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

  • 27298

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    P2.16-39 - The Application of 3D Medical Image Analyzer and a Fluorescence Guided Surgery for Pulmonary Sublobar Resection (ID 11838)

    16:45 - 18:00  |  Author(s): Daisuke Kaiho
    • Abstract
    • Slides

    Background
    

    The confirmation of an appropriate resection margin from the tumor is crucial for reducing the risk of local recurrence after sublobar resection for lung cancer. Furthermore, the precise anatomical sublobar resection is also important for preserving pulmonary function. We developed the novel operation method for pulmonary sublobar resection.

    a9ded1e5ce5d75814730bb4caaf49419 Method
    

    From Aug. 2014 to April 2018, 43 primary lung cancers were enrolled. Active limited resection was done in 29 and passive limited resection was done in 14. Preoperatively, each patient underwent computed tomography for creating several virtual sublobar resections by using Volume Analyzer Synapse VINCENT (Fujifilm, Tokyo, Japan). We measured the shortest distance from the tumor to the resection margin in each simulated resection and selected the most appropriate area of sublobar resection based on the adequate resection margin of approximately 2 cm from the tumor. After the simulation, we performed sublobar resection by using an infrared thoracoscopy with transbronchial ICG instillation. Before operation, 10ml of 10-fold diluted ICG with autologous blood and 400ml of air were instilled into each associated subsegmental bronchus. sublobar resection was performed under ICG visualization.

    4c3880bb027f159e801041b1021e88e8 Result
    

    The types of sublobar resection were subsegmental resection in 3, simple segmentectomy which was defined a simple plane cut surface of pulmonary division in 13, complex segmentectomy which was defined multiple plane cut surfaces of pulmonary division in 10 and extended segmentectomy which was defined segmentectomy with adjacent subsegmental resection in 14 and super deep extended wedge resection in 3. Average number of simulation was 4.3+/-1.5. The shortest distances from the tumor to the resection margin by simulation and an actual measurement were 23.6+/-11.6 mm and 24.6+/-8.6 mm, respectively (p=0.647). Postoperative recurrence was found in 5 cases (distant in 3 and mediastinal or supra-clavicular lymph node in 2) who all underwent passive limited resection. No ipsilateral lung recurrence was found.

    8eea62084ca7e541d918e823422bd82e Conclusion
    

    The advantages of this method are applicable to any type of sublobar resection, initial determination of resection area at operation, possible super deep wedge resection without broncho-vascular transection with enough margin, long identification of fluorescence, and indication in case of COPD, IP, reoperation and adhesion. On the other hand, the drawbacks are the necessity of a near infrared thoracoscopy and 3D medical image analyzer, knowledge of precise bronchial anatomy and advanced manipulation skills of bronchoscopy, ununiformity of ICG distribution and distribution of ICG into the adjacent area with the passage of time.

    6f8b794f3246b0c1e1780bb4d4d5dc53

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