Author of

• 20195

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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)

  • 24230

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    P3.16-007 - Incidence and Outcomes of Positive Parenchymal Margins after Lung Resection – an Analysis of 1428 Cases (ID 7932)

    09:30 - 09:30  |  Author(s): S. Gilbert
    • Abstract

    Background:
    Positive margins after pulmonary resection for cancer is an uncommon and challenging occurrence, with no consensus currently available to guide best adjuvant treatments. Our objective was to determine the rate of positive parenchymal margins after non-pneumonectomy lung resection with an assessment of adjuvant treatment strategies and outcomes.
    
    Method:
    Ethics board approval was obtained for a retrospective analysis of prospectively collected data on all lung resections performed at the Ottawa Hospital during the period 2008-2014. Individual patient records were then examined to confirm margin status by a review of the final pathology report. Survival and disease-free intervals were analysed using log-rank statistics, with significance set at 5%.
    
    Result:
    Over the study period, 1428 patients underwent non-pneumonectomy lung resection. A total of 29 cases (2%) were identified with a positive lung parenchymal margin (PPM). A matched subset (n=662) of the remaining 1379 patients with negative parenchymal (NPM) were used as control group. Median followup for NPM was 36.7 [0-105.6] and for PPM was 29.1 [0.5-71.5]. Overall, lobectomy was the most common pulmonary resection performed; wedge resections represented the majority of the PPM (n=16, 55%) followed by lobectomy (n=9; 31%) and segmental resections (n=1; 3%). Overall survival (Figure) and disease-free survival (not shown) were significantly (p<0.0001) worse for the PPM (Hazard ratio 5.59, 95%CI [2.05-15.6]) with a median survival of 31.5 months; the control group had not reached median survival. Stage I and II NSCLC were predominant in both groups; however postive margins were more often associated with metastatic disease (24% in PPM; 0.9% in NPM). The majority of PPM went on to receive additional treatment (n=17; 68%) consisting of adjuvant chemotherapy (n=7; 28%), radiotherapy (n=4; 16%), chemoradiotherapy (n=5; 20%) and re-resection in one case. The remaining patients were observed. Recurrence was found at the staple line in 7 cases (24%); the remainder recurred at distant sites.
    
    Conclusion:
    The overall rate of PPM in this study is low (2%) as compared to reported rates of 5-15%. Wedge resection for metastases was associated with most cases of PPM; most patients received additional treatment and had distant sites of recurrence. Overall survival was significantly worse for PPM despite adjuvant therapy, which likely reflects the underlying disease.