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Witold Rzyman



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    EP1.07 - Nursing and Allied Professionals (ID 197)

    • Event: WCLC 2019
    • Type: E-Poster Viewing in the Exhibit Hall
    • Track: Nursing and Allied Professionals
    • Presentations: 1
    • Now Available
    • Moderators:
    • Coordinates: 9/08/2019, 08:00 - 18:00, Exhibit Hall
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      EP1.07-03 - Preparedness in Promoting and Self-Assessment of Nurses Ability to Promote Health Awareness in Lung Cancer Prevention (Now Available) (ID 640)

      08:00 - 18:00  |  Author(s): Witold Rzyman

      • Abstract
      • Slides

      Background

      Aim: The aim of this study was to analyze the self-assessment of nurses’ knowledge regarding lung cancer, and to verify whether this group of professionals is prepared for promoting lung cancer prevention.

      Background: Lung cancer constitutes a health and epidemiological problem worldwide.

      Introduction: The complete elimination of exposure to the components of tobacco smoke is a primary prevention component of vital importance and should constitute extensive educational activities be undertaken by family nurses. However, according to available literature, the level of relevant knowledge represented by nurses remains insufficient.

      Method

      This study included 490 nurses from Pomerania province. All the respondents completed the questionnaire verifying their knowledge of the etiology of lung cancer and their preparedness for promoting the prevention of this malignancy and self-assessed knowledge of the problems in question.

      Result

      The average level of etiological knowledge of lung cancer was high. Preparedness for promoting health awareness in the prevention of lung cancer represented an intermediate level.

      The efficacy of screening is determined by its coverage. Nurses can provide a pivotal role in lung cancer prevention provided they are given training and responsibility for these additional duties.

      Conclusion

      Many nurses, given appropriate training, have the potential for educating people in the prevention of lung cancer. However, full utilization requires education and reorientation of nurses towards primary prevention, especially in healthcare education.

      Nursing professionals may require additional training and increases in staffing to adequately respond to the increase in responsibility for patient care.

      Implications highlight a need for additional training and consultancy to improve knowledge and preparedness of nurses to address concerns in lung cancer prevention.

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    EP1.17 - Treatment of Early Stage/Localized Disease (ID 207)

    • Event: WCLC 2019
    • Type: E-Poster Viewing in the Exhibit Hall
    • Track: Treatment of Early Stage/Localized Disease
    • Presentations: 1
    • Now Available
    • Moderators:
    • Coordinates: 9/08/2019, 08:00 - 18:00, Exhibit Hall
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      EP1.17-04 - Pneumonectomy Should Be Avoided in Patients Who Do Not Reach the Distance of 500 Meters in 6-Minute Walking Test Due to High Early Mortality (Now Available) (ID 1125)

      08:00 - 18:00  |  Author(s): Witold Rzyman

      • Abstract
      • Slides

      Background

      Pneumonectomy is required in less than 10% of patients operated for lung cancer. This type of surgery is performed ultimately because of its debilitating character, high morbidity, and mortality. Previously estimated values of the 6-minute walking test (6MWT) performed preoperatively helps to identify high risk of postoperative complications, increased early mortality and worse long term results in patients undergoing lobectomy for lung cancer. The aim of the study was to validate the value of 500 meters in 6MWT differentiating risk of complications in patients undergoing pneumonectomy.

      Method

      Between January 2009 and January 2018 1618 patients were operated in the Thoracic Surgery Department. All of the patients were accepted for resection based on a standard evaluation protocol. Additionally, on the day before the surgery, patients performed 6MWT. 141 patients underwent pneumonectomy, but 16 patients did not undergo 6MWT due to different reasons. Finally, 125 patients entered the analysis. The cut-off value of 6MWT – 500 meters was defined in previously published papers in patients requiring lobectomy. This value was validated in the current study in patients who underwent pneumonectomy.

