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Yukinori Sakao



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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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      P1.16-42 - Indocyanine Green Intersegmental Visualization During Fluorescence Imaging of Thoracoscopic Anatomic Segmentectomy: A Novel Approach (ID 11844)

      16:45 - 18:00  |  Author(s): Yukinori Sakao

      • Abstract

      Background

      Anatomic segmentectomy (AS) of the lung is a more complex operative procedure than standard lobectomy, especially when performed as a complete thoracoscopic surgery. Identification of the intersegmental boundary line (IBL) is a technical imperative, allowing surgeons to develop this plane during segmentectomy. Although several methods of IBL identification (IBL-ID) have been reported, our general usage of an intravenous indocyanine green (ICG) fluorescence system is alternative. In examining 83 patients by conventional ICG method (CIM), the IBL-ID success rate was high (98.8%), but intersegmental visibility was diminished due to smoking and emphysema. We also examined 29 patients using the Spectra A method (SAM), which heightened intersegmental contrast (IC) and preserved segment brightness (PB), compared with CIM, thus improving intersegmental visibility. To effect further improvement, a trial of the novel SAM with xenon light (SAM-X) was undertaken.

      a9ded1e5ce5d75814730bb4caaf49419 Method

      We prospectively studied 106 consecutive patients who underwent complete thoracoscopic AS of 111 lung segments (including subsegments) at our Hospital between October 2015 and October 2017. Following intraoperative transection of the segmental artery, vein and bronchi, 5 mg/body weight of ICG was administered intravenously, and fluorescence images were generated using the ICG system. Both the CIM with xenon light (CIM-X) and the SAM-X were simultaneously obtained in concert for IBL-ID, quantifying intersegmental visibility for histogram representation.

      4c3880bb027f159e801041b1021e88e8 Result

      The patient population (men, 50; women, 56) had a mean age of 67.4±10.7 years and a mean Brinkman index of 446.6±650.7, harboring malignant lung tumors (primary, 77; metastatic, 29, other, 5) as follows: right upper, 28; right middle, 1; right lower, 20; left upper, 38; left lower, 24. IBL-ID was achieved in all patients (100%). As with the SAM apparatus, the SAM-X provided significantly better accentuation of green fluorescence in RGB light analysis, compared with the CIM-X (p<0.01). Furthermore, both IC and PB showed significant increases (p<0.01 each), whether comparing SAM-X with CIM-X or with SAM; and SAM-X was strong (R=0.8), surpassing that of CIM-X (R=0.39) as for the correlation between IC and PB.

      8eea62084ca7e541d918e823422bd82e Conclusion

      The SAM-X device stabilized visibility and improved contrast between resected and non-resected segments and brightness of both resected and non-resected segments during thoracoscopic intersegmental identification.

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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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      P2.16-34 - Visceral Pleural Invasion is Closely Associated with Nodal Spread in cStage IA Lung Adenocarcinoma (ID 12880)

      16:45 - 18:00  |  Author(s): Yukinori Sakao

      • Abstract
      • Slides

      Background

      Survival outcomes of patients with clinical Stage IA (cIA) lung adenocarcinoma (LAD) are favorable after resections. In this decade, limited resection without lymphnodes dissections have been indicated for selected cases based on the radiological findings and intraoperative hilar explorations, while we sometimes experience occult lymphnodes metastases among them. These facts refer that limited resections could potentially induce underestimation of the disease, local failure and worsened patients’ prognoses. In the present study, we retrospectively investigate the clinicopathological and oncogenic factors in association with the occult nodal spread and skip metastases, and aim to identify population for standard resection in cIA LAD.

      a9ded1e5ce5d75814730bb4caaf49419 Method

      We retrospectively investigated 287 patients with cIA LAD who underwent standard pulmonary resections with mediastinal dissections from January 2013 through December 2017. Clinicopathological factors including location of the tumor, radiological pleural invasion and oncogenic status (EGFR/KRAS/ALK/Triple Negative) were reviewed for outcomes of occult nodal spread and skip metastasis. According to the ROC curves analyses, cutoff values of total diameter (TD), solid diameter (SD), mediastinal window diameter (MD) in CT image and pathological invasive size (IS) were settled to diagnose nodal metastases and skip pN2, respectively.

      4c3880bb027f159e801041b1021e88e8 Result

      Among 287 patients with cIA LAD, 34 (11.8%) with lymph node metastases and 8 (2.8%) with pN2 without hilar metastases (skip pN2) were identified. Univariate analyses revealed that high serum CEA level, TD, MD, SUVmax, IS and pathological pleural invasion (pl) were predictive for nodal metastases. And multivariate analysis showed that pl was closely associated with nodal metastases (Odds Ratio: 3.3, p=0.007). Furthermore, multivariate analysis following the univariate analyses also showed that presence of pl was the factor closely associated with skip N2 metastases (Odds Ratio: 5.7, p=0.029), whereas radiological findings nor oncogenic status were not so. In the clinical valuables, serum CEA level, SD, MD, SUVmax were significantly associated with pl.

      8eea62084ca7e541d918e823422bd82e Conclusion

      In resected cIA LAD, pathological pleural invasion was closely associated with both occult nodal spread and skip pN2, while any other preoperative factors and oncogenic status were not. New diagnostic modalities for pl may provide the candidates for standard resections in cIA LAD.

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