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A. Nakamura
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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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P1.16-025 - Safety of Simultaneous TEVAR and Combined Aortic Wall Resection at the Time of Lung Resection for T4 Lung Cancer Infiltrating the Aorta (ID 10506)
09:30 - 09:30 | Author(s): A. Nakamura
- Abstract
Background:
Combined resection of lung cancer and aortic wall for T4 lung cancer is highly invasive and is a challenging procedure for thoracic surgeon. With the advent of minimally invasive endovascular therapy with thoracic endovascular stent (TEVAR) in recent years, there is a possibility that resection of the aorta may be undergone with minimally invasive approach. The aim of this study is to report the safety of simultaneous TEVAR and combined resection of aortic wall on the same day at the time of lung resection.
Method:
We started this minimal invasive procedure form 2013 with the approval of the ethics committee, treatment using TEVAR in cooperation with cardiovascular surgery upon resection of the aorta. Four cases of primary lung cancer with aortic invasion, one case of recurrent lung cancer with aortic invasion after SBRT for second primary lung cancer after left upper lobectomy. Thoracic surgeon and cardiovascular surgeon discussed on predicted tumor invasion range and resection site, stent placement position and stent length, size, surgical procedure considering safe margin. TEVAR was performed on the same day as open chest surgery in all cases. At first aortic invasion was confirmed by thoracotomy in right lateral decubitus position and, then TEVAR was performed in supine position. After TEVAR, the patient was positioned in the right lateral decubitus position again and lung resection combined aortic resection was completed.
Result:
The site of endovascular stent insertion was the aortic arch and descending aorta in two (the subclavian artery occlusion in one, the fenestration for SCA in one), the distal arch just beneath the subclavian artery in two, and descending aorta in one case. The time required to place the stent was 49 to 149 minutes, and in all cases the stent could be placed at the target position. Procedure of lung resection was upper lobectomy in two, pneumonectomy in two, completion pneumonectomy in one. The depth of aortic wall resection was adventitia in three and adventitia + media in two. TEVAR-related complication was observed in one case; external iliac artery intimal damage requiring vessel repair. There were no complications associated with aortic resection. Two postoperative complications of atrial fibrillation and chylothorax were observed but there was no surgery related death.
Conclusion:
Simultaneous TEVAR and combined resection of aortic wall on the same day at the time of lung resection is feasible. Prior to surgery, thoracic surgeon should share information with cardiovascular surgeon to make this procedure safe.
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P3.16 - Surgery (ID 732)
- Event: WCLC 2017
- Type: Poster Session with Presenters Present
- Track: Surgery
- Presentations: 1
- Moderators:
- Coordinates: 10/18/2017, 09:30 - 16:00, Exhibit Hall (Hall B + C)
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P3.16-002 - Postoperative Prognostic Factors in Non-Small Cell Lung Cancer Patients with Lymph Node Metastasis (ID 9347)
09:30 - 09:30 | Author(s): A. Nakamura
- Abstract
Background:
Postoperative outcome for NSCLC patients with lymph node metastasis is unfavorable even after surgery with/without adjuvant chemotherapy. We sought to investigate postoperative prognostic factors in NSCLC patients with lymph node metastasis.
Method:
We retrospectively reviewed NSCLC patients with pathologically identified lymph node metastasis who underwent complete resection. Demographic, clinical, and pathologic factors (sex, age, smoking index, Performance Status, preoperative carcinoembryonic antigen [CEA], surgical procedure, lymphadenectomy extent, histology, tumor differentiation, tumor size, pT factor, metastatic node site, and adjuvant chemotherapy) were analyzed using the log-rank test as univariate analyses and a Cox proportional hazards regression model for multivariate analyses to identify independent predictors of favorable disease-specific survival (DSS).
Result:
Of the 146 eligible patients, 113 were male and 33 were female. The median age and preoperative CEA were 67 years and 5.3 ng/mL, respectively. Lobectomy or greater resection and segmentectomy were performed in 140 and 6 patients, respectively. Tumor histology was adenocarcinoma in 58 patients, squamous cell carcinoma in 70, and others in 18. Node metastasis was identified in hilum only in 85 patients and mediastinum in 61. Adjuvant chemotherapy was performed in 61 patients (platinum doublet in 56 and tegafur/uracil in 5, respectively) and was not performed in 85. The 5-year DSS was 58%. The CEA ≤5.3 ng/mL (HR: 0.368), without mediastinal node metastasis (HR: 0.436), and platinum doublet adjuvant chemotherapy (HR: 0.491) were identified as significant predictors of favorable DSS. The 5-year DSS in patients with CEA ≤5.3 and >5.3 ng/mL were 73% vs 41%, respectively (p<0.001). The 5-year DSS in patients who underwent platinum doublet chemotherapy or none/others were 67% vs 53%, respectively (p=0.047). Figure 1
Conclusion:
Even if NSCLC patients have lymph node metastasis, favorable postoperative prognosis may be expected in patients with low preoperative CEA. Platinum doublet adjuvant chemotherapy should be considered in patients with lymph node metastasis on pathological examination.
