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A. Palleschi



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    P1.05 - Poster Session with Presenters Present (ID 457)

    • Event: WCLC 2016
    • Type: Poster Presenters Present
    • Track: Early Stage NSCLC
    • Presentations: 1
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      P1.05-062 - Is Lung Microwave Thermoablation a Valid Alternative to Surgery in High Risk Patients? A Propensity Match Analysis (ID 5648)

      14:30 - 14:30  |  Author(s): A. Palleschi

      • Abstract

      Background:
      Surgery is considered the best treatment in Stage I non small cell lung cancer. Local non–surgical therapies (radiotherapy, thermoablation) are becoming valid alternative to surgery in high risk patients (poor cardiac or pulmonary function, elderly patients).

      Methods:
      Patients submitted in our Department to Microwave thermoablation (MW) were compared with a cohort of patient submitted to lung lobectomy in the same period of time, abstracted from our database with a propensity match method. The study was retrospective on data recorded prospectively. Primary endpoint was overall survival.

      Results:
      From June 2009 to October 2014 in our Department, 36 patients underwent MW for Stage I non-small cell lung cancer (NSCLC) or lung metastasis. From our database were abstracted 41 patients with a propensity match method, submitted to lung lobectomy. Two groups were comparable by age, diagnosis, stage and gender. MW group resulted elder than Surgery group (75,5 vs 72,2 years; p<0,001). Lesion diameter was greater in MW group (20,9 vs 26,5 cm; p<0,001). Overall survival, analyzed by actuarial survival curve, was comparable (Logrank test p=0,2).

      Conclusion:
      In our experience, in a propensity match evaluation, lung MW thermoablation resulted non inferior than lung lobectomy in terms of overall survival. Even though surgery is still considered the first choice in patients affected by Stage I NSCLC or lung metastasis, lung MW thermoablation is confirmed as a valid alternative treatment in high risk patients. Randomized prospective studies are mandatory.

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    P1.08 - Poster Session with Presenters Present (ID 460)

    • Event: WCLC 2016
    • Type: Poster Presenters Present
    • Track: Surgery
    • Presentations: 2
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      P1.08-050 - VATS Lobectomy in Locally Advanced NSCLC: A Single Centre Experience (ID 4793)

      14:30 - 14:30  |  Author(s): A. Palleschi

      • Abstract

      Background:
      VATS lobectomy has become the gold standard in early stage lung cancer treatment, but its role is still debated in case of locally advanced disease (tumor larger than 5 cm, chest wall involvement, hilar adenopathy, need for sleeve resection). The aim of this study was to evaluate the main differences between VATS lobectomy performed for early stage NSCLC and the ones performed for locally advanced disease.

      Methods:
      We retrospectively analyzed patients that underwent VATS lobectomy for tumor resection in our centre, from July 2011 till December 2015. Patients included in the study were similar for demographic characteristics and for number of resected lymph nodes. We performed 136 VATS lobectomies: 124 following standard indications (group A); 12 following “extended” indications (group B). Group B is composed by: 3 VATS sleeve lobectomy; 3 VATS lobectomy followed by limited chest wall resection (hybrid technique); 6 VATS lobectomy for NSCLC larger than 5cm. We evaluated the conversion rate to open surgery, the intraoperative blood loss, the operation lenght, the chest drain maintenance and the length of hospitalization.

      Results:
      Intra-operative conversion rate was higher in group A than in Group B, but not statistically different (13,7% vs 9%; p>0,05). No differences were detected in the intraoperative blood loss. Instead we observed differences in terms of operation length, of chest drain maintenance (4,8 vs 7,4 days; p<0,05) and of length of hospitalization (6,2 vs 10,3 days; p<0,05).

      Conclusion:
      We believe that VATS lobectomy can be proposed even in “complex cases”. Minimal invasive approach didn’t increase the intraoperative blood loss and didn’t imply a significant impact in terms of intraoperative conversion to open surgery. We detected differences in the operation length and in chest drain maintenance. Other studies with an higher population of “complex cases” are needed, but we are trustful that VATS lobectomy indications will be extended in the short term.

