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Sandeep Khandhar
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MA13 - Interventional Pulmonology (ID 914)
- Event: WCLC 2018
- Type: Mini Oral Abstract Session
- Track: Interventional Diagnostics/Pulmonology
- Presentations: 1
- Moderators:
- Coordinates: 9/25/2018, 10:30 - 12:00, Room 206 AC
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MA13.09 - Electromagnetic Navigation Bronchoscopy as an Integrated Approach to Aid in Diagnosis and Treatment of Pulmonary Lesions (ID 12623)
11:30 - 11:35 | Presenting Author(s): Sandeep Khandhar
- Abstract
- Presentation
Background
Electromagnetic navigation bronchoscopy (ENB) is an image-guided localization approach to guide endoscopic tools to lung targets. In a single procedure, ENB aids in localizing lung lesions for biopsy or molecular profiling, fiducial placement for stereotactic body radiation therapy (SBRT), or dye marking for surgical resection. The multidisciplinary utility of ENB in a large, prospective, multicenter study is unknown.
a9ded1e5ce5d75814730bb4caaf49419 Method
NAVIGATE (clinicaltrials.gov, NCT02410837) is a prospective, multicenter, observational cohort study of ENB using the superDimension™ navigation system. From April 2015 to August 2016, 1,215 consecutive subjects were enrolled at 29 United States sites. Two-year follow-up is ongoing. A prespecified 1-year interim analysis is presented.
4c3880bb027f159e801041b1021e88e8 Result
ENB was used to aid in lung lesion biopsy (n=1157 subjects), fiducial placement (n=258), pleural dye marking (n=23), and/or lymph node biopsy (n=30). EBUS-guided lymph node staging was conducted in the same procedure in 448 subjects. The median lesion-to-pleura distance was 9mm. The median lesion size was 20mm; most were in the middle (30%) and peripheral (67%) thirds of the lung. Pathology results were malignant in 44.3% (484/1092) (54.1% Stage I, 11.1% Stage II, 17.0% Stage III, 17.7% Stage IV). Molecular testing was attempted in 30.7% (80/261) of adenocarcinoma or NSCLC-not-otherwise-specified cases overall and 57.9% (33/57) of Stage IIIB/IV cases. Tissue was adequate in 87.5% (70/80) of cases. EGFR mutations (14.7%) and ALK translocations (4%) were the most frequently observed genetic alterations. The ENB procedure was well-tolerated; 2.9% of subjects had procedure-related pneumothorax requiring hospitalization or intervention, lower than published rates for CT-guided core biopsy (25%) and CT-guided fine needle aspiration (19%). Subject-reported impact of ENB on daily activities was 0.9 out of 10 (0 = no impact).
8eea62084ca7e541d918e823422bd82e Conclusion
In the largest prospective, multicenter study to date, ENB aided in lesion biopsy in the middle and periphery of the lung and tissue collection for molecular testing, with a very low morbidity. ENB facilitates a multidimensional approach to lung biopsy and mediastinal/hilar staging, offering the opportunity for multiple sites/tissues to be safely sampled in one anesthetic event.
6f8b794f3246b0c1e1780bb4d4d5dc53Only 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, select "Add to Cart" and proceed to checkout. If you would like to become a member of IASLC, please click here.
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P2.15 - Treatment in the Real World - Support, Survivorship, Systems Research (Not CME Accredited Session) (ID 964)
- 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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P2.15-12 - Exparel vs. Bupivicaine for Postoperative Analgesia After VATS Lung Resection: Results of a Randomized Control Trial (ID 13322)
16:45 - 18:00 | Presenting Author(s): Sandeep Khandhar
- Abstract
Background
Postoperative pain control practices are highly variable and opioid use is of considerable interest to clinicians and patients. This thoracic surgery program focuses on minimally invasive interventions and sought an optimal pain control regimen. Previously, tunneled pleural catheters with a continuous Bupivicaine infusion for 7 days were used. The shortened length of stay (LOS) and excellent patient satisfaction observed were attributed to this technique, however a prior randomized controlled trial (RCT) at this institution showed no differences in opioid use between catheters or singular injections of Bupivicaine. Exparel (Liposomal Bupivacaine formulation) reports local anesthesia up to 72 hours. Exparel’s emergence removed the catheter burden and compares local infiltration of Exparel with standard 0.25% Bupivacaine injections into the subcutaneous space.
a9ded1e5ce5d75814730bb4caaf49419 Method
This RCT compares both injections’ analgesic effects on opioid use. Adult VATS lung resection patients from 2015-2017 were eligible. Patients with: chronic opioid use, pain medication allergies, liver or renal dysfunction, severe COPD, peptic ulcerative disease, or pregnancy were excluded. The primary endpoint measured differences in opioid utilization in postoperative days (POD) 0-7, via chart review and self-reported pain medication use post-discharge. Hydromorphone equivalents were utilized for opioid conversions. Wilcoxon rank-sum and Fisher’s exact tests compared all appropriate endpoints.
4c3880bb027f159e801041b1021e88e8 Result
Sample sizes, opioid utilization, and pain scores are demonstrated in Table 1. No differences were observed for opioid utilization between groups for all PODs. No differences in pain scores (except for POD4), 30-day patient satisfaction (98% vs. 90% very satisfied), or LOS (0 [0-1] vs. 0 [0-1]) were observed.
8eea62084ca7e541d918e823422bd82e Conclusion
These results suggest clinical equipoise between Exparel and Bupivicaine and practitioners cannot justify routine use of Exparel in this patient population for improved postoperative pain control. Appropriate preoperative preparation and attention to proven evidence-based metrics designed to decrease morbidity, such as ambulation, should take precedence over a focus on pain management.
6f8b794f3246b0c1e1780bb4d4d5dc53
