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K. Suzuki
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ED 10 - Controversies in Stage IIIA Disease (ID 10)
- Event: WCLC 2015
- Type: Education Session
- Track: Treatment of Locoregional Disease – NSCLC
- Presentations: 1
- Moderators:C.P. Belani, E. Vokes
- Coordinates: 9/09/2015, 14:15 - 15:45, 201+203
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ED10.01 - Staging and Decision Making in Patient Selection-Surgery (ID 1810)
14:15 - 15:45 | Author(s): K. Suzuki
- Abstract
- Presentation
Abstract:
There are two clinical trial investigating the role of surgery in stage IIIA NSCLC.
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P3.02 - Poster Session/ Treatment of Localized Disease – NSCLC (ID 211)
- Event: WCLC 2015
- Type: Poster
- Track: Treatment of Localized Disease - NSCLC
- Presentations: 3
- Moderators:
- Coordinates: 9/09/2015, 09:30 - 17:00, Exhibit Hall (Hall B+C)
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P3.02-003 - Availability of the Serum CYFRA 21-1 Level with Resected Non-Small Cell Lung Cancer: The Detectability of Recurrence and the Prognostic Impact (ID 3233)
09:30 - 17:00 | Author(s): K. Suzuki
- Abstract
Background:
The appropriate protocol of postoperative surveillance for patients with non-small cell lung cancer (NSCLC) is still controversial. The aim of this study is to evaluate the detectability of recurrence and the prognostic impact of the serum CYFRA 21-1 levels.
Methods:
We retrospectively reviewed 1076 patients who underwent surgical resection for NSCLC at Juntendo University Hospital, between January 2008 and May 2013. Patients with renal dysfunction were excluded.
Results:
Recurrence developed in 47 patients (30.5%) in high preoperative serum CYFRA 21-1 group, and 147 patients (16.0%) in normal preoperative serum CYFRA 21-1 group. High preoperative serum CYFRA 21-1 was related to the high recurrence rate (p<.0001) and the poor prognosis (p<.0001). In high preoperative serum CYFRA 21-1 group, 111 patients measured the serum CYFRA 21-1 level within the 1-3 months after surgery. Among them, 31 patients (27.9%) had an elevated serum CYFRA 21-1 level, and the poor prognosis (p<.0001) (Fig.). In 94 patients who measured the serum CYFRA 21-1 level during the follow-up period, 35 patients (37.2%) could detect recurrence by an elevated serum CYFRA 21-1 level before recurrence. Only for high preoperative serum CYFRA 21-1 group, 23 patients (67.6%) could detect recurrence.
Conclusion:
High preoperative serum CYFRA 21-1 was related to the high recurrence rate and the poor prognosis. In addition, high early-postoperative (1-3 months after surgery) serum CYFRA 21-1 was related to the poor prognosis. Measuring the serum CYFRA 21-1 level during the follow-up period is useful in the detection of recurrence, but that rate is low.
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P3.02-020 - What Factors Affect Postoperative Respiratory Function in the Patients Performed Sleeve Lobectomy (ID 2508)
09:30 - 17:00 | Author(s): K. Suzuki
- Abstract
Background:
Prediction of postoperative forced expiratory volume in 1 second (FEV1.0) is known as the basis for surgical indications of lung resection. The 0.8L or less estimated postoperative FEV1.0 has been reported an increase in surgery related deaths. In fact, there are some cases that the postoperative FEV1.0 is less than prediction of postoperative FEV1.0. The postoperative respiratory function have been reported in segmentectomy and lobectomy, but little is known in sleeve lobectomy.
Methods:
Between January 2008 and October 2014, 37 patients underwent sleeve lobectomy and evaluated respiratory function tests of preoperative and passing more than six months after surgery at the Juntendo university, Tokyo, Japan. We defined postoperative FEV1.0 / prediction of postoperative FEV1.0 ratio as postoperative FEV1.0 ratio. The patients were divided by postoperative FEV1.0 ratio into the 16 patients who evaluated postoperative FEV1.0 ratio < 1 and the 21 patients who postoperative FEV1.0 ratio ≧ 1. We investigated clinic-pathological features, postoperative complications and predictive factors in postoperative reduction of FEV1.0.
