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Leona Yamamoto



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    P3.17 - Treatment of Locoregional Disease - NSCLC (Not CME Accredited Session) (ID 983)

    • 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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      P3.17-23 - Role of Surgery in Locoregional Advanced NSCLC; A Case of Aggressive Salvage Surgery After Definitive Chemoradiation (ID 13514)

      12:00 - 13:30  |  Author(s): Leona Yamamoto

      • Abstract
      • Slides

      Background

      Prognosis of patients with locally advanced NSCLC is limited. Multimodality approach can be effective in highly selected patients.

      a9ded1e5ce5d75814730bb4caaf49419 Method

      The present report describes an interesting case treated with aggressive salvage surgery after definitive chemoradiation.

      4c3880bb027f159e801041b1021e88e8 Result

      Case: 72 year-old male was found to have a centrally located tumor in right upper lobe at a regional hospital. The carina and lower trachea, and subcarinal lymph node was directly infiltrated with the tumor. Finally, the tumor was diagnosed as a cT4(carina & trachea) N2(#7 direct invasion) M0 squamous cell carcinoma. With thought of unresectable disease due to long invasion of central airway, definitive chemoradiation consisted of 4 cycles of Carboplatin and Paclitaxel in combination with 60Gy concurrent radiotherapy was performed. The tumor response was limited, and Docetaxel was used as 2nd line therapy. However, the disease was progressive, the tumor occluded the right main bronchus totally and also obstructed an orifice of the left main bronchus partially. The patient was referred to us for palliative airway stenting. Y-shaped silicon stent was inserted urgently, and his respiratory status was improved immediately. The patient strongly hoped to receive further therapy, a precise systemic workup was performed at our hospital. The tumor was still locoregional disease and length of the airway invasion was about 3cm, which was considered as resectable with right carinal upper lobectomy or carinal pneumonectomy. Although risk of the resection was extremely high not only due to complex surgical procedure but due to poor patient status and history of full-dose irradiation, our multidisciplinary team decided to perform aggressive salvage surgery. To minimize the risk of surgery, our plans were follows; 1: trying to preserve right lung, 2: modified clamshell approach to make tension-free reconstruction of carina with bilateral hilar release, 3: a tight covering of anastmosis with omentum and thymus. Macroscopic R0 resection was acheived with right carinal upper lobectomy. However, remaining right lung had severe fibrotic change due to irradiation, right carinal pneumonectomy was performed ultimately. Although postoperative tracheostomy and long-term respiratory support were required, his general condition was improved slowly. Most part of the anastomosis became necrosis, however the intensive covering avoided anastomotic problems except for mild stricture. He was finally discharged at 5 months after surgery, and was free from recurrence at 1-year.

      8eea62084ca7e541d918e823422bd82e Conclusion

      In the present case, aggressive salvage surgery achieved a successful outcome. A careful evaluation of patient and an elaborate plan of surgery were essential.

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