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Luigi Ventura
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OA 16 - Treatment Strategies and Follow Up (ID 686)
- Event: WCLC 2017
- Type: Oral
- Track: Early Stage NSCLC
- Presentations: 1
- Moderators:Jun Nakajima, T. Demmy
- Coordinates: 10/18/2017, 14:30 - 16:15, Room 315
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OA 16.02 - Risk of Recurrence in Stage I Adenocarcinoma of the Lung: A Multi-Institutional Study on Interaction with Type of Surgery and Type of Nodal Staging (ID 9304)
14:40 - 14:50 | Author(s): Luigi Ventura
- Abstract
- Presentation
Background:
In last years, an increasing interest emerges on the role of sub-lobar resection and lobe-specific lymphnode dissection in the treatment of early stage lung cancer. The aim of our study was to define impact on Cumulative incidence of recurrence (CIR) of type of surgical resection and type of nodal staging. Furthermore, we evaluated the effect of interactions between the different kinds of procedure.
Method:
An analysis of 969 consecutive stage I pulmonary adenocarcinoma patients, operated in six Thoracic Surgery Institutions between 2001 and 2013, was conducted. Type of surgical resection included lobectomy and sub-lobar resection; pneumonectomy and bilobectomy were excluded from the analysis. Nodal staging procedures were classified in nodal sampling (NS), lobe-specific lymph node dissection (LS-ND) and systematic lymph node dissection (SND). Multivariable-adjusted comparisons for CIR was performed using Fine and Grey model, taking into account death by any cause as competing event. Test of interaction between type of surgical resection and type of nodal staging was carried out and results presented in a stratified way. Missing data were multiple-imputed, combined estimates were obtained from 5 imputed datasets.
Result:Multivariable-adjusted Fine and Grey model for Comulative Incidence of Recurrence (take into account age, gender, smoking habit, side of intervention, pTNM stage, vascular invasion, pTNM stage, predominant histologic pattern and histologic grade)(Results of test of interaction presented in a stratified way)
Median follow-up was 63 months. Eight-hundred forty-six (87%) patients were submitted to lobectomy, while 123(13%) to sub-lobar resection. Four-hundred fifty-five (47%) patients received SND, 98(10%) LS-ND and 416(43%) NS. Two-hundred forty-seven (26%) patients developed a local/distant recurrence with a 5-year CIR of 24%. Multivariable-adjusted comparisons showed an independent negative effect of sub-lobar resection(HR 1.52;95%CI:1.07-2.17), LS-ND(HR 1.74;95%CI:1.16-2.6) and NS(HR 1.49;95%CI:1.12-1.98) on CIR(Table). Test of interaction showed an homogeneity of results among subgroups.Sub-lobar resection vs. Lobectomy HR (95%CI) P INTERACTION P-value Overall 1.52 (1.07 to 2.17) 0.02 0.268 SND 1.98 (1.14 to 3.42) LS-ND 1.87 (0.94 to 3.74) NS 1.08 (0.61 to 1.93) LS-ND vs SND HR (95%CI) P INTERACTION P-value Overall 1.74 (1.16 to 2.6) 0.007 0.903 Lobectomy 1.66 (1.03 to 2.69) Sub-lobar resection 1.58 (0.75 to 3.32) NS vs. SND HR (95%CI) P INTERACTION P-value Overall 1.49 (1.12 to 1.98) 0.007 0.131 Lobectomy 1.61 (1.18 to 2.19) Sub-lobar resection 0.88 (0.43 to 1.82)
Conclusion:
In our series, lobectomy and systematic lymph node dissection confirmed to be the optimal strategy to achieve a favorable prognosis in stage I adenocarcinoma of the lung. The real value of sub-lobar resection and less aggressive nodal staging should be assessed by randomized clinical trial before being integrated in clinical practice.
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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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P2.16-018 - Phrenic Nerve Injury After Lung Surgery: An Underestimated Problem (ID 9979)
09:30 - 09:30 | Presenting Author(s): Luigi Ventura
- Abstract
Background:
Inadvertent phrenic nerve injury (PNI) during lung cancer surgery is not well-studied. It is not always easy to make a clear-cut diagnosis with routine methods. Very few cases have been reported in literature. The aim of our study is to find an easily accessible and precise way to diagnose PNI and then to evaluate the incidence and its impact in early-stage lung cancer patients undergone minimally invasive surgery.
Method:
The first step was to examine the extent of diaphragm elevation in patients with invasive thymomas in whom phrenic nerve was certainly divided. The distance between the diaphragm and the apex of the chest was calculated on chest X-Ray before (DB: Distance before) and after (DA: Distance after) surgery. The following formula was used: [(DB-DA)/DB]x100. The result (mean+SD) was used as criteria for diagnosing PNI. The second step was to study PNI in early-stage lung cancer patients undergone VATS lobectomy using the above criteria.
Result:
Diaphragm elevation was found to be 24.24 +/- 6.2% in 22 invasive thymoma-patients and therefore, 30% was adopted as criteria for the diagnosis of PNI. Among 567 consecutive patients with early-stage lung cancer recruited from January 2014 to December 2016, 43 (7.6%) were diagnosed to have PNI (Table 1). No correlation was detected between PNI and location of the lesion or extent of lymph node dissection. Neither was there any difference in post-operative complications or length of hospital stay. But comparing spirometry data before and 6 months after surgery, reduction in FEV1, FVC, and DLCO was significantly greater in patients with PNI.Figure 1
Conclusion:
We found an easily accessible way to diagnose precisely PNI in lung cancer patients receiving VATS lobectomy. Inadvertent PNI during minimally invasive surgery seems to be underestimated, and it is associated with significant reduction in pulmonary function of the patient.
