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Takeshi Matsunaga
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P2.17 - Treatment of Locoregional Disease - NSCLC (Not CME Accredited Session) (ID 966)
- Event: WCLC 2018
- Type: Poster Viewing in the Exhibit Hall
- Track:
- Presentations: 2
- Moderators:
- Coordinates: 9/25/2018, 16:45 - 18:00, Exhibit Hall
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P2.17-14 - How Should Positive Margin for Bronchial Stumps (R1) Be Evaluated in Patients Undergoing Bronchoplasty for Lung Cancer? (ID 13637)
16:45 - 18:00 | Author(s): Takeshi Matsunaga
- Abstract
Background
Bronchoplasty for lung cancer is a surgical procedure aimed at respiratory function preservation and curability. And it may be performed for tumors exposed in the respiratory tract or tumors with lymph node extranodal invasion. "Surgical margin positive for bronchial stump" in bronchoplasty surgery has both out-of-wall and carcinoma in situ (CIS), but the difference is not detailed. In this study, we clarify how to evaluate bronchial stump in bronchoplasty.
a9ded1e5ce5d75814730bb4caaf49419 Method
Of 2221 patients of resected lung cancer performed in our hospital from January 2002 to December 2015, 130 patients (5.8%) underwent pulmonary resection with bronchoplasty. The patient's background and its prognostic factors were examined by using Kaplan-Myer method. In addition, we examined details of microscopic residual disease (R1) of bronchial stump.
4c3880bb027f159e801041b1021e88e8 Result
There were 101 males and the median age of patients was 67 years old. 19 cases performed sleeve pneumonectomy and 18 cases performed extended sleeve lobectomy. There were 34 cases of pN0, 49 cases of N1 and 49 cases of N2. 30-day mortality was 2.3% (3cases) and 14 cases were R1 resection. 11 of which were positive for bronchial stump. pN2 and incomplete resection cases were significantly poor prognosis (p=0.03, p=0.009). 5 of the 11 microscopic bronchial stump positive cases were due to CIS and 6 were due to out-of-wall positives. However, among these 11 cases, there was only one case of anastomotic recurrence. And there were no statistical differences, but CIS was often found in long-term surviving cases.
8eea62084ca7e541d918e823422bd82e Conclusion
In cases of pulmonary resection with bronchoplasty, pN2 and incomplete resection are poor prognostic factors. Even in bronchial stump positive cases of incomplete resection, there was only one case of local recurrence. And long-term surviving cases were observed. There are some CISs for long-term survival, but there is no statistical difference because of small cases. Further examination is required.
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P2.17-29 - Is Collagen Vascular Disease-Associated Interstitial Lung Disease a High Risk for Lung Cancer Surgery? (ID 12866)
16:45 - 18:00 | Author(s): Takeshi Matsunaga
- Abstract
Background
Interstitial lung disease (ILD) frequently coexists with collagen vascular disease (CVD), and most of such patients are treated with immunosuppressive agents. Although the prognosis of CVD-ILD is better than that of idiopathic interstitial pneumonias (IIPs), the effect of CVD-ILD on the outcome and postoperative complication, including acute exacerbation (AE), after lung cancer surgery are unknown.
a9ded1e5ce5d75814730bb4caaf49419 Method
The subjects of this retrospective study were 2272 patients who underwent surgical resection of lung cancer at our institute between 2009 and 2016. We compared the characteristics, postoperative complication, and outcome of 18 patients with CVD-ILD with those of 201 Patients with IIPs. The pattern of ILD were based on chest computed tomography and classified into usual interstitial pneumonia (UIP) and the others.
4c3880bb027f159e801041b1021e88e8 Result
The numbers of UIP patterns were 7 (39%) in CVD-ILD and 77 (38%) in IIPs. Thirteen patients (72%) were taking corticosteroids and 6 patients (33%) were taking immunosuppressive agents in CVD-ILD. Although postoperative AE occurred in 6 (3%) in IIPs, there were no AE events in CVD-ILD. Female (P < 0.01), lower pack-year smoke (P = 0.04), never smoker (P = 0.04), high value of LDH (P < 0.01), and medication of corticosteroids or immunosuppressive agents (P < 0.01) were significantly more common in CVD-ILD. Although there were no significant differences on the incidents of postoperative complications and mortalities, the duration to postoperative onset of IP exacerbation in CVD-ILD were tended to be longer than IIPs (P = 0.07). There were no significant differences on the cause of death between the 2 groups..
8eea62084ca7e541d918e823422bd82e Conclusion
There were no significant differences on the outcome and the incidents of postoperative complication, including AE.
6f8b794f3246b0c1e1780bb4d4d5dc53
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P3.01 - Advanced NSCLC (Not CME Accredited Session) (ID 967)
- 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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P3.01-71 - Results of Extended Resection in T4 Non-Small Cell Lung Cancer (ID 13143)
12:00 - 13:30 | Presenting Author(s): Takeshi Matsunaga
- Abstract
Background
The strategy for T4 non-small cell lung cancer remains controversies. Extended resection carried a high mortality rate and high advances in surgical technique was needed. However, extended resection may improve survival in selected patients.
a9ded1e5ce5d75814730bb4caaf49419 Method
Between 2000 and 2015, 41 patients with pT4 non-small cell lung cancer, undergoing extended mediastinal resection, were selected. Patients with pulmonary metastasis were excluded. The type of extended resection was carina in 11 (27%), superior vena cava in 9 (22%), the aorta in 6 (15%), esophagus in 2 (5%), left atrium in 7 (17%) and mediastinal tissue in 4 (10%). We investigated the results of surgical resection and over-all survival.
4c3880bb027f159e801041b1021e88e8 Result
There were p-stage IIIA in 26 and p-stage IIIB in 15. In histology, squamous cell carcinoma was observed in 22, adenocarcinoma in nine, pleomorphic carcinoma in four and others in six. The median of in-hospital days was 17d, that of operative time was 302m, and that of operative bleeding was 470cc. The rate of induction therapy was 10%. Pneumonectomy was performed in 22 (54%) and bronchoplasty was did in 18 (44%). The rate of morbidity was 66% and that of reoperation was 17%. 30-day mortality was 5%, 90-day mortality was 7% and in-hospital death was 2%. The median follow-up time was 34 months and overall 3- and 5-year survival was 57% and 39%. Significant prognostic factors were complete resection (p-value=0.0485) and smoking status (p-value=0.0498) in univariate analysis. Multivariate analysis did not reveal significant prognostic factors.
8eea62084ca7e541d918e823422bd82e Conclusion
Surgical resection for T4 lung cancer was feasible in this study. But, the frequency of morbidity and reoperation was high because of high ratio of pneumonectomy and mediastinal extended resection. So, we need to care for patients after operation, intensively.
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