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K. Kolbanov
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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)
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P1.08-078 - Does Surgery Have Real Benefit in Resectable Oligometastatic NSCLC? (ID 4106)
14:30 - 14:30 | Author(s): K. Kolbanov
- Abstract
Background:
The prognosis in patients with distant metastases of NSCLC is generally poor. Surgical resection of isolated distant metastases in NSCLC patients is not widely accepted and chemotherapy is usually administered. The study was aimed to evaluate the long-term results and prognosis after surgical resection of oligometastases in NSCLC patients.
Methods:
139 patients with isolated distant metastases of NSCLC (M1a – 38, M1b – 101) operated on in our clinic from 1998 to 2011 were included in the retrospective trial from the prospective database. Solitary brain metastasis was diagnosed in 82, pleural metastases – in 21, contralateral lung – in 17, adrenal metastases – in 11, others – in 8 patients. Synchronous metastases were detected in 61 (43,9%), metachronous – in 78 (56,1%) patients. In patients with pleural dissemination lung resection with pleurectomy followed by PDT was carried out. The primary lung cancer was completely resected in all cases. Surgery included pneumonectomy – in 17, lobectomy/bilobectomy – in 112 and sublobar resection – in 10 patients. Median follow up is 52 month.
Results:
Postoperative complications were registered in 10 (7,2%) patients, mortality – 2,2%. Median survival after pulmonary resection and removal of brain metastasis was 23,0 months, contralateral lung resection – 12,0, after lung resection with pleurectomy – 11,0 and adrenalectomy – 9,0 months. 5-year survival after lung resection and brain metastasectomy was 20,6%, contralateral lung resection – 12,0%, lung resection and pleurectomy (limited pleural spread) – 10,7%. No one survived more than 2 years after adrenalectomy. Survival of patients in N0-1 cases was significantly better in all groups: after brain metastasectomy - 34,5% vs 0%, contralateral lung resection – 28,0% vs 0%, pleural dissemination – 4,7% vs 0% in N2 positive patients with median survival 19,0 and 8,0; 15,0 and 8,0; 23,0 and 10,0 months respectively. Overall survival was worse in synchronous group if compare with metachronous detection: after brain metastasectomy 10,0% and 19,8%; contralateral lung resection 0% and 32,0% with median survival 18,0 and 25,0; 11,0 and 21,0 months respectively. Multivariate analysis confirmed that positive N2 status (p<0.001) and synchronous detection of oligometastatic disease (p=0.002) were independent unfavorable prognostic factors.
Conclusion:
Aggressive surgery in patients with oligometastatic NSCLC is justified in selected patients with solitary brain, contralateral lung metastasis and limited pleural dissemination, especially in N0-1cases and metachronous disease. Surgical resection should be whenever avoided in patients with oligometastatic lung cancer and positive N2 status.
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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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P3.04-020 - Segmentectomy in Patients with Pulmonary Malignancies Using 3D-CT Reconstruction and Bronchovascular Separation (ID 4107)
14:30 - 14:30 | Author(s): K. Kolbanov
- Abstract
Background:
Progress in diagnostics and surgery in thoracic oncology is associated with increasing number of patients-candidates for sublobar anatomic pulmonary resection. Vascular variability of pulmonary segments anatomy requires special tools for individual preoperative planning.
Methods:
84 patients who underwent segmentectomy due to low pulmonary function, severe comorbidity, previous history of lung resection and metastatic lesion were included at the retrospective trial from prospectively collected database. Inclusion criteria were clinical T1aN0M0 peripheral non-small cell lung cancer (NSCLC) measuring ≤2 cm (n=23) and resectable pulmonary metastases not suitable for wedge resection due to deep parenchymal location (n=61). Segmentectomies were divided into typical (where parenchymal division involves 2 planes) and atypical (more complex and technically demanding, when the segmental excision involves 3 planes). 19 patients underwent VATS segmentectomy. Three-dimensional computed tomography (3D-CT) with bronchovascular separation was used preoperatively in 32 patients from October 2014 to May 2016. Mortality, morbidity, proportion of typical versus atypical and VATS versus open segmentectomies in two groups: with or without 3D-CT bronchovascular reconstruction, were compared.
Results:
There was no mortality in whole group. Morbidity rate was 14% not exceeding grade 3a according thoracic mortality and morbidity (TMM) score. The difference in morbidity rate was not statistically significant between two groups (15,3% and 12,5%; p=0,64) The most common complication was prolonged air leak > 7 days (8%). 3D-CT powered by separation of arterial, venous and bronchial structures enabled surgeons to perform atypical segmentectomies and use VATS approach more often (37% vs 4% and 42% vs 16%, respectively). 7 atypical segmentectomies were performed by VATS due to 3D-CT reconstruction with bronchovascular separation.
Conclusion:
3D-CT reconstruction with bronchovascular separation provides precise preoperative planning of individual pulmonary segments anatomy and enables to increase the proportion of atypical and VATS sublobar anatomic pulmonary resections.
