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Olaf Mercier
Author of
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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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P2.16-26 - Lung Cancer Resection in Patients with Criteria for Lung Cancer Screening Provides Satisfactory Short Term Results (ID 12788)
16:45 - 18:00 | Author(s): Olaf Mercier
- Abstract
Background
Criteria for lung cancer screening (LCS) include age 55-74 years old, a smoking history ≥ 30 pack-years with < 15 years smoking cessation. The lack of data regarding the operative risk for lung cancer resection (LCR) in patients with LCS criteria is a limit for national reimbursement of LCS in France. We aimed to determine whether the operative risk for LCR is increased in patients with LCS criteria.
a9ded1e5ce5d75814730bb4caaf49419 Method
We performed a retrospective analysis of consecutive LCR operated between October 2015 and October 2016 in a high volume tertiary center with routine minimally invasive thoracic surgery (videothoracoscopy). Among 241 patients who underwent a LCR, the study population were the 169 patients aged 55-74 years old. We compared the perioperative characteristics of patients with and without LCS criteria.
4c3880bb027f159e801041b1021e88e8 Result
LCS criteria were present in 92 patients out of 169. Preoperative and operative/postoperative data were reported in Tables 1 and 2, respectively. Despite an increased preoperative cardiovascular risk and a poorer respiratory function, patients with LCS criteria presented a similar postoperative morbidity, mortality and hospital readmission compared with patients without LCS criteria.
Table 1: preoperative characteristics of patient aged 55-74 years old undergoing lung cancer resection. Comparison between patients with and without lung cancer screening (LCS) criteria. M: male; F: female; BMI: body mass index; CV: cardiovascular; EA: endarterectomy; ENT: ear nose and throat; NLR: neutrophil to lymphocyte ratio; CRP: C-reactive protein; FEV1: forced expiratory volume in 1 second. Quantitative data are expressed as mean ± standard deviation; qualitative data are expressed as n and %. All
(n=169)
With
LCS criteria
(n=92)
Without
LCS criteria
(n=77)
P
Age (years)
64.7 ± 5.1
64.1 ± 4.5
65.4 ± 5.6
NS
Sex (M/F)
100 / 69
65 / 27
35 / 42
0.002
BMI (kg/m2)
25.0 ± 4.8
24.3 ± 4.3
26.0 ± 5.2
0.023
Smoke habit
Pack years
35.3 ± 22.0
48.0 ± 15.6
16.7 ± 15.7
<0.0001
CV events history
47 (27.8%)
34 (37.0%)
13 (16.9%)
0.006
Cardiac event
31 (18.3%)
22 (23.9%)
9 (11.7%)
NS
PAD
18 (10.7%)
15 (16.3%)
3 (3.9%)
0.019
Carotid EA
4 (2.4%)
4 (4.3%)
1 (1.3%)
NS
stroke
11 (6.5%)
5 (5.4%)
6 (7.8%)
NS
Aortic surgery
10 (5.9%)
8 (8.7%)
2 (2.6%)
NS
Cancer history
60 (35.5%)
35 (38.0%)
25 (32.5%)
NS
ENT
14 (8.3%)
12 (13.0%)
2 (2.6%)
0.022
Bladder
8 (4.7%)
8 (8.7%)
0 (0%)
0.008
Digestive tract
8 (4.7%)
4 (4.3%)
4 (5.2%)
NS
Breast
5 (3.0%)
2 (2.2%)
3 (3.9%)
NS
Lung
9 (5.3%)
4 (4.3%)
5 (6.5%)
NS
Other
25 (14.8%)
14 (15.2%)
11 (14.3%)
NS
Inflammation
NLR
3.25 ± 2.27
3.41 ± 1.74
3.05 ± 2.78
NS
CRP > 10
32 (18.9%)
20 (21.7%)
12 (15.6%)
NS
FEV1
87.5 ± 19.9
83.1 ± 20.4
92.9 ± 17.9
0.001
Table 2: postoperative characteristics of patient aged 55-74 years old undergoing lung cancer resection. SSC: squamous cell carcinoma. Quantitative data are expressed as mean ± standard deviation but when specified; qualitative data are expressed as n and %. All
(n=169)
With LCS criteria
(n=92)
Without
LCS criteria
(n=77)
P
Infra lobar resection
19 (11.2%)
13 (14.1%)
6 (7.8%)
NS
Wedge resection
14
9
5
segmentectomy
5
4
1
Minimally invasive
13
9
4
Lobectomy
130 (76.9%)
72 (78.3%)
58 (75.3%)
Minimally invasive
79
46
34
Bilobectomy
8 (4.7%)
1 (1.1%)
7 (9.1%)
Totalisation pneumonectomy
2 (1.2%)
1 (1.1%)
1 (1.3%)
Pneumonectomy
10 (5.9%)
5 (5.4%)
5 (6.5%)
Pathology
NS
adenocarcinoma
113 (66.9%)
63 (68.5%)
50 (64.9%)
SCC
38 (22.5%)
23 (25.0%)
15 (19.5%)
others
18 (10.1%)
6 (6.5%)
12 (15.6%)
Stage
NS
Stage I
85 (50.3%)
44 (47.8%)
41 (53.2%)
Stage II
38 (22.5%)
25 (27.2%)
13 (16.9%)
Stage III
41 (22.3%)
20 (21.7%)
21 (27.3%)
Stage IV
5 (3.0%)
3 (3.3%)
2 (2.6%)
30-day Morbidity
No morbidity
84 (49.7%)
42 (45.7%)
42 (54.5%)
NS
Medically treated
49 (29.0%)
28 (30.4%)
21 (27.3%)
Clavien-Dindo I
1
1
0
Clavien-Dindo II
48
27
21
Requiring intervention
15 (8.9%)
14 (15.2%)
11 (14.1%)
Clavien-Dindo IIIa
16
7
9
Clavien-Dindo IIIb
9
7
2
Requiring ICU
11 (6.5%)
8 (8.7%)
3 (3.9%)
Clavien-Dindo IVa
8
6
2
Clavien-Dindo IVb
3
2
1
30 –days mortality
0 (0%)
0 (0%)
0 (0%)
Clavien-Dindo V
0
0
0
Hospital stay duration (days) median (IQR)
7 (5 ; 11)
7 (5 ; 11)
6 (5 ; 10)
NS
90-days hospital re-admission
4 (2.4%)
2 (2.2%)
2 (2.6%)
NS
LCS program would allow us to achieve similar operative outcomes than patients without LCS criteria despite poorer respiratory function and increased cardiovascular risk.
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