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Yuki Shimizu



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

      16:45 - 18:00  |  Author(s): Yuki Shimizu

      • 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.

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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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      P2.16-30 - Surgical Strategy for Clinical Stage IA Non-Small Cell Lung Cancer Patients with Risk Factors of Pathological Invasion and/or Metastasis (ID 12662)

      16:45 - 18:00  |  Author(s): Yuki Shimizu

      • Abstract
      • Slides

      Background

      Because pathological metastasis and involvement are thought to be associated with postoperative recurrence and poor outcomes in non-small cell lung cancer (NSCLC) patients, limited resection for high risk patients of pathological metastasis and involvement is controversial. The aim of this study was to examine a postoperative locoregional control in these patients.

      a9ded1e5ce5d75814730bb4caaf49419 Method

      We retrospectively reviewed completely resected clinical stage IA NSCLC patients on the 8th edition of the TNM classification (solid tumor component size of ≤3 cm on computed tomography; CT). The pathological metastasis and/or involvement was defined that pleural involvement, pulmonary metastasis, lymph node metastasis, and/or lymphovascular involvement were identified on pathological examination. To identify predictors for the pathological metastasis and/or involvement, demographic and clinical factors were analyzed by a univariate analysis and multivariate logistic regression analysis. For the significant factors, optimal cutoff points were determined with a receiver operating characteristic analysis. Locoregional recurrence-free probabilities were calculated using the Kaplan-Meier method in patients with/without the identified predictors, and were compared between patients who underwent limited resection and lobectomy by the log-rank test.

      4c3880bb027f159e801041b1021e88e8 Result

      Of the 286 eligible patients, pleural involvement, pulmonary metastasis, lymph node metastasis, lymphatic permeation, and vascular invasion were identified in 43 (15%), 5 (2%), 11 (4%), 15 (5%), and 32 patients (11%), respectively, and in total, 73 patients (26%) developed the pathological metastasis and/or involvement. Univariate and multivariate logistic regression analysis revealed solid tumor component size on CT (OR: 1.090) and consolidation/tumor ratio on CT (CTR; OR: 1.043) as significant predictors. The optimal cutoff points were determined as 1.7 cm and 86% for solid component size and CTR, respectively, and 47 of the 97 patients (48%) with >1.7 cm of solid component size and >86% of CTR developed the pathological metastasis and/or involvement. In the 97 patients, the 3-year locoregional recurrence-free probabilities were 70% versus 84% in patients who underwent limited resection (n = 21) and lobectomy (n = 76), respectively (p = 0.0963), whereas in 104 patients with ≤1.7 cm of solid component size and ≤86% of CTR, the 3-year locoregional recurrence-free probabilities were 95% versus 97% in patients who underwent limited resection (n = 52) and lobectomy (n = 52), respectively (p = 0.8622).

      8eea62084ca7e541d918e823422bd82e Conclusion

      An indication for limited resection may be decided with caution in clinical stage IA patients with the predictors of the pathological metastasis and/or involvement because of relatively higher incidence of postoperative locoregional recurrence after limited resection when compared with lobectomy.

      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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      P3.01-31 - Prognostic Factors in Patients with Resected Pathological N2 Non-Small Cell Lung Cancer (ID 12648)

      12:00 - 13:30  |  Author(s): Yuki Shimizu

      • Abstract

      Background

      Postoperative outcome for non-small cell lung cancer (NSCLC) patients with mediastinal lymph node metastasis is unfavorable even after complete resection. To identify the subgroup of NSCLC patients with mediastinal lymph node metastasis whom we recommend surgical treatment, we sought to investigate prognostic factors in these patients.

      a9ded1e5ce5d75814730bb4caaf49419 Method

      We retrospectively reviewed NSCLC patients with pathologically identified mediastinal lymph node metastasis who underwent complete resection with systematic nodal dissection between 2000 and 2016. Demographic, clinical, and pathologic factors (sex, age, Brinkman index, performance status [PS], % vital capacity, forced expiratory volume % in 1 second, preoperative carcinoembryonic antigen [CEA], histological subtype, pathological tumor size, p-T factor [7th edition], pleural invasion, pulmonary metastasis, histological grade, number of positive mediastinal nodal stations [single station vs multiple stations], number of positive mediastinal lymph nodes [1-2 vs ≥3], epidermal growth factor receptor [EGFR] mutation status, and adjuvant chemotherapy) were analyzed using the log-rank test as univariate analyses and a Cox proportional hazards regression model for multivariate analyses to identify independent predictors of favorable overall survival (OS).

      4c3880bb027f159e801041b1021e88e8 Result

      Of the 54 eligible patients, 38 were male and 16 were female. The median age and CEA were 65 years and 5.3 ng/mL, respectively. Lobectomy, bilobectomy, and pneumonectomy were performed in 49/3/2 patients. Histological subtypes were adenocarcinoma in 29 patients, squamous cell carcinoma in 17, and others in 8. EGFR was inspected in 33 patients, and 10 patients were EGFR mutated. Adjuvant chemotherapy was performed in 26 patients. The details of adjuvant chemotherapy were cisplatin-based combination chemotherapy in 18 patients, and carboplatin-based combination chemotherapy in 8.

      The 3-year and 5-year OS were 64.9% and 44.7%, respectively, with a median follow-up period of 41 months. The preoperative CEA <5.3 ng/mL (HR: 0.2151) and undergoing adjuvant chemotherapy (HR: 0.3580) were identified as significant predictors of favorable OS. The 3-year and 5-year OS in patients with CEA <5.3 and ≥5.3 ng/mL were 88.3/70.8% vs 41.0/17.9%, respectively (p<0.001). The 3-year and 5-year OS in patients who underwent adjuvant chemotherapy or none were 75.3/70.3% vs 55.3/23.1%, respectively (p = 0.009).

      8eea62084ca7e541d918e823422bd82e Conclusion

      Even if NSCLC patients have mediastinal lymph node metastasis, favorable postoperative prognosis may be expected in patients with low preoperative serum CEA. Adjuvant chemotherapy should be considered in patients with mediastinal lymph node metastasis on pathological examination.

      6f8b794f3246b0c1e1780bb4d4d5dc53

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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
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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  |  Author(s): Yuki Shimizu

      • 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.

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