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N. Yamasaki
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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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P3.02-016 - How to Manage for Unexpected Bleeding During Thoracoscopic Anatomical Pulmonary Resection (ID 418)
09:30 - 09:30 | Author(s): N. Yamasaki
- Abstract
Background:
The number of thoracoscopic pulmonary resection has been increasing due to the less invasiveness and development of endoscopic instruments and perioperative management of the patients. However, the intraoperative unexpected bleeding cases which required emergent conversion to thoracotomy were gradually reported. The aim of this retrospective study was to review our experience, management, and the outcome of unexpected bleeding during thoracoscopic surgery.
Methods:
All patients who underwent thoracoscopic anatomical pulmonary resection for primary lung cancer were analysed. Hemostatic procedures with angiorrhaphy and/or using the sealant were defined as intraoperative unexpected bleeding in this study. The location, cause, management of injured vessels, and perioperative outcome, including blood loss, hospital stay, the rate of morbidity and mortality were investigated to compare those without vessel injured.
Results:
From 2007 to 2014, a total of 241 thoracoscopic anatomical pulmonary resection was performed. 20 (8.3%) cases were required hemostatic procedures with angiorrhaphy and/or using the sealant. 15 (75%) cases of 20 were converted to thoracotomy. Injured vessels were pulmonary artery (n=13), vein (n=3), azygous vein (n=3), and superior vena cava (n=1), respectively. In pulmonary artery, the injury was seen in first branch (n=5) and small branches to right upper lobe (n=5). The main causes of injured vessels were related to the technical problems of energy devices and staplers. 16 (80%) cases were direct suture, ligation or division of injured vessels, and 3 cases were successfully controlled by TachoSil without converted to thoracotomy. Blood loss of 20 cases ranged from 150-2160 (median, 500) ml. 6 (30%) were administered with blood transfusion. Perioperative 5 comorbidities were identified in 4 patients, consisted of prolonged air leak in 2 patients and atrial fibrillation, transient recurrent laryngeal nerve palsy, and chylothorax in each patient. No mortality was identified in this study. The difference between vessel injured and non-injured patients in operation time (285 vs 235 minutes, average, p=0.003) and blood loss (804 vs 121 ml, average, p<0.001) were significant, but perioperative comorbidities including respiratory and cardiovascular complications and the duration of chest tube insertion (4.5 vs 3.5 days, average, p=0.20) and postoperative hospital stay (12.7 days vs 11.0 days, average, p=0.08) were not significant.
Conclusion:
The frequency of unexpected bleeding in this study was relatively high, but the management and the outcome of patients in this study were feasible in terms of safety. TachoSil is a useful sealant to be used next step for bleeding. For surgeons, it should be establish algorithms for this catastrophic intraoperative complication during thoracoscopic pulmonary resection.
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P3.02-023 - Surgical Outcomes of Lung Cancer Combined With Interstitial Pneumonia. - Single Institutional Report - (ID 1102)
09:30 - 09:30 | Author(s): N. Yamasaki
- Abstract
Background:
Several studies have reported that acute exacervation (AE) of idiopathic interstitial pneumonia (IIP) can occur after lung resection for patients with non-small cell lung cancer (NSCLC), though the strategy of the perioperative management is controversial.
Methods:
We examined our institutional data about the lung cancer patients from June 1994 through October 2013 at Nagasaki University Hospital in a retrospective manner.
Results:
A total of patients who underwent lung resection for NSCLC(1701 cases) was investigated, 58 had IIP, for an incidence rate of 3.8%. The majority of patients were men (52 cases, 89.6%) and ex- or current smokers (53 cases, 91.3%), and the average of Packs per year was 54.1 (range 30-150). Squamous cell carcinoma was the most common type of lung cancer (23 cases, 39.6%), and the second common type was adenocarcinoma (22 cases, 37.9%). Surgical procedure was wedge resection in 12 cases, segmentectomy in 6 cases, lobectomy in 39 cases, pneumonectomy in 1 case, respectively. 6 cases(10.3%) had AE of IIP following lung resection, 3 cases(50%) of those patient died in the hospital. The univariate analysis and multivariate analysis were carried out to identify possible risk factors for AE. The univariate analysis identified LDH and bleeding amount. Multivariate analysis further identified only LDH. As a treatment for AE, we performed steroid pulse therapy and administration of Neutrophil elastase inhibitor. In some cases that no effect was given by such treatments, we performed direct hemoperfusion with a polymyxin B immobilized fiber column and administered immunosuppressant.