      Result

      There were 93 men and 32 women with a mean age of 63 years. All patients underwent pneumonectomies due to primary lung cancer. The cut-off value of 500 meters identified patients with increased 90-day mortality [17.9% vs. 3.5% odds ratio (OR) 6.271 95% confidence interval (CI) 1.528-25.739 p=0.005], and first-year mortality (30.7% vs. 11.6% OR 3.378 95%CI 1.310-8.709 p=0.009), while 30-day mortality (10.3% vs. 2.3% OR 4.800 95%CI 0.840-27.418 p=0.055) fairly reached statistical significance. Patients who covered distance shorter than 500 meters had increased risk of atrial fibrillation (35.9% vs. 16.3% OR 2.880 95%CI 1.207-6.870 p=0.015) and cardiac complications (38.4% vs. 19.8% OR 2.537 95%CI 1.100-5.849 p=0.026). The rates of pulmonary complications, general complications, and duration of postoperative stay did not differ between the study populations.

      Conclusion

      Patients who do not reach the distance of 500 meters in 6MWT have a high risk of cardiac complications and early postoperative death after pneumonectomy.

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    IBS16 - Invasive Diagnosis and Surgery in Lung Cancer Screening Participants (Ticketed Session) (ID 41)

    • Event: WCLC 2019
    • Type: Interactive Breakfast Session
    • Track: Screening and Early Detection
    • Presentations: 1
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      IBS16.02 - Minimally Invasive Lung Cancer Screening (ID 3345)

      07:00 - 08:00  |  Presenting Author(s): Witold Rzyman

      • Abstract
      • Slides

      Abstract

      Lung cancer screening is a challenge for the specialists that are involved in this multidisciplinary venture. There is a huge number of individuals with CT-findings that are non-malignant and a lot of indeterminate pulmonary nodules that are difficult to assess. High sensitivity is required not to overlook early lung cancer but simultaneously acceptable specificity have to be ensured in order to reduce futile invasive diagnostics and treatment procedures related to false positive diagnoses (1,2,3).

      The experience of the multidisciplinary team and adoption of the specific radiological protocol that is strictly followed is a mainstay of successful lung cancer screening program. Thoracic radiologist is responsible for the reduction of false positive rate to a safe minimum. This goal can only be achieved by strict adherence to the guidelines and protocol for the assessment of nodules. LungRads or volumetry with assessment of volume doubling time should be applied to minimize false positive rate. The multidisciplinary discussion on tumor board meeting of the suspected cases is another element leading to the reduction of unnecessary invasive diagnostics and surgery in non-malignat leasions that produces harm, entails risk of complictions and increases costs (3). In Gdańsk where two screening programs were conducted during last 10 years most harmfull aspects were reduced almost doublefold (tab.1). several studies have shown that by applying an effective diagnostic algorithm together with multidisciplinary discussion of positive cases detected by CT screening, the frequency and extent of surgery for non-malignant disease can be minimized while a high cure rate for individuals diagnosed with lung cancer can be obtained (1,3,4). Mainly radiologists and thoracic surgeons involved in multidisciplinary tumor board have the important responsibility to minimize the risk of useless invasive procedures for benign disease and avoid overtreatment of very early cancers or precancerous lesions (1,3)

      The proportion of patients that are sent for invasive diagnostic procedures varies between 2-7% and depends on the quality of the screening center. In Gdańsk, although in both programs approximately 3,5% of individuals participating in the screening were sent for the diagnostics, lung cancer detection rate in these groups were 30% and 57% respectively so diagnostic accuracy increased significantly. The invasive diagnostic work –up is based on FNAB and CNB where radiologists play crucial role as in majority of the institutions they perform biopsies. Pulmonary nodules biopsy in the best institutions is performed with 80-90% specificity and sensitivity and reasonably low complication rate. Pneumothorax is among most frequently observed complications requiring pleural drainage in 10-20% of cases. Bronchoscopy, EBUS, EUS and PET-CT are additional tools that completing the diagnosis and staging. Endobronchial navigation bronchoscopy (ENB) is a supplementary method that enhances the diagnostic yield of flexible bronchoscopy from 36-68% to 63-77% depending on the size and location of peripheral pulmonary lesion. This method has great potential in the future treatment of small nodules detected in lung cancer screening programs. Lately two ablation systems are intensively tested that can be applied by ENB. The minimally invasive techniques in the future treatment of screening detected cancers are the only treatment options that could be accepted in this context. The application of ultrasound or radiofrequency ablation by ENB system in the treatment of pure GGO and mixed GGO lesions that are progressing would be the very promising solution.

