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F. Petrella



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

    • Event: WCLC 2016
    • Type: Poster Presenters Present
    • Track: Surgery
    • Presentations: 5
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      P1.08-023 - Analysis of Prognostic Factors and Long-Term Results of Primary Pulmonary Pleomorphic Carcinoma (ID 6191)

      14:30 - 14:30  |  Author(s): F. Petrella

      • Abstract

      Background:
      Pulmonary pleomorphic carcinoma (PPC) is a rare neoplasm and factors affecting survival after pulmonary resection, as well as its clinical and pathologic characteristics, are still unknown. For a better understanding we reviewed our large experience with these patients.

      Methods:
      Records of patients 134 patients (108 men, median age: 65 years) with diagnosis of PPC operated on between January 1999 and May 2015 were retrospectively analyzed from a prospective database; survival was calculated by using Kaplan-Meier method.

      Results:
      86 patients (64.1%) were smokers. Median tumor size was 4.8 cm (range, 0.6 to 23 cm). Initial histological diagnosis was NSCLC in 88 cases, adenocarcinoma in 21, pleomorphic tumor in 13, and no diagnosis in 12. 62 patients (46.0%) received a platinum based induction chemotherapy. Surgery included lobectomy in 87 patients (65%), pneumonectomy in 27 (20.1%), wedge resection in 12 (8.9%), and segmentectomy in 8 (6%). Four patients (3%) had an incomplete resection. Postoperative staging included 45 stage I (33.6%), 47 stage II (35.1%), and 42 stage III (31.3%). 64 patients (47.7%) received adjuvant treatment. Five-year overall survival and disease-free survival were 36.6% and 35.7%, respectively (median, 28 and 18 months, respectively). Recurrences occurred in 76 patients (56.7%) most of them at distant sites (47/76 [61.8%]). Factors associated with increased survival included no smoke habit (p=.02), no induction therapy (p=.04), right side disease (p=.01); pathological stage I (p=.001), no metastatic lymph nodes (p=.001), and adjuvant treatment (p=.003). At multivariate analysis, pN0, pstage I, and adjuvant treatment were independent prognostic factors (p=.002, 95%CI: 1.54-6.43; p=.003, 95%CI: 1.23-7.32, p=.001, 95%CI: 1.26-4.72, respectively).

      Conclusion:
      PPC are aggressive tumors usually presented as a large lesion in males. Preoperative diagnosis remains difficult. Prognosis is poor, and distant recurrence rate is high. Long-term survival can be achieved in early stage disease and by an appropriate adjuvant therapy.

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      P1.08-024 - Surgical Outcomes and Prognostic Factors in the Treatment of Adenosquamous Carcinoma of the Lung (ID 6200)

      14:30 - 14:30  |  Author(s): F. Petrella

      • Abstract

      Background:
      Adenosquamous carcinoma (ASC) of the lung is a rare pulmonary disease with poor prognosis. We evaluated the prognostic factors and outcome of this tumour.

      Methods:
      Records of patients undergoing pulmonary resection for ASC between 1998 through 2015 were reviewed using a prospective database. 124 patients (91 men, median age, 67 years) with ASC were operated on.

      Results:
      Surgical procedures included 3 exploratory thoracotomies, 6 bilobectomies, 76 lobectomies, 19 pneumonectomies, 12 wedges resections, and 8 segmentectomies. 38 patients (30.6%) received induction therapy (IT). 30-day mortality rate was 4.0% (n=5). Morbidity occurred in 29 (23.4%) patients; six patients (4.8%) had major complications: 2 bronchopleural fistulae, 3 haemothoraces, and 1 chylothorax. 23 patients (18.6%) had early minor complications: 14 (11.2%) atrial fibrillation, and 9 (7.2%) pulmonary (5 prolonged air leaks, 2 atelectasis and 2 subcutaneous emphysema). Overall 5-year survival rate and disease-free survival was 27.4% and 36.0%, respectively. 47 (37.9%) patients relapsed: 14 had brain metastases, 10 bone, 8 lung, and 15 at other sites. Patients <65 years (p=0.01), with early pathological stage (p=0.0001), without nodal involvement (p=0.001) had the best prognosis. At multivariate analysis, age <65 years (p=0.009 [95% CI 2.53-8.29]), early pathological stage (p=0.04 [95% CI 1.66-7.88]), and no nodal involvement (p=0.03 [95% CI 2.01-6.42]) influenced survival.

