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Shogo Toda

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    P3.16 - Treatment of Early Stage/Localized Disease (Not CME Accredited Session) (ID 982)

    • 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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      P3.16-22 - Wedge Resection for Small Pulmonary Lesions with Preoperative Bronchoscopic Barium Marking (ID 12861)

      12:00 - 13:30  |  Author(s): Shogo Toda

      • Abstract
      • Slides


      Barium marking is one of the various types of preoperative marking used with minimal pulmonary lesions. We evaluated the safety and efficacy of wedge resection for small pulmonary lesions after using preoperative bronchoscopic barium marking.

      a9ded1e5ce5d75814730bb4caaf49419 Method

      A retrospective study was conducted for patients who underwent barium marking before surgery between January 2009 and January 2018. Lesions were localized in advance by chest computed tomography (CT); then, a catheter was inserted into a bronchus close to the lesion under bronchoscopic guidance. Small amounts of barium sulfate ( 0.1–2 ml ) was injected under fluoroscopic guidance. During surgery, the lung surface was observed with a thoracoscope to check color change by barium. In case of the absence of clear identification by visual inspection, the lung was palpated to search for the barium marker. Once barium was detected, A grasping forcep was used to hold the lesion and barium en bloc, and a wedge resection was performed with stapling devices.

      4c3880bb027f159e801041b1021e88e8 Result

      We retrospectively investigated 29 lesions in 29 patients who underwent barium marking before surgery. Five lesions were solid nodules with a longest diameter of 0.5–1.4 cm (mean, 0.9 cm). Eight lesions were partially solid nodules with an overall longest diameter of 0.8–2.2 cm (mean, 1.3 cm) and solid longest diameter of 0.3–0.8 cm (mean, 0.5 cm). Sixteen lesions were pure ground-glass nodules (GGNs) with an overall longest diameter of 0.7–1.7 cm (mean, 1.0 cm). The only complication of marking was mild pneumothorax that did not require drainage in 1 patient. On performing CT after barium marking, the distance between marked barium and the lesion was 0.0–3.7 cm (mean, 0.9 cm). The period between marking and surgery was 5–33 days (median, 15 days). We performed wedge resection in all cases, and all lesions were resected completely. Pathological results showed adenocarcinoma in situ in 20 patients, primary lung adenocarcinoma in 4, metastatic pulmonary tumor in 3, an inflammatory pulmonary nodule in 1, and an intrapulmonary lymph nodule in 1. All margins were pathologically negative. The only postoperative complication was arrhythmia that required an anti-arrhythmic drug in 1 patient.

      8eea62084ca7e541d918e823422bd82e Conclusion

      Wedge resection for small pulmonary nodules after using preoperative bronchoscopic barium marking was safely conducted with satisfactory outcomes.


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