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Motohiro Nishimura
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P2.05 - Early Stage NSCLC (ID 706)
- Event: WCLC 2017
- Type: Poster Session with Presenters Present
- Track: Early Stage NSCLC
- Presentations: 1
- Moderators:
- Coordinates: 10/17/2017, 09:30 - 16:00, Exhibit Hall (Hall B + C)
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P2.05-013 - The Result of Preoperative Lipiodol Markings for 121 Small Pulmonary Nodules in 115 Patients (ID 9141)
09:30 - 09:30 | Author(s): Motohiro Nishimura
- Abstract
Background:
Some pulmonary nodules are so small that we surgeons can’t perceive by touch nor visually recognize during operation. For resection of such small nodules we have been undergoing preoperative lipiodol markings for 7 years. The appearance of the marking-spots on computed tomography (CT) is classified into 3 types in a previous research [H Miura, et al: CT findings after lipiodol marking performed before video-assisted thoracoscopic surgery for small pulmonary nodules. Acta Radiologica, 2016, Vol. 57(3) 303-310] .
Method:
CT-guided lipiodol marking for 121 nodules were performed in 115 patients before surgery. Lipiodol was injected using a 23-guage needle near the nodules. During surgery, the location of nodules could be detected using C-arm-shaped fluoroscopic unit as radiopaque spots and we resected them. We classified the CT appearance of the lipiodol marking retrospectively into 3 types; Dense, Punctate and Unclear as the previous research.
Result:
All nodules were successfully resected on the same day as marking performed. The results of pathological examination were 68 lung cancers (56%), 38 metastatic lung tumors (31%) and 15 others (12%). The classification of lipiodol spots resulted as following. 75 spots (62%) were Dense, 45 spots (37%) were Punctate, and 1 spot (0.8%) was Unclear. There was no significant difference in the average operative duration between the group of Dense and Punctate. Patients with smoking history occupied 67% of the Punctate group, on the other hand only 37% of the Dense group had smoking history (P<0.0001).
Conclusion:
Lipiodol marking for small pulmonary nodules are helpful and effective, especially for diagnosis and treatment of early stage lung cancer. Smoking history of patients has something to do with the CT appearance of lipiodol spots. Regardless of how marking shape is, difficulty of surgery doesn’t change in the point of operative duration.
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P2.16 - Surgery (ID 717)
- Event: WCLC 2017
- Type: Poster Session with Presenters Present
- Track: Surgery
- Presentations: 2
- Moderators:
- Coordinates: 10/17/2017, 09:30 - 16:00, Exhibit Hall (Hall B + C)
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P2.16-006 - Locking of the Scapula after Lobectomy with Rib Resection (ID 8757)
09:30 - 09:30 | Presenting Author(s): Motohiro Nishimura
- Abstract
Background:
Locking of scapula is rare complication of rib resection or thoracotomy. The patients experience severe pain and restriction of movement in their shoulder, and they are treated conservatively or surgically.
Method:
A 72-year-old woman underwent right upper lobectomy and extended combined resection of the posterior chest wall (via a standard posterolateral thoracotomy and resection of the 2nd to 4th ribs), to treat a stage3A lung cancer. Chest wall reconstruction was not performed. Her immediate postoperative course was uneventful, she was discharged from our hospital on 7th operative day. One year after operation, severe pain appeared in her right shoulder while she put on her underwear. She was referred to our hospital.
Result:
Physical examination revealed that resting pain was not so severe, but the range of shoulder motion was restricted due to severe pain. We suspected that the inferior angle of the scapula was caught inside the 5th rib. Chest x-ray showed that scapula prolapsed into the intrathoracic cavity through the resection site in the right chest wall (figure). The manipulative closed reduction was successful, then her symptoms were resolved. We advised her to pay attention to her right shoulder movement especially in over 90 degrees abduction. Five month later, no recurrences were observed. Figure 1
Conclusion:
As to rib defects like this case, the necessity of the reconstruction is controversial because the defect is completely covered by scapula. Moreover scapular prolapse into the intrathoracic cavity is rare and implants have a potential to infection. We conclude that the partial resection of the inferior angle of the scapula should have been performed at her operation in order not to be caught inside the rib.
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P2.16-008 - Collapsed Lung Index Ten Minutes after Thoracotomy and Pre-Operative Pulmonary Function Tests (ID 8932)
09:30 - 09:30 | Author(s): Motohiro Nishimura
- Abstract
Background:
The lung is still pneumatized and we cannot take a broad view of the chest cavity. As for surgeons, the prediction of lung prolapse is valuable for surgical manipulations. We estimated the degree of the collapsed lung ten minutes after thoracotomy (collapsed lung index; CLI). We also evaluated the relationship between CLI and pre-operative pulmonary function test.
Method:
From December 2016 to June 2017, we included 38 patients undergoing video-assisted thoracoscopic surgery (VATS) without pleural adhesion. CLI was determined as the degree of collapse of the lung ten minutes after opening the first thoracic port. CLI definition was as follows; Grade 1: the distance between visceral pleura and chest wall was less than 1cm, Grade 2: the distance was less than 3cm, Grade 3: the distance was less than 5cm, Grade 4: the distance was more than 5 cm and the lung parenchyma was partially deflated, and Grade 5: the lung was completely collapsed. We also checked the relationship between CLI and pre-operative pulmonary function test of the patients.
Result:
The patients are 47 years old to 83 years old. They consist of 25 males and 13 females. The numbers of CLI Grade 1 were 0 cases, Grade 2 were 4 cases, Grade 3 were 18 cases, Grade 4 were 14 cases, and Grade 5 were 2 cases. VATS were easily undergone with broad surgical view Grade 4 and Grade 5. The 42% of the cases are included in CLI Grade 4 and Grade 5. The mean value of %VC was 102.6 %, FEV1.0G was 76.8 %, and FEV1.0% was 100.3 % in Grade 4 and Grade 5 patients. The preoperative pulmonary function tests were better in Grade 4 and 5 than the other Grades.
Conclusion:
We proposed CLI to estimate the surgical views at the beginning of VATS. The preoperative pulmonary function will predict the surgical field. We are waiting for some methods to deflate the lung in CLI Grade 1, 2, and 3 to Grade 4 or 5. The complete collapsed lung should make a good contribution for Single port VATS.
