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S.J. Khandhar
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MA05 - Innovative Techniques in Pulmonology and the Impact on Lung Cancer (ID 378)
- Event: WCLC 2016
- Type: Mini Oral Session
- Track: Pulmonology
- Presentations: 1
- Moderators:J. Eckmayr, P.R. Mohapatra
- Coordinates: 12/05/2016, 16:00 - 17:30, Strauss 1
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MA05.02 - Electromagnetic Navigation Bronchoscopy: A Prospective, Global, Multicenter Analysis of 1000 Subjects with Lung Lesions (ID 4643)
16:00 - 17:30 | Author(s): S.J. Khandhar
- Abstract
- Presentation
Background:
Electromagnetic navigation bronchoscopy (ENB) may aid in accessing smaller, more peripheral lesions and hence facilitate earlier diagnosis. ENB may also provide a safer alternative to transthoracic biopsy, and allow adequate tissue capture for molecular testing, diagnosis, staging, and localization for surgery in a single anesthetic event. However, usage patterns, safety, and performance remain largely unexplored in a prospective, multicenter study.
Methods:
NAVIGATE is a global, prospective, multicenter study of ENB using the superDimension™ navigation system (Medtronic, Minneapolis). A pre-specified 1-month interim analysis was conducted on the first 1,000 primary cohort subjects enrolled at 29 centers in the United States and Europe. Enrollment and 2-year follow-up are ongoing.
Results:
One-month follow-up was completed in 933/1,000 subjects. Of 1,000 procedures, ENB was intended for lung biopsy in 96.4%, to place fiducial markers in 21.0%, and for dye marking in 1.7% (multiple indications in 34.9%). Lymph node biopsies were attempted in 33.4% of procedures (322/334 using linear endobronchial ultrasound [EBUS]). General anesthesia was used in 79.7% and radial EBUS in 54.3%. Among 1,129 lung lesions, fluoroscopy was used in 90.1% and rapid on-site pathology evaluation in 683/1035 (66.0%). Median lesion size was 20.0 mm (interquartile range 16.0 mm). Most lesions were in the peripheral (62.6%) or middle (30.1%) lung thirds. A bronchus sign was present in 48.4% and 6.3% were ground glass. Navigation was subjectively considered successful in 1,036 lesions (91.8%). Site-reported pathology results were read as malignant in 452 lesions (43.6%), including 38.1% with primary lung cancer. Of 247 lesions with adenocarcinoma or unspecified non-small-cell lung cancer, 70 (28.3%) were sent for molecular testing with adequate tissue in 56/70 (80.0%). Primary lung cancer clinical stage was 52.9% I; 10.7% II, 18.9% III, and 17.3% IV. Preliminary non-malignant results were obtained in 444 lesions (42.9%). An additional 140 lesions (13.5%) were read as inconclusive. Longer follow-up is required to calculate the true negative rate and diagnostic yield. ENB-related pneumothorax was 4.9% (49/1,000) overall and 3.2% Grade ≥2 based on the Common Terminology Criteria for Adverse Events scale. The ENB-related Grade ≥2 bronchopulmonary hemorrhage and Grade ≥4 respiratory failures rates were 1.0% and 0.6%.
Conclusion:
Interim 1-month results suggest a low adverse event rate in the largest prospective, multicenter ENB study conducted to date. Continued enrollment and 2-year follow-up will elucidate the real-world utilization patterns, diagnostic yield, factors contributing to successful diagnosis, and the impact of ENB on lung cancer management.
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OA01 - Risk Assessment and Follow up in Surgical Patients (ID 371)
- Event: WCLC 2016
- Type: Oral Session
- Track: Surgery
- Presentations: 1
- Moderators:W. Zhong, E. Lim
- Coordinates: 12/05/2016, 11:00 - 12:30, Schubert 2
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OA01.06 - Early Post-Operative Ambulation after Thoracic Surgery - The WAVE Experience (ID 5194)
11:00 - 12:30 | Author(s): S.J. Khandhar
- Abstract
- Presentation
Background:
The occurrence of minimally invasive thoracic surgery interventions has grown steadily since the early 1990s, yet practice patterns for peri-operative management of these patients has lagged behind technical progress. Our thoracic program has created WAVE (Walking After VATS Experiment) which focuses on a multidisciplinary approach to early ambulation after thoracic surgery. A report from our first 3 years of data (July 2010 - July 2013) was presented at the 2013 IASLC meeting in Sydney, Australia. In response to the positive comments, we have continued our endeavor and in addition, investigated 30 day outcomes and length of stay for the homogeneous subset of anatomic lobectomy.
Methods:
Data was collected from a single surgeon at a single center and includes all consecutive thoracic surgical patients recovered through the WAVE program from July 2010 - July 2016. We excluded patients undergoing tracheostomy, endoscopic only procedures, and mediastinoscopy. Data was collected prospectively and analyzed retrospectively.
Results:
From July 2010 - July 2016, 1152 patients were included for analysis. Within the 6 year period, 798/1152 patients (69%) walked any distance within one hour of extubation, 945/1152 patients (82%) walked 250 feet at any time while in the PACU, 721/1152 patients (63%) successfully walked the targeted distance of 250 feet within one hour of extubation and only 37/1152 patients (3%) were unable to ambulate at all in the PACU. There were no adverse events. The subset of anatomic lobectomies included 290 patients of which 197/290 patients (68%) walked any distance within one hour of extubation, 239/290 patients (82%) successfully walked 250 feet at any time while in the PACU, 175/290 patients (60%) achieved the target distance of 250 feet within one hour of extubation and only 5/290 patients (1.7%) were unable to ambulate at all in the PACU. The rate of 30 day post-operative complications compares favorably with the literature and are as follows: 4.1% atrial arrhythmia, 1.0% pneumonia, 6.6% air leak > 5 days, 0.7% DVT, 0.3% acute renal failure, 0.3% pulmonary embolism, 0% stroke, 0% myocardial infarction, 4.8% readmission and 0% mortality. Mean length of hospital stay was 1.6 days with a median of 1 day.
Conclusion:
Our “WAVE” experience reveals that aggressive early ambulation is effective in reducing post-operative complications and shortening length of stay. The platform is simple, reproducible and feasible for any thoracic surgical program. Key features for successful implementation include patient and family engagement, a multi-disciplinary team and administrative support.
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