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Kingsfield Ong



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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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      P2.16-37 - The Introduction of Robotic Lobectomy for Non-Small Cell Lung Cancer in South East Asia: A 5-Year Single Centre Study (ID 13415)

      16:45 - 18:00  |  Presenting Author(s): Kingsfield Ong

      • Abstract
      • Slides

      Background

      Over the past decade, minimally invasive robotic-assisted thoracic surgery has gradually evolved into the preferred platform for oncological thoracic resection, demonstrating respectable perioperative and long-term outcomes. The aim of this study is to evaluate the feasibility of completely portal robotic lobectomy (CPRL4) for non-small cell lung cancer (NCSLC) at a geographical region that has yet to assimilate this relatively new platform.

      a9ded1e5ce5d75814730bb4caaf49419 Method

      This is a 5-year retrospective review of consecutive patients with NCSLC who underwent CPRL4 by a single surgeon at our institution from January 2013 – October 2017.

      4c3880bb027f159e801041b1021e88e8 Result

      A total of 80 patients (female 55%, median age 67 years) underwent elective completely portal robotic lobectomy CPRL4 for NCSLC. 67.5% were non-smokers. The top 3 co-morbidities were hypertension (60%), hyperlipidaemia (55%) and diabetes (21.3%). 17.5% had previous non-lung related malignancies. Median operative time was 202 mins (range 80 – 335 mins). Conversion rate was 12.5%, the vast majority were due to non-progression of the case. Median ICU/HDU stay, chest tube duration and length of hospital stay were 1 day (range 0 – 4 days), 3 days (range 1 – 34 days) and 4 days (range 2 – 30 days) respectively. There was no perioperative (30-day) mortality in this study. The two commonest complications were prolonged chest tube duration (11.3%) and atrial fibrillation (3.75%). Median tumour size on histology was 2.3cm (range 0.9 – 7cm). Most were adenocarcinomas (85%), followed by squamous cell carcinoma (7.5%), adeno-squamous cell carcinomas (2.5%) and other rare tumours. Final pathological staging distribution was 68.8% stage 1, 15.8% stage 2, 9.2% stage 3A and 5.3% stage 4. 25% were upstaged after pathological staging. Median follow up was 2 years (range 0.2-5.33 years). All lung cancer related mortality at the end of follow-up was 7.8%.

      8eea62084ca7e541d918e823422bd82e Conclusion

      The perioperative and early to mid-term oncologic results of CRPL4 for NSCLC are promising. With the surge of big data supporting this platform of oncologic surgery, we are confident that CPRL4 will be the preferred choice for minimally invasive surgery in lung cancer patients. However, to establish this body of evidence, further prospective randomised controlled trials will be necessary.

      6f8b794f3246b0c1e1780bb4d4d5dc53

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    P3.17 - Treatment of Locoregional Disease - NSCLC (Not CME Accredited Session) (ID 983)

    • 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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      P3.17-11 - Duo Synchronous Primary Lung Tumours Mimicking a Solitary Spiculated Cavitatory Mass on Computed Tomographic Imaging (ID 13404)

      12:00 - 13:30  |  Presenting Author(s): Kingsfield Ong

      • Abstract
      • Slides

      Background

      Multiple primary lung cancer (MPLC) is a well-established clinical entity with an incidence ranging 1-8%. It is the simultaneous presence of two or more primary lung cancers in an individual. Although the current high-resolution imaging tools have enabled such lesions to be readily detectable, we report a rare case of two synchronous primary lung adenocarcinomas that presented as a single lesion on computed tomographic (CT) imaging.

      a9ded1e5ce5d75814730bb4caaf49419 Method

      A 60-year-old Chinese gentleman, smoker, had an incidental finding of 2.4 cm lesion in the right lower zone on chest X-ray. CT of the thorax demonstrated 2.2 x 2.7 x 3.1 cm right lower lobe spiculated soft tissue mass with a small central cavitation and enlarged right hilar and pre-carinal lymph nodes measuring 1.5 x 1.6 cm and 1.8 x 1.8 cm respectively. Positron emission tomography – CT showed 3.1 cm spiculated lung mass in the right lower lobe (maxSUV 7.5), with metastatic FDG-avid right hilar node, right tracheo-bronchial node (maxSUV 4.8) and right paratracheal node. CT guided biopsy was done and histology showed primary lung adenocarcinoma.

      4c3880bb027f159e801041b1021e88e8 Result

      The patient underwent completely portal robotic right lower lobectomy with mediastinal lymph node dissection. His recovery was uneventful and was discharged on post-operative day 5. Histological examination revealed R0 resection of two distinctly separate adenocarcinomas measuring 2.3 x 2 x 1.5cm and 2.5 x 2.5 x 2.2cm respectively. The former showed acinar (40%), lepidic (30%), micropapillary (20%) and solid (10%) growth patterns while the latter showed solid (80%) and acinar (20%) growth patterns. Lymph node stations 2, 4, 7, 9, 10, 11 were dissected and analysed. Station 7 and 11 nodes were found to contain metastases. Final pathological staging was Stage 3A (pT1cN2M0). Subsequently, he underwent adjuvant chemotherapy (Carbo/Alimta #4) followed by radiotherapy (50.4Gy/28#). There was no tumour recurrence at the 1 year follow-up.

      8eea62084ca7e541d918e823422bd82e Conclusion

      Despite current state of the art imaging modalities for lung cancer, there remains the possibility of MPLC mimicking a solitary cavitatory lung lesion during clinical staging.

      6f8b794f3246b0c1e1780bb4d4d5dc53

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