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Ryohei Yoshikawa
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P1.02 - Biology/Pathology (ID 614)
- Event: WCLC 2017
- Type: Poster Session with Presenters Present
- Track: Biology/Pathology
- Presentations: 1
- Moderators:
- Coordinates: 10/16/2017, 09:30 - 16:00, Exhibit Hall (Hall B + C)
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P1.02-031 - Clinicopathological Study of 16 Cases with Pulmonary Pleomorphic Carcinoma (ID 9334)
09:30 - 09:30 | Author(s): Ryohei Yoshikawa
- Abstract
Background:
Pulmonary pleomorphic carcinoma is a rare histologic type with poor prognosis, proposed in the third edition of the 1999 WHO histologic classification of lung tumors.
Method:
We performed surgical treatment for 16 cases with pulmonary pleomorphic carcinoma between April 2000 and April 2017, and investigated the patients’ characteristics and perioperative outcomes.
Result:
The male-to-female ratio was 14 to two. The median age was 68 years, ranging from 55 to 88. All cases had a smoking habit. The locations of tumors were RUL in 5 cases, RML in 3, RLL in 4, LUL in 4 and LLL in 2. Pathological stages were IA2 in1, IA3 in 1, IB in 2, IIA in 3, IIB in 1, IIIA in 6 and IIIB in 2, based on eighth of the TNM classification for lung cancer. Nodal status was classified as pN0 in 11, pN1 in 1 and pN2 in 4. Epithelial components were squamous cell carcinoma in 5 (31%), adenocarcinoma in 5 (31%), double-cell components in 2 (12.5%), no epithelial components in 2 (12.5%) and indistinct in 2 (12.5%), while sarcomatous elements, spindle cells in 8 (50%), giant cells in 1 (6%), double-cell elements in 5 (31%) and indistinct in 2 (13%). Eight cases received adjuvant treatments, including chemotherapy in 5, radiotherapy in 1 and chemoradiotherapy in 2. Postoperative recurrence was detected in 9 cases (56%). And 7 of the nine cases had the recurrence within 6 months after the surgical resection. On the contrary, no recurrence was detected in 7 cases comprised of pN0 in 5 cases and pN1-2 in 2. And 2 of the 7 cases have been disease-free for more than two and a half years.
Conclusion:
Although pulmonary pleomorphic carcinoma has poor prognosis, patients without lymph node metastasis have the possibility of having favorable prognosis compared to the patients with lymph node metastasis. It is important to observe the postoperative courses carefully during 6 months from surgical resection in order to detect the early recurrences promptly.
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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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P1.16-014 - The Efficacy of Thoracoscopic Right Upper Lobectomy Using Fissureless Technique in Patients with Dense Fissures (ID 9254)
09:30 - 09:30 | Author(s): Ryohei Yoshikawa
- Abstract
Background:
We adopted the ‘thoracoscopic fissureless technique’ for patients with dense fissure undergoing right upper lobectomy to avoid postoperative air leakage. This technique is considered useful in thoracoscopic approach which has the limited direction in dissection. We investigated the efficacy of thoracoscopic right upper lobectomy using fissureless technique in this study.
Method:
Between April 2012 and March 2017, 77 patients underwent thoracoscopic right upper lobectomy with three or four ports, of whom 23 adopted fissureless lobectomy. We compared the characteristics and perioperative outcomes of the patients undergoing the fissureless technique (fissureless group, n=23) and the traditional fissure dissection technique for pulmonary artery exposure (traditional group, n=54). The details of the fissureless technique is as follows. While the upper lobe is retracted towards the back, the upper lobe vein and the anterior PA trunk to the upper lobe are exposed and divided. After the division of right upper lobe bronchus by a stapler, the ascending artery is divided. However, it is better to dissect and divide the ascending A2 prior to right upper bronchus when the ascending A2 branches from a comparatively proximal portion. The fissure is finally divided.
Result:
The patients’ characteristics and perioperative results in the 2 groups are shown in the table. There was no significant inter-group difference about sex ratio, age, blood loss (p=0.95), intraoperative massive bleeding rate (p=0.66), conversion rate (p=0.55) or morbidity (p=0.13), fissureless group had shorter operation time (p=0.047) or postoperative hospital stay (p=0.0004). Additionally, fissureless group had tendency to reduce the duration of postoperative chest tube drainage (p=0.07).Variable Fissureless group, n=23 (%) Traditional group, n=54 (%) p-value Operation tim (min.) 197±45 225±61 0.047 Blood loss (ml) 93±150 95±165 0.95 Intraoperative massive bleeding (n) 1 (4.3) 5 (9.3) 0.66 Conversion to thoracotomy (n) 0 (0) 3 (5.6) 0.55 Duration of chest tube drainage (days) 2.7±1.6 3.9±3.2 0.07 Length of postoperative hospital stay (days) 4.6±1.3 7.5±3.5 0.0004 Morbidity (n) 2 (8.7) 14 (25.9) 0.13
Conclusion:
Thoracoscopic right upper lobectomy using fissureless technique is considered useful because it had a tendency to reduce the duration of postoperative drainage, and significantly reduced operation time and the length of postoperative hospital stay.
