Author of

• 10946

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  P1.19 - Poster Session 1 - Imaging (ID 179)

  • Event: WCLC 2013
  • Type: Poster Session
  • Track: Imaging, Staging & Screening
  • Presentations: 1
  • Moderators:
  • Coordinates: 10/28/2013, 09:30 - 16:30, Exhibit Hall, Ground Level

  • 10953

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    P1.19-007 - Prediction of pleural adhesion during video-assisted thoracopic surgery in lung cancer patients (ID 2175)

    09:30 - 16:30  |  Author(s): H. Seo
    • Abstract

    Background
    Pleural adhesions increase the risk of lung injury and lead consequent prolonged air-leak or conversion to open thoracotomy. We aimed to find the clinical or image predictor for pleural adhesion during video-assisted thoracoscopic surgery (VATS) in lung cancer patients.

    Methods
    Eighty-nine consecutive patients who underwent VATS for lung cancer were included. We retrospectively investigated operative records and clinical information including age, gender, smoking history, body mass index (BMI), forced expiratory volume in 1 second (FEV1), and forced vital capacity (FVC). Pleural adhesion was categorized into 5 grades; none, minimal, moderate (requiring adhesiolysis during VATS with 30 minute or less), severe (requiring adhesiolysis with 30 minute or longer), and very severe (near total involvement of the hemithorax). Advanced adhesion was defined as the presence of moderate or severe or very severe adhesion. Two radiologists blinded to clinical information performed visual analysis for image characteristics of chest CT in consensus. The presence of parenchymal band or calcified granuloma or pleural retraction around the tumor was determined. Severity of emphysema or interstitial fibrosis was assessed as 5 grades (none, trivial, mild, moderate, and severe). The extent of bronchiectasis or pleural thickening or pleural calcification or extrapleural fat thickening was evaluated as 3 grades (none, localized, and extensive).

    Results
    Pleural adhesion was found in 51 subjects (57.3 %) including 15 (16.9 %) minimal, 18 (20.2 %) moderate, 16 (18.0 %) severe, 2 (2.2 %) very severe adhesion. Male gender and current smoker was 66 subject (74.2 %) and 60 (67.4 %), respectively. Mean age was 64.6 ± 10.4 years-old. Mean value of FEV1 and FVC was 2.4 ± 0.6 ml (range; 0.7-3.9) and 3.4 ± 0.8 ml (range; 1.3-5.0), respectively. Tumor size was 3.1 ± 1.5 cm. Parenchymal band, calcified granuloma, pleural retraction was found in 41.6 %, 27 %, and 44.9 %, respectively. Most subjects had no (49.4 %) or minimal (23.6 %) emphysema. Mild, moderate, and severe emphysema was found in 18.0 %, 7.9 %, and 1.1 %, respectively. Most patients have no bronchiectasis (86.5 %) and no interstitial fibrosis (89.9 %). Localized and extensive bronchiectasis was found in 12.4 % and 1.1 %, respectively. Trivial and moderate interstitial fibrosis was found in 6.7 % and 3.4 %. Localized and extensive pleural thickening was found in 10.1 % and 1.1 %, respectively. Localized and extensive pleural calcification was found in 4.5 % and 1.1 %, respectively. Both localized and extensive extrapleural fat thickening was found in 5.6 %. In univariate analysis, male gender (P = 0.013), age (P = 0.21), FEV1 (P < 0.001), tumor size (P = 0.003) were significant predictors of advanced adhesion. Among the image characteristics, severity of emphysema was a significant predictor of advanced adhesion in univarite analysis (coeffient of 1.83, P = 0.007). Multivariate analysis revealed that independent predictor for advanced pleural adhesion was only FEV1 (coefficient of 0.13, P < 0.001).

    Conclusion
    Severity of emphysema and FEV1 might enhance the prediction of pleural adhesion during VATS in lung cancer patients.