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S. Yamashita
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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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P3.16-044 - Feasible Outcome of Radical Extended Surgery in T4 Locally Advanced NSCLC; 23-Year Japanese Single Center Experience (ID 9273)
09:30 - 09:30 | Author(s): S. Yamashita
- Abstract
Background:
T4 NSCLC is sometimes considered as an unresectable disease due to the surgical difficulties and expected poor outcome. Especially, pulmonary resections accompanied with carinal resection and resections under extracorporeal circulation (ECC) have huge surgical invasiveness and risks of postoperative life-threatening complications. On the other hand, in practice, such surgery plays an important role to control disease in highly selected T4 cases. We reviewed our 23-year experience to clarify the benefit and risk of radical extended surgery in T4 locally advanced NSCLC.
Method:
All patients underwent curative-intent radical extended surgery such as pulmonary resection accompanied with carinal resection or resection under ECC for cT4 NSCLC (UICC ver.7) at Fukuoka University, between 1993 and 2016. All relevant data were retrieved from our institutional database and analyzed retrospectively.
Result:
27 patients were enrolled with a mean age of 57.9±11.2 (35-74) at surgery. 25 patients (92.6%) were male, and only 2 were female. 17 patients underwent pulmonary resection with carinal resection (CR group), 11 underwent pulmonary resection under ECC (ECC group). 1 case required both CR and ECC procedure. As an extent of pulmonary resection, pneumonectomy was performed in 24 patients, lobectomy in 2, and bilobectomy in 1. In CR group, all of 17 patients underwent carinal pneumonectomy (Rt; 12, Lt; 5). In ECC group, reason for ECC use were as follows; resection and reconstruction for descending aorta 6, left atrium 3, aortic arch 1, and pulmonary artery trunk 1. As ECC, cardiopulmonary bypass was used in 5 patients, extracorporeal membrane oxygenation in 6. In this cohort, multimodality approach was indicated only in 10 patients (37%). R0 resection was achieved in 22 patients (81.5%). Regarding pathologic N status, N0 was in 10 patients, N1 in 4, N2 in 12, and N3 in1. Overall survival (OS) in the whole cohort was 62.6% at 1-year, 58.1% at 3-year, 43.6% at 5-year, respectively. OS in CR group was 63.6% at 1-year, 42.4% at 5-year, OS in ECC group was 64.2% at 1-year, 48.1% at 5-year. 30-day mortality was observed in 3 patients (11.1%), in-hospital mortality was observed in 7 (25.9%). No significant difference in surgical and survival outcome was observed between two groups.
Conclusion:
Our long-term results of extended surgery in T4 NSCLC were feasible. Outcome of carinal resection was equal to resection under ECC. However, surgical and short-term outcome could be improved. Individualized approach combined with other modality therapy will be a next step to better short- and long-term outcome.
