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Takahide Toyoda



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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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      P1.16-36 - Real-Time Ct Guided Video Assisted Thoracoscopic Partial Resection of Peripheral Small-Sized Lung Tumors. (ID 13502)

      16:45 - 18:00  |  Author(s): Takahide Toyoda

      • Abstract
      • Slides

      Background

      As pulmonary resection for small and grand-grass opacity (GGO) dominant pulmonary nodules have been increasing, various navigation systems to detect these nodules have been reported. The aim of this study is to evaluate feasibility of real-time CT guided pulmonary resection for impalpable small pulmonary nodules.

      a9ded1e5ce5d75814730bb4caaf49419 Method

      From July to November in 2017, 11 patients were eligible for pulmonary resection for lung cancer or malignancy suspected lesions, which was expected to be difficult to detect during operation. These nodules were defined as GGO-dominant (>50%) tumor with a diameter of 3cm or lower (GGO-dominant type), and tumor with a diameter of 2cm or lower, which is located deeper than the diameter of the tumor from visceral pleura (deep solid type). First, we put several surgical clips as first marker on the visceral pleura of the tumor-located lobethrough 3-ports VATS approach. The tumor and the first markers were visualized by cone beam CT, then the second marker was put just on the tumor based on the image. Pulmonary resection was performed according to second marker guided by automated staplers. CT scanning was also performed for confirmation of the complete resection.

      4c3880bb027f159e801041b1021e88e8 Result

      These procedures were performed for 4 men and 7 women (mean age: 58 years (39-71)). Tumors were located in the right upper lobe/right lower lobe/left upper lobe/left lower lobe in 5/2/2/2 patients. Diameters of tumors were 1.5cm or less. Six tumors were GGO-dominant types whereas 5 were solid types located in the deep from the visceral pleura; therefore all tumors couldn’t be detected by video-scopic observation. The average number of cone beam CT scanning is 2.7 times. All patients accomplished macroscopic and microscopic complete resection with no adverse events during perioperative periods.

      8eea62084ca7e541d918e823422bd82e Conclusion

      This feasibility study suggested that cone beam CT was safe and useful guide forvideo assisted thoracoscopic partial resection for impalpable peripheral pulmonary nodules.

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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: 2
    • Moderators:
    • Coordinates: 9/25/2018, 16:45 - 18:00, Exhibit Hall
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      P2.16-39 - The Application of 3D Medical Image Analyzer and a Fluorescence Guided Surgery for Pulmonary Sublobar Resection (ID 11838)

      16:45 - 18:00  |  Author(s): Takahide Toyoda

      • Abstract
      • Slides

      Background

      The confirmation of an appropriate resection margin from the tumor is crucial for reducing the risk of local recurrence after sublobar resection for lung cancer. Furthermore, the precise anatomical sublobar resection is also important for preserving pulmonary function. We developed the novel operation method for pulmonary sublobar resection.

      a9ded1e5ce5d75814730bb4caaf49419 Method

      From Aug. 2014 to April 2018, 43 primary lung cancers were enrolled. Active limited resection was done in 29 and passive limited resection was done in 14. Preoperatively, each patient underwent computed tomography for creating several virtual sublobar resections by using Volume Analyzer Synapse VINCENT (Fujifilm, Tokyo, Japan). We measured the shortest distance from the tumor to the resection margin in each simulated resection and selected the most appropriate area of sublobar resection based on the adequate resection margin of approximately 2 cm from the tumor. After the simulation, we performed sublobar resection by using an infrared thoracoscopy with transbronchial ICG instillation. Before operation, 10ml of 10-fold diluted ICG with autologous blood and 400ml of air were instilled into each associated subsegmental bronchus. sublobar resection was performed under ICG visualization.

      4c3880bb027f159e801041b1021e88e8 Result

      The types of sublobar resection were subsegmental resection in 3, simple segmentectomy which was defined a simple plane cut surface of pulmonary division in 13, complex segmentectomy which was defined multiple plane cut surfaces of pulmonary division in 10 and extended segmentectomy which was defined segmentectomy with adjacent subsegmental resection in 14 and super deep extended wedge resection in 3. Average number of simulation was 4.3+/-1.5. The shortest distances from the tumor to the resection margin by simulation and an actual measurement were 23.6+/-11.6 mm and 24.6+/-8.6 mm, respectively (p=0.647). Postoperative recurrence was found in 5 cases (distant in 3 and mediastinal or supra-clavicular lymph node in 2) who all underwent passive limited resection. No ipsilateral lung recurrence was found.

      8eea62084ca7e541d918e823422bd82e Conclusion

      The advantages of this method are applicable to any type of sublobar resection, initial determination of resection area at operation, possible super deep wedge resection without broncho-vascular transection with enough margin, long identification of fluorescence, and indication in case of COPD, IP, reoperation and adhesion. On the other hand, the drawbacks are the necessity of a near infrared thoracoscopy and 3D medical image analyzer, knowledge of precise bronchial anatomy and advanced manipulation skills of bronchoscopy, ununiformity of ICG distribution and distribution of ICG into the adjacent area with the passage of time.