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P2.16 - Surgery (ID 717)
- Event: WCLC 2017
- Type: Poster Session with Presenters Present
- Track: Surgery
- Presentations: 1
- Moderators:
- Coordinates: 10/17/2017, 09:30 - 16:00, Exhibit Hall (Hall B + C)
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P2.16-009 - Strategy for Oncologic Emergency in Thoracic Disease (ID 8953)
09:30 - 09:30 | Presenting Author(s): Ryohei Yoshikawa
- Abstract
Background:
No large series of oncologic emergencies in thoracic surgery has been reported. Such patients are usually in critical condition and need immediate intervention of various types. Here, we present the surgical interventions that have occurred in our experience with oncologic emergencies.
Method:
We retrospectively analyzed 28 patients with oncologic emergencies who underwent surgical intervention at our hospital in 2002‒2016. The mean patient age was 76 years, and there were 19 (68%) males and 9 (32%) females. The primary disease was primary pulmonary carcinoma in 13 cases, including adenocarcinoma and squamous cell carcinoma in 4 and 6, respectively, other-organ carcinomas in 12, and mediastinal tumors in 3. Airway stenosis was the complaint in 19 (68%), including hemoptysis in 2, superior vena cava syndrome in 3 (11%), infectious diseases in 2 (7%), tumor bleeding in 2 (7%), and pneumothorax in 2 (7%).
Result:
The goal of surgery was a radical operation in 8 (29%), biopsy in 3 (11%), and palliative therapy in 17 (60%) patients. The surgical procedure was lobectomy in 4 patients, bronchoplasty in 4, wedge resection in 3, pneumonectomy in 1, tumor removal in 2, pleural decortication in 1, excisional biopsy in 4, airway intervention (stent or laser cauterization) in 11, and tracheostomy in 6. The mean hospital stay was 32±39 (range 3–155) days. The outcome was hospital death in 7 (25%) and discharge in 21 (75%). Of the discharges, 3 (11%) patients were transferred to another hospital, and 18 (64%) were sent home. The mean survival was 743±743 (range 3–3798) days. Of the 21 discharges, 7 (25%) patients are alive, including 4 (14%) who are cancer-free and 3 (11%) with cancer. As treatment, radical surgery was more effective than conservative therapy.
Conclusion:
The oncologic emergencies experienced in thoracic surgery included obstruction/stenosis, bleeding, infection, and rupture. Stenosis comprised the majority and was caused by tumor growth in the airway and compression and invasion by tumors. Good outcomes were expected in patients with slow-growing tumors who underwent laser cauterization or airway stent placement.
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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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P3.16-029 - Recurrence within a Year after Complete Resection of Primary Lung Cancer (ID 9227)
09:30 - 09:30 | Author(s): Ryohei Yoshikawa
- Abstract
Background:
Optimal postoperative follow-up method for lung cancer patients is not determined. Investigation of early recurrence risk may help differentiating the patients who should be intensively follow up, and further lead to improve prognosis of those cases. We clinicopathologically evaluated the lung cancer patients with recurrence within a year after complete resection.
Method:
We retrospectively reviewed 63 patients with recurrent diseases after complete resection of lung cancer between 2006 and 2016 in our institution.
Result:
We found 32 patients (50.1%) who had recurrent disease within a year after resection (former group), 31 patients (49.2%) over a year after resection (latter group). Average ages of each group were 70.1 years for the former, and 68.4 years for the latter. As for histological types, the former were composed of Adenocarcinoma (Ad) 12 / non-Ad 20, and the latter composed of Ad 27/ non-Ad 4 cases. Ad was found more frequently in the latter than the former, significantly（p<0.0001）. Pathological stage (I/ II-IV) of each groups were 8 / 24 cases for the former, 18 / 13 cases for the latter. The former had more advanced stages than the latter, not significantly. Average tumor size (mm) was 45.5 for the former, 32.3 for the latter, not significantly. Pleural invasion (-/+) were 11/32 cases for the former, 11/31 for the latter, not significantly. On the other hand, Lymphatic invasion (-/+) were 24/32 cases for the former, 16/31 for the latter（p=0.0168）. Vessel invasion (-/+) were 23/32 for the former, 14/31 for the latter（p=0.0313）. The former had more Lymphatic invasion (+), Vessel invasion (+) patients than the latter, significantly. Postoperative survival times were 503.6 days for the former in average, 1704.1 days for the latter. The prognosis of the latter was better than the former（p＜0.05）. The number of deaths were 19 for the former (including 1 case with intercurrent disease death), 9 for the latter (same 2 cases). The former had more cases of death （p=0.0238）than the latter, significantly.
Conclusion:
Lung cancer patients with recurrence within a year after resection showed non-Ad histology and lymphovasclar invasion positivity more frequently, than those over a year after resection. Such patients had shorter survival time and more number of deaths than those over a year, showing poorer prognosis.
