Virtual Library
Start Your Search
R. Manser
Author of
-
+
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)
-
+
P1.08-038 - VATS Sub-Lobar Anatomical Pulmonary Resections: Indications and Outcomes in Thoracic Oncological Practice (ID 5815)
14:30 - 14:30 | Author(s): R. Manser
- Abstract
Background:
In patients with limited pulmonary reserve, sub-lobar anatomic pulmonary resection (SLAPR) may have reduced perioperative morbidity and mortality and additionally may better preserve long-term pulmonary function compared to lobectomy. SLAPR may also mitigate the oncological deficiencies of wedge resection. However, the safety and oncological efficacy of video assisted thoracoscopic surgical (VATS) SLAPR has not been well described. We therefore audited our recent experience of VATS SLAPR to evaluate: indications, safety, and oncological outcomes.
Methods:
We retrospectively reviewed a prospectively maintained database to identify all consecutive patients who underwent planned VATS SLAPR with curative intent. Demographics, co-morbidities, indications and treatment outcomes were retrieved, with supplemental chart review where necessary.
Results:
Seventy seven VATS SLAPRs were performed between December 2010 and May 2016. Median age of patients was 67 (44-83) years and 57% (44/77) were male. The majority (47/77; 61%) of SLAPRs were undertaken for resection of NSCLC. Indications for SLAPR in NSCLC patients included: inadequate pulmonary reserve (DLCO <60% or predicted post-operative DLCO <40%) in 21/47 (44%), excessive (≥2 major) comorbidities in 18/47 (38%), advanced age (≥75 years) in 13/47 (27%) or a combination of these factors precluding lobectomy. In patients with metastatic 22(28%) and benign 8(10%) nodules, indications included proximity to vascular structures or inability to palpate lesion precluding simple wedge resections. Superior segmentectomy (22/77; 28%) and lingula sparing left upper lobectomy (17/77; 22%) were the commonest SLAPRs performed. Seventy one (92%) were completed via VATS. Emergency conversion occurred in one case. Morbidity rate was 30% (23/77) and 30 day mortality rate was 2.5% (2/77). Pre-operative DLCO was not associated with post-operative pulmonary complication (P=0.7) or length of hospital stay (P=0.20). In the NSCLC sub group, all patients were clinically stage I; R0 resection was achieved in 100%. Median of 12(4-27) nodes were excised with a nodal upstaging rate of 25% (12/47) and pathological stage was I in 65%. Median disease free survival (DFS) was 40 months and median overall survival (OS) was not reached. Loco regional recurrence rate was zero. Pre-operative DLCO dichotomised using median did not correlate with OS (P=0.8) or DFS (P=0.29).
Conclusion:
A variety of VATS SLAPRs may be performed safely with acceptable morbidity and mortality in high risk patients. Complete microscopic resection and adequate nodal dissection can be achieved. Although larger studies and longer follow is needed, our findings suggest that VATS SLAPR achieves comparable oncological outcomes in high risk patients to formal lobectomy.