      Although lobectomy is still a gold standard in the treatment of stage I NSCLC this dogma most probably is going to be changed in the near future, at least for T1N0 tumors. Many retrospective studies report no difference in overall and recurrence free survival of patients operated with lobectomy and sublobar resection. There are however many studies that are showing conflicting results. In the analysis of 6000 operated stage I NSCLC patients based on national lung cancer registry in Poland Dziedzic et al. have shown significantly inferior overall survival in wedge resection group comparing to lobectomy and segementectomy groups (5). Segmentectomy provides two benefits comparing to wegde resection: allows to obtain a wide resection margin and to perform hilar lymphnode resection. It is however much more technically demanding when VATS procedure is considered.

      In the presentation the crucial aspects of “minimally invasive” LDCT lung cancer screening will be discussed.

      References:

      1. Flores R, Bauer T, Aye R; I-ELCAP Investigators. Balancing curability and unnecessary surgery in the context of computed tomography screening for lung cancer. J Thorac Cardiovasc Surg. 2014 May;147(5):1619-26.

      2. Rzyman W, Jelitto Górska M, Dziedzic R, et al. Diagnostic work up and surgery in participants of the Gdańsk lung cancer screening programme: the incidence of surgery for non malignant conditions. Interact CardioVasc Thorac Surg. 2013; 17: 969 973.

      3. Holst Pedersen J, Rzyman W, Veronesi G et al. Recommendations from the European Society of Thoracic Surgeons (ESTS) regarding computed tomography screening for lung cancer in Europe. Eur J Cardiothorac Surg 2017;0:411–20.

      4. Veronesi G, Bellomi M, Mulshine JL, et al. Lung cancer screening with low-dose computed tomography: A non-invasive diagnostic protocol for baseline lung nodules. Lung Cancer. 2008;61:340-349.

      5. Dziedzic R, Zurek W, Marjanski T et al. Stage I non-small-cell lung cancer: long-term results of lobectomy versus sublobar resection from the Polish National Lung Cancer Registry. Eur J Cardiothorac Surg. 2017 Aug 1;52(2):363-369.

      Tab.1 Comparison of two lung cancer screening programs performed in Gdańsk, Poland between 2009–2011 and 2016-2018 in terms of selected results affecting quality of screening.

      PILOT

      2009-2011

      MOLTEST

      2016-2018

      Lung cancer (det. rate)

      1,2%

      2%

      False positive rate

      34,7%

      17,6%

      Invasive work-up

      3,6%

      3,5%

      Futile surgery

      29%

      16%

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    P1.11 - Screening and Early Detection (ID 177)

    • Event: WCLC 2019
    • Type: Poster Viewing in the Exhibit Hall
    • Track: Screening and Early Detection
    • Presentations: 1
    • Moderators:
    • Coordinates: 9/08/2019, 09:45 - 18:00, Exhibit Hall
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      P1.11-08 - Are Risk Prediction Models Superior Over Standard Criteria for Lung Cancer Screening in Europe? Macroscale Simulation on Large Polish Cohort (ID 1911)

      09:45 - 18:00  |  Author(s): Witold Rzyman

      • Abstract
      • Slides

      Background

      Inauguration of the national lung cancer screening programme in Poland is to take place in 2019. Yet, issues such as optimal selection criteria remain unresolved. A computational macroscale simulation of lung cancer risk prediction models’ implementation and comparison in a large lung cancer screening cohort of 5,534 individuals from a single, experienced European center was performed.

      Method

      A total of 5,534 healthy volunteers (aged 50-79, smoking history ≥30 pack-years) were enrolled in the Moltest Bis Programme (Moltest) between 2016 and 2017. Inclusion criteria were based on the Lung Cancer Screening National Comprehensive Cancer Network Clinical Practice Guidelines. Each participant underwent a low-dose computed chest tomography scan and selected participants underwent a further, diagnostic work-up. A computational macroscale simulation of Tammemagi PLCOm2012, Liverpool Lung Project (LLP) and Bach risk models’ implementation was applied. Jupyter notebook v.1.0 scientific environment was used to calculate lung cancer probability of all Moltest participants. Patients i) with 6-year lung cancer probability ≥1.3% were considered as high risk in PLCOm2012 model, ii) in LLP model with 5-year lung cancer probability ≥5.0%, and iii) in Bach model with 1-year lung cancer probability ≥2.0%. Such selected patients were eligible for the inclusion to the simulated lung cancer screening programme. Boolean functions were created and data frames containing patients’ epidemiological characteristics were joined using Pandas Python Library v.0.23 for Python v.3.7.

