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Lorenzo Spaggiari
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EP1.01 - Advanced NSCLC (ID 150)
- Event: WCLC 2019
- Type: E-Poster Viewing in the Exhibit Hall
- Track: Advanced NSCLC
- Presentations: 3
- Now Available
- Moderators:
- Coordinates: 9/08/2019, 08:00 - 18:00, Exhibit Hall
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EP1.01-01 - Atrial Resection Without Cardiopulmonary Bypass for Lung Cancer (Now Available) (ID 2778)
08:00 - 18:00 | Author(s): Lorenzo Spaggiari
- Abstract
Background
Results of resection of lung cancer invading left atrium (T4atrium) without cardiopulmonary bypass (CPB) remain controversial. We reviewed our experience analyzing surgical results and postoperative outcomes.
Method
Patients who underwent extended lung resection for T4atrium without CPB between 1998 and 2018 were retrospectively reviewed using a prospective database.
Result
Forty-four patients were collected (34 men, median age, 63 years). Twenty-five patients underwent preoperative mediastinal staging and 27 received induction treatment (IT). Lung resection included 40 (90.9%) pneumonectomies, 3 (6.8%) lobectomies and one bilobectomy (2.3%). Pathological nodal status was N0 in 10 patients (22.7%), N1 in 18 (40.9%), and N2 in 16 (36.4%). Four patients receiving IT had complete pathological response (9.1%). Eight patients (18.2%) had microscopic tumor evidence on atrial resected margins. Mortality was nil. Major complication rate was 11.4%: one BPF, one cardiac herniation, and three hemothorax all requiring re-intervention. Minor complication rate was 25.5%. After a median survival of 37 months (range, 1-144 months), 20 patients (45.4%) were alive. Five-year survival and disease-free interval were 39% and 45.8%, respectively. Patients with N0 and R0 disease had a best prognosis (log-rank test: p=.03, and p=.01, respectively). IT neither influenced survival nor postoperative complications. At multivariate analysis, pN0 [p=.04 (95% CI: 0,65-9,66)] and negative atrial margins [p=.02 (95% CI: 0,96-8,35) were positive independent prognostic factors.
Conclusion
Resection of T4atrium is technically feasible without mortality and acceptable morbidity. Patients with N2 cancers should not be operated on. Lung cancer invading left atrium should not be systematically considered as a definitive contraindication to surgery.
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EP1.01-44 - Early and Long-Term Results of Tracheal Sleeve Pneumonectomy for Lung Cancer After Induction Therapy (Now Available) (ID 2794)
08:00 - 18:00 | Author(s): Lorenzo Spaggiari
- Abstract
Background
The role of induction therapy (IT) and its effects on morbidity and mortality of patients receiving tracheal sleeve pneumonectomy (TSP) are unclear. We evaluated early and long-term outcomes of patients who underwent TSP after IT.
Method
From 1998 to 2018, 32 patients (26 men; median age, 63 years) underwent TSP. Twenty-two patients (69%) received IT (cisplatin-based chemotherapy). The TSPs were all right sided and included three completion pneumonectomies. Superior vena cava resection was combined with TSP in 15 cases. Diaphragmatic and vertebral resection was also associated in 1 case each.
Result
Operative mortality was nil. Thirty-day mortality was 9% (n = 3). Major complications occurred in 7 patients (21.8%): bronchopleural fistulas in 3; acute respiratory distress syndrome in 2; cardiac hernia in 1; and empyema in 1. The IT had no significant effects on morbidity and mortality. Resection was complete in 31 patients (97%). Pathologic N status was N0 in 2 cases, N1 in 17, and N2 in 13. Nodal downstaging was diagnosed in 13 of 22 patients (59.1%) who received IT (11 passed from N2 to N1, and 2 to N0). Mean survival was 36 months (range, 1 to 181). Overall 5-year survival and disease-free survival were 30.3% and 27.7%, respectively. Patients receiving IT had a poor survival (p = 0.03). At multivariate analysis, nodal downstaging and adjuvant treatment significantly affected survival (p = 0.035 and p = 0.007, respectively).
Conclusion
Tracheal sleeve pneumonectomy is a feasible but technically challenging surgical procedure and provides acceptable results in terms of early and long-term outcomes. Induction therapy did not significantly affect morbidity and mortality.
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EP1.01-81 - Resection of Tumors with Carinal Involvement After Induction Therapy (Now Available) (ID 2790)
08:00 - 18:00 | Author(s): Lorenzo Spaggiari
- Abstract
Background
Tumors involving the carina may be treated with resection of trachea-bronchial bifurcation with or without lung resection. The role of induction therapy (IT) and its effects on morbidity/mortality are unclear. We evaluated surgical and long-term outcomes of patients who underwent carinal resection after IT.
Method
From 1998 to 2018, 45 patients (35 men; median age, 62 years) underwent carinal resection. Twenty-nine patients (64.4%) received IT (24 chemotherapy and 5 chemo-radiation). Histology included 41 non-small cell lung cancers, 3 adenoid cystic carcinomas, 1 carcinoid. Carinal pneumonectomy was performed in 32 cases (all right sided), carinal resection plus right upper lobectomy in 9, carinal resection plus upper bilobectomy in 1, and carinal resection without pulmonary resection in 3. Superior vena cava resection was associated in 22 cases.
