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T. Schmid
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P1.08 - Poster Session with Presenters Present (ID 460)
- Event: WCLC 2016
- Type: Poster Presenters Present
- Track: Surgery
- Presentations: 3
- Moderators:
- Coordinates: 12/05/2016, 14:30 - 15:45, Hall B (Poster Area)
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P1.08-010 - Octogenarians Perform Equally to Younger Patients in Lung Cancer Surgery (ID 4653)
14:30 - 14:30 | Author(s): T. Schmid
- Abstract
Background:
Due to prolonged life expectancy, more patients aged 80 years or older will be diagnosed with lung cancer and eventually undergo anatomic lung resection. This study was performed to evaluate outcome in surgically treated octogenarians compared to younger patients.
Methods:
The institutional database of all consecutive patients treated between 2009 and 2015 was analysed. The age cut-off was set at 80 years. Perioperative and follow-up data were compared between the two groups.
Results:
A total of 453 patients were treated by a VATS approach at our center for proven NSCLC. 28 (6.2%) patients were aged 80 or older. There was no difference in gender distribution, clinical T stage, preoperative FEV1/FVC and preoperative haemoglobin values. Clinical N stage was higher in the octogenarians (p=0.049). Median operative time was 175 minutes in the younger patients compared to 156 minutes in the octogenarians (p=0.104). Neither tumor diameter nor distribution of tumor histology showed any significant difference between the two groups. Postoperative haemoglobin values as a surrogate parameter for intraoperative complications were comparable between the groups. Median hospital stay was 10 days in both groups (p=0.634). There was no in-hospital mortality in the octogenarians. Disease free (72.1 vs. 58.4 months, p=0.673) and overall survival (81.7 vs. 83.8 months, p=0.456) did not show any significant difference between octogenarians and younger patients. Figure 1
Conclusion:
Lung resection can safely be performed in selected octogenarians with acceptable morbidity and low mortality rates. In our experience it is even as safe as in younger patients. Our data adds evidence that in such patients potentially curative treatment should not be withheld.
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P1.08-041 - Disease Free and Overall Survival is Equal in Open and VATS Resection for Early Lung Cancer in a Multivariate Analysis (ID 4644)
14:30 - 14:30 | Author(s): T. Schmid
- Abstract
Background:
Video-assisted thoracic surgery (VATS) has become a valid alternative to open resection for lung cancer treatment. However, robust data on the oncologic equality are still missing. This study evaluates disease free and overall survival for patients with early stage (cN0) lung cancer treated either with open or VATS resection.
Methods:
A total of 359 patients with early stage (cN0) lung cancer with available survival data in our institutional database were treated between 2004 and 2015. VATS was introduced in 2009, since that time all clinically nodal negative patients were treated with an intended VATS approach.
Results:
There were 198 male patients; median age was 65 (range 38-85) years. 256 (71.3%) patients were treated with a minimally invasive approach. There were significantly more female patients (p=0.002) and lower pT-stages (p=0.002) in the VATS group. Nodal upstaging was found in 19.1% in the VATS group and 23.3% in the open group (p=0.486). 5-year disease free survival was 61.2% in the VATS group and 63.8% in the open group (p=0.492). 5-year overall survival was 84.3% in the VATS group and 73.3% in the open group (p=0.139), Figure 1. In a multivariate analysis including age, gender, pT-status, pN-status and surgical approach, none of the factors proofed to independently predict disease free survival. In overall survival, a positive pN status was found to be the only independent negative prognostic factor (HR: 2.2, 95% CI: 1.2-4.1). Figure 1
Conclusion:
Overall and disease free survival are not influenced by the type of surgical approach. Due to perioperative benefits with shorter length of hospital stay and less complications, a minimally invasive approach as the gold standard of surgical treatment for clinically nodal negative lung cancer patients should be advocated.
