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F. Osawa
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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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P1.16-014 - The Efficacy of Thoracoscopic Right Upper Lobectomy Using Fissureless Technique in Patients with Dense Fissures (ID 9254)
09:30 - 09:30 | Author(s): F. Osawa
- Abstract
Background:
We adopted the ‘thoracoscopic fissureless technique’ for patients with dense fissure undergoing right upper lobectomy to avoid postoperative air leakage. This technique is considered useful in thoracoscopic approach which has the limited direction in dissection. We investigated the efficacy of thoracoscopic right upper lobectomy using fissureless technique in this study.
Method:
Between April 2012 and March 2017, 77 patients underwent thoracoscopic right upper lobectomy with three or four ports, of whom 23 adopted fissureless lobectomy. We compared the characteristics and perioperative outcomes of the patients undergoing the fissureless technique (fissureless group, n=23) and the traditional fissure dissection technique for pulmonary artery exposure (traditional group, n=54). The details of the fissureless technique is as follows. While the upper lobe is retracted towards the back, the upper lobe vein and the anterior PA trunk to the upper lobe are exposed and divided. After the division of right upper lobe bronchus by a stapler, the ascending artery is divided. However, it is better to dissect and divide the ascending A2 prior to right upper bronchus when the ascending A2 branches from a comparatively proximal portion. The fissure is finally divided.
Result:
The patients’ characteristics and perioperative results in the 2 groups are shown in the table. There was no significant inter-group difference about sex ratio, age, blood loss (p=0.95), intraoperative massive bleeding rate (p=0.66), conversion rate (p=0.55) or morbidity (p=0.13), fissureless group had shorter operation time (p=0.047) or postoperative hospital stay (p=0.0004). Additionally, fissureless group had tendency to reduce the duration of postoperative chest tube drainage (p=0.07).Variable Fissureless group, n=23 (%) Traditional group, n=54 (%) p-value Operation tim (min.) 197±45 225±61 0.047 Blood loss (ml) 93±150 95±165 0.95 Intraoperative massive bleeding (n) 1 (4.3) 5 (9.3) 0.66 Conversion to thoracotomy (n) 0 (0) 3 (5.6) 0.55 Duration of chest tube drainage (days) 2.7±1.6 3.9±3.2 0.07 Length of postoperative hospital stay (days) 4.6±1.3 7.5±3.5 0.0004 Morbidity (n) 2 (8.7) 14 (25.9) 0.13
Conclusion:
Thoracoscopic right upper lobectomy using fissureless technique is considered useful because it had a tendency to reduce the duration of postoperative drainage, and significantly reduced operation time and the length of postoperative hospital stay.
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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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P2.16-009 - Strategy for Oncologic Emergency in Thoracic Disease (ID 8953)
09:30 - 09:30 | Author(s): F. Osawa
- Abstract
Background:
No large series of oncologic emergencies in thoracic surgery has been reported. Such patients are usually in critical condition and need immediate intervention of various types. Here, we present the surgical interventions that have occurred in our experience with oncologic emergencies.
Method:
We retrospectively analyzed 28 patients with oncologic emergencies who underwent surgical intervention at our hospital in 2002‒2016. The mean patient age was 76 years, and there were 19 (68%) males and 9 (32%) females. The primary disease was primary pulmonary carcinoma in 13 cases, including adenocarcinoma and squamous cell carcinoma in 4 and 6, respectively, other-organ carcinomas in 12, and mediastinal tumors in 3. Airway stenosis was the complaint in 19 (68%), including hemoptysis in 2, superior vena cava syndrome in 3 (11%), infectious diseases in 2 (7%), tumor bleeding in 2 (7%), and pneumothorax in 2 (7%).
Result:
The goal of surgery was a radical operation in 8 (29%), biopsy in 3 (11%), and palliative therapy in 17 (60%) patients. The surgical procedure was lobectomy in 4 patients, bronchoplasty in 4, wedge resection in 3, pneumonectomy in 1, tumor removal in 2, pleural decortication in 1, excisional biopsy in 4, airway intervention (stent or laser cauterization) in 11, and tracheostomy in 6. The mean hospital stay was 32±39 (range 3–155) days. The outcome was hospital death in 7 (25%) and discharge in 21 (75%). Of the discharges, 3 (11%) patients were transferred to another hospital, and 18 (64%) were sent home. The mean survival was 743±743 (range 3–3798) days. Of the 21 discharges, 7 (25%) patients are alive, including 4 (14%) who are cancer-free and 3 (11%) with cancer. As treatment, radical surgery was more effective than conservative therapy.
Conclusion:
The oncologic emergencies experienced in thoracic surgery included obstruction/stenosis, bleeding, infection, and rupture. Stenosis comprised the majority and was caused by tumor growth in the airway and compression and invasion by tumors. Good outcomes were expected in patients with slow-growing tumors who underwent laser cauterization or airway stent placement.