Result
Operative mortality was nil. Thirty-day mortality was 8.8% (n=4). Major complications occurred in 9 patients (20%): 5 bronchopleural fistulas, 2 ARDS, 2 cardiac hernias. IT did not influence morbidity rate (p=.7371). Pathological N status included 6 N0, 22 N1, and 17 N2. Follow-up was completed for all patients. Median survival was 16 months (range, 1 to 181 months). Overall 5-year survival rates was 35.8%. Overall, 5-year freedom from recurrence was 49.8%. Patients receiving IT had a poor survival (22.6% versus 60%) but it was not statistically significant (p=.0596). Histology, extended resection, and N status, did not influence survival.
Conclusion
Carinal resection is a feasible but challenging procedure providing acceptable mortality and long-term outcomes. IT did not influence morbidity, mortality, and overall survival.
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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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EP1.17-19 - Robotic-Assisted Thoracic Surgery for Early Stage Lung Cancer: Ten Years' Single Institution Experience (Now Available) (ID 2770)
08:00 - 18:00 | Author(s): Lorenzo Spaggiari
- Abstract
Background
Less invasive surgical resection for early stage lung cancer is gaining popularity. We analyzed the short- and long-term outcomes of robotic-assisted thoracic surgery (RATS) for early stage non-small cell lung cancer (NSCLC).
Method
We retrospectively reviewed 339 patients who underwent RATS for clinical stages I (n = 318) or II (n = 21) NSCLC from November 2006 to December 2016 and we analyzed long-term survival by Kaplan-Meier method.
Result
Twenty-nine patients underwent segmentectomy, 307 lobectomy, and 3 pneumonectomy. Conversion occurred in 22 patients (6.5%): 15 (4.4%) due to technical issues, 4 (1.2%) for oncological reasons, and 3 (0.9%) for bleeding. The median number of N1 and N2 stations resected was 2 and 3, respectively, and the median number of N1 and N2 lymph nodes resected was 9 and 6, respectively. Median operative time was 192 minutes for lobectomy, 172 minutes for segmentectomy, and 275 minutes for pneumonectomy. Median length of hospital stay was 5 days (2-191). The most common postoperative complication was prolonged air leak (12.1%). Major complications occurred in eight patients (2.4%). The 30-day and 90-day operative mortality was 0% and 0.3%, respectively. Two and 5-year cancer-specific survival rate was 96.1% and 91.5%, respectively. Five-year survival rate was 96.2% for patients who underwent segmentectomy, and 89.1% for lobectomy. All three patients who underwent pneumonectomy were alive at 5 years with no disease.
Conclusion
Besides the well-known short-term outcomes showing very low morbidity and mortality rates, mediastinal lymph node dissection during RATS adequately assesses lymph node stations detecting occult lymph node metastasis and leading to excellent oncologic results. However, these results await longer follow-up studies.
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P1.15 - Thymoma/Other Thoracic Malignancies (ID 184)
- Event: WCLC 2019
- Type: Poster Viewing in the Exhibit Hall
- Track: Thymoma/Other Thoracic Malignancies
- Presentations: 2
- Now Available
- Moderators:
- Coordinates: 9/08/2019, 09:45 - 18:00, Exhibit Hall
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P1.15-01 - Prognostic Factors and Long-Term Outcomes After Pulmonary Metastasectomy from Renal Cell Carcinoma (Now Available) (ID 2816)
09:45 - 18:00 | Author(s): Lorenzo Spaggiari
- Abstract
Background
Treatment of pulmonary metastases from renal cell carcinoma (RCC) remains controversial. However, some studies revealed potential survival benefits of pulmonary metastasectomy (PM) in these patients. We evaluate our experience analyzing surgical results, postoperative outcomes, and prognostic factors in patients receiving PM for RCC.
Method
Using a prospective database, we retrospectively reviewed data from 133 patients who underwent PM for RCC between 1998 and 2018. There were 93 men (median age, 62 years, range, 29-80). Surgery included 104 wedge/segmentectomies (78.2%), 28 lobectomy/bilobectomy (21.0%), one pneumonectomy (0.8%). Twenty-one patients (15.8%) received a redo-metastasectomy. A single metastasis or 2-3 metastases were removed in 42 patients (31.6%) each; in 91 patients (68.4%) 4 or more metastases were removed. Lymphadenectomy was performed in 84 patients (63.2%): 58/84 (69.1%) were pN0, and 26/84 (30.9%) were pN+.
Result
Complete resection was achieved in 124 patients (93.2%). Mortality was nil. We had only minor complications occurring in 23 patients (18.0%). After a median follow-up of 2.5 years (range, 0.03-13.3 years), 102 patients (76.7%) were alive. Five and 10-year survival were 57% and 53%, respectively. Disease-free interval was <12 months in 39 patients (29.4%); between 12 and 36 months in 33 (24.8%), and >36 month in 61 (45.8%), respectively. DFI and complete resection did not influence survival rate. Number of resected metastases influenced long-term outcome (60% for less 3 metastases versus 32% for 4 or more, log-rank test: p=.02). Patients with nodal involvement had a poor survival (58% for N0 versus 29% for N+, p=.01). At multivariate analysis, both number of resected metastases and nodal involvement were independent prognostic factors [p=.03 (95% CI: 0,66-8,46) and p=.001 (CI: 0,57-6,35), respectively].