Results:
In the group of postoperative FEV1.0 ratio < 1, the median age was 63 years old (range, 35-77 years), 14 cases (88%) were male, the median postoperative FEV1.0 was 2.05L (range, 0.99-2.54) and the median prediction of postoperative FEV1.0 was 1.82L (range, 0.97-2.23). The group of postoperative FEV1.0 ratio < 1 had marginally more phrenic nerve resection (19%) and blood transfusion (50%) than the group of postoperative FEV1.0 ratio ≧ 1 (p=0.077 and p=0.072). There was no difference in the incidence of morbidity between both groups. The phrenic nerve resection was marginally risk factors of postoperative reduction of FEV1.0 in univariate analysis (p =0.053). The phrenic nerve resection and right side were risk factors of postoperative reduction of FEV1.0 in multivariate analysis (p =0.026 and p =0.048).
Conclusion:
Right side and phrenic nerve resection were independent factors to predict the postoperative FEV1.0 falls below postoperative prediction FEV1.0.
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P3.02-022 - The Digital Monitoring of Postoperative Air Leak Patterns and Air Leak Flow Is Useful for Predicting Prolonged Air Leak after Pulmonary Resection (ID 1092)
09:30 - 17:00 | Author(s): K. Suzuki
- Abstract
Background:
The presence of prolonged air leak (PAL) after pulmonary resection sometimes results in serious complications, such as empyema. Therefore, early prediction and intervention for PAL should be performed. Thopaz[TM] is a digital monitoring thoracic drainage system which enables the objective evaluation of air leak. This study aimed to establish the diagnostic criteria for the early prediction of PAL using the Thopaz[TM ]system.
Methods:
The postoperative data of 150 patients who underwent pulmonary resection and for whom the digital monitoring of thoracic drainage was performed using Thopaz[TM] between December 2013 and January 2015 were prospectively collected. When the air flow level was < 20 mL/min for > 12 hours, the chest tube was removed. We examined the postoperative data, including the chest X-ray findings, the presence of postoperative complications, the duration of air leak, the duration of chest tube placement, the patterns of air leak until 72 hours after operation and the level of peak air flow until 24 hours after operation as determined by Thopaz[TM]. The patterns of air leak were defined as Types A-E (A: No air leak was observed until the removal of the chest tube; B: Air leak flow gradually decreased; C: Although no air leak was observed immediately after operation, air leak occurred postoperatively; D: The repeated exacerbation and remission of air leak was observed; E: Air leak was observed without a trend toward improvement).
Results:
There were 100 men and 50 women; 99 smokers and 51 never-smokers; and 119 cases of lung cancer and 31 cases of other diseases. Their surgeries included 23 wedge resections, 24 segmentectomies and 103 lobectomies. Air leak at the time of the sealing test during the operation was observed in 82 (55%) patients. Air leak was observed in 31 (21%) patients, in whom the mean (± SD) duration of air leak was 3.9 (± 3.7) days. The mean (± SD) duration of chest tube placement was 3.2 (± 1.9) days in the whole study population (n = 150) and 5.2 (± 2.7) days in the 31patients with postoperative air leak. On chest X-ray films, 12 cases of subcutaneous emphysema and 4 cases of atelectasis were observed postoperatively. No complications associated with Thopaz[TM] developed. PAL > 4 days was observed in 10 (6.7%) patients. The frequencies of PAL according to the air leak patterns were 0% (0/119) in type A, 23% (3/13) in type B, 20% (2/10) in type C, 50% (2/4) in type D and 75% (3/4) in type E. The frequencies of PAL according to the peak air flow were 11% (2/18) in < 100 ml/min, 62% (8/13) in ≥ 100 ml/min, 60% (6/10) in ≥ 200 ml/min, 83% (5/6) in ≥ 400 ml/min and 80% (4/5) in ≥ 500ml/min.
Conclusion:
The risk of PAL was higher in patients showing type D and E air leak patterns, and a peak air flow of ≥ 400 ml/min. The results indicate that PAL after pulmonary resection may be predicted by air leak patterns and peak air flow using the Thopaz[TM] system.
