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F. Davini

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    P1.02 - Poster Session/ Treatment of Localized Disease – NSCLC (ID 209)

    • Event: WCLC 2015
    • Type: Poster
    • Track: Treatment of Localized Disease - NSCLC
    • Presentations: 1
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      P1.02-031 - Wedge Resection for NSCLC: Does Minimally Invasive Surgery Warrant the Maximum Advantage? (ID 432)

      09:30 - 17:00  |  Author(s): F. Davini

      • Abstract
      • Slides

      Anatomic resections of the lung are firmly considered the gold standard treatment for early stage Non Small Cell Lung Cancer (NSCLC). The role of non-anatomic surgery is still not clear and it is generally used for very selected patients, who cannot undergo an anatomical resection of lung parenchyma for functional reasons. The aim of this study is to analyze whether surgical approach (VATS or open) might have an influence on the long term outcome of NSCLC patients treated by wedge resection.

      From December 2006 till 2010, 1695 patients underwent surgery for primary NSCLC at our Institution. Among them, 97 patients received a wedge resection either by open or thoracoscopic apprach due to coexisting morbidities or low pulmonary function; 54 were selected for our study. We excluded from our analysis all patients with a previous lung cancer, with suspected (on the basis of CT or PET CT images) or confirmed N2 disease, nodules greater than 5 cm or with involvement of the chest wall or mediastinal structures. Follow-up was carried out at December 2013.

      Out of the 54 wedge resections, 30 were performed through a thoracothomy, while 24 cases by means of a VATS procedures. There were no statistically significant difference among clinical features of the two groups. Mean tumor diameter were 2,1 cm in the open group (OG) and 1,7 cm in the VATS group (VG); mean distance from visceral pleura was significantly higher in the OG (2,1 cm vs 0,8 cm; p=0,02) and so were the stapler edge (2,4 cm vs 1,2 cm; p<0,03). Mean follow-up was 42 months. In the open surgery group 2 patients (6,7%) had a local recurrence and in 10 patients (33,3%) we noticed systemic metasthasis. In the VATS group we had 4 cases (16,7%) of local recurrences and 7 (29,2%) of distant metasthasis. Local recurrence rate was significantly different between the two groups (p=0,048), while no significant correlation was found regarding the distant methastasis rate. Three patients died during the follow up period (two in the group treated with thoracotomy, 1 with VATS).

      Although different deepness of nodule between the two groups may represent a bias, we noticed a significant lower recurrence rate when surgery was performed by thoracotomy. Tumors larger than 1,5 cm are more likely to develop a recurrence, regardless to the kind of surgical approach. Wedge resection may be considered a feasible procedure for highly selected patients affected by NSCLC: open approach may be related to a better long term outcome in patients with small and deep nodules.

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