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Hirofumi Suzuki
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P2.15 - Treatment in the Real World - Support, Survivorship, Systems Research (Not CME Accredited Session) (ID 964)
- 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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P2.15-27 - Lung Volume Change After Lobectomy Estimated by Three-Dimensional Image Analysis System (ID 11961)
16:45 - 18:00 | Presenting Author(s): Hirofumi Suzuki
- Abstract
Background
High-precision three-dimensional (3D) image analysis system has been used for preoperative planning in various fields including thoracic surgery. Such software has made us quite easy to measure lung volume. Change of pulmonary function after surgery has been surveyed in some reports, but there are few reports about lung volume change after surgery.
a9ded1e5ce5d75814730bb4caaf49419 Method
We conducted a retrospective review of 49 patients who underwent lobectomy between January 2014 and June 2016 at General Hospital of Japan Railway Company. We used 3D image analysis system (SYNAPSE VINCENT, Fujifilm Corp, Tokyo, Japan) to calculate lung volume of each patient from computed tomography (CT) images which were taken twice, before surgery and 6 months after surgery. We estimated lung volume change from the difference between those two values.
4c3880bb027f159e801041b1021e88e8 Result
There were 19 right upper lobectomies (RUL), 7 right middle lobectomies (RML), 8 right lower lobectomies (RLL), 5 left upper lobectomies (LUL), and 10 left lower lobectomies (LLL). We performed lobectomies in three different surgical approaches; Thoracotomy (n=5), Hybrid Video-assisted thoracic surgery (VATS) (n=24), Complete VATS (n=20). 7 patients needed pleurodesis after surgery to treat air leakage. The average of total lung volume change was -10.4%. Right lobectomies showed 11.45% decrease of lung volume in average, while left lobectomies showed 5.34% decrease (p=0.18). Decrease ratio seemed to depend on the way of approaches; Thoracotomy was -19.98% and VATS (hybrid and complete) was -8.58% (p=0.12). Volume change of patients who underwent pleurodesis after surgery was -20.37%, while the ratio of the others was -7.84% (p=0.03).
8eea62084ca7e541d918e823422bd82e Conclusion
VATS seemed to be better in the point of lung volume after lobectomy than thoracotomy. Pleurodesis turned out to reduce lung volume significantly. For furthur study, we will compare lung volume with pulmonary function on a lager aomount of data .
6f8b794f3246b0c1e1780bb4d4d5dc53
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P3.CR - Case Reports (Not CME Accredited Session) (ID 984)
- 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.CR-31 - A Case of Thymoma with Autoimmune Hepatitis Following Preoperative Chemotherapy (ID 13065)
12:00 - 13:30 | Author(s): Hirofumi Suzuki
- Abstract
Background
We encountered a case of thymoma with autoimmune hepatitis.
a9ded1e5ce5d75814730bb4caaf49419 Method
A 63-year-old woman was found to have an abnormal finding on chest radiography during a medical checkup, but did not seek further care. She was referred to our hospital one year later when a bilateral hilar abnormality was again found during a checkup. Chest computed tomography (CT) showed a 4.6 × 3.0 × 5.6 cm mass with calcifications in the anterior mediastinum. The tumor invaded the right lung and middle lobe, in association with a 2.0-cm daughter nodule in the head of the main tumor, with multiple pleural seeding lesions in the right thoracic cavity. Although she was asymptomatic, the anti-acetylcholine receptor antibody level was elevated to 33 nmol/L and the soluble IL-2 receptor antibody was elevated to 1,700 U/mL. The mass was diagnosed with CT-guided biopsy as a type-B2 thymic tumor (cT3N0M1a, c-Stage IV). She underwent induction chemotherapy (ADOC, 2 courses). After chemotherapy, abnormal liver enzyme levels (aspartate aminotransferase: 451 U/L, alanine aminotransferase: 529 U/L) were noted on preoperative examination. She was diagnosed with autoimmune hepatitis based on liver biopsy findings and treated with oral prednisolone 30 mg.
4c3880bb027f159e801041b1021e88e8 Result
Surgery was performed after prednisolone dose was gradually decreased to 20 mg. Extended thymectomy and pulmonary wedge resection using median sternotomy were performed. Pleural dissemination was resected using video-assisted thoracoscopic surgery. The pathological findings showed type-B3 thymic carcinoma (pT3N0M1a, p-Stage IV, Masaoka classification IVa). She was placed under observation without any additional treatment. Prednisolone dose has been gradually decreased to 15 mg without exacerbation of liver function. The anti-acetylcholine receptor antibody level decreased after surgery.
8eea62084ca7e541d918e823422bd82e Conclusion
Autoimmune diseases in association with thymoma are well known, but reports of autoimmune hepatitis are very rare. Autoimmune hepatitis must be considered when acute liver damage is observed.
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