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Raquel Sâmia Gonzaga Alves



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    P1.16 - Treatment of Early Stage/Localized Disease (Not CME Accredited Session) (ID 948)

    • Event: WCLC 2018
    • Type: Poster Viewing in the Exhibit Hall
    • Track:
    • Presentations: 2
    • Moderators:
    • Coordinates: 9/24/2018, 16:45 - 18:00, Exhibit Hall
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      P1.16-30 - Quality of Lymphadenectomy During Lobectomy for Non-small Cell Lung Cancer: VATS Versus Thoracotomy (ID 13017)

      16:45 - 18:00  |  Presenting Author(s): Raquel Sâmia Gonzaga Alves

      • Abstract
      • Slides

      Background

      Lobectomy by video-assisted thoracoscopic surgery (VATS) is preferred over thoracotomy in patients with early-stage non-small cell lung cancer (NSCLC). However, controversy still exists regarding the quality of the lymph node dissection accomplished using VATS. This study analyzed the lymphadenectomy by surgical approach and applied the International Association of the Study of Lung Cancer (IASLC) criteria of lobe-guided lymphadenectomy.

      a9ded1e5ce5d75814730bb4caaf49419 Method

      We performed a retrospective review of patients with stage I or II NSCLC who underwent lobectomy via thoracotomy (2003-2007, n=408) or VATS (2014-2017, n=754) at our institution. We compared the lymph node stations dissected by lobe-specific and the outcomes between the two approaches.

      4c3880bb027f159e801041b1021e88e8 Result

      VATS was equal or superior to thoracotomy for dissection of all lymph node stations except stations 8R (p=0.0018) and 8L (p=0.0002) and was superior for subcarinal lymphadenectomy (p=<.0001). When examined by lung lobe(s), VATS was superior for lymphadenectomy during right upper lobectomies (p=<.0001) and at least equal to thoracotomy for all other lobes. Additionally, VATS was associated with less blood loss (p=<.0001), pneumonia (p=0.0008) and acute respiratory distress syndrome (p=0.0082), fewer air leaks (p=<.0001) and lower 30-day mortality (p=0.0308).

      results table.png

      8eea62084ca7e541d918e823422bd82e Conclusion

      At our institution, the transition from thoracotomy to VATS lobectomy for early-stage NSCLC did not negatively impact the quality of the lymph node dissection. Moreover, VATS significantly improved surgical outcomes.

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      P1.16-32 - Lung Cancer Completeness of Resection in Uniportal Versus Multiportal Video-Assisted Thoracoscopic Surgery Lobectomy (ID 14315)

      16:45 - 18:00  |  Author(s): Raquel Sâmia Gonzaga Alves

      • Abstract

      Background

      In 2005, the International Association for the Study of Lung Cancer (IASLC) added a new category to complete and incomplete resection for residual tumor classification (R): uncertain resection (R(un)). R status has a major prognostic impact, and the prognosis of patients with a R(un) resection differs from that of patients with either complete (R0) or incomplete resection (R1 or R2). The aim of this study was to measure R status with the expanded classification system when performing lobectomy for non-small cell lung cancer (NSCLC) using a uniportal (U-VATS) or multiportal (M-VATS) video-assisted thoracoscopic surgery.

      a9ded1e5ce5d75814730bb4caaf49419 Method

      From August 2014 through December 2017, 672 VATS lobectomies were performed for the primary treatment of clinical stage I and II NSCLC, 43 patients with ground glass opacity or complex cases were excluded. Patients were analyzed according to ports used (one or multiple), R status, lobe-specific lymphadenectomy, subcarinal lymphadenectomy, length of hospital stay and length of thoracic drainage. A propensity-matched analysis was planned however, all variables were evenly distributed in both groups.

      4c3880bb027f159e801041b1021e88e8 Result

      Of 629 VATS lobectomies, 234 (37%) were performed with U-VATS and 395 (63%) with M-VATS. Most resections were classified as R(un) (84%); 2% were incomplete. When compared with M-VATS, U-VATS was associated with superior completeness of resection (p=0.0159), superior lobe-specific lymphadenectomy (p=0.0004), and superior subcarinal lymphadenectomy (p=0.0064). The highest mediastinal lymph node station dissected was not different between the approaches. The patients who underwent U-VATS had shorter hospital stays (mean: 4.4 days vs 6.2 days, p=0.0001) and less thoracic drainage (mean: 4.7 days vs 5.8 days, p=0.0004). There was no difference in operative mortality (p=0.3024) (Table 1).

      results.png

      8eea62084ca7e541d918e823422bd82e Conclusion

      In our institution, most VATS lobectomies were uncertain resections due to the lymph node evaluation by IASLC definition. Using U-VATS is not inferior to M-VATS in accomplishing a complete oncologic resection thoracoscopically.

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