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Toshihiko Moroga
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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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P2.16-020 - Surgical Strategy for Synchronous Multiple Lung Cancer with Ground Glass Opacity (ID 10044)
09:30 - 09:30 | Presenting Author(s): Toshihiko Moroga
- Abstract
Background:
With the recent advances of diagnostic imaging modalities such as high-resolution computed tomography (HRCT), the detection rate of multiple synchronous lung cancer with ground-glass opacity (GGO) has increased. In clinical practice, preoperative pathological diagnosis of GGO lesions by transbronchial biopsy is difficult. It is necessary to develop the optimal surgical strategy that achieves both accurate diagnosis and curative resection. We recently encountered three cases of synchronous multiple lung cancer with GGO.
Method:
Case 1: A 68-year-old male had abnormal shadows detected on chest computed tomography (CT). HRCT showed a 3.5cm-in-diameter part-solid nodule in the right upper lobe (RUL), a 2.5cm-in-diameter part-solid nodule in the right lower lobe (RLL), and a 1.5cm-in-diameter pure ground-grass nodule (GGN) in the left lower lobe (LLL). Thoracoscopic right upper lobectomy and right S6 segmentectomy was performed. The histopathological diagnosis of the RUL tumor was well-to-moderately differentiated adenocarcinoma and RLL tumor was well differentiated adenocarcinoma. These tumors were found to harbor different epidermal growth factor receptor (EGFR) gene mutation. The LLL tumor is followed up by CT scan. Case 2: A 71-year-old female had an abnormal shadow incidentally detected on chest radiography. HRCT showed a 1.0cm-in-diameter pure GGN in RUL and a 3.0cm-in-diameter part-solid nodule in left upper lobe (LUL). To achieve a minimal invasive approach for bilateral lesions, we planned to perform staged bilateral surgery that the limited resection precedes the anatomical resection. Thoracoscopic wedge resection of RUL was performed as the first operation, then thoracoscopic left upper lobectomy was performed as the second. The histopathological diagnosis of both tumors were well-to-moderately differentiated adenocarcinoma with different EGFR mutation status. Case 3: A 68-year-old female had abnormal shadows detected on chest CT. HRCT showed a 1.5cm-in-diameter pure GGN in RUL and a 1.0cm-in-diameter pure GGN in LLL. Thoracoscopic wedge resection of LLL was performed as the first operation, then thoracoscopic right S3 segmentectomy was performed as the second. The histopathological diagnosis of the LLL tumor was well-to-moderately adenocarcinoma and the RUL tumor was well differentiated adenocarcinoma.
Result:
All three cases had an uneventful postoperative course with no evidence of recurrence.
Conclusion:
In case of multiple tumors, we decide surgical procedures based on the size, number, location, and radiological findings of the tumors. We select combination surgery with anatomical resection and limited resection, and avoid bilobectomy if possible. Additionally, the thoracoscopic approach for multiple lung cancer seems to be a good option to perform minimally invasive surgical procedures.
