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Toshiya Yokota



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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: 1
    • Moderators:
    • Coordinates: 9/25/2018, 16:45 - 18:00, Exhibit Hall
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      P2.17-31 - The Effect of the Extended Bilateral Mediastinal Lymph Node Dissection Through a Median Sternotomy for Non-Small-Cell Carcinoma of the Left Lung. (ID 13832)

      16:45 - 18:00  |  Presenting Author(s): Toshiya Yokota

      • Abstract
      • Slides

      Background

      Whether mediastinal lymph node dissection (MLND) improves survival is controversial. But, lymph node dissection plays important role in oncologic surgery. The removal of the whole regional lymphatic system together with primary tumor is one of the fundamental rules in oncological surgery.  For left-side tumors, upper zone lymph nodes are considered inaccessible. Due to anatomical limitations imposed by arch of aorta, it is difficult to perform complete dissection upper zone mediastinal lymph nodes through the left thoracotomy. According to the study of regional lymphatic drainage, we considered reasonable lymphadenectomy contributes the post-operative survival of the NSCLC patients with mediastinal lymph node metastasis. And we had devised Systemic extended bilateral mediastinal dissection and lung resection through a median sternotomy (ND3 operation) for patient with NSCLC of the left lung. This study aimed to investigate the prognostic impact of Extended bilateral mediastinal lymph node dissection for left NSCLC.

      a9ded1e5ce5d75814730bb4caaf49419 Method

      We retrospectively studied 314 patients [220 male and 94 female, mean ages 61.2 years (range, 37-75)], underwent ND3 operation due to NSCLC, from January 1990 till December 2017. The patients with NSCLC who are estimated to be able to conventional radical operation and aged 75 year-old or less becomes the adaptation of ND3 operation.

      4c3880bb027f159e801041b1021e88e8 Result

      Postoperative survival rates calculated with Kaplan-Meier method. Clinicalpathological data were compared according to the p stage. Overall 5-year survival rate in the 314 patients of left lung primary was 65.5%. Operative mortality in 314 patients was 2.8%. Lymph node metastasis to the mediastinum was confirmed in 95 (30.1%) patients (pN2 was 53 patients,pN3α was 23 patients, pN3β was 2 patients, pN3γ was 16 patients).

      According to pathological stages, five-year survival rate was 90.5% in stage IA ,75.8% in stage IB, 58.7% in stage IIA, 68.2% in stageIIB, 51.2% in stageIIIA, 38.9% in stageIIIB. And it was 51.5% in pN2 cases, and 53.6% in pN3α cases. Five-year disease free survival rate was was 84.3% in stage IA ,70.3% in stage IB,53.6% in stage IIA, 52.2% in stageIIB, 33.8% in stageIIIA, 15.6% in stageIIIB, 34.0% in pN2 cases, and 20.6% in pN3α cases.

      8eea62084ca7e541d918e823422bd82e Conclusion

      In this nonrandomized study, the post-operative survival of left side NSCLC patients with mediastinal lymph node metastasis would be remarkably improved. And better local tumor control by ND3 operation does not increase mortality. When faced with a patient with resectable mediastinal lymph node metastasis, we should consider Extended bilateral mediastinal lymph node dissection through a median sternotomy.

      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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      P3.01-41 - Anatomical and Clinical Basis of #11 LN by Systematic Bilateral Mediastinal Nodal Dissection for Left Lung Cancer through Median Sternotomy (ID 13183)

      12:00 - 13:30  |  Author(s): Toshiya Yokota

      • Abstract

      Background

      Patients with mediastinal lymph node metastasis have a poor prognosis, and lung operation is not typically indicated. We performed bilateral mediastinal lymph node dissection by median sternotomy to resect lung cancer and dissect the bilateral mediastinal lymph nodes. Although some studies have examined the communications between the left and right lymphatic pathways in lung cancer cases, we anatomically analyzed this technique of bilateral lymph node dissection, and confirmed its usefulness. There are some reports on #11LN positive cases and other lymph node metastasis cases. We investigated metastatic status between #11 lymph node positive cases and other lymph nodes by systematic bilateral mediastinal nodal dissection for left lung cancer through median sternotomy.

      a9ded1e5ce5d75814730bb4caaf49419 Method

      We performed this operation in 314 patients with primary left lung cancer excluding small cell carcinoma and stage IV since 1987. From among the 314 patients, 25 had in p-N1, 50 in p-N2, 24 in p-N3 lymph node metastases. Based on macroscopic dissection procedures, dissection of the lymphatics from the lungs to the supraclavicular lymph nodes was performed by sequential removal of the related organs. In particular we examined the metastatic status and clinical significance of #11 lymph node in N1-3 52cases. We systematically compared and analyzed the route of lymphatic communications to the contralateral side with emphasis on the anatomical significance of the left-to-right lymphatic communications of the bilateral mediastinal lymph nodes.

