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Terumoto Koike
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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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P1.16-025 - Safety of Simultaneous TEVAR and Combined Aortic Wall Resection at the Time of Lung Resection for T4 Lung Cancer Infiltrating the Aorta (ID 10506)
09:30 - 09:30 | Author(s): Terumoto Koike
- Abstract
Background:
Combined resection of lung cancer and aortic wall for T4 lung cancer is highly invasive and is a challenging procedure for thoracic surgeon. With the advent of minimally invasive endovascular therapy with thoracic endovascular stent (TEVAR) in recent years, there is a possibility that resection of the aorta may be undergone with minimally invasive approach. The aim of this study is to report the safety of simultaneous TEVAR and combined resection of aortic wall on the same day at the time of lung resection.
Method:
We started this minimal invasive procedure form 2013 with the approval of the ethics committee, treatment using TEVAR in cooperation with cardiovascular surgery upon resection of the aorta. Four cases of primary lung cancer with aortic invasion, one case of recurrent lung cancer with aortic invasion after SBRT for second primary lung cancer after left upper lobectomy. Thoracic surgeon and cardiovascular surgeon discussed on predicted tumor invasion range and resection site, stent placement position and stent length, size, surgical procedure considering safe margin. TEVAR was performed on the same day as open chest surgery in all cases. At first aortic invasion was confirmed by thoracotomy in right lateral decubitus position and, then TEVAR was performed in supine position. After TEVAR, the patient was positioned in the right lateral decubitus position again and lung resection combined aortic resection was completed.
Result:
The site of endovascular stent insertion was the aortic arch and descending aorta in two (the subclavian artery occlusion in one, the fenestration for SCA in one), the distal arch just beneath the subclavian artery in two, and descending aorta in one case. The time required to place the stent was 49 to 149 minutes, and in all cases the stent could be placed at the target position. Procedure of lung resection was upper lobectomy in two, pneumonectomy in two, completion pneumonectomy in one. The depth of aortic wall resection was adventitia in three and adventitia + media in two. TEVAR-related complication was observed in one case; external iliac artery intimal damage requiring vessel repair. There were no complications associated with aortic resection. Two postoperative complications of atrial fibrillation and chylothorax were observed but there was no surgery related death.
Conclusion:
Simultaneous TEVAR and combined resection of aortic wall on the same day at the time of lung resection is feasible. Prior to surgery, thoracic surgeon should share information with cardiovascular surgeon to make this procedure safe.
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P3.16 - Surgery (ID 732)
- Event: WCLC 2017
- Type: Poster Session with Presenters Present
- Track: Surgery
- Presentations: 2
- Moderators:
- Coordinates: 10/18/2017, 09:30 - 16:00, Exhibit Hall (Hall B + C)
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P3.16-002 - Postoperative Prognostic Factors in Non-Small Cell Lung Cancer Patients with Lymph Node Metastasis (ID 9347)
09:30 - 09:30 | Author(s): Terumoto Koike
- Abstract
Background:
Postoperative outcome for NSCLC patients with lymph node metastasis is unfavorable even after surgery with/without adjuvant chemotherapy. We sought to investigate postoperative prognostic factors in NSCLC patients with lymph node metastasis.
Method:
We retrospectively reviewed NSCLC patients with pathologically identified lymph node metastasis who underwent complete resection. Demographic, clinical, and pathologic factors (sex, age, smoking index, Performance Status, preoperative carcinoembryonic antigen [CEA], surgical procedure, lymphadenectomy extent, histology, tumor differentiation, tumor size, pT factor, metastatic node site, and adjuvant chemotherapy) were analyzed using the log-rank test as univariate analyses and a Cox proportional hazards regression model for multivariate analyses to identify independent predictors of favorable disease-specific survival (DSS).
