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C. Bareggi



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

    • Event: WCLC 2016
    • Type: Poster Presenters Present
    • Track: Surgery
    • Presentations: 1
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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): C. Bareggi

      • 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): C. Bareggi

      • 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.