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Y. Arai
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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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P3.03-006 - Wide Wedge Resection with Adequate Surgical Margin for Pure GGO Lesion after Marking the Position near the Tumor with Lipiodol under a CT Scan Guide (ID 983)
09:30 - 09:30 | Author(s): Y. Arai
- Abstract
Background:
It is said that wide wedge resection of lung is suitable for the surgical method for adenocarcinoma in situ (=AIS) in lung cancer in case that surgical margin is gotten enough. If the tumor shadow in high resolution CT scan is pure ground glass opacity (=pure GGO), we can suppose the tumor to be AIS. But pure GGO lesion is often too difficult for us to recognize the localization and the border of a tumor at surgery. We had once undergone segmentectomy or lobectomy after the pure GGO lesion had progressed so as to include consolidation in the tumor as a result of several follow-up CT examinations. The technique of the lipiodol marking to lung under a CT scan guide was developed and a small lesion of lung came to be able to be marked safely. Therefore we have undergone wide wedge resection in which the surgical margin was gotten enough for expected AIS with the following modified technique of the marking.
Methods:
We have performed this technique for the pure GGO lesions which is increasing in size or in concentrations but do not have occurrence of consolidations in periodic high resolution CT scan examination. Marking technique is following. Marking is performed under local anesthesia in a CT room one day before surgery. We stab the skin at slightly remote diagonal position from right above tumor with 22G needle and push forward needlepoint to the central near side of tumor while confirming it by real-time CT scan before we inject 0.3ml of lipiodol at the central near side of tumor. The operation of marking is finished after confirming whether pneumothorax exists. Surgical technique is following. We perform this surgery by three port thoracoscopic surgery. We grasp the marked position of the lung with ring forceps under thoracoscope while confirming the lesion marked by lipiodol is located in the center of the ring by real time fluoroscopy (Mobile C-arms). Then we cut the lung along ring circumference of the forceps with automatic suture instruments. After taking out a specimen outside the body, we confirmed that the surgical margin was gotten enough by measuring the distance between the resection stump and the position of marking under fluoroscopy.
Results:
We performed wide wedge resection to 19 cases (22 lesions) with this technique between 2011 and 2014. Tumor diameter was an average of 9mm (6-13mm). Surgical margin was an average of 17mm (11-28mm). Pathological diagnosis was AIS in 19 lesions, minimally invasive adenocarcinoma in 1 lesion, atypical adenomatous hyperplasia in 1 lesion and mucinous adenocarcinoma in 1 lesion. There was one complication before surgery (pneumothorax which needed drainage after marking). We underwent left S9 segmental resection with lymph node dissection in addition for a case of mucinous adenocarcinoma.
Conclusion:
This technique is an extremely useful method when we perform the most minimally invasive surgery such as wide wedge resection for very early lung cancer before progressing because it is easy to get surgical margin enough.
