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J. Shimada
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P3.02 - Poster Session/ Treatment of Localized Disease – NSCLC (ID 211)
- Event: WCLC 2015
- Type: Poster
- Track: Treatment of Localized Disease - NSCLC
- Presentations: 2
- Moderators:
- Coordinates: 9/09/2015, 09:30 - 17:00, Exhibit Hall (Hall B+C)
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P3.02-009 - Predictors of Prolonged Air Leak after Pulmonary Lobectomy (ID 756)
09:30 - 09:30 | Author(s): J. Shimada
- Abstract
Background:
Prolonged air leak (PAL) is a common complication, which occurs in 3% to 25% of patients undergoing pulmonary resection. PAL may cause severe morbidity such as pneumonia and empyema, and prolong the need for chest tube drainage and hospitalization. Thus, a careful perioperative management to decrease the risk of PAL is needed. The purpose of this study is to analyze the significance of various risk factors for postoperative PAL (air leak longer lasting more than 7 days) in patients undergoing pulmonary lobectomy for lung cancer.
Methods:
This study includes 134 patients who underwent pulmonary lobectomy for lung cancer between September 2009 and December 2014 at Kyoto Prefectural University of Medicine. We usually approached through video assisted thoracoscopic surgery that used a mini-thoracotomy and two ports. The divided interlober fissures and the small pleural defects causing minor air leak were covered with bioabsorbable sheet and/or fibrin glue. The patients with pulmonary air leak lasting until postoperative day 7 underwent pleurodesis. We retrospectively analyzed the perioperative variables in the two groups of the patients with PAL or without PAL. All results were expressed as mean ± standard error (patients with PAL vs patients without PAL). P-value <0.05 was considered statistically significant.
Results:
PAL occurred in 17 patients (12.7%), lasting an average of 8.9 days. The patients were 16 men and 1 woman with a mean age of 70.3 years old (58-79 years old). All patients underwent pleurodesis with successful closure of air leak and no patients required re-thoracotomy. Univariate analysis demonstrated significant independent predictors of PAL; a male predominance (94 vs 57% ;p=0.004), a high Brinkman index (960±580 vs 490±590; p=0.003), a preoperative low serum albumin level (4.0±0.7 vs 4.3±0.3 g/dl; p=0.003), and a long operative time (230±84 vs 184±53 min; p=0.045). A tendency toward a longer stapler length used for the interlober fissure division was also shown in the patient with PAL (109±61 vs 77±68 mm; p=0.064). PAL was not influenced by age, BMI, preoperative serum total protein level, preoperative hemoglobin, preoperative total lymphocyte count, %VC, FEV1.0%, resected lobe, and pleural adhesions.
Conclusion:
We report that a male, a long smoking history, a preoperative low albumin level, and a long operative time increased the risk of air leak lasting more than 7 days following lobectomy for primary lung cancer. Pleural adhesion, which had been reported to be a risk factor of PAL, was not related with PAL. Our analysis suggests that, for the sake of preventing PAL, we should pay attention to the preoperative nutritional status as well as well as surgical techniques, such as interlober fissure division in the cases that need multiple stapling to complete fissures.
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P3.02-035 - A Case of Synchronous Quintuple Lung Cancers Treated with Salvage Surgery after Treatment with Erlotinib (ID 2696)
09:30 - 09:30 | Author(s): J. Shimada
- Abstract
Background:
The detection of multiple ground glass nodules(GGNs) is increasing with improvement in the computed tomography (CT) technique. Indelible GGNs are very often indicative of atypical adenomatous hyperplasia or relatively early stage lung adenocarcinoma, so its detection and accurate diagnosis are required for appropriate treatment.
Methods:
Figure 1A 64-year-old woman with no significant medical history was referred to our hospital after an abnormal shadow was detected on chest radiograph. CT showed two part-solid GGNs in the right upper lobe(diameter: S2,9mm;S3, 5mm), two solid nodules surrounded slightly part of GGN in the right middle lobe (S4, 27mm;S5, 38mm), and one part-solid GGN in the right lower lobe(S8, 8mm).Fluorine-18-fluorodeoxyglucose positron emission tomography showed abnormal uptake in the two nodules in the middle lobe. Biopsy of the nodule in S4 was performed using a bronchoscope, and the results indicated adenocarcinoma with an EGFR exon21 (L858R) substitution mutation. The two solid nodules in the middle lobe were diagnosed as intrapulmonary metastasis in the same lobe(cT3N0M0,stageIIB). Because the patient refused surgery, two courses of combination chemotherapy with cisplatin, pemetrexed, and bevacizumab were administered, which was discontinued because of the adverse effects. Therefore, oral administration of erlotinib was started, and she showed a partial response. Fourteen months after initiation of treatment with erlotinib, salvage surgery was performed. Salvage surgery involved right middle lobe resection with preoperative lipiodol marking for GGNs, upper lobe wedge resection, and lower lobe wedge resection.
Results:
The five nodules could be resected completely with adequate resection margin. Histopathologically, all nodules were diagnosed as adenocarcinoma of the lung, with a lepidic pattern and no vascular invasion. Since the histopathological features differed slightly between nodules, the lung cancers were not diagnosed as intrapulmonary metastases but synchronous quintuple lung cancers. The final histopathological diagnosis was pT2aN0M0, stage IB lung cancer.
Conclusion:
Our findings indicate that synchronous lung cancers as well as lung intrapulmonary metastasis need to be considered in patients presenting with multiple lung nodules with even a minor GGN component, and that complete resection after treatment with erlotinib could be the appropriate treatment in such cases. EGFR tyrosine kinase inhibitor (TKI) often leads lung cancers with EGFR mutations to good response, but most tumors acquire resistance to EGFR-TKI after less than 12 months treatment. There is a possibility that salvage operation is useful after treatment of EGFR-TKI.