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      P1.08-051 - VATS Lobectomy Combined with Limited Thoracotomy for Treatment of Superior Sulcus Tumors (ID 5195)

      14:30 - 14:30  |  Author(s): A. Palleschi

      • Abstract

      Background:
      Despite the increasing of VATS procedures even for locally advanced NSCLC, Pancoast tumors have been rarely approached with VATS combined with chest wall resection. This report describes an hybrid surgical technique to approach "en block" chest resection and pulmonary lobectomy for superior sulcus tumors

      Methods:
      We present two cases of patients referred to our Institution. A female patient affected by right anterior Pancoast tumor surgically staged as cT4N0M0 for suspected anonymous vein invasion, underwent induction therapy with four cycles of cisplatin and Pemetrexed plus 60 Gy irradiation, with satisfactory tumor reduction. The surgical operation comprised an initial VATS approach to the hilar structures followed by a limited C-shaped anterior contra-incision; finally, the right upper lobe "en block" with the anterior part of the first and second rib was removed. The second case is a 57-year-old man, affected by a cT3N0M0 posterior Pancoast tumor, treated with induction chemoradiotherapy prior to the hybrid surgical approach. After thoracoscopic pleural cavity inspection, an upper right VATS lobectomy by a 3-port standard approach was performed. The chest wall was resected through a limited paravertebral incision, allowing the extraction of the lobe together with the rib segments. The posterior chest wall defect was repaired with a synthetic patch.

      Results:
      The postoperative period was uneventful in both cases, and the pain never exceed a score of 4 on a visual analogue scale. The patients were discharged respectively 9 and 11 days after surgery. Pathological results revealed in both cases nonvital tumor cells in the specimen (ypT0N0M0). The patients are free from disease and post-thoracotomy syndrome at 14 and 18 months' follow-up

      Conclusion:
      VATS combined with thoracotomy approach leads to asses with precision the thoracic wall resection and reduce surgical trauma with very good results in term of postoperative morbidity. We strongly support the “VATS observation first” philosophy, to exclude previously undetected pleural dissemination and to precisely define the tumor location. Further experiences are needed to validate the role of VATS lobectomy in the multidisciplinary management of Pancoast tumor

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    P3.03 - Poster Session with Presenters Present (ID 473)

    • Event: WCLC 2016
    • Type: Poster Presenters Present
    • Track: Mesothelioma/Thymic Malignancies/Esophageal Cancer/Other Thoracic Malignancies
    • Presentations: 1
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      P3.03-009 - Role of microRNAs as Biomarkers of Malignant Mesothelioma in Patients with Pleural Effusion (ID 5172)

      14:30 - 14:30  |  Author(s): A. Palleschi

      • Abstract

      Background:
      Pleural effusion (PE) is a common clinical presentation of a large number of different diseases including malignant pleural mesothelioma (MPM). The approach to patients with PE is not simple and pre-operative cytological examinations or even intra-operative frozen sections are often unhelpful in the differential diagnosis. This fact makes critical the management of PE, especially when MPM is suspected. Changes in the expression of microRNAs (miRNAs) have been implicated in several diseases, making miRNAs attractive biomarkers. Our aim was to determine whether a miRNA signature in plasma or in Exhaled Breath Condensate (EBC) may help to discriminate between PE related to MPM and PE of patients affected by other pleural diseases (NM).

      Methods:
      We prospectively enrolled consecutive patients with PE from suspected MPM, scheduled for thoracoscopic pleural biopsy. We recorded clinical data and definitive histological diagnosis. Exclusion criteria were age< 18 years, history of previous tumor or immunological disorder. Ethics committee approval was achieved. Written informed consent was obtained from all participants. We collected a sample of plasma and EBC from each patient before the biopsy. We screened 733 miRNAs in blood and EBC by high-throughput Open Array and compared their expression in the two groups. We used a multiple linear regression model adjusted for four principal variables (age, sex, BMI and smoking habits) to compare MPM and NM.

      Results:
      We enrolled 32 patients; the figure below shows main clinical data. Figure 1 After miRNA screening, we identified 3 miRNAs which were upregulated in EBC and 44 in plasma. In particular, in EBC: miR-378, miR-206, miR-9 with a fold-change (FC) of 1.54, 1.4, 1.23 respectively (p-value= 0.019, 0.04 and 0.04 respectively). The most significant in plasma was miR-489 (FC= 1.35, p-value= 0.0001).



      Conclusion:
      We identified a miRNAs panel that might be useful for developing a non-invasive procedure for MPM diagnosis in patients with PE.