Author of

• 20039

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  Poster Display Session (ID 63)

  • Event: ELCC 2017
  • Type: Poster Display Session
  • Track:
  • Presentations: 2
  • Moderators:
  • Coordinates: 5/07/2017, 12:30 - 13:00, Hall 1

  • 19911

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    155P - Combination of hepatic surgery and minimally invasive thoracic surgery using a subxyphoid approach through an abdominal incision (ID 323)

    12:30 - 13:00  |  Author(s): D.H. Kim
    • Abstract

    Background:
    If an intrathoracic mass is found in a patient scheduled for open hepatic surgery, combined surgery is not recommended because of the high risk. If combined surgery is essential, the thoracic approach must be minimally invasive. We here introduce a subxyphoid approach through an abdominal incision to minimize the invasiveness of combined thoracic and hepatic surgery.
    
    Methods:
    From April 2012 to December 2016, 17 patients requiring combined hepatic and thoracic surgery were treated via the subxyphoid approach through an abdominal incision. We retrospectively analyzed the clinical data and evaluated the feasibility of the procedure.
    
    Results:
    The hepatic lesions included 7 cases (41.2%) of colon cancer metastases and 10 cases (58.8%) of primary hepatocellular carcinoma. The types of liver resection performed included two wedge resections (11.8%), two multiple wedge resections (11.8%), eight segmentectomies (47.1%), three lobectomies (17.5%), and two other procedures (11.8%). Unilateral, mediastinal, and bilateral subxyphoid approaches toward thoracic surgery were employed in 11 (64.7%), 2 (11.8%), and 4 (23.5%) cases, respectively. The thoracic surgeries included six cases (35.3%) of wedge resection, five cases (29.4%) of multiple wedge resection, two (11.8%) segmentectomies, and four (23.5%) mediastinal mass excisions. The mean number of lung masses excised was 1.7±1.0 (range 1–5). No lung-related morbidities were noted; one patient died as a result of the abdominal procedure. The mean thoracic and total operation times were 79.7±63.0 min (range, 20–205 min) and 411.0±109.0 min (range, 255–635 min), respectively. Mean ICU and mean hospital stay did not differ between the patients described above and others who underwent open hepatic surgery during the same period.
    
    Conclusions:
    The subxyphoid approach through an abdominal incision allows aggressive treatment of intrathoracic masses in patients scheduled for open hepatic surgery. This approach did not have a significant impact on the time of operation and the period of the recovery. The approach is especially suitable for patients with bilateral lung lesions.
    
    Clinical trial identification:
    
    
    Legal entity responsible for the study:
    Department of Cardiovascular and Thoracic Surgery, Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital
    
    Funding:
    Department of Cardiovascular and Thoracic Surgery, Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital
    
    Disclosure:
    All authors have declared no conflicts of interest.
    
    

  • 19825

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    50P - Usefulness of F-18 FDG PET/CT to identify metastatic mediastinal lymph node in NSCLC patients with bilateral benign mediastinal lymph node hyperplasia (ID 272)

    12:30 - 13:00  |  Author(s): D.H. Kim
    • Abstract

    Background:
    F-18 FDG PET/CT is superior to CT imaging in identifying metastatic mediastinal lymph node (MLN) involvement in NSCLC. However, the accuracy of F-18 FDG PET in nodal staging is substantially reduced by false increases in F-18 FDG uptake in the inflammatory nodes. The efficacy of this technique is controversial because of reactively increased F-18 FDG uptake in the mediastinum, especially in regions endemic for the granulomatous disease. Here, we determined the qualitative and quantitative parameters of F-18 FDG-PET/CT for evaluation of mediastinal nodes to distinguish between malignant and benign lesions.
    
    Methods:
    27 patients with pathologically documented NSCLC who showed bilateral F-18 FDG-avid MLNs on pre-treatment staging PET/CT image were included. 104 MLNs were pathologically analysed through EBUS-TBNA or MLN dissection. The MLN with prominent F-18 FDG uptake compared with other F-18 FDG-avid LNs via visual assessment was qualitatively considered as metastasis. The maximum standardized uptake value (SUVmax) of LN and SUVmax of LN to the liver and blood pool were calculated for quantifying F-18 FDG uptake. SUVmax/contra was obtained to identify metastatic MLNs.
    
    Results:
    The qualitative evaluation showed sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) for separating metastatic LN from benign reactive hyperplasia of 66.7%, 87.0%, 74.3%, and 88.2%, respectively. SUVmax of LN and normalized SUVmax of LN to the liver and blood pool did not significantly differ; however, SUVmax/contra was significantly higher for metastatic LNs than benign lesions. Receiver-operating-characteristic derived SUVmax/contra cut-off was 1.18 (AUC, 0.734). The quantitative evaluation showed sensitivity, specificity, PPV, and NPV of 66.7%, 75.3%, 77.4%, and 86.4%, respectively.
    
    Conclusions:
    Qualitative interpretation of F-18 FDG PET/CT was superior to quantitative parameters in discriminating metastatic LNs from benign reactive hyperplasia in patients with bilateral F-18 FDG-avid mediastinal LNs. We suggest SUVmax/contra may aid in the interpretation of mediastinal nodal staging in patients with NSCLC.
    
    Clinical trial identification:
    
    
    Legal entity responsible for the study:
    None
    
    Funding:
    N/A
    
    Disclosure:
    All authors have declared no conflicts of interest.