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T. Nakagawa
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P1.08 - Poster Session with Presenters Present (ID 460)
- Event: WCLC 2016
- Type: Poster Presenters Present
- Track: Surgery
- Presentations: 2
- Moderators:
- Coordinates: 12/05/2016, 14:30 - 15:45, Hall B (Poster Area)
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P1.08-053 - Thoracoscopic Partial Resection for Peripheral Pulmonary Nodules without Using Stapler (ID 3700)
14:30 - 14:30 | Author(s): T. Nakagawa
- Abstract
Background:
Advances in radiologic studies, such as high resolution computed tomography (HRCT), have enabled frequent detection of small lung nodules. Accordingly, opportunity for sublobar resections for small lesions has increased. Recently, we have introduced thoracoscopic partial resection for peripheral pulmonary small nodules without using stapler to reduce the cost of operation.
Methods:
After detecting the peripheral nodules, partial resection was performed with electrocautery and two different methods of surface sealing were followed. Coagulation method (C method) with SOFT COAG alone and Coagulation-suturing method (CS method) with SOFT COAG combined with continuous suturing by an absorbable barbed suture. The clinical outcome of the two methods was retrospectively compared in this study.
Results:
C method was performed in 19 lesions of 18 cases and CS method was performed in 17 lesions of 16 cases. Primary lung cancer was most frequent as 19 lesions of 18 cases. There was no significant difference between the two groups in size and depth of the lesions. Operation time was significantly longer in CS method than in C method. Postoperative air leakage was complicated to 4 cases in C method and one of them needed re-do surgery, whereas only one case in CS method had temporary air leakage. Postoperative computed tomography revealed cavitation in 3 cases of C method and in 4 cases of CS method all without related symptoms. There was no local recurrence in resected sites.
Conclusion:
C method was technically easy to perform, but air leakage may be possibly prolonged after surgery. CS method may have an advantage of less air leakage than C method, but technical learning is important to shorten operation time.
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P1.08-061 - Clinical Experience of Rib Resection for Lung Cancer with Chest Wall Invasion Using a Pneumatic High Speed Power Drill System (ID 3843)
14:30 - 14:30 | Author(s): T. Nakagawa
- Abstract
Background:
Rib resection is sometimes required for chest wall tumors or lung cancer with localized chest wall invasion.There are some reports on thoracoscopic rib resection, which may be much less invasive and provide an excellent surgical view of the target. We have used a pneumatic high speed power drill system, commonly used as a dentist’s drill, in order to be accomplished less invasive thoracoscopic rib resection.
Methods:
A pneumatic high speed power drill (HiLAN® GA520R B Braun Aesculap, Tokyo, Japan) was inserted in the thoracic cavity and the head of the drill, which has a diamond burr, adequately attached to the rib surface. The rib was then sheared by whittling until dislocated. Cut pieces of bone tissue were removed by suction with saline dropping on the head of the drill. Soft tissue including the parietal pleura, intercostal muscle and vessels were dissected using power devices or an electrical scalpel after cutting the ribs.Figure 1
Results:
From February 2014 to date, we have experienced seven patients with chest wall resection using a drill. Hybrid-VATS was performed for four of the patients, while complete-VATS was performed for the remaining three patients.There were no intraoperative issues and the postoperative courses were all eventless. The mean follow-up period is about 13 months. Two of the 7 patients had recurrence of the disease with distant metastasis. However, there is no local recurrence.
Conclusion:
A pneumatic high speed power drill is easy to handle and useful for rib resection in lung cancer surgery and possibly better suited even when compared to the Gigli saw or endoscopic rib cutter for selective patients undergoing thoracoscopic surgery. Rib resection using a drill might be less invasive procedure.
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P2.06 - Poster Session with Presenters Present (ID 467)
- Event: WCLC 2016
- Type: Poster Presenters Present
- Track: Scientific Co-Operation/Research Groups (Clinical Trials in Progress should be submitted in this category)
- Presentations: 1
- Moderators:
- Coordinates: 12/06/2016, 14:30 - 15:45, Hall B (Poster Area)
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P2.06-037 - A Feasibility Study of Concurrent Chemoradiation Followed by Surgery for Pathologically-Proven Clinical IIIA-N2 Non-Small Cell Lung Cancer (ID 4700)
14:30 - 14:30 | Author(s): T. Nakagawa
- Abstract
Background:
The standard treatment for stage IIIA-N2 non-small cell lung cancer (NSCLC) is definitive chemoradiotherapy. However, the strategy for resectable IIIA-N2 disease remains controversial. This phase II multi-institutional trial (WJOG5308L) was designed to evaluate the feasibility for neoadjuvant chemoradiotherapy followed by surgery (tri-modality) in patients with pathologically-proven N2 NSCLC.
Methods:
Patients with resectable IIIA-N2 (pathologically proven N2) were eligible. Neoadjuvant chemotherapy consisted of weekly paclitaxel (40mg/m2) plus carboplatin (AUC 2) for 5 weeks. Concurrent radiotherapy (RT) was prescribed with 50 Gy in 25 fractions to the mediastinum and primary tumor. Patients underwent surgical resection, unless PD disease, followed by two courses of paclitaxel plus carboplatin consolidation chemotherapy. The primary endpoint was complete resection (R0) rate. Secondary endpoints were progression-free survival, overall survival, response rate, protocol completion rate and morbidity/mortality.
Results:
From December 2011 to November 2013, 40 patients were enrolled. The median follow-up time was 33.97 (7.2-46.3) months. The radiological responses to neoadjuvant chemoradiotherapy were as follows: no complete response, 23 (57.5%) partial response, 16 (40.0%) stable disease and one (2.5%) progression. 34 of 40 patients underwent surgery. Reasons for not receiving surgery were radiation pneumonitis (n=4), PD (n=1) and delay of protocol (n=1). Of 34 resections, twenty-eight were lobectomies, three were bilobectomies, two were pneumonectomies, and one was exploratory thoracotomy. Six patients underwent sleeve lobectomy, without any complication. Thirty-two patients achieved the primary endpoint, complete resection (R0) rate 80% (32/40). Pathological complete response (PCR) rate was 30.3%. Finally, 20 patients (50%) completed all planned tri-modality treatment. The 2-year progression-free and overall survival rates for all patients were 62.5% and 75.0%, respectively. The 2-year recurrence-free survival for patients who received R0 was 61.5%. Neutropenia was the main grade 3/4 morbidity and tolerable. 30-days mortality rate was 0 %. Two treat-related deaths (late bronchial fistula) occurred. Sites of first disease recurrences were mediastinal lymphnodes (n=9, 22.5%), lung (n=8, 20%), and brain (n=4, 10%).
Conclusion:
Tri-modality treatment, neoadjuvant chemoradiotherapy followed by surgery, for resectable IIIA-N2 NSCLC seems feasible and promising.
