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Jun Zhang
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P1.16 - Surgery (ID 702)
- Event: WCLC 2017
- Type: Poster Session with Presenters Present
- Track: Surgery
- Presentations: 1
- Moderators:
- Coordinates: 10/16/2017, 09:30 - 16:00, Exhibit Hall (Hall B + C)
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P1.16-015 - miMRST Thoracotomy Cures Aged, Sickly Weak and/or Cardiopulmonary Dysfunction Patients with Lung Cancer (ID 9297)
09:30 - 16:00 | Presenting Author(s): Jun Zhang
- Abstract
Background:
Lung cancer is increasing rapidly in China. More and more aged, sickly weak and/or cardiopulmonary dysfunction patients are found with lung cancer, but even for small lung cancer (≤2cm) patients, surgery was usually denied because they could not tolerate traditional large-incision standard posterolateral thoracotomy (SPLT); video-assisted thoracoscopic surgery (VATS) is expensive not always avalable in all hospitals, let alone most Chinese patients still could not afford VATS. miMRST, minimally invasive small incision, muscle- and rib-sparing thoracotomy, minimally invasive lung cancer radical surgery, was developed to help resolve these problems: resecting the tumor minimally invasively, not cost too much, with improved prognosis, widely accepted by Chinese patients.
Method:
Case 1: man, aged 67 in Aug 2012, left lower lobe 2.0cm tumor, hypertension for years, feard of SPLT large-incision. Case 2: man, aged 64 in Jan 2013, left lower lobe 1.0cm tumor, smoking 44 years, with serious chronic bronchitis 15 years, asthma episodes per year, coronary heart disease 13 years, coronary stenting 10 years, serious gastric ulcers, colorectal polyps 2 years, could not tolerate SPLT. Case 3: woman, aged 70 in Feb 2013, left lower lobe 2.0cm tumor, sickly weak and cardiopulmonary dysfunction for years , feard of and could not tolerate SPLT. miMRST was scheduled.
Result:
About 10cm lateral chest incision, with the latissimus dorsi and serratus anterior muscles protected, no rib cut needed, was enough for most lung cancer resection and mediastinal lymph node dissection, no need for the surgeon’s hands entering into the thoracic cavity, not as large-incision standard posterolateral thoracotomy (SPLT) and modified muscle and rib sparing thoracotomy (MRST) usually do. Left lower lobe lobectomy and mediastinal lymph node desection was performed for all three cases, for Case 1: No.5,6,7,9,10,11,12 group, Case 2: No.3A,4,5,6,7,8,9,10,11,12,12u,13,14 group, Case 3: No.3A,5,6,7,8,9,10,10R,11,12,12u,13,14 group lymph nodes and surrounding adipose tissue were dissected. Post-operative pathological diagnosis was adenocarcinoma, squamous carcinoma and adenocarcinaoma, respectively; all pT1N0M0 Stage IA. All recoverd quickly and no adjuvant tratment was used. Follow-up: all healthy in their 5th year postoperatively, 58, 53, 52 months, respectively. No sign of recurrence and metastasis.
Conclusion:
miMRST, minimally invasive small incision, muscle- and rib-sparing thoracotomy, shows advantage of less damage, quick and better recovery than SPLT, cost less than VATS. miMRST is very suitable for lung cancer surgery in developing countries like China, where most patients could not afford for the expensive VATS. (This study was partly supported by Science Foundation of Shenyang City, China, No. F16-206-9-05)
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P2.05 - Early Stage NSCLC (ID 706)
- Event: WCLC 2017
- Type: Poster Session with Presenters Present
- Track: Early Stage NSCLC
- Presentations: 1
- Moderators:
- Coordinates: 10/17/2017, 09:30 - 16:00, Exhibit Hall (Hall B + C)
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P2.05-015 - Wedge Resection Is Enough for Curing GGO Patients with Minimally Invasive Adenocarcinoma (MIA) of the Lung? (ID 9296)
09:30 - 16:00 | Presenting Author(s): Jun Zhang
- Abstract
Background:
More and more pulmonary ground-glass opacity (GGO) were detected and surgically resected, but the resection extent remains unconcluded, especially for those micro- small lung cancer (≤1cm) (mi-SLC), some are adenocarcinoma in situ (AIS), some minimally invasive adenocarcinoma (MIA), both belonging to early stage lung cancer. Wedge resection may be enough for curing lung MIA.
Method:
Case 1: Woman, aged 59 in Nov 2013, right middle lobe pure GGO 1.0cm, peripheral; sickly weak for years; anti-inflammatory strategy used, GGO size no change. Case 2: man, aged 64 in Oct 2013, right upper lobe mixed GGO 1.0cm, peripheral; with hypertension and chronic bronchitis for years; anti-inflammatory strategy used, the GGO showed a little increased one month later. Both patients were referral to China Medical University Lung Cancer Center for surgical resection, “miMRST”, minimally invasive small incision, muscle- and rib-sparing thoracotomy, minimally invasive lung cancer radical surgery, was scheduled.
Result:
About 10cm lateral chest incision, with the latissimus dorsi and serratus anterior muscles protected, no rib cut needed, was enough for most lung cancer resection and mediastinal lymph node dissection, no need for the surgeon’s hands entering into the thoracic cavity, not as large-incision standard posterolateral thoracotomy (SPLT) and modified muscle and rib sparing thoracotomy (MRST) usually do. For Case 1, right middle lobe wedge resection was undergone first, frozen pathological diagnosis was atypical adenomatous hyperplasia (AAH), carcinoma should be excluded by following wax slide pathology. For Case 2, right upper lobe wedge resection was performed, frozen diagnosis was AAH, carcinoma should be excluded by following wax slide pathology. Both patients recovered much better and quickly than other patients who underwent SPLT. Postoperative pathology was MIA for both cases. Considering both in a status of sickly and weak health condition, no further tratment was used. Follow-up: both patients are living healthilly, in their 4th year postoperatively, obviously more healthy and stronger than before; no sign of recurrence and metastasis.
Conclusion:
Even though lobectomy and systematic mediastinal lympph node dissection still remains the standard surgical procedure for non-small cell lung cancer, more and more limited (wedege) resection for early stage lung cancer, including SLC and mi-SLC, especially MIA, showed a better outcome. Wedge resection is of first choice for these aged, sickly and weak patients, further, wedge resection might be enough for curing mi-SLC, eapecially those GGO MIA. Prospective observation is needed. (This study was partly supported by Science Foundation of Shenyang City, China, No. F16-206-9-05)
