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Tomasz Gil



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    OA 04 - Surgery from Minimal to Radical (ID 661)

    • Event: WCLC 2017
    • Type: Oral
    • Track: Surgery
    • Presentations: 1
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      OA 04.01 - Randomised Trial of Systematic Lymph Node Dissection versus Bilateral Mediastinal Lymphadenectomy in Patients with Non-Small Cell Carcinoma (ID 7414)

      15:45 - 15:55  |  Author(s): Tomasz Gil

      • Abstract
      • Presentation
      • Slides

      Background:
      Experimental studies have shown different pathways of lymphatic drainage from particular pulmonary lobes. Especially important is lymphatic drainage from the left lower lobe to the contralateral mediastinal nodes. The aim of this study was to analyse the impact of bilateral mediastinal lymphadenectomy (BML) on survival in non small-cell lung cancer (NSCLC) patients.

      Method:
      Prospective, randomised trial including patients with proven or suspected NSCLC, stage cI-IIIA. Randomisation was performed in ratio 1:1. In the BML group, systematic lymph node dissection (SLND) was supplemented with contralateral mediastinal lymphadenectomy via additional cervical incision. In the SLND group, standard lung resection with SLND was performed.

      Result:
      102 patients were enrolled. 13 of them met the exclusion criteria, and data of 89 patients were analysed: 40 in the BML group and 49 in the SLND group. There were no significant differences between groups regarding age, sex, Thoracoscore, Revised Cardiac Risk Index, dyspnoea, lobar location of the tumour, histology and cTNM. Mean follow-up time was 66.5 months. In the whole group, the 4-year survival rate was significantly higher in the BML group than in the SLND group (72.5% vs 51%, p=0.039). Separate comparisons were performed for different lobar locations of the tumour. There was no significant difference in 4-year survival rates and mean survival time between both groups for tumours located in the right lung and those located in the left upper lobe. For the left lower lobe, the 4-year survival rate, and mean survival time was significantly higher in the BML group (90.9% vs 25%, p=0.003, and 1923 vs 1244 days, p=0.027, respectively). Also, analysis of the survival curves (Figure) has shown significant difference (p=0.018.).Figure 1



      Conclusion:
      For NSCLC located in the left lower lobe, removal of the contralateral mediastinal lymph nodes is associated with survival benefit. These results should be confirmed in larger studies.

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    P2.16 - Surgery (ID 717)

    • Event: WCLC 2017
    • Type: Poster Session with Presenters Present
    • Track: Surgery
    • Presentations: 1
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      P2.16-027 - Comparison of Single Chest Tube Versus Double Chest Tube Drainage After Lung Resection for the Treatment of Non-Small Cell Lung Cancer (ID 9573)

      09:30 - 09:30  |  Presenting Author(s): Tomasz Gil

      • Abstract

      Background:
      After pulmonary resections, one or two chest tubes are used, and the choice is based mainly on local habits rather than on evidence. The aim of the study was to evaluate the efficacy of chest drainage after lung resection using single chest tube versus two chest tubes in patients with non-small cell lung cancer (NSCLC).

      Method:
      Single-centre prospective randomized trial including patients who underwent anatomical lung resection for NSCLC between February 2016 and may 2017. At the end of the operation, patients were randomized in a 1:1 ratio, to the single tube group or to the two tubes group. On the day of surgery, controlled suction of -20 mmHg was used, switched on the 1st postoperative day to -8 mmHg. Chest tubes were removed in the absence of air leak for more than 24 hours, and the chest tube output <250 mL/day.

      Result:
      There were 357 patients enrolled, including 219 men, mean age 64.43 years (range: 22-84) and 138 women, mean age 64.06 years (range: 24-85). One chest tube was used in 176 patients, including 50 cases of VATS lobectomy and 126 cases of open lobectomy. Two chest tubes were used in 181 patients, including 35 patients after VATS lobectomy and 146 after open lobectomy. In the single chest tube group there was significantly shorter air leak time (4.25 vs. 4.5 day; p = 0.001, drainage time (3.6 vs 4.7 day; p = 0.0001), and postoperative hospital stay (6.15 vs 7.5 day; p <0.0011. Multivariate regression analysis demonstrated that time of chest tube drainage after cessation of the air leak depends on the volume of chest tube output in the first 6 hours (p = 0.00001) and the time of air leak (p = 0.0014), regardless of the number of drains.

      Conclusion:
      Single chest tube after anatomical lung resections is associated with shorter air leak, shorter drainage time, shorter hospital stay compared to two chest tube drainage. Routine use of single chest tube is safe and effective treatment.