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David Sanchez



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    MA03 - Lung Cancer Screening - Next Step (ID 896)

    • Event: WCLC 2018
    • Type: Mini Oral Abstract Session
    • Track: Screening and Early Detection
    • Presentations: 1
    • Moderators:
    • Coordinates: 9/24/2018, 10:30 - 12:00, Room 206 AC
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      MA03.11 - Trained Dogs Can Identify Malignant Pulmonary Nodules in Exhaled Gas (ID 13056)

      11:35 - 11:40  |  Author(s): David Sanchez

      • Abstract
      • Presentation
      • Slides

      Background

      After our recent report that trained dogs can identify the presence of lung cancer (LC) in exhaled air samples of patients with and without large LC(1), we designed a prospective controlled study to investigate if such trained dog can also discriminate between the exhaled gas samples of individuals with and without malignant pulmonary nodules.

      a9ded1e5ce5d75814730bb4caaf49419 Method

      We collected samples of exhaled air from 30 patients with indeterminate pulmonary nodules before the diagnostic and therapeutic surgery, and from 77 individuals without LC and without pulmonary nodules. Exclusion criteria were other neoplasm, and chemotherapy treatment. Participants refrained to eat, drink and smoke 30 minutes before they exhaled inside a crystal tube filled with hidrophilic and hidrophovic wool and closed with silicon taps, as we used in our previous report. Likewise, the training method of the dog was also based on a progressive prize-dependent learning method. Tubes containing the samples were introduced in wood boxes with an open side to enable the smelling of the sample. The dog was confronted to samples with and without pulmonary nodules in a proportion of 1/4 in order to discriminate malignant ones.

      4c3880bb027f159e801041b1021e88e8 Result

      The dog was confronted with 90 samples with indeterminate pulmonary nodules (3 per patient) and 372 samples without pulmonary nodules and without LC. The dog was confronted 10 times to each sample of pulmonary nodules with different combinations of “no LC” exhaled gas samples, which represents a total of 900 attempts. The dog must mark the samples he identifies as malignant ones. He achieved successful results with a sensitivity of 0,97, a specificity of 0,99, a PPV of 0,97 and a PNV of 0,99. Out of 30 patients with indeterminate pulmonary nodules the dog recognized 27 of them as positive for LC and 3 as negative for LC. Those results matched with the anatomical pathology surgery report.

      8eea62084ca7e541d918e823422bd82e Conclusion

      Trained dogs can discriminate the presence of malignant pulmonary nodules from exhaled gas samples with an extraordinarily high degree of reliability.

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    P2.01 - Advanced NSCLC (Not CME Accredited Session) (ID 950)

    • Event: WCLC 2018
    • Type: Poster Viewing in the Exhibit Hall
    • Track:
    • Presentations: 1
    • Moderators:
    • Coordinates: 9/25/2018, 16:45 - 18:00, Exhibit Hall
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      P2.01-72 - Bronchial Sleeve vs Pneumonectomy: Complications, Recurrences and Survival (ID 14131)

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

      • Abstract
      • Slides

      Background

      The present study describes and compares the rate of complications in hospital length of stay (LOS), recurrences and long-term survival between pneumonectomies and bronchial sleeves in our center's experience.

      a9ded1e5ce5d75814730bb4caaf49419 Method

      This is a descriptive, retrospective study. All patients who underwent bronchial SL or PN for NSCLC in our center between 2011 and 2017 were included. Individual clinical report was done, other indications for surgery were excluded. General demographics, preoperative lung function, histology and postoperative complications were included. Oncologic follow-up was done to detect recurrence and death. The statistical program used was SPSS.

      4c3880bb027f159e801041b1021e88e8 Result

      From of 87 patients registered, 47 had bronchial sleeve resection (54,02%) and 40 pneumonectomy (45.97%). The average age: SL 63.7, PN 61,7 years. Males were predominate in both groups (SL 83%, PN 75%). The average size tumoral were: SL 4,8 cm, PN 7,5 cm, p=0.46). Histological type predominant was C. squamous: SL 57,44%, PN 60%, p=0,46). The average LOS was higher SL than PN (2,37 and 6,37 respectively). Upper SL were most frequent: LSD 23 cases, LSI 17 cases, left pneumonectomies were the most accomplished.

      25 patients had postoperative complications: SL 17 (68%), PN 8 (32%). The most frequent complications were persistent air leak (SL 6 cases, PN 0 cases, p=0.09) and cardiac arrhythmias. (SL 3 cases, PN 4 cases p=0.09)

      No case of local recurrence was found after both techniques and 8 cases of regional recurrences (SL 6, PN 2, p=0,81).

      No differences in terms of overall survival were detected when both techniques were compared (median survival in months, p=0.35).

      8eea62084ca7e541d918e823422bd82e Conclusion

      More postoperative complications were found in SL group with equal postoperative mortality, this is mostly because persistent air leak and bronchial stenosis, this could explain increase of LOS.

      There are no local recurrences in any groups, this could mean that both techniques are oncologically equivalent. Our definition of regional recurrences as tumor involving the ipsilateral lung might again explain the higher incidence in SL.

      There are no statistically differences in terms of OS in both techniques. However, long-term survival tendency appears to be in favor of SL specially after 5 years. This might be related to non oncologic late complications related to pneumonectomy.

      In conclusion, we consider SL as a feasible and secure technique with a reasonable incidence of inherent complications and equal oncological results.

