Virtual Library
Start Your Search
Josep Maria Gimferrer
Author of
-
+
P2.01 - Advanced NSCLC (Not CME Accredited Session) (ID 950)
- Event: WCLC 2018
- Type: Poster Viewing in the Exhibit Hall
- Track:
- Presentations: 1
- Moderators:
- Coordinates: 9/25/2018, 16:45 - 18:00, Exhibit Hall
-
+
P2.01-72 - Bronchial Sleeve vs Pneumonectomy: Complications, Recurrences and Survival (ID 14131)
16:45 - 18:00 | Author(s): Josep Maria Gimferrer
- Abstract
Background
The present study describes and compares the rate of complications in hospital length of stay (LOS), recurrences and long-term survival between pneumonectomies and bronchial sleeves in our center's experience.
a9ded1e5ce5d75814730bb4caaf49419 Method
This is a descriptive, retrospective study. All patients who underwent bronchial SL or PN for NSCLC in our center between 2011 and 2017 were included. Individual clinical report was done, other indications for surgery were excluded. General demographics, preoperative lung function, histology and postoperative complications were included. Oncologic follow-up was done to detect recurrence and death. The statistical program used was SPSS.
4c3880bb027f159e801041b1021e88e8 Result
From of 87 patients registered, 47 had bronchial sleeve resection (54,02%) and 40 pneumonectomy (45.97%). The average age: SL 63.7, PN 61,7 years. Males were predominate in both groups (SL 83%, PN 75%). The average size tumoral were: SL 4,8 cm, PN 7,5 cm, p=0.46). Histological type predominant was C. squamous: SL 57,44%, PN 60%, p=0,46). The average LOS was higher SL than PN (2,37 and 6,37 respectively). Upper SL were most frequent: LSD 23 cases, LSI 17 cases, left pneumonectomies were the most accomplished.
25 patients had postoperative complications: SL 17 (68%), PN 8 (32%). The most frequent complications were persistent air leak (SL 6 cases, PN 0 cases, p=0.09) and cardiac arrhythmias. (SL 3 cases, PN 4 cases p=0.09)
No case of local recurrence was found after both techniques and 8 cases of regional recurrences (SL 6, PN 2, p=0,81).
No differences in terms of overall survival were detected when both techniques were compared (median survival in months, p=0.35).
8eea62084ca7e541d918e823422bd82e Conclusion
More postoperative complications were found in SL group with equal postoperative mortality, this is mostly because persistent air leak and bronchial stenosis, this could explain increase of LOS.
There are no local recurrences in any groups, this could mean that both techniques are oncologically equivalent. Our definition of regional recurrences as tumor involving the ipsilateral lung might again explain the higher incidence in SL.
There are no statistically differences in terms of OS in both techniques. However, long-term survival tendency appears to be in favor of SL specially after 5 years. This might be related to non oncologic late complications related to pneumonectomy.
In conclusion, we consider SL as a feasible and secure technique with a reasonable incidence of inherent complications and equal oncological results.
6f8b794f3246b0c1e1780bb4d4d5dc53
-
+
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
-
+
P2.16-25 - Lower Hiliar Lymph Node Upstaging in Early NSCLC Vats Surgery is Related to Tumor Location and Does Not Afect Survival (ID 12132)
16:45 - 18:00 | Author(s): Josep Maria Gimferrer
- Abstract
Background
Nodal upstaging after early stage lung cancer surgery is not only inevitable, but it is also considered a quality marker for surgical lymphadenectomy. Underdiagnosis of pN1 has important significance and leads to undertreatment. Lymphadenectomy has been questioned in video thoracoscopic surgery (VATS) since its description. Recently some authors published lower pN1 upstaging incidence after VATS resection compared to open thoracotomy. We want to evaluate the rate of upstaging in our centre after starting a VATS program.
a9ded1e5ce5d75814730bb4caaf49419 Method
All patient who required an anatomical resection for non-small cell lung cancer (NSCL) in our department have been retrospectively reviewed. Patients were divided in two groups in relation of the performed surgical approach, thoracotomy (THO) and VATS. Both groups were compared in terms of gender, age, smoking history, comorbidities, lung function, histology, clinical stage and tumour location. Rate of hilar lymph node upstaging (pN1) and mediastinal lymph node upstaging (pN2) were compared between both groups. Univariate and multivariate analysis was performed to identify independent risk factors for pN1 upstaging. Overall survival was compared between both techniques in pN0 patients.
4c3880bb027f159e801041b1021e88e8 Result
Between January 2011 and October 2017, 1.081 lung resections were carried out in our centre. 323 of those were anatomical resections for early stage (≤ IIB) non-small cell lung cancer (NSCLC). There were no differences among groups except for FEV1, previous history of Diabetes Mellitus, tumour size and location (p<0.05). pN1 ratio was 20,5% in THO vs. 8,6% in VATS (p < 0,05) when performed accesses was compared. No differences were observed regarding pN2 upstaging (6% in THO and 6,5% in VATS; p>0,05). Only gender and centrality were identified as independent risk factors for hiliar lymph node upstaging in a multivariate analysis. For those patient with no upstaging (pN0) there were no survival differences comparing open and VATS approaches.
8eea62084ca7e541d918e823422bd82e Conclusion
In our series pN1 upstaging is less frequent in VATS than in open surgery. When analysed, tumour centrality has shown to be an independent risk factor for hilar upstaging. Additionally central tumours were much more prevalent in open surgery group. In conclusion, lower incidence of unnoticed pN1 in VATS surgery could be related to a selection bias, because thoracotomy was preferred when tumour considered central.
Furthermore, the fact that no differences on survival in pN0 patients were detected suggests that no patients have been underdiagnosed and in consequence undertreated.
6f8b794f3246b0c1e1780bb4d4d5dc53
