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Yoshimasa Tokunaga



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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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      P2.16-41 - Intraoperative Computed Tomography After Tumor Marking with Metal Clips for Non-Palpable Lung Tumors (ID 11172)

      16:45 - 18:00  |  Presenting Author(s): Yoshimasa Tokunaga

      • Abstract
      • Slides

      Background

      Locating small, non-palpable lung tumors during video-assisted thoracoscopic surgery (VATS) is difficult. We report a simple method to identify such tumors during VATS, using intraoperative computed tomography (IO-CT).

      a9ded1e5ce5d75814730bb4caaf49419 Method

      From 2015 to 2017, we performed IO-CT scans for patients who preoperatively seemed to have non-palpable lung tumors. We initially tried to locate these tumors by finger palpation through the thoracoscopic ports. IO-CT scans were performed after marking tumors with metal clips. For difficult-to-palpate tumors, tumor marking was based on the anatomical position as follows. First, we estimated the intercostal muscle that could best be used as a marker from preoperative CT. A needle was inserted along the caudal side of the intercostal muscle to make a slight “pin-point” depression in the parietal pleura. Next, under bilateral lung ventilation, the surface of the visceral pleura touching the parietal pleural needle depression was marked by a modern electrosurgical unit in SOFT COAG mode. Under unilateral lung ventilation again, metal clips were used to indicate the SOFT COAG marking. Intraoperative CT scans under bilateral lung ventilation and 3D-CT imaging allowed us to locate the tumor by reference to the clips. We performed wedge resections during VATS, based on the marking clips, using surgical staplers.

      4c3880bb027f159e801041b1021e88e8 Result

      We employed this procedure for a total of 20 tumors in 17 patients, whose mean age was 63.5 years (range: 34–78 years). Of the 20 tumors, 11 were in the right lung and 9 in the left lung; 8 were non-palpable and 12 were palpable; in preoperative CT, 7 were seen as pure ground-glass nodule (GGN) type, 2 were part-solid type, and 11 were pure solid type; pathologically, 10 were primary lung cancers, 7 were metastatic lung cancers and 3 were benign tumors. Mean tumor size was 7.1 mm and mean distance from the pleura was 7.2 mm. All tumors were identified intraoperatively by using IO-CT scans. All tumors were completely resected during VATS, with no intra-postoperative complications.

      8eea62084ca7e541d918e823422bd82e Conclusion

      IO-CT scans after tumor marking with metal clips during VATS can accurately locate non-palpable small sized lung tumors.

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