Author of

• 20125

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  OA 04 - Surgery from Minimal to Radical (ID 661)

  • Event: WCLC 2017
  • Type: Oral
  • Track: Surgery
  • Presentations: 1
  • Moderators:J. Lee, A. Chang
  • Coordinates: 10/16/2017, 15:45 - 17:30, Room 311 + 312

  • 23038

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    OA 04.05 - Intermediate Results of ICG Anatomical Segmentectomy Based on the Virtual Segmentectomy Simulation (ID 8050)

    15:45 - 17:30  |  Author(s): T. Toyoda
    • Abstract
    • Presentation
    • Slides

    Background:
    The confirmation of an appropriate resection margin from the tumor is crucial for reducing the risk of local recurrence after lung segmentectomy for pulmonary malignancies. And the precise anatomical segmentectomy is also important for preserving pulmonary function. We evaluated intermediate results of tumor recurrence after anatomical ICG segmentectomy based on the virtual segmentectomy simulation.
    
    Method:
    From August 2014 to May 2017, forty-five patients underwent pulmonary segmentectomy under the guidance of ICG fluorescence. Before operation, several types of virtual segmentectomy were created by using Volume Analyzer Synapse VINCENT (Fujifilm co., Tokyo, Japan). We measured the shortest distance from the tumor to the resection margin in each simulated segmentectomy and selected the most appropriate area of sublobar resection based on the adequate resection margin of approximately 2 cm from the tumor. After this virtual segmentectomy, we performed segmentectomy by using an infrared thoracoscopy with transbronchial ICG instillation. Before operation, 10ml of 10-fold diluted ICG with autologous blood and 400ml of air were instilled into each associated subsegmental bronchus. Segmentectomy was performed under ICG visualization. We evaluated tumor recurrence and survival after the operation.
    
    Result:
    Thirty-seven patients were primary lung cancer and eight patients were metastatic lung tumor. Active limited resection was done in 28 patients, passive limited resection was in nine and metastatic lung tumor resection was in eight. Subsegmental resection was done in five, segmental resection in 22 and extended segmentectomy, which indicates resection of several segments with adjacent subsegment(s), was 18. The average shortest distance from the tumor to the resection margin in simulation and resected specimen were 22.5+/-11.7 mm and 24.1+/-7.3 mm, respectively (p=0.405). Postoperative complications were prolonged air leak longer than seven days in two cases and atrial fibrillation in one. In terms of the recurrence and survival after ICG segmentectomy, although the mean duration of follow-up was still short (530+/-349 days), no cancer recurrence in the ipsilateral lung was identified in lung cancer patients. In particular, no recurrence was found in the lung as well as lymph node in active segmentectomy patients.
    
    Conclusion:
    The combination of lung volume analyzer and ICG segmentectomy was an excellent tool for precise anatomical segmentectomy with an appropriate resection margin and excellent control of tumor recurrence.
    
    

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