Author of

• 10907

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  P1.16 - Poster Session 1 - Other Thoracic Malignancies (ID 186)

  • Event: WCLC 2013
  • Type: Poster Session
  • Track: Thymoma & Other Thoracic Malignancies
  • Presentations: 1
  • Moderators:
  • Coordinates: 10/28/2013, 09:30 - 16:30, Exhibit Hall, Ground Level

  • 10910

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    P1.16-003 - Features of computed tomography images and tumor viability: 141 lesions of pulmonary metastasis of non-seminoma (ID 1863)

    09:30 - 16:30  |  Author(s): M. Nishimura
    • Abstract

    Background
    The standard treatment for advanced non-seminoma is to excise all residual masses, including pulmonary metastatic lesions, in patients whose tumor markers return to normal after chemotherapy. However, too many regions and too great a volume of the patient’s lung are often resected. On the other hand, viable cells are frequently not present in the resected tissue. This study therefore tried to identify distinct features of viable lesions on computed tomography (CT).

    Methods
    Figure 1From January 2008 to December 2011, 17 cases of non-seminoma with lung metastasis underwent lung resection after normalization of tumor markers (α-fetoprotein and hCG). To excise all very small or impalpable lesions, we performed lipiodol marking under computed tomography, for a maximum of 8 sites in one operation. CT images of the 141 resected lesions were investigated for size and properties, and compared with pathological findings. Statistical analysis was performed using the chi-square test.

    Results
    We confirmed viable cells in 8 of 17 cases and 47 of 141 lesions. In those cases, viable cells were detected in both lungs. However, no significant relationship was found between average size and cell viability. The minimum diameter of tumor showing positive pathological change was 3 mm. No significant relation was observed between pathological findings and CT characteristics such as solid, cystic, scar-like or clear boundary.Figure 1

    Conclusion
    The ability to excise tissue from the lung is limited, and we would like to avoid excision of lesions against which chemotherapy has already been successful and which do not contain residual cells. However, the present results suggest the difficulty of specifying regions with viable cells based on CT. For this reason, minute lesions should still be excised, and marking has a very important role to play.

• 12008

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  P2.25 - Poster Session 2 - Nurses (ID 249)

  • Event: WCLC 2013
  • Type: Poster Session
  • Track: Nurses
  • Presentations: 1
  • Moderators:
  • Coordinates: 10/29/2013, 09:30 - 16:30, Exhibit Hall, Ground Level

  • 12009

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    P2.25-001 - Workflow improvement and results of standardization of thoracic surgery procedures among six hospitals (ID 1133)

    09:30 - 16:30  |  Author(s): M. Nishimura
    • Abstract

    Background
    Five full-time doctors are sent to 5 affiliated hospitals from University Hospital of Kyoto Prefectural University of Medicine. To conduct a surgery in the affiliated hospitals, a doctor is sent from the university, for ensuring an efficient and secure medical care with limited members. Until now, each hospital performed surgeries in its own way. However, to perform safer and efficient surgery with a limited number of operating room nurses and thoracic surgeons, they need to work as one team. We report the standardization of thoracic surgery procedures.

    Methods
    First, to understand the current situation at each affiliated hospital, we survey all aspects of surgical procedures. Subsequently, we held 5 meetings among the group and standardized the surgical procedures. A thoracic surgeon and 3–4 operating room nurses from each hospital joined in the discussion. The topics of the discussion covered all aspects of surgery and methods from each hospital were analyzed and standardized. We have already standardized the thoracoscopy system and energy device in all hospitals. We also standardized the main surgical instruments and methods in these meetings. The content of the standardized main surgical procedure was thoroughly explained in a video distributed to each hospital in DVD format. We evaluated the frequency of use of the surgical instruments and excluded rarely used items. To increase the understanding on automatic suture instruments and energy device, the important usage points were shared in the meeting. Nurses were trained on the usage. In the 6[th] affiliated hospital meeting, a questionnaire was conducted to survey the awareness of this approach.

    Results
    The amount of time required from entering the operating room to starting the surgery was shortened from 62 to 55.5 minutes (average). The time required from the end of surgery to exiting the operating room was also shortened from 46.1 to 38.7 minutes (average). The difference among hospitals was successfully reduced. Because the main surgical instruments and methods were standardized, almost the same level of surgery could be performed in each hospital. Surgical instruments were reduced from 48.3 to 41.1 types (average). Total number of surgical instruments was successfully reduced from 91.8 to 73.5 items (average). In the questionnaire, all members referred to other hospitals devices, and they will attempt productions of their own device. All members confirmed improved understanding on thoracic surgery and 88% confirmed increased interest in thoracic surgery．

    Conclusion
    Standardization of the surgical procedures improved the workflow, enabled safe and efficient surgery among the affiliated hospitals, and increased awareness of the importance of workflow improvement. Change in awareness toward thoracic surgery was observed among participating members, suggesting that the present approach is highly useful.

