Virtual Library

Start Your Search

David Waller

Author of

  • +

    GR01 - Thymic Malignancies Tumor Board (ID 777)

    • Event: WCLC 2018
    • Type: Grand Rounds Session
    • Track: Thymoma/Other Thoracic Malignancies
    • Presentations: 1
    • Moderators:
    • Coordinates: 9/25/2018, 10:30 - 12:00, Room 206 F
    • +

      GR01.03 - Surgical Oncology (ID 11388)

      11:00 - 11:15  |  Presenting Author(s): David Waller

      • Abstract

      Abstract not provided

  • +

    P2.06 - Mesothelioma (Not CME Accredited Session) (ID 955)

    • Event: WCLC 2018
    • Type: Poster Viewing in the Exhibit Hall
    • Track:
    • Presentations: 1
    • Moderators:
    • Coordinates: 9/25/2018, 16:45 - 18:00, Exhibit Hall
    • +

      P2.06-03 - Can We Predict Pathological Nodal Positivity in Malignant Pleural Mesothelioma from Preoperative Clinical Variables? (ID 14047)

      16:45 - 18:00  |  Author(s): David Waller

      • Abstract
      • Slides


      The associated morbidity from radical surgery implies that it should only be offered to those with the best prognosis. The prognosis following radical surgery for mesothelioma is significantly influenced by the presence of pathological nodal metastases. However, the prediction of nodal positivity is inaccurate and complicated. This can be attributed to the unique lymphatic drainage pattern in which many nodal groups (internal mammary, intercostal) cannot be biopsied preoperatively. Previous studies have correlated preclinical variables with poor prognosis (Pass, J Thorac Oncol.2014;9:856-64).

      a9ded1e5ce5d75814730bb4caaf49419 Method

      We have correlated clinical variables known to be associated with overall prognosis in mesothelioma with the pathological findings of systematic nodal dissection at thoracotomy and pleurectomy/decortication.

      The variables analysed: patient demographics, Haemoglobin and CRP, T and N stage on preoperative CT scan, duration of symptoms of weight loss and chest pain and cell type on preoperative biopsy. Data were summarised as median (range), mean (SD) and subject to Chi-squared test for the categorical data and Mann-Whitney Test for the numeric data and to regression analysis.

      4c3880bb027f159e801041b1021e88e8 Result

      32 patients(25males:7females)underwent extended pleurectomy decortication with intraoperative systematic nodal dissection. On pathologic diagnosis post-resection, 20(62%) patients were diagnosed with nodal metastasis. On univariate analysis, only age and CRP was statistically significant (p=0.049,respectively 0.05). The remaining variables did not achieve statistical significance. There were statistical trends suggesting that nodal positivity was more likely in the younger males with a lower Haemoglobin and a raised CRP.

      Median (range)

      Node negative n=12

      Node positive n=20

      P value

      Age (years)

      71 (58-76)

      66 (33-78)


      Symptom duration (months)

      6 (4 -10)

      6 (4-10)



      25.5 (22-40)

      26 (19-38)


      Hb (g/l)

      133.5 (98-145)

      118 (82 -145)



      7 (4 – 14.8)

      7.7 (2.5 -10.6)



      318 (170-599)

      291 (132 -918)


      CT T stage

      3 (1-4)

      3 (1-4)


      CT N stage

      0.5 (0-2)

      0.5 (0-2)


      C-reactive protein

      7 (1-123)

      23 (1-154)






      CT correctly predicted positive node status in 30% of cases and negative node status in 80% of cases.

      8eea62084ca7e541d918e823422bd82e Conclusion

      Nodal positivity in patients suitable for EPD cannot be reliably predicted by CT but can be inferred from certain clinical variables. Future work in a larger population is required to identify a definitive pre-operative model. This will allow for better selection of patients for primary surgical intervention or alternatively for induction chemotherapy.


      Only Active Members that have purchased this event or have registered via an access code will be able to view this content. To view this presentation, please login or select "Add to Cart" and proceed to checkout.