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P1.08-042 - Overall Survival and Tumor Recurrence after VATS Lobectomy of N1 Positive NSCLC is Equal to Open Resection (ID 4721)
14:30 - 14:30 | Author(s): T. Schmid
- Abstract
Background:
Video-assisted thoracoscopic surgery (VATS) is an accepted alternative to open resection for early stage non-small cell lung cancer. This study was performed to analyze survival after primary VATS anatomic resection for nodal positive NSCLC compared to an open approach.
Methods:
The prospective institutional VATS database was searched for pN1 patients after primary surgery for NSCLC (62/504 patients between February 2009 and December 2015). Exclusion criteria were neoadjuvant treatment and conversion to thoracotomy. Demographics and survival were compared to a historic group of N1 positive patients, who underwent primary open surgery via a standard posterolateral thoracotomy for lung cancer between 2002 and 2007 (57 patients).
Results:
Age (65 vs 61.5 years), gender and stage distribution (UICC IIA vs >IIA) did not differ between the VATS and open group. Half of the patients in the VATS group had clinical stage N0 (31/62) confirmed by PET-CT. More people received adjuvant therapy after VATS lobectomy (50/62 vs 31/57, p=0.003). Median follow up was 22 months in the VATS group and 47 months in the open group (p<0.0001). Disease recurrence occurred in 16/62 and 22/57 patients after a median of 13 and 12 months, respectively, (p=0.1692). Overall survival did not differ between the two groups (Figure 1, log rank, p=0.4006). No survival difference was found between unforeseen and clinically evident nodal positive patients in the VATS group (p=0.9686). Figure 1
Conclusion:
VATS lobectomy in nodal positive lung cancer patients is oncologically equal to open resection with similar survival and recurrence rates. Half of the lymph node metastases have been missed by clinical staging. Interestingly, the higher rate of patients receiving adjuvant chemotherapy after VATS lobectomy did not result in significant better survival.
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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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P3.04-019 - Nodal Upstaging in cN0 Lung Cancer is More Influenced by Tumor Size Than the Surgical Approach (ID 4651)
14:30 - 14:30 | Author(s): T. Schmid
- Abstract
Background:
Several studies reported a lower rate of nodal upstaging in patients undergoing Video-assisted-thoracoscopic-surgery (VATS) anatomic resections compared to patients treated with an open resection. Aim of this analysis was to investigate nodal upstaging in cases treated by VATS or an open approach and to delineate predictive factors in a large consecutive cohort of patients.
Methods:
NSCLC patients with cN0 status treated between 2004 and 2015 were included in this retrospective analysis. Tumors were reevaluated with regards to tumor location: a tumor was classified “central”, if it had contact to the main bronchus or first segmental branch in a CT scan or was visible during bronchoscopy. All others were classified “peripheral”. VATS was introduced in 2009, since that time all clinically nodal negative patients were treated with an intended VATS approach.
Results:
Surgery was performed in 370 cN0 patients: 257 (69.5%) VATS and 113 (30.5%) open resections. 49 lesions (13.2%) were classified as central tumors. Nodal upstaging was detected in 73 (19.7%) patients. The rate of upstaging was 19.1% and 21.2% in VATS and open resection, respectively (p=0.629). There was significantly more upstaging in centrally located tumors with thoracotomy (33.3% vs. 10.3%, p=0.045). No difference was found in peripherally located tumors (18.5% vs. 20.2%, p=0.73). cT stage was significantly higher in thoracotomy patients (p<0.001) and was also associated with a higher rate of upstaging. No difference between VATS and open resection was observed in the different tumor stages (cT1: 14.7% vs. 10.9%, p=0.478; cT2: 30.5% vs. 27.1%, p=0.698; cT3: 28.6% vs. 50, p=0.285). However, there was a trend towards larger tumorsize in centrally located tumors with thoracotomy (p=0.062).
Conclusion:
According to our analysis VATS is not associated with reduced rates of nodal upstaging. cT status was a predictive factor for nodal upstaging. The higher rate of nodal upstaging in centrally located tumors with open resection might be biased by a larger tumor size.