Conclusion:
Patients with lung cancer combined with IIP increases the risk of chest surgery, and the prognosis of them is poor. Because the prediction of AE is often difficult, surgery and perioperative management should be done very carefully.
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P3.03 - Poster Session/ Treatment of Locoregional Disease – NSCLC (ID 214)
- Event: WCLC 2015
- Type: Poster
- Track: Treatment of Locoregional Disease – NSCLC
- Presentations: 1
- Moderators:
- Coordinates: 9/09/2015, 09:30 - 17:00, Exhibit Hall (Hall B+C)
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P3.03-033 - Management of Clinical T3-4 Locally Advanced Non-Small-Cell Lung Cancer (ID 1324)
09:30 - 09:30 | Author(s): N. Yamasaki
- Abstract
Background:
Several studies of trimodality therapy for locally advanced lung cancer invvasing neighboring structures including SST were reported. They resulted in high rates of pathological complete response and better survival than previous reports. The aim of this study was to retrospectively review our experience of patients for clinical T3-T4 lung cancer.
Methods:
Between January 2000 and March 2014, 52 patients underwent surgical complete resection for locally advanced clinical T3-T4 non-small cell lung cancer. Also, we are conducting a phase II trial from 2011 to evaluate induction chemoradiotherapy using cisplatin and TS-1 combined concurrent radiotherapy (40Gy) followed by surgery would improve the survival of these patients. The extent of chest wall involvement was limited to the parietal pleura, pm1 (T3 in the same lobe) and pm2 (T4 in another lobe beyond the interlobe) were excluded in this study. Patients were divided into three groups. In the initial surgery group (IS group, n=35), patients underwent surgery without induction therapy. In the chemotherapy group (CT group, n=4), patients were received chemotherapy followed by surgery, and in chemoradiotehrapy group (CRT group, n=13), patient were received chemoradiotherapy followed by surgery.
Results:
The median age was 64 years old (range, 41-83). Patients with T3 were in 42 (chest wall : n=30, pericardium : n=5, diaphragm : n=4, main bronchus : n=3 ), and with T4 were in 10 (left atrium : n=2, carina : n=2, vertebra : n=2, esophagus : n=1, subclavian artery : n=1, superior vena cava : n=1, mediastinal fat : n=1), respectively. The histological types included 21 squamous cell carcinoma, 16 adenocarcinoma, 4 large cell carcinoma, 4 pleomorphic carcinoma, and 7 other types. All patients underwent complete resection. The 3- and 5-year overall survival rate was 61.5% and 17.5%, respectively in this series. The 3-and 5-year survival rate in patients with T3 was 65.3%, 20.8%, while that with T4 was 48.0%, 0%, respectively. There was no significant difference in survival rate between them (p=0.1454). The prognosis in the N0 disease was significant better than N1-2 disease (p=0.0073). Multivariate analysis showed N0 disease was independent factor of a favorable prognosis (p=0.046). In the CRT group, patients with T3 disease was in 9, and T4 in 4. Induction therapy was completed in all 13 candidates (100%), and 5 (38%) had a complete response, 8(62%) had a partial response in the pathological examinations. The 3-year survival rate in the CRT group was 69.2%. The prognosis in the CRT group was better than the IS plus CT group, but there was no significant difference between the group. Although there were no locoregional recurrences after surgery in the CRT group, 4 patients experienced major postoperative complications and 1 patient who underwent combined resection of both chest wall and superior vena cava with reconstruction by artificial materials died of septic shock.
Conclusion:
Multimodality therapy consisted of 2 cycle chemotherapy with concurrent 40 Gy of radiation for clinical T3-4 locally advanced lung cancer showed be feasible and good local control. However, the criteria for selecting patients should be mature, especially patients using artificial material.
