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Shun-ichi Watanabe
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MS20 - Innovative and Evolving Strategies in Diagnosis and Management of Stage I NSCLC (ID 799)
- Event: WCLC 2018
- Type: Mini Symposium
- Track: Treatment of Early Stage/Localized Disease
- Presentations: 1
- Moderators:
- Coordinates: 9/25/2018, 15:15 - 16:45, Room 202 BD
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MS20.06 - Less Is More: Segmentectomy in the Management of Early Stage NSCLC (ID 11489)
16:30 - 16:45 | Presenting Author(s): Shun-ichi Watanabe
- Abstract
- Presentation
Abstract not provided
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P1.17 - Treatment of Locoregional Disease - NSCLC (Not CME Accredited Session) (ID 949)
- Event: WCLC 2018
- Type: Poster Viewing in the Exhibit Hall
- Track:
- Presentations: 1
- Moderators:
- Coordinates: 9/24/2018, 16:45 - 18:00, Exhibit Hall
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P1.17-06 - Salvage Surgery After Chemotherapy and/or Radiotherapy Including SBRT and Proton: Consecutive Analysis of 46 Patients (ID 13342)
16:45 - 18:00 | Author(s): Shun-ichi Watanabe
- Abstract
Background
Local recurrence after definitive chemotherapy and/or radiotherapy with curative intent is frequently experienced in patients with locally advanced lung cancer. We evaluated the frequency, feasibility, and efficacy of salvage pulmonary resection after definitive chemotherapy and/or radiotherapy.
a9ded1e5ce5d75814730bb4caaf49419 Method
We analyzed the characteristics and medical courses of consecutive patients who had undergone salvage pulmonary resection after local relapse or progression after chemotherapy, chemoradiotherapy and radiotherapy including stereotactic body radiation therapy (SBRT) and proton beam therapy (PBT). In this analysis, local relapse or progression were defined as increase in remaining tumor size or detection of new lesions by CT and/or FDG/PET-CT. Indications of resectability was assessed by multidisciplinary tumor board.
4c3880bb027f159e801041b1021e88e8 Result
Between January 2000 and January 2018, 46 patients (0.63%) received salvage surgery out of 7,290 patients underwent surgery for primary lung cancer at National Cancer Center Hospital, Tokyo, Japan. Median follow-up time was 24.5 months (range, 2-157.6). Of 46 patients evaluated, 30 (65.2%) were men, the median age was 64.5 years (range, 20-78 years), 22 (47.8%) underwent chemotherapy, 18 (39.1%) underwent resection after definitive chemoradiotherapy, 3 (6.5%) underwent resection after SBRT and 3 (6.5%) underwent resection after PBT. The number of patients undergoing salvage surgery has increased in recent years: 9 patients were between 2000 and 2009, whereas 37 patients were between 2010 and 2018. Method of surgical resection was as follows: 28 lobectomies (2 bilobectomy, 15 right upper, 1 right middle, 6 right lower, 2 left upper, 2 left lower), 10 pneumonectomies (left:right=7:3). One patient received a wedge resection, and one recieved wedge resection with chest well resection, and 2 segmentectomy and lymphadectomy for residual lymph nodes respectively. A complete resection (R0) was achieved in 42 cases (91.3%). Postoperative complications were observed in 3 patients (6.5%): prolonged air leakage, bronchopleural fistula, and atrial fibrillation. There were no post-operative deaths within 30 days after surgery. The five-year progression free and overall survival rate after surgical resection was 39.1% (95% CI.: 19.9-57.9) and 64.1% (95% CI.: 39.3-80.9), respectively.
8eea62084ca7e541d918e823422bd82e Conclusion
The frequency of salvage surgery after initial treatment has been increasing possibly due to a better treatment course using novel medical and radiation oncology technique. Salvage pulmonary resections demonstrated acceptable morbidity and mortality with promising long-term efficacy in selected patients.
6f8b794f3246b0c1e1780bb4d4d5dc53
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P3.01 - Advanced NSCLC (Not CME Accredited Session) (ID 967)
- Event: WCLC 2018
- Type: Poster Viewing in the Exhibit Hall
- Track:
- Presentations: 1
- Moderators:
- Coordinates: 9/26/2018, 12:00 - 13:30, Exhibit Hall
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P3.01-102 - Potential Predictors of Unexpected Readmission After Lung Resection (ID 14403)
12:00 - 13:30 | Author(s): Shun-ichi Watanabe
- Abstract
Background
Postoperative unexpected readmissions are sentinel events that negatively impact patients. Previous analyses of risk factors of unexpected readmission after lung resection have identified several predictive factors. However, both the operative procedures and perioperative care can vary between institutions. The current study aimed to investigate the incidence levels and potential predictors of unexpected readmission after lung cancer surgery at our institution.
a9ded1e5ce5d75814730bb4caaf49419 Method
Patients who underwent lung resection for primary lung cancers between January 2016 and December 2017 at our institution were enrolled in this study. Operative procedures included pneumonectomy, lobectomy, segmentectomy, and wedge resection. Pleural biopsy and unresectable cases were excluded from this study. Unexpected readmissions were defined as an unscheduled readmission after surgery to our hospital. All patients were examined at our outpatient clinic within 14 days after initial discharge. Thirty-day readmission rates and diagnoses were edaluated. Univariate analysis was performed to identify perioperative factors associated readmission.
4c3880bb027f159e801041b1021e88e8 Result
During the 24-month study period, 1,000 patients underwent lung resection for primary cancer. The median age was 69 years (32–90 years). Fourteen pneumonectomies, 687 lobectomies, 193 segmentectomies, and 106 wedge resections were performed. The median length of postoperative hospital stay was 4 days (2–117 days). The 30-day mortality rate was 0.3% (3 of 1,000 patients). Forty-three patients (4.3%) experienced an unexpected readmission within 30 days after discharge. The median interval to readmission from the day of discharge was 10 days (1-29 days). The most common diagnoses for readmission were empyema (n=11; 26%), exacerbation of interstitial pneumonia (n=7; 16%), pneumothorax (n=7; 16%), and pneumonia (n=5; 12%). The median length of readmission hospital stay was 10 days (2–90 days). Among readmitted patients, 9.3% (4 of 43) had died in the hospital due to exacerbation of interstitial pneumonia. In a univariate analysis, significant factors (p<0.05) associated with increased risk of unexpected readmission were man, smoking history, diabetes mellitus, larger tumor size, positive lymph node, either lobectomy or pneumonectomy, longer operative time, either prolonged air leakage (i.e., more than 5 days) or reoperation for air leakage, longer hospital stay after initial surgery.
8eea62084ca7e541d918e823422bd82e Conclusion
The unexpected readmission rate after lung resection was 4.3% (n=43), with respiratory complications (n=30; 70%) being the most common cause. Four patients (9.3%) died in the hospital due to exacerbation of interstitial pneumonia. Several perioperative factors were identified as risk factors for readmission in this study.
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