurrence, 14 (77.8%) had single station mediastinal metastasis. The 5-year overall survival rates with multiple station or single station mediastinal metastases were 34.5% and 48.9%, respectively (NS). The 5-year overall survival rates with multiple (hilum and mediastinal) station lymph node metastases and only mediastinal station lymph node metastasis were 37.7% and 64.8%, respectively.
Conclusion:
This study showed that 6.2% of small-sized NSCLC had N2 disease. Moreover, 59.6% of small-sized NSCLC was upstaged from clinical diagnosis to pathological diagnosis. Single station mediastinal metastases showed a longer overall survival rate (64.8%) than multiple station mediastinal lymph node metastases. Therefore, we recommend systematic lymph node dissection for local treatment as well as accurate diagnosis. As multiple mediastinal node metastases showed an unfavorable prognosis, surgery combined with systematic treatment is recommended.
-
+
P1.04 - Poster Session/ Biology, Pathology, and Molecular Testing (ID 233)
- Event: WCLC 2015
- Type: Poster
- Track: Biology, Pathology, and Molecular Testing
- Presentations: 1
- Moderators:
- Coordinates: 9/07/2015, 09:30 - 17:00, Exhibit Hall (Hall B+C)
-
+
P1.04-035 - Clinicopathologic and Biological Characteristics of Young Age Non-Small Cell Lung Cancer (ID 2421)
09:30 - 09:30 | Author(s): Y. Shimada
- Abstract
Background:
The Japan Lung Cancer Society, Japanese Association for Chest Surgery, and Japanese Respiratory Society jointly established the Japanese Joint Committee for Lung Cancer Registration. The Japanese Joint Committee reported that number of resected lung cancer patients under 40 years of age in Japan was 101 cases of 11663 registered patients in 2004. Apparently there are many people on their 50s to 70s who was resected for treatment of lung cancer. Lung cancer in patients under 40 years old is rare. Young lung cancer patients should have specific characteristics.
Methods:
We performed 2835 operations for lung cancer for 15years from 2000 through 2014 in our hospital. Among 2835 patients with lung cancer, 47 patients were younger than 40. Among 47 patients 26 patients were male and 21 patients were female. We examined characteristics of young lung cancer patients by clinicopathologic and molecular biologic characteristics.
Results:
Among patients with operation, pathological stage IA, IB, IIA, IIB, IIIA, IIIB were 24, 6, 3, 2, 6, 5 cases, respectively. 36 cases were diagnosed as adenocarcinoma. Squamous cell carcinoma was only one case. 3 cases were diagnosed as large cell carcinoma. Most of young lung cancer cases were diagnosed as adenocarcinoma. 5-year survival of resected lung cancer patients was 74%. 5-year survival of inoperable cases was 23.8%. We will show the biological characteristics of young age lung cancer patients. 9cases showed EGFR sensitive mutation. 4 cases showed the transforming EML4-ALK fusion gene.
Conclusion:
Young lung cancer patients showed specific clinicopathologic and molecular biologic characteristics compared with the older age patients.
-
+
P2.03 - Poster Session/ Treatment of Locoregional Disease – NSCLC (ID 213)
- Event: WCLC 2015
- Type: Poster
- Track: Treatment of Locoregional Disease – NSCLC
- Presentations: 1
- Moderators:
- Coordinates: 9/08/2015, 09:30 - 17:00, Exhibit Hall (Hall B+C)
-
+
P2.03-035 - Impact of Lymph Node Involvement on Survival in Patients with Completely Resected Pulmonary Squamous Cell Carcinoma (ID 1301)
09:30 - 09:30 | Author(s): Y. Shimada
- Abstract
Background:
Lymph node involvement is an important prognostic factor in non-small cell lung cancer (NSCLC) patients. However, the prognostic impact varies among the histological types of NSCLC because of the lymph node spread pattern or other factors. We re-evaluated the impact of lymph node involvement and other clinicopathologic factors on survival in patients with pulmonary squamous cell carcinoma (SqCC) and identified high-risk patients who may benefit from additional therapy.
Methods:
Between 1990 and 2010, 530 consecutive T1-4N0-2M0 SqCC patients underwent complete resection with systematic lymph node dissection at our hospital. We statistically analyzed the association between lymph node involvement and clinicopathologic factors, as well as clinical outcomes.
Results:
The 5-year overall survival (5y-OS) rates of the patients with stages I, II, and III were 66.5%, 57.6%, and 30.0%, respectively (stage I vs stage II, NS). Multivariate survival analysis showed that patients with N2 had significant associations with unfavorable prognosis (HR = 2.58, p < 0.0001). The 5y-OS rate for N2 tumors (32.1%) was significantly worse than those for N0 and N1 tumors (63.0% and 56.6%, respectively). In stages I and II, tumor size > 5 cm, pleural invasion (PL), and age over 70 years were found to be significant independent prognostic factors by multivariate survival analysis, but lymph node status (N0 or N1) was not. Thus, tumors ≤ 5 cm without PL and tumors ≤ 3 cm with PL were classified as the new stage I (5y-OS, 69.8%) in the patients with N0 or N1, and tumors > 5 cm without PL and tumors > 3 cm with PL were classified as the new stage II (5y-OS, 45.7%). In contrast, tumors with N2 were classified as the new stage III (5y-OS, 32.1%). There was a statistically significant difference among these groups.
