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T. Haruki



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    O09 - General Thoracic Surgery (ID 100)

    • Event: WCLC 2013
    • Type: Oral Abstract Session
    • Track: Surgery
    • Presentations: 1
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      O09.05 - Intraoperative autostapling cartridge lavage cytology in surgical resection of pulmonary malignant tumors - possible role in preventing local failure (ID 2543)

      16:15 - 17:45  |  Author(s): T. Haruki

      • Abstract
      • Presentation
      • Slides

      Background
      Limited resection of primary lung cancer or sublobar resection of pulmonary metastatic tumor can result in cut-end recurrence. It is important to confirm the absence of tumor cells at the cut-end. Since 2004, all autostapling cartridges used for wedge or segmental resection of pulmonary malignancies are washed with 50 ml saline. Washing saline is centrifuged and the sediment is stained using Papanicolaou’s method and examined for cancer cells during surgery to confirm negative margin. The aim of this study is to evaluate the efficacy of the intraoperative autostapling cartridge lavage cytology in preventing surgical cut-end recurrence.

      Methods
      The intraoperative cytology analysis was performed in 271 patients undergoing wedge or segmental resection for 319 lesions including primary lung cancers and pulmonary metastatic tumors between April 2004 and April 2010. We retrospectively reviewed the clinicopathologic features of patients with positive cytology results and those who developed recurrence at the surgical margins.

      Results
      The median age of the 271 patients at surgery was 67 years (range: 31−92 years). The median size of the 319 lesions was 1.4 cm (range: 0.4−3.5 cm), and there were 149 primary lung cancers and 170 pulmonary metastatic tumors (primary site: 116 colorectal and 54 others). Twenty-two lesions (7%) showed positive cytology results (11 primary and 11 metastatic). In primary lung cancers, tumor size (≧ 21 mm, p = 0.02), moderate to poor differentiation (p ＜ 0.01), vascular invasion or lymphatic permeation (p ＜ 0.01), and visceral pleural invasion (p ＜ 0.01) were significant predictors of a positive result. In contrast, there were no significant predictors in pulmonary metastatic tumors. The cut-ends of the 19 lesions among the 22 positive cytology margin lesions were additionally resected, but those of the remaining 3 lesions were not because of impaired respiratory function. With the median follow-up period of 42 months, surgical cut-end recurrence occurred in 2 of the 19 lesions for which additional resection had been performed (11%, 1 primary and 1 metastatic). Of the 3 lesions for which additional resection was impossible, cut-end recurrence developed in 2 (67%, 1 primary and 1 metastatic). Among the 297 lesions showing negative cytology result, cut-end recurrence occurred in 5 (2%, 4 primary and 1 metastatic).

      Conclusion
      Intraoperative autostapling cartridge lavage cytology in sublobar resection for primary or metastatic lung tumor may be useful in preventing surgical cut-end recurrence.

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    P2.07 - Poster Session 2 - Surgery (ID 190)

    • Event: WCLC 2013
    • Type: Poster Session
    • Track: Surgery
    • Presentations: 1
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      P2.07-020 - Clinicopathological characteristics of patients with unexpected pathological N1 and N2 lung cancer (ID 1762)

      09:30 - 16:30  |  Author(s): T. Haruki

      • Abstract

      Background
      Although positron emission tomography/computed tomography (PET/CT) seems to be able to provide accurate information of lymph nodes status in non-small cell lung cancer (NSCLC) patients, we sometimes experience surgical cases with unexpected lymph nodes metastasis. The objective of this study is to demonstrate clinicopathological characteristics of patients with unexpected pathological (p) N1 and N2 NSCLC.

      Methods
      All patients with lung cancer underwent enhanced CT of the chest and PET/CT preoperatively for evaluating of lymph node status. Mediastinoscopy or EBUS-TBNA was not routinely performed. Unexpected pN1 and pN2 diseases were defined as surgical cases which were proved to have hilar or mediastinal lymph nodes metastasis postoperatively in spite of negative 18-fluoro-2-deoxy-D-glucose (FDG) uptake in hilar or mediastinal lymph nodes on preoperative PET/CT. We retrospectively reviewed clinical features of these patients and analyze predictive factors for these unexpected diseases.

      Results
      Between January 2007 and December 2012, 533 patients with lung cancer underwent　surgical resection at our institution. Among them, we reviewed 182 patients who had available preoperative PET/CT data and underwent a curative-intent operation with systematic or selective lymph node dissection. One hundred fifty-one patients (83%) had lung cancer with expected lymph node status, whereas, 31 patients (17%) were found to have lung cancer with unexpected lymph nodes metastasis, consisting of 12 (39%) unexpected pN1 and 19 (61%) unexpected pN2 diseases. There were 16 men and 15 women with a median age of 67 years. Seventeen patients were current- or past- smokers, and 14 were never-smokers. Tumor size ranged from 12 to 52 mm, and pathological T factor was pT1a in 3, pT1b in 5, pT2a in 19, pT2b in 3, and pT3 in 1. Histological type of the primary tumor were adenocarcinoma in 28 (90%), squamous cell carcinoma in 2, and large cell carcinoma in 1. Among 28 adenocarcinomas, the most common predominant subtype was papillary (20 patients; 71%), followed by acinar (5 patients), solid with mucin, micropapillary, and invasive mucinous (one patient, respectively). Of these patients, 7 patients had micropapillary component in varying proportions in their tumors. EGFR gene mutation status was available in 22 patients, and of these, 12 patients (55%) had tumors with EGFR gene mutation, consisting of exon 19 deletion in 5, exon 21 point mutation in 5, and other minor mutation in 1. In univariate analysis, tumor size (> 3cm), pleural, and lymphatic invasion were significant predictive factors for unexpected pN1 and pN2 diseases. Only in 151 adenocarcinomas, papillary predomiant tumor and having micropapillary component were significant predictive factors for unexpected lymph node metastasis.

      Conclusion
      We should take care that false-negative rate is relatively high on preoperative PET/CT for lymph node status in NSCLC. Histological findings of the primary tumor are often important because they can provide predictive information for lymph nodes status even if there is no FDG uptake in regional lymph nodes on preoperative PET/CT. We hope new accurate imaging modality which can reflect tumor histology and lymph nodes micrometastasis.