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N. Epifanov
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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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P1.16-011 - The Role of 3D-CT in Patients with Pulmonary Malignancies Undergoing Segmentectomy (ID 9045)
09:30 - 09:30 | Author(s): N. Epifanov
- Abstract
Background:
Progress in diagnostics and surgery in thoracic oncology is associated with increasing number of patients-candidates for sublobar anatomic pulmonary resection. Vascular variability of pulmonary segments anatomy requires special tools for individual preoperative planning.
Method:
We retrospectively analyzed 114 patients who underwent segmentectomy due to low pulmonary function, severe comorbidity or previous history of lung resection. Indications for surgery were clinical T1aN0M0 peripheral non-small cell lung cancer (NSCLC) ≤2 cm (n=53), resectable pulmonary metastases not suitable for wedge resection due to deep parenchymal location (n=47) and benign lesions (n=14). Segmentectomies were divided into typical (where parenchymal division involves 2 planes) and atypical (more complex and technically demanding, when the segmental excision involves 3 planes). 38 patients underwent VATS segmentectomy. Three-dimensional computed tomography (3D-CT) with bronchovascular separation was used preoperatively in 58 patients from October 2014 to April 2017. Mortality, morbidity, proportion of typical versus atypical and VATS versus open segmentectomies in two groups: with or without 3D-CT bronchovascular reconstruction, were compared.
Result:
There was no mortality in whole group. Morbidity rate was 7,9% not exceeding grade 3a according thoracic mortality and morbidity (TMM) score. The difference in morbidity rate was not statistically significant between two groups (6,9% and 8,9%; p=0,23) The most common complication was prolonged air leak > 7 days (2,6%). 3D-CT powered by separation of arterial, venous and bronchial structures enabled surgeons to perform atypical segmentectomies and use VATS approach more often (31,3% vs 13,5%; p>0,05 and 50,0% vs 11,5%; p<0,05, respectively). 8 atypical segmentectomies were performed by VATS due to 3D-CT reconstruction with bronchovascular separation. 5-year survival was 86% and 21% in NSCLC and pulmonary metastases groups, respectively.
Conclusion:
3D-CT reconstruction with bronchovascular separation provides precise preoperative planning of individual pulmonary segments anatomy and allows to increase the proportion of atypical and VATS sublobar anatomic pulmonary resections.
