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A. Mussi
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P1.02 - Poster Session/ Treatment of Localized Disease – NSCLC (ID 209)
- Event: WCLC 2015
- Type: Poster
- Track: Treatment of Localized Disease - NSCLC
- Presentations: 1
- Moderators:
- Coordinates: 9/07/2015, 09:30 - 17:00, Exhibit Hall (Hall B+C)
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P1.02-031 - Wedge Resection for NSCLC: Does Minimally Invasive Surgery Warrant the Maximum Advantage? (ID 432)
09:30 - 17:00 | Author(s): A. Mussi
- Abstract
Background:
Anatomic resections of the lung are firmly considered the gold standard treatment for early stage Non Small Cell Lung Cancer (NSCLC). The role of non-anatomic surgery is still not clear and it is generally used for very selected patients, who cannot undergo an anatomical resection of lung parenchyma for functional reasons. The aim of this study is to analyze whether surgical approach (VATS or open) might have an influence on the long term outcome of NSCLC patients treated by wedge resection.
Methods:
From December 2006 till 2010, 1695 patients underwent surgery for primary NSCLC at our Institution. Among them, 97 patients received a wedge resection either by open or thoracoscopic apprach due to coexisting morbidities or low pulmonary function; 54 were selected for our study. We excluded from our analysis all patients with a previous lung cancer, with suspected (on the basis of CT or PET CT images) or confirmed N2 disease, nodules greater than 5 cm or with involvement of the chest wall or mediastinal structures. Follow-up was carried out at December 2013.
Results:
Out of the 54 wedge resections, 30 were performed through a thoracothomy, while 24 cases by means of a VATS procedures. There were no statistically significant difference among clinical features of the two groups. Mean tumor diameter were 2,1 cm in the open group (OG) and 1,7 cm in the VATS group (VG); mean distance from visceral pleura was significantly higher in the OG (2,1 cm vs 0,8 cm; p=0,02) and so were the stapler edge (2,4 cm vs 1,2 cm; p<0,03). Mean follow-up was 42 months. In the open surgery group 2 patients (6,7%) had a local recurrence and in 10 patients (33,3%) we noticed systemic metasthasis. In the VATS group we had 4 cases (16,7%) of local recurrences and 7 (29,2%) of distant metasthasis. Local recurrence rate was significantly different between the two groups (p=0,048), while no significant correlation was found regarding the distant methastasis rate. Three patients died during the follow up period (two in the group treated with thoracotomy, 1 with VATS).
Conclusion:
Although different deepness of nodule between the two groups may represent a bias, we noticed a significant lower recurrence rate when surgery was performed by thoracotomy. Tumors larger than 1,5 cm are more likely to develop a recurrence, regardless to the kind of surgical approach. Wedge resection may be considered a feasible procedure for highly selected patients affected by NSCLC: open approach may be related to a better long term outcome in patients with small and deep nodules.
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P2.08 - Poster Session/ Thymoma, Mesothelioma and Other Thoracic Malignancies (ID 225)
- Event: WCLC 2015
- Type: Poster
- Track: Thymoma, Mesothelioma and Other Thoracic Malignancies
- Presentations: 1
- Moderators:
- Coordinates: 9/08/2015, 09:30 - 17:00, Exhibit Hall (Hall B+C)
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P2.08-034 - 'Nerve Sparing' Surgery for Invasive Thymomas (ID 985)
09:30 - 17:00 | Author(s): A. Mussi
- Abstract
Background:
Masaoka-Koga stage and the radicality of the surgical resection are the most important prognostic factors for thymomas. Infiltration of the phrenic nerve interests 10-40 % of invasive thymomas (stage III and IVA). We report the clinical and oncological outcome of patients operated on for invasive thymoma by a intention-to-treat “nerve sparing” technique.
Methods:
In the period 1992-2012 we have applied the “nerve sparing” surgery in all patients with invasive thymoma, and without pre-operative evidence of phrenic nerve paralysis. In that period we have operated on 72 stage III e 33 stage IVA thymomas. Thirteen out of them had a preoperative radiological evidence of phrenic paralysis (5 stage III and 8 IVA) and they were preliminary excluded. In 30 patients phrenic nerve was partially or completely surrounded by the thymoma and they underwent an attempt of ‘’nerve sparing’’ surgery. In twenty six cases the resection of the thymoma with a phrenic sparing procedure was possible. All patients underwent subsequent adjuvant radiation (45-60 Gy).
Results:
Twelve male and 14 female have been treated, with a mean age of 56 years (range 26-83). At the hystological analysis there were: 1 Type A, 5 Type AB, 10 Type B1, 5 Type B2, 5 Type B3. Myasthenia gravis and red cell aplasia were associated in fifteen and one case, respectively. Despite the attempt of preserving the phrenic nerve, in five patients phrenic palsy was observed in the immediate postoperative period. Three of them showed a complete phrenic nerve recovery, while in the other 2 cases nerve paralysis was irreversible. Mean follow up was 96 months (DS ±73) with an mean overall survival of 89 months (DS ±68). The mean disease free interval was 81 months (DS ±71). Three patients (11,5%) had a pleural recurrence (2 stage IVA, 1 stage III) requiring further surgical resection. Two patients (7,7 %) died (1 of systemic metastases and 1 for other cause).
Conclusion:
Preserving the phrenic nerve in case of invasive thymomas is feasible and if associated to adjuvant radiotherapy may also allow to achieve good long term disease-free results. In reason of the excellent local control of disease it should be proposed mainly to patients with invasive thymoma and myasthenia gravis or with a poor pulmonary function.
