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Y. Wang
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P1.08 - Poster Session with Presenters Present (ID 460)
- Event: WCLC 2016
- Type: Poster Presenters Present
- Track: Surgery
- Presentations: 1
- Moderators:
- Coordinates: 12/05/2016, 14:30 - 15:45, Hall B (Poster Area)
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P1.08-004 - Prediction of Surgical Outcome by Modeling Based on Risk Factors of Morbidity Following Pulmonary Resection for Lung Cancer in the Elderly (ID 5394)
14:30 - 14:30 | Author(s): Y. Wang
- Abstract
Background:
Surgical treatment for elderly patients with lung cancer presents more challenges compared with general population. The aim of the study was to predict surgical outcome following pulmonary resection in the elderly with lung cancer by developing a clinical model.
Methods:
Clinical records of 525 patients aged over 70 years who underwent pulmonary resection for lung cancer in a single center were reviewed. Patients were divided into three ordered categories of surgical outcome according to the Clavien–Dindo classification. Using a development cohort of 401 patients, an ordinal logistic regression was performed to develop a prediction model for surgical outcome. The model was internally validated by bootstrap method and externally validated by another cohort of 124 patients. Two previous models were tested as benchmarks of our model.
Results:
The model was developed based on five risk factors of morbidity: ASA classification (p<0.001), pulmonary disease (p=0.001), tumor size (p=0.011), tumor location (p=0.015) and surgical approach (p=0.036). C-statistics of the model was similar to bootstrapping one. Hosmer-Lemeshow test showed a good goodness-of-fit. In external validation the performance of our model was superior to the two previous models. Figure 1Prediction Performance of the Present and Previous Models
Models c-statistic (95%CI) Hosmer-Lemeshow test The present model 0.75 (0.69-0.80) 0.674 After bootstrapping 0.75 (0.68-0.80) 0.671 External validation 0.70 (0.64-0.75) 0.382 Kates M, et al (2009) 0.63 (0.57-0.69) 0.115 Poullis M, et al (2013) 0.61 (0.54-0.67) 0.091
Conclusion:
Our model displayed an acceptable ability to predict surgical outcome in elderly patients undergoing pulmonary resection for lung cancer.
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P3.04 - Poster Session with Presenters Present (ID 474)
- Event: WCLC 2016
- Type: Poster Presenters Present
- Track: Surgery
- Presentations: 1
- Moderators:
- Coordinates: 12/07/2016, 14:30 - 15:45, Hall B (Poster Area)
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P3.04-031 - Intermittent Chest Tube Clamping May Shorten Chest Tube Duration and Postoperative Hospital Stay of Lung Cancer Surgery (ID 5034)
14:30 - 14:30 | Author(s): Y. Wang
- Abstract
Background:
Postoperative pleural drainage markedly influences the length of postoperative hospital stay and financial costs of medical care. Previous report documented the safety of chest tube clamping before removal. This study aims to see if intermittent chest tube clamping might shorten tube duration and hospital stay of lung cancer surgery.
Methods:
From July 2012 to June 2016, 285 consecutive cases of operable lung cancer patients undergoing lobectomy and systematic mediastinal lymphadenectomy were retrospectively analyzed. Chest tube management protocol was modified since January 2014 according to the literature. Before that time, patients (Group control, n=63) were managed with gravity drainage (water seal only and without suction). After that, patients (Group clamping, n=222) were managed with gravity drainage during first 24 hours after surgery (water seal only and without suction). Once a radiograph confirmed the reexpansion of the lung and no air leak detected, the tube would then be clamped intermittently at 24 hours after surgery and nurses checked the patients every 6 hours. If no abnormal symptoms developed (such as severe dyspnea, pneumothorax, subcutaneous emphysema), then unclamped 30 minutes to record drainage volume every 24 hours. The tube would be removed if drainage was normal and its volume was less than 200 ml in both group. All clinical data were recorded. Propensity score matching at 1:1 ratio was applied to balance variables potentially affecting chest tube duration between Group Clamping and Group Control. Analyses were performed to compare chest tube duration and postoperative hospital stay between the two groups. Variables linked with chest tube duration were gender, operation side, VATS and chylothorax, which were assessed using multivariable logistic regression analysis in whole cohort.
Results:
The rate of thoracocentesis after chest tube removal did not increase in Group Clamping compared with Group Control in whole cohort (0.5% vs. 1.5%, P=0.386). The rates of pyrexia were also comparable in two groups (2.3% vs. 3.2%, P=0.685). After propensity score matching, 61 cases remained in each group. Group Clamping showed shorter chest tube duration (4.0 days vs. 4.8 days, P=0.001) and shorter postoperative stay (5.7 days vs. 6.4 days, P=0.025) compared with Group Control. Factors significantly associated with shorter chest tube duration were being female, left lobectomy, chest tube clamping, VATS and absence of chylothorax (P<0.05).
Conclusion:
This study suggests that chest tube clamping may decrease the length of chest tube duration and postoperative hospital stay while maintaining patient safety.
