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M. Kataoka
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P3.04 - Poster Session with Presenters Present (ID 474)
- Event: WCLC 2016
- Type: Poster Presenters Present
- Track: Surgery
- Presentations: 2
- Moderators:
- Coordinates: 12/07/2016, 14:30 - 15:45, Hall B (Poster Area)
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P3.04-006 - The Effect of Preoperative Multi-Disciplinary Support Commenced at Outpatient Clinic on Lung Cancer Patients (ID 4477)
14:30 - 15:45 | Author(s): M. Kataoka
- Abstract
Background:
We assessed the effect of preoperative multi-disciplinary support, commenced at the outpatient clinic of our hospital, on patients with lung cancer.
Methods:
Since 2013, coaching on respiratory rehabilitation is being provided to the lung cancer patients at our outpatient clinic. In 2014, preoperative multi-disciplinary support was introduced in addition to rehabilitation support. Multi-disciplinary team consisted of an anesthesiologist, a nutritionist, pharmacist, medical social worker, and nurse. We examined 54 cases of primary lung cancer patients, undergoing video-assisted lobectomy. Patients were classified into three groups: ‘no support’; ‘rehabilitation alone’, and ‘preope rative support’. The ‘no support’ group received no preoperative support and included the last consecutive 18 cases before the introduction of preoperative support.The ‘rehabilitation alone’ group included 18 consecutive cases, when no other support was available. The ‘preoperative support’ group included 18 consecutive cases, starting from the first patient receiving multi-disciplinary preoperative support.
Results:
Data are presented in the following order: ‘no support’, ‘rehabilitation alone’, and ‘preoperative support’. Morbidity rates were 27.8%, 16.6%, and 0%, respectively. The number of days of postoperative hospital stay were 11.3/10, 8.7/8, and 6.9/7 (average/median), respectively and there was a significant difference among the groups (p=0.000266). Univariate and multivariate analysis were performed according to the following parameters: age, sex, stage, operation time, blood loss, days of raised body temperature, postoperative complications, days of antibiotic treatment, days with a chest drain, day of first walk postoperatively, clinical path, and preoperative support. In univariate analysis, the number of days with a chest drain, the day of first walk postoperatively, clinical path, and preoperative support correlated with the postoperative stay in hospital. In multivariate analysis, preoperative support was most strongly associated with a shorter postoperative stay according to logistic regression analysis with backward stepwise deletion. Moreover, there was a reduction in the overall medical expenses per patient, in the preoperative support group (p=0.0405). A postoperative questionnaire was administered to patients and their families. Results showed that patients recognized the effect of preoperative interventions on outcome and a shift in patient attitude, from a passive to an active mindset, was observed.
Conclusion:
Preoperative rehabilitation and nutritional support improve physiological function; anesthesiologist and pharmacist review identify problems and improve strategy; and hearing and explanation by nursing staff increase problem-solving capacity and coping mechanisms of patients. These effects may result in a shorter hospital stay.
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P3.04-046 - Cases of Surgical Resection of Post-Operative Lymph Node Recurrences from Primary Lung Cancer (ID 5317)
14:30 - 15:45 | Author(s): M. Kataoka
- Abstract
Background:
The prognosis of patients with recurrent nodal metastasis after resection of primary lung cancer is poor, and surgical resection is not indicated for patients with lymph node (LN) disease beyond N3. Recently, some reports showed the efficacy of surgical resection of the small number of distant metastases (oligometastasis). In our hospital, we had 7 cases of nodal metastasis resection after primary lung cancer resection. The purpose of this study was to discuss the possibility of improving prognosis by resection of nodal recurrence.
Methods:
From 2007 to 2013, we examined 7 patients for whom lymphadenectomy was performed to treat lymph nodal recurrence following curative resection of the primary cancer at our hospital.The mean age was 58 years(45-73 years);there were 2 female and 5 male patients.At the initial operation,there was 1 case of stageⅡA,1 case of stageⅡB,4 cases of stageⅢA,1case of stageⅢB cancer.Pathologically,there ware 3 adenocarcinoma cases,3 squamous cell carcinoma cases,and 1 adenosquamous carcinoma case.All patients underwent postoperative adjuvant chemotherapy, and 4 patients underwent postoperative radiotherapy for residual or recurrent tumors.
Results:
All 7 patients underwent lymphadenectomy;3 had supraclavicular recurrent LN and 4 had mediastinal recurrent LN.In 2 of the supraclavicular cases and 1 of the mediastinal cases,the patients are alive without any recurrence.In the other four cases,the patients showed re-recurrence,received chemotherapy,and are alive.The median survival time from the day of recurrent lymphadenectomy was 32 months (27-62months) and that from the day of the initial operation was 76 months (36-101months).The median disease-free survival time from the day of recurrent lymphadenectomy was 19 months (9-62months).The 2 years disease-free survival was 42.9%. The median interval from initial operation to recurrent lymphadenectomy was 43.3 months for the 3 cases without recurrence and 19.8 months for the 4 cases with re-recurrence
Conclusion:
Complete cure or better prognosis could be expected via surgical resection for some cases with LN recurrence when the lesion is localized and has no distant metastasis.A longer interval between initial operation and the day of recurrence might indicate better prognosis. Therefore,surgical resection of LN recurrence might be indicated if other metastatic lesions do not occur after a certain period.