• 12853

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  P3.24 - Poster Session 3 - Supportive Care (ID 160)

  • Event: WCLC 2013
  • Type: Poster Session
  • Track: Supportive Care
  • Presentations: 2
  • Moderators:
  • Coordinates: 10/30/2013, 09:30 - 16:30, Exhibit Hall, Ground Level

  • 12871

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    P3.24-018 - Chest wall desmoid tumor with rapid growth after the resection of lung cancer (ID 1207)

    09:30 - 16:30  |  Author(s): M. Nishimura
    • Abstract

    Background
    Desmiod tumor (aggressive fibromatosis) is an aggressive fibroblastic proliferation of well-circumscribed, locally invasive, differentiated fibrous tissue. Chest wall desmoids account for approximately 20% of all desmoids tumors. The etiology of this tumors is unknown. Local inflammatory changes involved in the healing response after trauma have often been postulated as stimulating the development of desmiod tumors. Although distant spread has not been documented in long-term follow-up studies, these tumors have a strong propensity to recur locally after resection. Several authors have emphasized the use of external radiotherapy as an adjunct to surgery to improve local control.

    Methods
    A 62-year-old male underwent left upper lobectomy using an anterolateral approach. The postoperative diagnosis was pulmonary adenocarcinoma (pT1N0M0 stage1A). Two years after operation, a computed tomography showed the 65x45x25mm diameter mass on the left chest wall around the previous operative scar. Three months later, the mass rapidly enlarged 110x100x55mm in size. A desmoid tumor was suspected from the specimen of an incisional biopsy.Figure 1

    Results
    A Resection of the tumor with the chest wall (from the 2nd rib to the 4th rib) was performed. And thoracoplasty using a myocutaneous flap made of latissimus dorsi muscle with the 10th rib and a titanium plates and Composix Mesh was performed for a defect in the chest wall. Histopathological examination revealed a desmoid tumor. The specimen showed proliferation of spindle shape cells with collagen fibers. No mitoses were present. Tumor cells invaded to ribs and intercostals muscles but surgical margin was negative. Adjuvant radiation therapy with a total dose of 50.4Gy was administered to prevent local recurrence.

    Conclusion
    He is doing well without recurrence at 37months after surgery and radiation. Wide local excision with negative pathological margins is the treatment of choice for most desmoid tumors. Postoperative radiation may be a treatment of choice to prevent local recurrence because the development of local recurrence would result in mutilating reopreration with disfigurement or even amputation.

  • 12877

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    P3.24-024 - Lymphangioma of the diaphragm (ID 1531)

    09:30 - 16:30  |  Author(s): M. Nishimura
    • Abstract

    Background
    Lymphangioma usually occurs in the head and neck area. We present a very rare case of cystic lymphangioma that originated from the diaphragm. Few cases were reported in the literature.

    Methods
    A 69-year-old woman was referred to our hospital for macrocytic anemia and weight loss. Pernicious anemia was diagnosed by the presence of the atrophic gastritis, the decreased serum vitamin B12 level, and the anti-parietal cell antibodies and anti-intrinsic factor antibodies in blood serum. In addition, on chest computed tomography (CT) she was found to have a multicystic mass, measuring 50 mm in diameter, which seemed located in the anterior mediastinum and abdominal cavity, across the diaphragm. The cranial part of the mass consisted of solid structure including fat components but no calcification, and the caudal part consisted of multicystic structure, of which septal wall was slightly enhanced. The mass did not appear to invade the liver but to compress. Fluorine-18-fluorodeoxyglucose positron emission tomography (PET) scan showed no abnormal uptake. The mass was suspected a cystic teratoma, a bronchial cyst, a lipoma, a thymoma, or Morgagni hernia. It was resected through right diagonal thoraco-laparotomy with short upper midline incision.

    Results
    Seen from intrathoracic side the mass did not invade the pericardium and seemed to have firm adhesion to the diaphragm, and from intraabdominal side did not perforate the peritoneum or invade the liver, and no hernia canal was seen. The mass was not able to apart from the diaphragm, and combined resection of the diaphragm was performed. Pathologically it was diagnosed as a lymphangioma.

    Conclusion
    Lymphangioma arising from diaphragm is a very rare tumor. It should be considered in the differential diagnosis of diaphragm tumor.