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T. Sugiyama
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P2.04 - Poster Session with Presenters Present (ID 466)
- Event: WCLC 2016
- Type: Poster Presenters Present
- Track: Mesothelioma/Thymic Malignancies/Esophageal Cancer/Other Thoracic Malignancies
- Presentations: 1
- Moderators:
- Coordinates: 12/06/2016, 14:30 - 15:45, Hall B (Poster Area)
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P2.04-004 - Thymectomy without Definitive Diagnosis Could Be Feasible in Patients with Suspicious of Thymic Epithelial Tumor (ID 4086)
14:30 - 14:30 | Author(s): T. Sugiyama
- Abstract
Background:
As for thymic epithelial tumors (TETs), National Comprehensive Cancer Network guideline has suggested that complete excision of tumor should be performed without preoperative biopsy when resectable. However, there have been very few evidences on this strategy of diagnosis and treatment. The purpose of this study is to evaluate the validity of radical resection of anterior mediastinal masses (AMMs) without pathological confirmation.
Methods:
Two hundred and fifty-eight patients with AMMs underwent surgical resection between 2004 and 2015 at the Nagoya University Hospital. Among them, 186 patients were suspected to have TETs by clinical features, serum tumor markers, and the findings of computed tomography (CT) and positron emission tomography (PET). We retrospectively reviewed cases of the patients with AMMs and evaluated the strategy of treatment for them.
Results:
Of the186 patients with suspicious of TETs, 56 patients received preoperative biopsy and had the pathological diagnosis. The method included CT-guided needle biopsy in 49 patients (26%) and video-associated thoracic surgery biopsy in 4 (2%) to plan neoadjuvant therapy and/or to distinguish from malignant lymphomas or malignant germ cell tumors, and intraoperative pathologic examination using frozen section of the tumor in 3 (1.6%). The remaining 130 patients (70%) underwent thymectomy without pathological confirmation. Among them, the tumors in 115 patients (88%) were finally diagnosed as TETs including 100 thymomas, 11 thymic carcinomas and 4 thymic carcinoids. The patients except one received complete resection. The remaining 15 patients (12%) were diagnosed as 4 thymic cysts, 4 lymphomas of mucosa-associated lymphoid tissue type (MALT), 2 bronchogenic cysts, 2 mature teratomas and 3 other tumors. Thymic cysts with thick wall in part and small MALT lymphomas with intermediate accumulation of PET were sometimes difficult to distinguish from TETs preoperatively.
Conclusion:
Eighty-eight percent of the patients with suspicious of TETs who underwent thymectomy without biopsy were accurately diagnosed and properly treated with complete resection. Thymectomy without a definitive diagnosis could be feasible in patients with suspicious of TETs when they are considered resectable, although there are some tumors such as thymic cyst and MALT lymphoma hard to distinguish from TETs.
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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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P3.04-038 - Pulmonary Resection for Metastatic Pancreaticobiliary Cancer: Can It Be Justified as a Treatment of Choice? (ID 5016)
14:30 - 14:30 | Author(s): T. Sugiyama
- Abstract
Background:
Patients with distant metastases of pancreaticobiliary cancers still have poor prognoses of 3-7% of 5-year survival, and the best reported median overall survival time (MST) of pancreatic carcinoma patients with metastatic stage IV disease treated with optimal chemotherapy was only 11 months. Surgical resection for metastatic lesions from pancreaticobiliary cancer is scarcely performed because of their malignant potential, therefore, few studies have reported on pulmonary metastasectomy for those patients. The purpose of this study is to review our experience of pulmonary resection for metastatic pancreaticobiliary cancer, and to assess whether this treatment offers them better survival.
Methods:
Between 2007 and 2015, 21 patients of pancreaticobiliary cacncer had potentially resectable pulmonary metastases after definitive resection of primary site (pancreatic cancer, n=9; cholangiocarcinoma, n= 10; gallbladder cancer, n= 2). There were 14 males and 7 females with a median age of 67 years (42-81years). The medical records were retrospectively reviewed, and the overall survival was analyzed. Disease-free interval (DFI) was defined as the time between operations for the primary cancer and the metastatic lesion.
Results:
The median DFI was 51months (4-145 months), and 11 patients had solitary pulmonary lesion, 5 had double lesions, and 6 had three or more. Operative procedures of metastasectomy consisted of 15 wedge resections, 2 segmentectomies, and 4 lobectomies. Although no surgical complications and operative mortalities occurred, 9 patients died of primary diseases after pulmonary resection. The estimated MST after pulmonary resection was 35 months, and 3 and 5-years survival was 32% and 16%, respectively.Overall 3-year survival of patients with longer DFI (DFI> 36months) was marginally significantly better than that of those with shorter DFI (DFI≦36months) (49% vs. 19%, p=0.17). The longest survivor was still alive more than 5 years without recurrence after lung resection.
Conclusion:
Pulmonary resection for metastatic pancreaticobiliary cancer could be performed safely and might offer better survival. Although the optimal operative indication is still unclear, our results suggest that pulmonary resection could be a treatment of choice in selected patients with those diseases. Longer DFI before pulmonary metastasis might be helpful to select proper patients for the metastasectomy.
