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Angela 3355399488 De Palma



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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: 1
    • Now Available
    • Moderators:
    • Coordinates: 9/08/2019, 08:00 - 18:00, Exhibit Hall
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      EP1.01-78 - T4 Lung Cancer Invading the Descending Thoracic Aorta: A Case Successfully Treated with Surgery by a Multidisciplinary Team (Now Available) (ID 2555)

      08:00 - 18:00  |  Presenting Author(s): Angela 3355399488 De Palma

      • Abstract
      • Slides

      Background

      T4 lung cancer invading the great vessels was usually considered a relative contraindication for radical surgery, because of technical difficulties and intra/postoperative bleeding complications. Recent studies have proved radical pneumonectomy or lobectomy together with aorta endograft positioning to have low mortality and morbidity rate and fairly good overall survival; however, only few cases have been reported in the literature. We report a case of T4 lung cancer invading the descending thoracic aorta (DTA) successfully treated with surgery by a multidisciplinary thoracic and vascular team.

      Method

      A 60-year old male patient was admitted to our Department with a left upper lobe pulmonary tumor of 9 cm invading the DTA, as shown by preoperative computed tomography (CT) scan and magnetic resonance imaging (MRI). 18F-fluorodeoxyglucose positron emission tomography (FDG-PET)/CT total body scan revealed an uptake only at tumor site (SUV max 26.28) with no lymph nodes positivity. Preoperative spirometry values were FEV1 79%, FVC 82% and DLCO 72.5%. Pulmonary perfusion scintigraphy showed 65% for the right lung and 35% for the left one. We performed left pneumonectomy and hilar-mediastinal lymphadenectomy by posterolateral thoracothomy approach, observing about 5 cm long abventitial infiltration of DTA, 3 cm after left subclavian artery origin. An aortic endograft (GORE TAG Comformable Thoracic Stent Graft with ACTIVE CONTROL System) via left femoral artery was disposed 2 cm distal to the subclavian artery origin, then the infiltrated abventitial aortic wall (40% of the aortic circumference) was removed, leaving only the macroscopic healthy endothelium and protecting it with a Goretex mesh (BARD COMPOSIX E/X MESH).

      Result

      The patient spent one night in intensive care unit (ICU), transfusing blood once. The only postoperative complication was a transitory atrial fibrillation pharmacologically treated. He was discharged 9 days after surgery. Pathologic analysis showed a non-mucinous lung adenocarcinoma invading the visceral pleura with a metastatic bronchial lymph node (pT4N1M0), with margins free of tumor. Chemotherapy and radiotherapy were administered and the patient is alive and in good condition 6 months after surgery, free of relapse.

      Conclusion

      In selected cases, in young patients with good performance status, surgery for T4 lung cancer invading the DTA can successfully be accomplished, without complications, by an experienced multidisciplinary thoracic and vascular surgeons team, in high volume centers.

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    P2.13 - Staging (ID 315)

    • Event: WCLC 2019
    • Type: Poster Viewing in the Exhibit Hall
    • Track: Staging
    • Presentations: 1
    • Now Available
    • Moderators:
    • Coordinates: 9/09/2019, 10:15 - 18:15, Exhibit Hall
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      P2.13-12 - Endobronchial Ultrasound for Diagnosis and Staging of Lung Cancer: Our Experience (Now Available) (ID 2593)

      10:15 - 18:15  |  Presenting Author(s): Angela 3355399488 De Palma

      • Abstract
      • Slides

      Background

      Surgical treatment of non-small cell lung cancer (NSCLC) can only be achieved in 20-25% of affected patients. Staging, deriving from the TNM classification, is the most relevant element for the selection of patients and N parameter is an essential prognostic factor. In recent years, in order to assess the N parameter with an endoscopic approach, ultrasound probes of small size have been assembled at the tip of the videobronchoscope (EBUS: Endobronchial Ultrasonography), allowing to perform real-time, ultrasound guided, transbronchial needle aspiration (TBNA) and/or transbronchial needle biopsies (TBNB) of hilar and mediastinal lymph nodes. This invasive examination of the tracheo-bronchial tree is nowadays of primary importance for the diagnosis and staging of lung cancer. We report our experience with this innovative endoscopic technique.

      Method

      We retrospectively analyzed data of patients submitted to EBUS-TBNA/TBNB at our Section of Thoracic Surgery, from September 2008 to December 2018, considering the following factors: gender, EBUS-TBNA/TBNB positivity/negativity, duration of the procedure, number of samples taken from each lymph node station, complications related to the procedure.

      Result

      EBUS was performed in 131 patients (95 men, 36 women) and repeated twice in 5/131 patients, for a total number of 136 EBUS procedures. Ultrasound evidence of lymph nodes was positive in 120/136 cases, in which TBNA/TBNB was performed, with the following cyto/histopathological results: positivity in 61 cases (51%), negativity in 23 cases (19%), inadequate material for diagnosis in 28 cases (23%), suspect/doubt in 6 cases (5%), no results in 2 cases (2%). Mean duration of the procedure was 30 minutes (range 15-60 minutes) and mean number of samples for each lymph node station was 3. No intra- or postprocedure complications were observed. Only 19 on 36 cases without diagnosis could undergo diagnostic surgery with the following results: 9 sarcoidosis, 6 lung cancer, 1 lymphoma, 1 epitelioid hemangioendotelioma, 1 paraganglioma, 1 antracosis.

      Conclusion

      In our experience, EBUS-TBNA/TBNB resulted a safe and free from major complications procedure, easily repeatable, in a standardized way, after an adequate "learning curve" and it can avoid more invasive diagnostic technique such as mediastinoscopy. In fact, according to the current guidelines of the ESTS (European Society of Thoracic Surgeons) EBUS-TBNA should be used as the first diagnostic test in patients with hilar-mediastinal lymphadenopathy with or without the presence of a suspect lung mass, in order to obtain both staging and diagnosis.

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