      6f8b794f3246b0c1e1780bb4d4d5dc53

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      P2.16-44 - Long-Term Outcome of Pulmonary Segmentectomy for c-IA Non-Small Cell Lung Cancer (ID 14202)

      16:45 - 18:00  |  Author(s): Takahide Toyoda

      • Abstract

      Background

      Pulmonary segmentectomy is being accepted as a favorable treatment option for small peripheral non-small cell lung cancer (NSCLC) although lobectomy is the standard surgical procedure. The long-term outcome and related issues in remote phase after pulmonary segmentectomy needs to be investigated.

      a9ded1e5ce5d75814730bb4caaf49419 Method

      We retrospectively reviewed 135 and 313 patients with clinical (c-) stage IA NSCLC who underwent segmentectomy (S) or lobectomy (L) from January 2008 to December 2015. Patient characteristics, prognosis, recurrence sites, and occurrence of second primary lung cancer were reviewed and compared between the 2 groups. Segmentectomy was intentionally selected when a target tumor was less than 3cm in diameter and ground-glass predominant. Solid part predominant tumors were also eligible for segmentectomy if its diameter was 2cm or less. Segmentectomy was reluctantly selected instead of lobectomy if patients presented insufficient vital organ function or have other pulmonary lesions which needed to be removed.

      4c3880bb027f159e801041b1021e88e8 Result

      In segmentectomy group, the average age was 68.1± 9.1 and 74 males were included. The solid tumor diameter and consolidation-tumor ratio in the S group were statistically smaller than those in the L group. There were no statistical differences in 5-year overall survival (S: 92.0% vs L: 91.5%) and relapse-free survival (5y-RFS) (S: 87.9% vs L: 84.4%) between the 2groups. The 5-year RFS stratified by clinical T factors in 8th edition showed no statistical differences between the 2 groups. Tumor recurrence occurred in 14 patients (10.4%), including loco-regional in 11 (8.1%) and distant metastasis in 3 (2.2%) patients. Recurrence on the intersegmental plane was developed in 2 patients. Loco-regional recurrence rates were similar in the 2 groups; however, loco-regional recurrence after segmentectomy tended to arise later than those after lobectomy (median of loco-regional recurrence free survival: 1094 and 512 days). Multi-variate analysis showed that a risk factor for loco-regional recurrence was solid tumor diameter, not segmentectomy. Second primary lung cancer occurred in 7 and 12 patients after segmentectomy and lobectomy, respectively. Additional lung resection including completion lobectomy was applied and showed better outcome than non-surgical treatment.

      8eea62084ca7e541d918e823422bd82e Conclusion

      The long-term outcome of segmentectomy for selected patients is equivalent to those of lobectomy. However, careful follow-up is mandatory as recurrence and second primary lung cancer can occur in the same lobe after segmentectomy which is avoidable by lobectomy.

      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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      P3.16-09 - High Preoperative D-Dimer Level Predicts Early Recurrence After Surgery for Non-Small Cell Lung Cancer (ID 11928)

      12:00 - 13:30  |  Author(s): Takahide Toyoda

      • Abstract

      Background

      Carcinoma cells often affect the coagulation and fibrinolysis among cancer patients. Plasma dimerized plasmin fragment D (D-dimer) has been reported as the prognostic marker of various type of malignancies. For non-small cell lung cancer (NSCLC) patients, significance of D-dimer levels still remains unclear.

      a9ded1e5ce5d75814730bb4caaf49419 Method

      Two hundreds and thirty five patients with NSCLC who underwent radical surgery between April 2015 and March 2017 were retrospectively reviewed. We divided two groups including 1) high D-dimer (over 1.0ug/mL) group (hDD group, n=47), and 2) normal D-dimer group (nDD group, n=188). The clinical characteristics, tumor CT findings, pathological findings, and clinical outcomes were analyzed.

      4c3880bb027f159e801041b1021e88e8 Result

      The mean D-dimer level was 2.49±2.58 among hDD group. The hDD group had the character of 1) male gender, 2) elder patients, 3) larger tumor size (p=0.0011), 4) pure solid appearance (p=0.0203). The hDD group showed worse overall survival (OS), disease free survival (DFS), and disease specific survival (DSS) than nDD group (Figure 1-A, B, C; log-rank test, p<0.0001, =0.0007, =0.0003, retrospectively) and these findings were also observed only for the p-Stage IA cases. Interestingly patients with grand glass attenuation-dominant nodule were not affected by D-dimer level with favor prognosis. Pathology showed more frequent vessel involvement (v+) in hDD group (p=0.033), but there was no significant difference for histology or histological subtypes of adenocarcinoma.os_dfs_dss2.png

      Figure1:

      Kaplan-Meier survival curves of postoperative overall survival (A), disease free survival (B), and disease specific survival (C) by preoperative D-dimer level.

      8eea62084ca7e541d918e823422bd82e Conclusion

      The preoperative D-dimer level predicts the postoperative early recurrence and poor prognosis in the patients with NSCLC with pure solid appearance on chest CT.

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