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A. Akopov
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P3.04 - Poster Session with Presenters Present (ID 474)
- Event: WCLC 2016
- Type: Poster Presenters Present
- Track: Surgery
- Presentations: 2
- Moderators:
- Coordinates: 12/07/2016, 14:30 - 15:45, Hall B (Poster Area)
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P3.04-001 - Near-Infrared Fluorescent Identification of Lymphatic Flow in Non-Small Cell Lung Cancer (ID 5497)
14:30 - 14:30 | Author(s): A. Akopov
- Abstract
Background:
None of the methods of intraoperative determining the sentinel lymph nodes is used in lung cancer. We tried to evaluate the features of lymphatic flow and sentinel lymph nodes (SLN) mapping in patients with NSCLC using near-infrared (NIR) fluorescence imaging.
Methods:
50 patients with NSCLC (squamous cell – 34, adenocarcinoma – 15, large cell – 1) who underwent curative resections (pneumonectomy – 19, lobectomy – 31) were prospectively divided into two groups – with preoperative chemotherapy (CT+S group, 15 patients) and without (S group, 35 patients). Immediately after entering the pleural cavity 2 ml of indocyanin green (ICG) solution as an NIR fluorescent lymphatic tracer was injected in 3-4 points around the tumor. Lymphatic flow and SLN were real-time identified by fluorescence imaging system intraoperatively every 15 minutes after injection and postoperatively ex vivo. Ipsilateral hilar and mediastinal lymphadenectomy was done.
Results:
The fluorescent identification rate of pulmonary lymphatic vessels were 97% (34 of 35 patients) in S group and 40% (6 of 15 patients) in CT+S group, p=0,001. The interval between injection and visualization of lymphatic channels was 15 min in 9 patients (18%), 30 min in 28 patients (56%) and 45 minutes in 3 patients (6%). In 40 patients with positive NIR visualization, lymphatic vessels were presented in the form of thin glowing fluorescent lines in 36 patients (90%), and in the form of diffuse fluorescent glow throughout the affected lobe in 4 patients (10%). At least one SLN was detected in 46 of 50 patients (97% in S group and 80% in CT+S group, p=0,10) with a number of SLNs identified of 1 to 4 per patient (an average, 2,7). Metastatic nodal disease was never identified in patients with a histologically negative SLN (overall accuracy rate 100%). No adverse reactions were noted. In 4 patients nor SLN neither lymphatic vessels were detected: 3 of them had complete responses after preoperative treatment.
Conclusion:
Application of NIR fluorescence allows studying features of lymphatic vessels and SLN in NSCLC. Absence of metastatic disease in the SLN directly correlates with final nodal status of the lymphadenectomy specimen.
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P3.04-002 - Reducing the Amount of Resection after Induction Photodynamic and Chemotherapy in Inoperable Non-Small Cell Lung Cancer (ID 5494)
14:30 - 14:30 | Author(s): A. Akopov
- Abstract
Background:
Involvement of the main bronchus in non-small cell lung cancer (NSCLC) often determines functional inoperability. Induction chemotherapy and endobronchial photodynamic therapy (PDT) were done with the purpose of performing lobectomy (bilobectomy) instead of pneumonectomy.
Methods:
Prospective study included patients with central NSCLC with the involvement of the main bronchus or trachea who were initially considered as intolerant to pneumonectomy. After an induction from two to six courses of chemotherapy and endobronchial PDT (chlorine E6 as a photosensitizer, light wavelength of 662 nm) patients were re-examined and lobectomy was offered to patients with positive response.
Results:
From 2008 to 2015 48 patients with NSCLC were considered as intolerant to pneumonectomy due to low level of FEV1 (an average, 49±18% predicted, from 21% to 67%), data of perfusion scintigraphy, level of DLCO, level of Vo~2~ max and contralateral side lobectomy performed earlier. After preoperative treatment 38 patients (79%) underwent lobectomy instead of pneumonectomy. Initial tumor was localized the right main bronchus in 13 patients (34%), left main bronchus — in 18 (47%), tracheal bifurcation — in 7 patients (18%). Stages were: IIA – 2 patients, IIB – 2 patients, IIIA – 15 patients, IIIB – 19 patients. cN0 disease was diagnosed in 12 patients (32%), cN1 – in 9 (24%), cN2 – in 17 patients (44%). In all cases tumor disappeared from the main bronchus after preoperative treatment. 11 conventional lobectomies, 15 wedge, 9 sleeve lobectomies and 3 bilobectomies were done. In all cases bronchial cutting was done in initially affected zone. Pathological examination revealed 34 of 38 patients operated completely (R0-89%), 4 – microscopically incompletely (positive bronchial resection margin, R1-11%), рN+ was diagnosed in 12 patients (32%). No postoperative mortality and major complications were noted. During follow-up (from 6 to 72 months) one local recurrence was developed (3%); three – and five-year survival rates were 88% and 55%.
Conclusion:
Preoperative treatment including chemotherapy and PDT led to less extensive resections (lobectomy instead of pneumonectomy) reducing surgical risks.
