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Yves Lacasse

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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: 1
    • Moderators:
    • Coordinates: 9/24/2018, 16:45 - 18:00, Exhibit Hall
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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): Yves Lacasse

      • Abstract


      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).


      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.