      Conclusion:
      ASCs are uncommon and extremely aggressive tumours. Young patients (<65 years) with early stage tumour and no nodal involvement have the best prognosis.

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      P1.08-031 - Non-Small Cell Lung Cancer in Patients Aged 40 Years or Younger: Clinical, Surgical, and Long-Term Outcomes (ID 6201)

      14:30 - 14:30  |  Author(s): F. Petrella

      • Abstract

      Background:
      Non-small cell lung cancer (NSCLC) in young patients is uncommon and has clinical characteristics different from that in older patients. We report the outcomes of a single institutional experience in the treatment of young patients with NSCLC.

      Methods:
      Records of patients with NSCLC operated on between 1998 and 2013 were retrospectively analyzed from a prospective database.We identify two groups: G1 with patients resected with intention-to-treat, and G2 who underwent only diagnostic surgical procedures due to advanced NSCLC. There were 47 patients (27 in G1, 13 men; and 20 in G2, 10 men) with a median age of 37 years in G1 (range, 16-40) and 38 years in G2 (range, 24-40).Survival was calculated by using Kaplan-Meier method.

      Results:
      Induction treatment (IT) was administered in 17 patients in G1; no patient in G2 received IT. In G1, surgery included 3 wedges, 1 segmentectomy, 18 lobectomies, 5 pneumonectomies; in G2, surgery included 3 explorative thoracotomies, 8 nodal biopsies, and 6 pleural biopsies. Histological diagnosis was adenocarcinoma in all the patients. Median tumor size was 22 mm (range, 5-125) in G1. Postoperative staging in G1 included 11 stage I, 4 stage II, and 12 stage III; all patients in G2 were stage IV and none was alive at 5-year. Five-year overall survival and disease-free survival in G1 were 55% and 51%, respectively (median, 30 and 16 months, respectively). In G1 recurrence occurred in 12 patients most of them at extra-thoracic sites (9/12 [75%]). Factors associated with increased survival in G1 included IT (p=.0002) and right side disease (p=.01). At multivariate analysis in G1, IT [p=.03 (95% CI: 0.67-0.89)] influenced long-term survival.

      Conclusion:
      In our experience, all young patients had adenocarcinoma with a predominance of women. Patients receiving pulmonary resection for curative intent had the best prognosis and among these, those receiving IT had the best long-term survival.

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      P1.08-080 - Bilobectomy for Lung Cancer: Analysis of Indications, Postoperative Results and Long-term Outcomes (ID 6220)

      14:30 - 14:30  |  Author(s): F. Petrella

      • Abstract

      Background:
      Bilobectomy for lung cancer is considered a high risk procedure for the increased postoperative complication rate and the negative impact on survival. We analyzed the safety and the oncologic results of this procedure.

      Methods:
      We retrospectively reviewed patients who underwent bilobectomy for lung cancer between October 1998 and December 2015. Age, gender, bilobectomy type and indication, complications, pathology, stage, and survival were analyzed.

      Results:
      Bilobectomy was performed on 166 patients (122 men; mean age, 62 years. There were 87 upper-middle and 79 middle-lower bilobectomies. Indications were tumor extending across the fissure in 37 (22.3%) patients, endobronchial tumor in 44 (26.5%), extrinsic tumor or nodal invasion of bronchus intermedius in 70 (42.2%), and vascular invasion in 15 (10%). An extended resection was performed in 25 patients (15.1%). Induction therapy was performed in 47 patients (28.3%). Thirty-day mortality was 1.2% (n=2). Overall morbidity was 43.4%. Mean chest tube persistence was 7 days (range, 6-46 days). Overall 5-year survival was 58%. Significance differences in survival were observed among different stages (stage I, 70%; stage II, 55%; stage III, 40%; p=.0003) and the N status (N0, 69%; N1, 56%; N2, 40%; p=.0005). Extended procedure (p=.0003) and superior bilobectomy (p=.0008) adversely influenced survival. Multivariate analysis demonstrated that an extended resection (p=.01), an advanced N disease (p=.02), and an upper-mild lobectomy (p=.02) adversely affected prognosis.