Conclusion
PM may be a promising treatment for metastatic RCC allowing a good long-term survival rate. Nodal involvement and a number of resected metastases equal or more than 4 are predictors of poor survival.
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P1.15-11 - Intrathoracic Neurogenic Tumors: Clinical, Pathological, and Long-Term Outcomes (Now Available) (ID 2823)
09:45 - 18:00 | Author(s): Lorenzo Spaggiari
- Abstract
Background
Intrathoracic neurogenic tumors are uncommon neoplasms arising from nerve tissues. We report our single-center experience in treating this rare intrathoracic neurogenic tumors.
Method
We retrospectively analyzed the clinical, surgical and pathological records of patients receiving the resection of an intrathoracic neurogenic tumor between May 1998 and December 2018.
Result
There were 82 patients (24 females) with an average age of 53 years (29 to 75 years). Mean diameter was 32 mm, ranging from 12 mm to 68 mm. Histology included 42 benign schwannomas, 7 malignant schwannomas, 15 neurinomas, 14 neurilemmomas, and 4 paragangliomas. 55 were located in the posterior mediastinum, 13 in the thoracic inlet, 7 in the anterior mediastinum, 4 in the lung parenchyma, and 3 in the chest wall. Symptoms were seen in 51 patients (62.2%) and including cough in 23, dyspnea in 15, neurologic symptoms in 11, and wheezing in 2. In 3 patients (3.6%), the tumor showed an intraspinal extension. Tumor resection was made by thoracotomy in 42 (51.2%) cases and thoracoscopy in 40 (48.8%). Resection was complete in 80 patients (97.6%). Postoperative radiotherapy was administerd in 2 cases. Mortality was nil. Morbidity rate occurred in 4 patients (4.8%) and included 2 prolonged air leaks, 1 hemothorax, and 1 chylothorax. Five-year survival was 97% in an average follow-up of 4.9 years. No recurrence occurred during the follow-up period neither for malignant nor for benign tumors.
Conclusion
The treatment of choice for thoracic neurogenic tumors is complete resection. Long-term prognosis is favorable both for malignant and benign neurogenic tumors.
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P2.04 - Immuno-oncology (ID 167)
- Event: WCLC 2019
- Type: Poster Viewing in the Exhibit Hall
- Track: Immuno-oncology
- Presentations: 1
- Now Available
- Moderators:
- Coordinates: 9/09/2019, 10:15 - 18:15, Exhibit Hall
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P2.04-07 - Surgical Resection of Advanced Lung Cancer After a Response to EGFR-TKI and/or Immunotherapy: A Single Institution Experience (Now Available) (ID 2801)
10:15 - 18:15 | Author(s): Lorenzo Spaggiari
- Abstract
Background
The usefulness of residual tumor resection after epidermal growth factor receptor tyrosine kinase inhibitor (EGFR-TKI) or immunotherapy treatment remains unclear. We describe a single institutional case-series of patients who underwent residual tumor resection after responding to EGFR-TKIs and/or immunotherapy for advanced non-small cell lung cancer (NSCLC)
Method
Using a prospective database, we reviewed clinical, surgical, pathological, and prognostic data of 15 patients who underwent surgical resection of advanced lung cancer after a response to EGFR-TKI and/or immunotherapy between January 2016 and March 2019.
Result
There were 10 males and 5 females, all smokers; median age of 58 years (range, 43-72). All patients had T4N2 NSCLC. Five patients received only EGFR-TKI, 6 received EGFR-TKI and immunotherapy, and 4 only immunotherapy. Median time from beginning therapy to surgery was 17 months (range, 6-23 ). Surgery included 13 lobectomies, one right upper sleeve, and one right pneumonectomy. Lymph node dissection and vascular and bronchial isolation was extremely difficult. Intraoperative morbidity and mortality was nil. Postoperative morbidity was 20% (n=3) and included one bronchopleural fistula, one prolonged air leaks, one atrial fibrillation. Median hospital stay was 6 days (range, 5-15). Pathology showed 6 complete responses (40.0%) (2 after immunotherapy, 4 after EGFR-TKI and immunotherapy) and 9partial responses (60%). Moreover, the area of tumor clearance was characterized by (i) immune activation-dense tumor infiltrating lymphocytes; (ii) massive tumor cell death-cholesterol clefts; and (iii) tissue repair-neovascularization and proliferative fibrosis (each feature enriched in major pathologic responders versus nonresponders, p < 0.05). With a mean follow-up of 23 months, all patients are alive.
Conclusion
The timing and validity of a salvage surgery for residual lesions remain unclear when TKIs and/or immunotherapy are offered as first-line therapy to patients with advanced NSCLC. In our cases, surgery was performed with acceptable morbidity. Surgical resection of the residual tumor might contribute to good local control.