      4c3880bb027f159e801041b1021e88e8 Result

      The overall 5-year survival rate (Kaplan-Meier method), including operative deaths and deaths due to unrelated diseases, was 65.5%(MST11.3yrs) in the patients with left lung cancer. With respect to the p-N factor, the 5-year survival rate were 40% in p-N1, 48.7% in p-N2, 53.6% in p-N3, 38.3% in #11LN positive in left lung cancer patients.

      We will report the investigation of the prognosis of left non small cell lung cancer patients who underwent initially our extended bilateral mediastinal dissection, focused on the patients with #11LN positive cases.

      8eea62084ca7e541d918e823422bd82e Conclusion

      We identified the route of lymphatic communications to the contralateral side, and systematically analyzed the anatomical significance of the left-to-right lymphatic communications in #11 LN positive cases. The overall 5-year survival rate (Kaplan-Meier method), including operative deaths and deaths due to unrelated diseases, was 65.5%(MST11.3yrs) in the patients with left lung cancer. With respect to the p-N1-3 factor, the 5-year survival rate were 40% in p-N1, 48.7% in p-N2, 53.6% in p-N3, 38.3% in #11LN positive in left lung cancer patients.

      6f8b794f3246b0c1e1780bb4d4d5dc53

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    P3.CR - Case Reports (Not CME Accredited Session) (ID 984)

    • 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.CR-01 - To Better Understand the Anatomical Proximity of Cardiac Plexus to Prevent Lethal Arrhythmias Associated with Lung Cancer Surgery (ID 11809)

      12:00 - 13:30  |  Author(s): Toshiya Yokota

      • Abstract
      • Slides

      Background

      Arrhythmias are known as one of the complications after surgery, and most of them are not lethal. But life-threatening bradycardic arrhythmias, such as complete AV block and asystole, have been described in the literature, but in reality very rare.

      a9ded1e5ce5d75814730bb4caaf49419 Method

      To consider the relationship between arrhythmias and the involvement of cardiac plexus during lymph node dissection from anatomical viewpoint by presenting two patients who were complicated with life-threatening arrhythmias during and after surgery.

      4c3880bb027f159e801041b1021e88e8 Result

      A 71 year-old Japanese woman had an abnormality in a chest X ray on the annual medical checkup. A CT scan and a bronchoscopic biopsy led to the diagnosis of adenocarcinoma in left lower lobe, cT2aN0M0 StageⅠB. A preoperative electrocardiogram showed a heart rate of 55 per minute with normal sinus rhythm, and the echocardiography was normal. The patient underwent a thoracoscope-assisted left lower lobectomy and lymph node dissection. Post-operatively the patient was noticed to have lower heart rates of 40s, and when the patient sat up on the next morning, the bradycardia progressed to asystole for 10 seconds. CPR was performed and sinus rhythm was resumed. Having a temporary then a permanent pacemaker been implanted, the patient was uneventfully discharged from hospital on postoperative day (POD) 22. The second patient was a 67 year old Japanese man who presented with bloody sputum. An X ray and a bronchoscopic biopsy led to the diagnosis of squamous cell carcinoma in left lower lobe, cT2bN0M0 StageⅡA. A preoperative electrocardiogram showed a heart rate of 73 per minute with normal sinus rhythm and the echocardiography was normal. The patient underwent a left lower lobectomy and bilateral mediastinal lymph node dissection through a median sternotomy. During lymph node dissection along the right vagus nerve, the patient’s heart rate and blood pressure dropped suddenly and an electrocardiogram monitor showed ST elevation. These abnormalities returned to normal soon after cardiac massage was performed and a coronary vasodilator was given. A temporary pacing wire was inserted at the end of the surgery. The postoperative course was uneventful and the patient was discharged on POD 11.

      8eea62084ca7e541d918e823422bd82e Conclusion

      The cause of arrythmias is probable that cardicac plexus was stimulated inadvertently during lymph nodes dissection around the vagus nerve, considering a role of cardicac plexus from the anatomical viewpoint. It is important to be familiar not only with the course of phrenic, vagus and recurrent laryngeal nerve but also the anatomy of cardiac plexus in lung cancer surgery.

      6f8b794f3246b0c1e1780bb4d4d5dc53

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