Conclusion:
N2 status was strongly associated with poor outcome in SqCC patients, but not N1 status. Our results indicate that lymph node status should not be incorporated into the staging system for N0-1 SqCC patients This information might prompt the design of clinical trials on additional therapy for these patients. Figure 1
-
+
P3.02 - Poster Session/ Treatment of Localized Disease – NSCLC (ID 211)
- Event: WCLC 2015
- Type: Poster
- Track: Treatment of Localized Disease - NSCLC
- Presentations: 1
- Moderators:
- Coordinates: 9/09/2015, 09:30 - 17:00, Exhibit Hall (Hall B+C)
-
+
P3.02-011 - Evaluation of a New Chest Tube Management Using Digital Air Leak Monitoring after Lung Resection (ID 2440)
09:30 - 09:30 | Author(s): Y. Shimada
- Abstract
Background:
The use of digital drainage systems after thoracic surgery is becoming accepted as a safe method. The aim of this study was to assess the effectiveness of the digital drainage system versus traditional devices on chest tube removal and air leak duration after lung resection. We report the management of a digital drainage system in patients undergoing lung resection.
Methods:
This study is retrospective study of patients undergoing anatomical lung resection (segmentectomy, lobectomy, sleeve lobectomy, or bilobectomy).145 patients who underwent lung resections for lung cancer were evaluated. Chest tubes were removed when an air leak was not evident anymore and the drained fluid was less than 200 mL/day.
Results:
These series includes 140 lobectomies, 2 sleeve lobectomies, 1 bilobectomy and 2 anatomical segmentectomies. Patients who use digital drainage system had a significantly shorter air leak duration (0.9 versus 1.7 days; p=0.037), no significance of duration of chest tube placement (4.4 versus 5.5 days; p=0.112) and no significance of chest tube placement after the air leakage disappearance (3.5 versus 3.8 days; p=0.71).
Conclusion:
Patients managed with digital drainage system experienced a shorter duration of air leak compared with those managed with traditional devices. Digital devices appear to be safe and effective and may prove to be a useful tool in the management of lung resection.
-
+
P3.08 - Poster Session/ Thymoma, Mesothelioma and Other Thoracic Malignancies (ID 226)
- Event: WCLC 2015
- Type: Poster
- Track: Thymoma, Mesothelioma and Other Thoracic Malignancies
- Presentations: 1
- Moderators:
- Coordinates: 9/09/2015, 09:30 - 17:00, Exhibit Hall (Hall B+C)
-
+
P3.08-032 - Maximizing Use of Robot-Arms in the Robot-Assisted Thoracic Surgery (ID 875)
09:30 - 09:30 | Author(s): Y. Shimada
- Abstract
Background:
We have previously reported on the importance of appropriate robot-arm settings and replacement of instrument-ports in robot-assisted thoracic surgery. Because the thoracic cavity requires a large space to access all lesions in various areas of the thoracic cavity from the apex to the diaphragm and mediastinum and the chest wall. Moreover it can be difficult manipulate the da Vinci[® ]Surgical System (Intuitive Surgical, Inc., Sunnyvale, CA) using only arms No. 1 and No. 2 depending on the tumor location. In this report, we show how robot-arm No. 3 can be used with maximum effectiveness in the da Vinci[®]-assisted thoracic surgery.
Methods:
Robot-arm No. 3 of the da Vinci® Surgical System was usually positioned on the same side of arm No. 2, and sometimes it was used as an assistant arm to avoid conflict with other arms in our previous report. We describe new effective application of robot-arm No. 3 for the da Vinci S®-assisted thoracic surgery. A 62-year-old man had an anterior mediastinal tumor suspected to be non-invasive thymoma. Instead of arm No. 1, arm No. 3 was placed in the 6th intercostal in the mid-axillary line inserted from reverse the side, rotating it behind the body of the da Vinci® Surgical System.
Results:
Robotic surgery enables access to tumors located throughout in the thoracic cavity. The time required for the da Vinci S ® -setting was 12 minutes and the console-time (the da Vinci S ®working time) was 75 minutes. Thymectomy was performed successfully, and the amount of bleeding was 68 ml, and there were no complications. The pathological findings were thymoma, Masaoka stage II.
Conclusion:
Arm No. 3 has wider range of motion than other arms because it has one more additional joint. That is the reason why arm No. 3 enables good operability and ability to reach remote lesions, such as in the apex, diaphragm, or costophrenic angle. Moreover, between the space of the camera-arm and arm No. 3 make enough working space than using arm No. 1 to avoid conflict between arms. This use of the da Vinci S ® arms should be helpful in robotic procedures for thoracic surgeons in manipulating the da Vinci S ® instrument arms. Our recent experience has taught us that arm No. 3 is extremely useful when used as the main arm instead of arm No. 1. This idea should facilitate the da Vinci S®-assisted thoracic surgery procedures as a new effective application of robot-arm No. 3.
