Author of

• 25934

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  P1.14 - Thymoma/Other Thoracic Malignancies (Not CME Accredited Session) (ID 946)

  • Event: WCLC 2018
  • Type: Poster Viewing in the Exhibit Hall
  • Track:
  • Presentations: 1
  • Moderators:
  • Coordinates: 9/24/2018, 16:45 - 18:00, Exhibit Hall

  • 26645

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    P1.14-08 - The Usefulness of the Hemiclamshell Thoracotomy in Thoracic Surgery (ID 13663)

    16:45 - 18:00  |  Author(s): Akihiro Nakamura
    • Abstract

    Background
    

    The antero-lateral approach provides good exposure of the cervicothoracic region and enables removal of lesions that develop in this complex anatomic area.

    a9ded1e5ce5d75814730bb4caaf49419 Method
    

    We retrospectively evaluated the indications and outcomes of the hemiclamshell approach in patients undergoing tumor resection in thoracic surgery. Eleven lung cancer patients and one non seminomotous germ cell tumor of the mediastinum who underwent tumor resection via hemiclamshell approach in our department, between 2007 and 2018 were studied retrospectively, analyzing the indications, morbidity and outcome.

    4c3880bb027f159e801041b1021e88e8 Result
    

    The indications were apical tumors with vascular invasion in four, giant mass (10, 17, 21cm in tumor diameter) with superior or inferior vena cava invasion in three, aortic arch invasion in one, sternal invasion in one, mediastinal lymph node metastasis in the left upper lung cancer in one, and pulmonary artery aneurysm after left upper lobectomy in one. In eleven lung cancer patients, combined resection of the neighboring organ was performed in nine organs among eight patients: subclavian artery in two, carotid artery in one, aorta in one, superior vena cava in one, chest wall in two, phrenic nerve in one, and pericardium in one. One-month mortality was 0%. Operative morbidity was observed in four patients (33%): two patients suffered from deep wound infection, one from a chylothorax, and one from pleural effusion. R0 resection was achieved in eleven patients.

    8eea62084ca7e541d918e823422bd82e Conclusion
    

    The hemiclamshell approach was associated with relative high morbidity rate but no mortality. Hemiclamshell is suitable for tumours of the cervicothoracic junction with vascular invasion and giant tumors, providing good access for control of the large vessels including pulmonary artery and vein.

    6f8b794f3246b0c1e1780bb4d4d5dc53

• 25970

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  P3.16 - Treatment of Early Stage/Localized Disease (Not CME Accredited Session) (ID 982)

  • Event: WCLC 2018
  • Type: Poster Viewing in the Exhibit Hall
  • Track:
  • Presentations: 1
  • Moderators:
  • Coordinates: 9/26/2018, 12:00 - 13:30, Exhibit Hall

  • 27775

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    P3.16-33 - Characteristics and Risk Factors of Recurrence After Segmentectomy in Patients With Clinical Stage I Non-Small Cell Lung Cancer (ID 13108)

    12:00 - 13:30  |  Presenting Author(s): Akihiro Nakamura
    • Abstract

    Background
    

    Although lobectomy is the standard surgical procedure for operable non–small cell lung cancer (NSCLC), sometimes we performed segmentectomy for compromised patients, and patients with small-sized NSCLC and adequate pulmonary function for curative intent.

    The aim of this study was to investigate first recurrence sites and risk factors of recurrence in NSCLC patients who underwent segmentectomy.

    a9ded1e5ce5d75814730bb4caaf49419 Method
    

    We retrospectively reviewed 136 patients with clinical stage I NSCLC (the 7th edition of the TNM classification) who underwent segmentectomy at Niigata University Medical and Dental Hospital between 2000 and 2016. We investigated first recurrence site to classify as intrathoracic or extrathoracic recurrence. The significant demographic, clinical, and pathologic factors identified with the log rank test in univariate analyses were analyzed with the Cox proportional hazards regression model to examine independent predictors for recurrence in multivariate analysis. For the significant predictor, we determined optimal cutoff points by receiver operating characteristic (ROC) analysis and Youden’s Index

    4c3880bb027f159e801041b1021e88e8 Result
    

    Of the 136 patients in this study, 81 were male and 55 were female, and the median age was 71 years (range, 41 to 86 years). During the median follow-up period of 1568 days (range, 15 to 6584 days), recurrence was developed in 11 patients. Intrathoracic recurrence was developed only in 4 patients, including 2 patients with surgical resection margin recurrence.

    The 5- and 10-year recurrence-free probabilities were 89.7% and 89.7%, respectively. Solid tumor component size on computed tomography (CT) was identified as an independent significant predictor (hazard ratio [HR], 3.459). To illustrate ROC curve and use Youden’s Index, the optimal cutoff points were determined as 1.5 cm for solid component size on CT.

    8eea62084ca7e541d918e823422bd82e Conclusion
    

    In the study, the NSCLC patients with solid component of larger than 1.5 cm on CT had a higher risk for postoperative recurrence after segmentectomy. However it is still unknown whether these patients could be cured by lobectomy, because many of the patients with postoperative recurrence had extrathoracic recurrence.

    6f8b794f3246b0c1e1780bb4d4d5dc53