Author of

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  P1.24 - Poster Session 1 - Clinical Care (ID 146)

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

  • 11043

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    P1.24-042 - Video-assisted thoracic surgery lobectomy for patient receiving induction chemoradiotherapy for locally advanced non-small cell lung cancer (ID 3015)

    09:30 - 16:30  |  Author(s): K. Anami
    • Abstract

    Background
    Video-assisted thoracic surgery (VATS) lobectomy is an accepted oncologic approach for early-stage peripheral typed non-small cell lung cancer (NSCLC).Recently the indication of VATS lobectomy is becoming widely adapted to more complicated cases thanks to development of thoracoscopic instruments and technical aspects.

    Methods
    We here report a case of patient who underwent VATS lobectomy after induction chemoradiotherapy for locally advanced NSCLC.

    Results
    A 56-year-old man with a 35 pack-year history of tobacco use presented with productive cough. A computed tomography (CT) revealed a 6-cm hilar mass with consolidation in the right upper lobe and hilar, interlobar,and single mediasitnal lymphnode metastases. There was a significant mass uptake of FDG (standardized uptake value: 16.1 to 19.2) on Positron emission tomography (PET). Bronchofiberscopy showed an intraluminal extension of the tumor centrally to the orifice of the right upper lobe. Bronchofiberscopic biopsy demonstrated squamous cell carcinoma. This patient have a clinical T2bN2M0 IIIA NSCLC. He received two cycles of CDDP+GEM followed by concurrent CDDP+VNR and 40Gy irradiation. Preoperative assessment by CT and PET revealed marked regression of the tumor. A VATS lobectomy was then performed. One utility incision (4 cm) was made over the 4th intercostal and three ports (0.5-1.5 cm each) were placed without rib spreading. By using bipolar scissors, the major vascular structures and the bronchus were safely dissected from the irradiated surrounding tissue similarly to an open procedure. The bronchus could be divided using a stapling device. An anatomic lobectomy with sysytematic mediasitanal lymphnode dissection was fully and safely performed. The chest tube was removed on the postoperative 1st day. He had an uneventful 9-day hospital course. This final pathological finding revealed microscopically residual tumor only in the bronchial wall and lung parenchema andin the single mediastinal lymphnode. This patient have an yield pathological T3N2M0 StageⅢA NSCLC.He received additional 4 cycles of CDDP based chemotherapy postoperatively and is alive with disease free 25 months after surgery.

    Conclusion
    VATS lobectomy is a feasible approach for selected patients undergoing resection after induction chemoradiotherapy for locally advanced NSCLC.