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Oleg Pikin
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P1.16 - Surgery (ID 702)
- Event: WCLC 2017
- Type: Poster Session with Presenters Present
- Track: Surgery
- Presentations: 1
- Moderators:
- Coordinates: 10/16/2017, 09:30 - 16:00, Exhibit Hall (Hall B + C)
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P1.16-011 - The Role of 3D-CT in Patients with Pulmonary Malignancies Undergoing Segmentectomy (ID 9045)
09:30 - 09:30 | Author(s): Oleg Pikin
- 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.
Method:
We retrospectively analyzed 114 patients who underwent segmentectomy due to low pulmonary function, severe comorbidity or previous history of lung resection. Indications for surgery were clinical T1aN0M0 peripheral non-small cell lung cancer (NSCLC) ≤2 cm (n=53), resectable pulmonary metastases not suitable for wedge resection due to deep parenchymal location (n=47) and benign lesions (n=14). 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). 38 patients underwent VATS segmentectomy. Three-dimensional computed tomography (3D-CT) with bronchovascular separation was used preoperatively in 58 patients from October 2014 to April 2017. Mortality, morbidity, proportion of typical versus atypical and VATS versus open segmentectomies in two groups: with or without 3D-CT bronchovascular reconstruction, were compared.
Result:
There was no mortality in whole group. Morbidity rate was 7,9% not exceeding grade 3a according thoracic mortality and morbidity (TMM) score. The difference in morbidity rate was not statistically significant between two groups (6,9% and 8,9%; p=0,23) The most common complication was prolonged air leak > 7 days (2,6%). 3D-CT powered by separation of arterial, venous and bronchial structures enabled surgeons to perform atypical segmentectomies and use VATS approach more often (31,3% vs 13,5%; p>0,05 and 50,0% vs 11,5%; p<0,05, respectively). 8 atypical segmentectomies were performed by VATS due to 3D-CT reconstruction with bronchovascular separation. 5-year survival was 86% and 21% in NSCLC and pulmonary metastases groups, respectively.
Conclusion:
3D-CT reconstruction with bronchovascular separation provides precise preoperative planning of individual pulmonary segments anatomy and allows to increase the proportion of atypical and VATS sublobar anatomic pulmonary resections.
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P3.16 - Surgery (ID 732)
- Event: WCLC 2017
- Type: Poster Session with Presenters Present
- Track: Surgery
- Presentations: 1
- Moderators:
- Coordinates: 10/18/2017, 09:30 - 16:00, Exhibit Hall (Hall B + C)
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P3.16-021 - Thoracic Morbidity and Mortality System in Analysis of Postoperative Complications after Pneumonectomy in NSCLC Patients (ID 8580)
09:30 - 09:30 | Presenting Author(s): Oleg Pikin
- Abstract
Background:
Postoperative complications after pneumonectomy for NSCLC depend on the extension of surgery, comorbidities and accurate registration of any adverse event. The aim of the study was to evaluate the short-term results after standard and extended pneumonectomy in NSCLC patients according to the TMM (Thoracic Morbidity and Mortality) grading system.
Method:
We included 216 NSCLC patients consecutively submitted to pneumonectomy at our institution from January 2011 to December 2015 in the retrospective study performed on data prospectively collected in an electronic clinical database. All patients were divided into two different groups: standard (n=142) and extended (n=74) pneumonectomy, where resection of adjacent organs was indicated. The patients undergone extended pneumonectomy were subdivided into single (n=49) and multi-organ resection (n=25) groups. Systemic mediastinal lymph node dissection was carried out in all cases. Morbidity and mortality rate was analyzed according to the definitions proposed by the ESTS and TMM classification system.
Result:
Postoperative morbidity and mortality rate after standard pneumonectomy (23,9% and 3,5%) was significantly lower than extended procedure (43,2% and 10,8%) (p=0.02). Multi-organ resection was an independent prognostic factor of unfavourable outcome: morbidity and mortality was significantly higher in the multi-organ group (48,0% and 16,0%), while in the single-organ group it was 40,8% and 8,2% respectively (p=0.01). The incidence of the BPF was the only one variable in the ESTS complications definition which differs significantly between the groups of standard, single- and multi-organ resection: 3,5%, 6,1% and 16,0% respectively (p=0.02). Major complications rate (grade IIIA and higher according to the TMM) was significantly higher in the multi-organ group (40,0%) than in the single-organ (28,6%) and standard (14,8%) group (p=0.01).
Conclusion:
TMM classification system is more accurate in grading and further analysis of postoperative complications after pneumonectomy in NSCLC patients in compare with ESTS criteria. Multi-organ resection should be carried out with caution due to unacceptable high morbidity and mortality rate.
