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Masaya Yotsukura
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MA08 - Pawing the Way to Improve Outcomes in Stage III NSCLC (ID 127)
- Event: WCLC 2019
- Type: Mini Oral Session
- Track: Treatment of Locoregional Disease - NSCLC
- Presentations: 1
- Now Available
- Moderators:Simon Ekman, Helena A Yu
- Coordinates: 9/08/2019, 15:15 - 16:45, Tokyo (1982)
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MA08.06 - Perioperative Outcomes of Lung Cancer Patients with Interstitial Pneumonia (Now Available) (ID 1372)
15:15 - 16:45 | Author(s): Masaya Yotsukura
- Abstract
- Presentation
Background
Interstitial lung disease is mostly found in elderly male smokers who also have relatively high risks of developing lung cancer. For these patients, modality to treat malignancy is limited to prevent acute exacerbation of interstitial pneumonia. We analyzed the perioperative outcomes of this group of patients with both interstitial pneumonitis and resectable lung cancer with curative intent.
Method
We retrieved the characteristics and medical courses of consecutive patients who had undergone pulmonary resections from medical records. In this analysis, usual interstitial pneumonia (UIP) was characterized by the presence of basal predominant, subpleural reticular abnormalities with traction bronchiectasis and honeycomb cysts detected in bilateral lung field on chest computed tomography preoperatively. Pathological findings on surgical specimen were used confirmation of diagnosis. The incidence and outcomes of acute exacerbation within 30 days from operation were analysed.
Result
From 2015 to 2017, there were 1,477 patients who underwent pulmonary resection for primary lung cancer at our institute. Among them there were 81 (5.5%) patients diagnosed as UIP by specific findings on chest computed tomography. Of 81 patients evaluated, 68 (84.0 %) were men, the median age was 73 years (range, 55-88). For Eastern Cooperative Oncology Group (ECOG) performance status, all 81 patients were categorized in status 0. Seventy-four patients (91.4%) underwent lobectomy, 1 (1.2%) bi-lobectomy, 2 (2.5%) segmentectomy and 4 (4.9%) wide wedge resections for primary lung cancer. The mean duration of surgery was 129 mins (range, 54-316), and mean value for blood loss was 36.5 ml (range, 0-396). A complete resection (R0) was achieved in 79 cases (97.5%). Postoperative complications were observed in 19 patients (23.5%) including prolonged air leakage (n=4, 4.9%), late onset of air leakage (n=3, 3.7%), surgical site infection, chylothorax and cerebral infarction. Nine patients (11.1%) manifested acute exacerbation of interstitial pneumonia within 30 days after surgery. There were 3 post-operative deaths (3.7%) within 30 days after surgery. Two deaths (2.5%) were due to acute exacerbation of interstitial pneumonia and 1 (1.2%) case of SAH on 1POD.
Conclusion
Pulmonary resection for patients with interstitial lung disease led to 9 (11.1%) cases of acute exacerbation within 30 days from surgery. Mortality related to acute exacerbation was found only 2 cases (2.5%) at our hospital, which was tolerable postoperative outcome for pulmonary resection for lung cancer with curative intent.
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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
- Moderators:
- Coordinates: 9/08/2019, 09:45 - 18:00, Exhibit Hall
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P1.17-37 - Minimally Invasive Open Surgery (MIOS) for Clinical Stage I Lung Cancer: Perioperative Outcomes in Recent 5 Years (ID 1638)
09:45 - 18:00 | Author(s): Masaya Yotsukura
- Abstract
Background
Many thoracic surgeons have tried to make lung cancer surgery less invasive. Although several minimally invasive procedures for lung cancer surgery have been proposed, it has been controversial which procedure is the most optimal. Since around 2010, minimally invasive open surgery (MIOS) has been adopted for lung cancer surgery at our institute. MIOS was performed with direct vision and thoracoscopic vision through a 2-cm port and a muscle-sparing mini-thoracotomy (incision, 6-8 cm in the fourth or fifth intercostal space at the anterior or posterior axillary line). The objective of this study was to evaluate MIOS in terms of perioperative outcomes in recent 5 years.
Method
Between 2013 and 2017, 2404 patients underwent pulmonary resection for lung cancer at National Cancer Center Hospital, Tokyo, Japan. Among them, 1930 patients with clinical stage I lung cancer were included in this study. We investigated several perioperative factors according to the type of pulmonary resection: lobectomy, segmentectomy and wedge resection.
Result
The patients consisted of 993 men (51.5%) and 937 women (48.5%) with a median age of 69 years (range: 32-90 years). Lobectomy was performed in 1288 patients (66.7%), segmentectomy in 397 (20.6%), and wide wedge resection in 245 (12.7%). Median blood loss was 32 ml (range: 1-1489 ml) for lobectomy, 20 ml (range: 1-435 ml) for segmentectomy, and 4 ml (range: 1-177 ml) for wedge resection. Median operative time was 122 min (range: 45-293 min) for lobectomy, 115 min (range: 69-211 min) for segmentectomy, and 66 min (range: 29-177 min) for wedge resection. Median length of post-operative hospital stay was 4 days (range: 1-57 days) for lobectomy, 4 days (range: 2-20 days) for segmentectomy, and 3 days (range: 2-24 days) for wedge resection. There were no operative deaths. The morbidity rate was 11.8% for lobectomy, 7.3% for segmentectomy, and 4.1% for wedge resection. The 30-day mortality rate was 0.16% for lobectomy, 0.25% for segmentectomy, and 0% for wedge resection.
Conclusion
MIOS for clinical stage I lung cancer is a technically safe and feasible procedure with a low complication rate and a shorter hospital stay. The oncological outcomes with a longer follow-up need to be investigated.