Result:
Of the 146 eligible patients, 113 were male and 33 were female. The median age and preoperative CEA were 67 years and 5.3 ng/mL, respectively. Lobectomy or greater resection and segmentectomy were performed in 140 and 6 patients, respectively. Tumor histology was adenocarcinoma in 58 patients, squamous cell carcinoma in 70, and others in 18. Node metastasis was identified in hilum only in 85 patients and mediastinum in 61. Adjuvant chemotherapy was performed in 61 patients (platinum doublet in 56 and tegafur/uracil in 5, respectively) and was not performed in 85. The 5-year DSS was 58%. The CEA ≤5.3 ng/mL (HR: 0.368), without mediastinal node metastasis (HR: 0.436), and platinum doublet adjuvant chemotherapy (HR: 0.491) were identified as significant predictors of favorable DSS. The 5-year DSS in patients with CEA ≤5.3 and >5.3 ng/mL were 73% vs 41%, respectively (p<0.001). The 5-year DSS in patients who underwent platinum doublet chemotherapy or none/others were 67% vs 53%, respectively (p=0.047). Figure 1
Conclusion:
Even if NSCLC patients have lymph node metastasis, favorable postoperative prognosis may be expected in patients with low preoperative CEA. Platinum doublet adjuvant chemotherapy should be considered in patients with lymph node metastasis on pathological examination.
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P3.16-051 - Implications of Preoperative Serum Tumor Levels on Pathological Characteristics in Patients with Lung Adenocarcinoma (ID 9217)
09:30 - 09:30 | Presenting Author(s): Terumoto Koike
- Abstract
Background:
Although preoperative serum tumor marker levels, such as carcinoembryonic antigen (CEA) and squamous cell carcinoma antigen (SCC) are often evaluated in non-small cell lung cancer patients, the implication of these levels are still unknown. This study examined the predictive effect of preoperative tumor marker levels on pathological characteristics of lung adenocarcinoma.
Method:
We retrospectively reviewed patients with lung adenocarcinoma who underwent macroscopic complete resection. The pathological metastasis and/or involvement was defined that positive pleural effusion or lavage cytology, pleural involvement, pulmonary metastasis, lymph node metastasis, and/or lymphovascular involvement were identified on pathological examination. To identify predictors for the pathological metastasis and/or involvement, tumor markers (CEA, SCC, Sialyl Lewis[x]-1 [SLX], cytokeratin-19 fragments [CYFRA], neuron-specific enolase [NSE], and pro-gastrin-releasing peptide [ProGRP]), and demographic and clinical factors were analyzed by a univariate analysis and multivariate logistic regression analysis. For the significant tumor markers, optimal cutoff points were determined with a receiver operating characteristic analysis.
Result:
Of the 263 eligible patients, 138 were male and 125 were female. The median age was 70 years. The median preoperative CEA, SCC, SLX, CYFRA, NSE, and ProGRP levels were 3.7 ng/ml，0.8 ng/ml，28 U/ml，1.8 ng/ml，8.4 ng/ml，and 46.9 pg/ml, respectively. According to the 7[th] edition of the TNM classification, 186 patients (71%) had c-stage IA disease, 48 (18%) had c-stage IB disease, 26 (10%) had c-stage II disease, and 3 (1%) had c-stage III disease. Positive pleural effusion, positive pleural lavage cytology, pleural involvement, pulmonary metastasis, lymph node metastasis, lymphatic permeation, and vascular invasion were identified in 3 (1%), 4 (2%), 48 (18%), 9 (3%), 28 (11%), 20 (8%), and 35 patients (13%), respectively, and in total, 83 patients (32%) developed the pathological metastasis and/or involvement. The univariate analysis identified CEA, smoking index, size, solid size, and c-stage as significant predictors. A multivariate analysis revealed CEA (OR: 1.113, p=0.005) and solid size (OR: 1.052, p<0.001) as significant predictors. The optimal cutoff point was determined as 6.0 ng/ml for the preoperative CEA, and 35 of the 63 patients (56%) with ≥6.0 ng/ml of CEA developed the pathological metastasis and/or involvement whereas 48 of the 200 patients (24%) with <6.0 ng/ml of CEA developed pathological metastasis and/or involvement.
Conclusion:
Our results suggested the predictive effect of the high preoperative CEA level on pathological metastasis and involvement in patients with lung adenocarcinoma, and thus, we may consider preoperative CEA to decide surgical procedure for these patients, such as the extent of pulmonary resection and lymphadenectomy.
