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A. Pestal



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    P1.24 - Poster Session 1 - Clinical Care (ID 146)

    • Event: WCLC 2013
    • Type: Poster Session
    • Track: Supportive Care
    • Presentations: 1
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      P1.24-053 - Repeated Pulmonary Resections at Pulmonary Metastases Surgery (ID 3499)

      09:30 - 16:30  |  Author(s): A. Pestal

      • Abstract

      Background
      Repeated pulmonary resections there are predominantly used in sarcomas and colorectal cancers and in young age. Bad prognosis is in patients with reccurency of pulmonary metastases in period to six months. There are exist four prognostic groups according present risk factors (short disease free interval, multiple metastases).

      Methods
      We performed in period I/1997 to XII/2011 165 operations in 149 patients. 10patients had multiple pulmonary resections. According origin histology were – 6x sarcomas. 2x tu Grawitz, 1x Schwannoma malignum, 1x ca laryngis. There are synovialosarcoma, osteosarcoma, rhabdomyosarcoma, alveolar sarcoma and sarcoma uteri in group of sarcomas.

      Results
      As approach we used VATS 2x, clamshel thoracotomy 2x, muscle sparing vertical thoracotomy 7x and posterolateral thoracotomy 6x. We performed extraanatomic resection 13x, lobectomy 4x and completion pneumonectomy 1x. We observed 6x complications (3x small air leak, 3x wound infection) in postoperative period. No necessary rethoracotomy for complications, letality 0.

      Conclusion
      Surgery is part of complex therapy. There are very necessary strict selection of candidates for surgery and experienced team of thoracic surgeons. Surgery is safe and useful procedure at pulmonary metastases surgery.

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    P3.07 - Poster Session 3 - Surgery (ID 193)

    • Event: WCLC 2013
    • Type: Poster Session
    • Track: Surgery
    • Presentations: 1
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      P3.07-044 - Systematic Nodal Dissection During Pulmonary Metastasectomy: Results of a Clinical Study (ID 3138)

      09:30 - 16:30  |  Author(s): A. Pestal

      • Abstract

      Background
      Systematic nodal dissection has become a standard part of a curative resection for the non-small cell lung cancer. Its value in lung metastasectomy is unknown. The aim of our study was to assess the frequency of lymph node metastases in the patients undergoing lung metastasectomy, survival of the patients with and without lymph node involvement and to consider, if and when routine nodal dissection should be recommended. Study was supported by the grants of the Ministry of Health of the Czech Republic IGA MZ ČR NS10095-4, NT/12085-3.

      Methods
      All consecutive patients selected for lung metastasectomy in 3 surgery departments from 7/2008 to 12/2011, were operated by standard technique of the lung metastasectomy with systematic nodal dissection according to the ESTS guidelines for intraoperative lymph node staging in non-small cell lung cancer. If wedge resection was done, N1 nodes were removed only as a part of the local procedure. Patients with mediastinal lymph node involvement detected by the preoperative CT or PET scan and patients with metastatic lung cancer were excluded from the study.

      Results
      There were 101 lung metastasectomies, for metastatic carcinoma in 87 patients, for metastatic sarcoma in 14 cases. Surgical procedures were as follows: 71 wedge resections, 27 lobectomies, 8 segmentectomies. Bilateral metastases were present in 22 patients; solitary metastatic lesion was found in 57 cases. Average diameter of the metastasis was 25.3 mm. Average number of the lymph nodes yielded by lymphadenectomy was 16.4. Metastatic involvement of the mediastinal lymph nodes was found in 9 cases (8.9%), metastatic carcinoma (colorectal in 4 cases) in 7 cases and sarcoma in 2 cases. Average DFI was 37.5 months. 3-years survival according Kaplan-Meier was 76% (0.76±0.06), for metastatic carcinoma 81% (0.81±0.06), sarcoma 46% (0.46±0.15); for colorectal carcinoma 92% (0.92±0.06). 3-years survival for patients with negative lymph nodes was 78% (0.78±0.06), with metastatic involvement 53% (0.53±0.25). Statistical analysis with two-sided log-rank test at the 0.05 level of significance showed better survival for the patients with metastatic carcinoma in comparison with sarcoma (p=0.0007) and better survival for patients without metastatic lymph node involvement (p=0.044).

      Conclusion
      Even in carefully selected group of patients, incidence of the mediastinal lymph node metastases is high and systematic lymphadenectomy should be considered in all cases. Because of a lack of robust data, we recommend routine nodal dissection only as a part of a clinical study. Due to the small numbers available, lymphadenectomy remains questionable in bilateral cases, for sarcoma metastases and in patients in high operative risk.