      6f8b794f3246b0c1e1780bb4d4d5dc53

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    P2.16 - Treatment of Early Stage/Localized Disease (Not CME Accredited Session) (ID 965)

    • Event: WCLC 2018
    • Type: Poster Viewing in the Exhibit Hall
    • Track:
    • Presentations: 1
    • Moderators:
    • Coordinates: 9/25/2018, 16:45 - 18:00, Exhibit Hall
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      P2.16-25 - Lower Hiliar Lymph Node Upstaging in Early NSCLC Vats Surgery is Related to Tumor Location and Does Not Afect Survival (ID 12132)

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

      • Abstract
      • Slides

      Background

      Nodal upstaging after early stage lung cancer surgery is not only inevitable, but it is also considered a quality marker for surgical lymphadenectomy. Underdiagnosis of pN1 has important significance and leads to undertreatment. Lymphadenectomy has been questioned in video thoracoscopic surgery (VATS) since its description. Recently some authors published lower pN1 upstaging incidence after VATS resection compared to open thoracotomy. We want to evaluate the rate of upstaging in our centre after starting a VATS program.

      a9ded1e5ce5d75814730bb4caaf49419 Method

      All patient who required an anatomical resection for non-small cell lung cancer (NSCL) in our department have been retrospectively reviewed. Patients were divided in two groups in relation of the performed surgical approach, thoracotomy (THO) and VATS. Both groups were compared in terms of gender, age, smoking history, comorbidities, lung function, histology, clinical stage and tumour location. Rate of hilar lymph node upstaging (pN1) and mediastinal lymph node upstaging (pN2) were compared between both groups. Univariate and multivariate analysis was performed to identify independent risk factors for pN1 upstaging. Overall survival was compared between both techniques in pN0 patients.

      4c3880bb027f159e801041b1021e88e8 Result

      Between January 2011 and October 2017, 1.081 lung resections were carried out in our centre. 323 of those were anatomical resections for early stage (≤ IIB) non-small cell lung cancer (NSCLC). There were no differences among groups except for FEV1, previous history of Diabetes Mellitus, tumour size and location (p<0.05). pN1 ratio was 20,5% in THO vs. 8,6% in VATS (p < 0,05) when performed accesses was compared. No differences were observed regarding pN2 upstaging (6% in THO and 6,5% in VATS; p>0,05). Only gender and centrality were identified as independent risk factors for hiliar lymph node upstaging in a multivariate analysis. For those patient with no upstaging (pN0) there were no survival differences comparing open and VATS approaches.

      8eea62084ca7e541d918e823422bd82e Conclusion

      In our series pN1 upstaging is less frequent in VATS than in open surgery. When analysed, tumour centrality has shown to be an independent risk factor for hilar upstaging. Additionally central tumours were much more prevalent in open surgery group. In conclusion, lower incidence of unnoticed pN1 in VATS surgery could be related to a selection bias, because thoracotomy was preferred when tumour considered central.

      Furthermore, the fact that no differences on survival in pN0 patients were detected suggests that no patients have been underdiagnosed and in consequence undertreated.

      6f8b794f3246b0c1e1780bb4d4d5dc53

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    P3.11 - Screening and Early Detection (Not CME Accredited Session) (ID 977)

    • 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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      P3.11-16 - Comparative Analysis of Health-Care Resources and Economic Costs of Lung Cancer Patients Treated Medically or Surgically in Catalunya (ID 14023)

      12:00 - 13:30  |  Author(s): David Sanchez

      • Abstract
      • Slides

      Background

      To contribute to the debate about the cost-benefit ratio of lung cancer computerized tomography (CT) screening programs, and to support the implementation of large scale lung ancer (LC) screening programs to increase the number of potential LC patients that can benefit from this treatment.

      a9ded1e5ce5d75814730bb4caaf49419 Method

      Observational, comparative, retrospective study includes 13.415 patients who were diagnosed of LC between 2014 and 2016 in Catalunya. All of them were treated medically or surgically. We obtain information from the data bases of the “Health attention area. Information and knowledge unit.” of the following variables (both before and after LC diagnosis): vital status and autonomy level, drug dispensation, radiotherapy sessions, use of health-care resources, day-hospital visits, hospitalization events, use of nursing homes, non-urgent sanitary transport, monthly and annual costs (€) per patient (and 3 year/survival)

      Variables were compared between the group medical treatment vs. the group surgical treatment using unpaired parametric tests. Since this is an observational study, no formal calculation of sample size was pretended. Yet, post-hoc results identified a cohort of 13.415 participants, which should be enough for descriptive purposes.

      4c3880bb027f159e801041b1021e88e8 Result

      3 year/Survival after LC diagnosis was much higher in surgical patients (78,9% vs 23,3%) (p<0.001). Surgically treated patients achieve a higher level of autonomy earlier before diagnosis.

      The monthly rate of total drug dispensation, cancer drugs, radiotherapy sessions, opioid and analgesic dispensation before and after LC diagnosis were much higher in medical patients. The rate of dispensation of ansiolitic, sedatives and anti-depressives were similar in both groups.

      Hospitalization events were slightly higher in the surgical group. There were no significant differences between groups in the rate of primary care or hospital outpatient clinic visits. The use of Health-care resources and non-emergency sanitary transport peaked before diagnosis to a larger extend in medical patients.

      The average annual cost of medical and surgical patients one year after LC diagnosis and treatment was 67% higher in medical patients (17.495 vs. 10.447 €).

      8eea62084ca7e541d918e823422bd82e Conclusion

      Surgical treatment of LC offers better clinical outcomes and is cost-efficient. These arguments support the implementation of large scale LC screening programs to increase the number of potential LC patients that can benefit from this treatment.

      6f8b794f3246b0c1e1780bb4d4d5dc53

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