      Result

      In a computational macroscale simulation 3,897 (70.4%), 3,118 (56.3%) and 925 (16.7%) out of 5,534 Moltest participants met the threshold criteria of lung cancer probability in PLCOm2012, LLP and Bach models, respectively. With 199 (3.6%) Moltest individuals initially referred for diagnostic work-up in the programme, lung cancer was confirmed in 105 (1.9%) cases. Contrarily, among high-risk individuals selected based on PLCOm2012, LLP and Bach models, respectively, 103 (2.6%), 56 (1.8%) and 24 (2.6%) constituted the lung cancer cases primarily detected in the Moltest programme. Thus, in PLCOm2012, LLP and Bach models the proportions of screen-detected lung cancer cases were 98.1%, 53.3% and 22.9%, respectively.

      Conclusion

      Risk prediction models provide a vast disparity in selecting lung cancer high-risk individuals. Lung cancer screening enrollment based on Tammemagi’s PLCOm2012 risk prediction model is superior over LLP, Bach models and standard selection criteria based on age and pack-years.

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    P1.17 - Treatment of Early Stage/Localized Disease (ID 188)

    • Event: WCLC 2019
    • Type: Poster Viewing in the Exhibit Hall
    • Track: Treatment of Early Stage/Localized Disease
    • Presentations: 1
    • Now Available
    • Moderators:
    • Coordinates: 9/08/2019, 09:45 - 18:00, Exhibit Hall
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      P1.17-31 - VATS Segmentectomies Are at Least as Safe as VATS Lobectomies (Now Available) (ID 1453)

      09:45 - 18:00  |  Author(s): Witold Rzyman

      • Abstract
      • Slides

      Background

      Video-assisted thoracic surgery (VATS) segmentectomy is a feasible and effective treatment of not only benign lung tumors but also non-small cell lung cancer (NSCLC). Expanding the indications for surgical treatment of early NSCLC in high-risk patients may result in an increased number of complications in the postoperative period.

      Method

      Between January 2018 and December 2018 22 VATS segmentectomies were performed in a single center. The postoperative period was recorded and these data were compared to postoperative results of 31 patients who underwent VATS wedge excisions in the relevant period and 438 VATS lobectomies during the VATS program in the department. In order to assess the influence of the type of resection on the number of postoperative complications, multivariable analysis was performed. The selection biases were reduced by the use of propensity-score matched analysis (PSMA; using the nearest neighbor matching method by age, gender, Charlson Comorbidity Index [CCI] and 6-minute walking distance).

      Result

      In the multivariable analysis, CCI was the only independent risk factor of increased complications rate (HR 1.321 95%CI 1.009-1.730 p=0.042). Type of resection, gender, and 6-minute walking distance did not influence the risk of complications. The rate of complications in patients who underwent VATS wedge excision was 12.9%, VATS segmentectomies 27.2% and VATS lobectomies 51.5% (OR 2.846 95%CI 1.021-8.298 p=0.026 segmentectomies vs. lobectomies). However, in PSMA analysis, there was a trend towards lower complications rate in patients who underwent VATS segmentectomy comparing to VATS lobectomies (30% vs. 60% OR 0.286 95%CI 0.061-1.263 p=0.057). Postoperative hospital stay did not differ between the study groups 4 vs. 5 days (p=0.170).

      Conclusion

      VATS segmentectomy is characterized by similar complications rate and postoperative hospital stay if compared with VATS lobectomy.

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    S01 - IASLC CT Screening Symposium: Forefront Advances in Lung Cancer Screening (Ticketed Session) (ID 96)

    • Event: WCLC 2019
    • Type: Symposium
    • Track: Screening and Early Detection
    • Presentations: 1
    • Now Available
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      S01.05 - Panel Discussion (Now Available) (ID 3631)

      07:00 - 12:00  |  Presenting Author(s): Witold Rzyman

      • Abstract
      • Presentation
      • Slides

      Abstract not provided

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