      Conclusion:
      Bilobectomy is associated with a low mortality and an increased morbidity. Survival relates to disease stage and N factor. Optimal prognosis is obtained in patients with lower-middle lobectomy without extension of the resection.

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      P1.08-082 - Surgical Techniques and Long-Term Results of the Pulmonary Artery Reconstruction in Patients with Lung Cancer (ID 6216)

      14:30 - 14:30  |  Author(s): F. Petrella

      • Abstract

      Background:
      Pulmonary artery (PA) reconstruction for lung cancer is technically feasible with low morbidity and mortality. We assessed our experience with partial or circumferential resection of PA during lung resection.

      Methods:
      Between 1998 and 2015, we performed PA angioplasty in 150 patients with lung cancer. Seventy-five patients received induction chemotherapy (IC). Partial PA resection was performed in 146 cases. PA reconstruction was performed by running suture in 113 and using a pericardial patch in 33. A circumferential PA resection was performed in 4 patients and reconstruction was made in PTFE and by a custom-made bovine pericardial conduit each. Bronchial sleeve resection was associated in 56 cases. Thirty-two patients had stage I disease, 43 stage II, 51 IIIA, and 17 IIIB. Seven patients had a complete response after IC.

      Results:
      Thirty-day mortality was 3.3% (n=5); two of these patients had a massive hemoptysis leading to death; 33 patients had pulmonary complications, 28 cardiac, 17 air leaks. Overall 5- and 10-year survival was 50% and 39%, respectively. Five- and 10-year survival for stages I and II versus stage III was, respectively, 66% versus 32% and 56% versus 20% (p<.0001). Five-year survival was 61% for N0 and N1 nodal involvement versus 28% for N2, respectively; 10-year survival was 45% versus 28% (p=.001). IC did not influence survival. Multivariate analysis yielded advanced stage, N2 status, and squamous cell carcinoma as negative prognostic factors.

      Conclusion:
      PA reconstruction is safe, with excellent long-term survival. Our results support this technique as an effective option to pneumonectomy for patients with lung cancer.

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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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      P3.03-059 - Diaphragmatic and Pericardial Reconstruction by Heterologous Pericardial Patch after Extrapleural Pneumonectomy for Mesothelioma (ID 6208)

      14:30 - 14:30  |  Author(s): F. Petrella

      • Abstract

      Background:
      Extrapleural pneumonectomy (EPP) with resection of pericardium and diaphragm offers acceptable therapeutic results in patients with mesothelioma. We analyzed efficacy of biological bovine pericardial patch (BPP) versus artificial materials (Marlex/Goretex, Vicryl) for diaphragmatic and pericardial reconstruction after EPP.

      Methods:
      We reviewed 61 patients operated on for EPP after induction chemotherapy (01/2013-05/2015). We distinguished two groups: Group 1, in which BPP 12x25 cm patch was used, and Group 2, in which artificial materials were used. Technically, diaphragmatic patch was sewn circumferentially to diaphragmatic remnant posteriorly, chest wall anteriorly, and hiatal musculature medially by separated stitches. Pericardial patch was sewn circumferentially to pericardial remnant by separated stitches.

      Results:
      Group 1, 27 patients (44.3%), right side in 14 (51.8%) and left in 13 (48.2%): BPP was used for pericardium and diaphragm in 21, only pericardium in 4, and only diaphragm in 2. Group 2, 34 patients (53.7%), right in 15 (44.1%) and left in 19 (55.9%): Marlex/Goretex for diaphragm and Vicryl for pericardium in 28, Goretex for diaphragm and Vicryl for pericardium in 2, only Goretex or Vicryl for both in 1 and 3 patients, respectively. In Group 1, a single BPP was used for pericardial and double patch for diaphragm. Two patients (7.4%) in Group 1 and 2 (5.9%) in Group 2 (p=0.56), all on the left side, had early dehiscence of diaphragmatic prosthesis requiring re-intervention. No early complication for pericardial patch. At follow-up (Group 1: median 14.7 mo., range 0-72; Group 2, median 14.2 mo., range 0-76), no late complications were observed for pericardial/diaphragmatic prostheses.

      Conclusion:
      Reconstruction of pericardium and diaphragm using BPP, is safe, easy, and may be considered a viable alternative to synthetic materials. Attention should be used in fixing the BPP on the left side (costo-phrenic angle) to avoid BPP dehiscence and visceral herniation.