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Vinod Ravi



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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: 1
    • Now Available
    • Moderators:
    • Coordinates: 9/08/2019, 09:45 - 18:00, Exhibit Hall
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      P1.15-06 - Resection of Thoracic Paragangliomas: A Multicenter Experience (Now Available) (ID 2966)

      09:45 - 18:00  |  Author(s): Vinod Ravi

      • Abstract
      • Slides

      Background

      Paragangliomas are chromaffin cell tumor arising from the sympathetic ganglia. Approximately
      2% of paragangliomas occur in the thoracic cavity. Surgical resection is an effective treatment with most cases
      being curative. Tumor recurrence and long-term prognosis data remain scarce. We described our 14-year
      experience of complete resections.

      Method

      We analyzed surgical characteristics and outcomes from our multicenter cohort of 17 patients
      with complete paraganglioma resection. We performed a retrospective review from May 2004 to August 2018
      across three institutions. Perioperative data were collected using all available medical records from diagnosis to
      date. Description of baseline demographics, surgical outcomes, complications and survival rates were included in
      the analysis. Data are reported as mean ± standard deviation (SD) where applicable.

      Result

      A total of 17 patients underwent resection of thoracic paraganglioma. Baseline demographics,
      operative characteristics and outcomes are presented in Table 1. Mean age at the time of surgery was 46.8 ± 17.2
      with ages ranging from 15 to 76 years. Sixty-five percent of patients were male. Eleven patients (64.7%) had the
      tumor arising from the left atrium, 3 (17.6%) from the mediastinum, 2 (11.8%) from the aorta, and one (5.9%)
      from both the left and right atria. Eight (47%) patients underwent cardiac autotransplant technique for a better
      resection approach. Additionally, 2 patients had a concomitant aortic valve and a pulmonic valve replacement,
      respectively. Complications included tamponade, right ventricular failure requiring RVAD, left ventricular failure
      requiring IABP, bi-ventricular failure requiring both RVAD and IABP, junctional bradycardia, tracheostomy, and
      vocal cord paralysis. Recurrence of the tumor presented in three patients (17.6%). One-year, five-year and
      ten-year survival was 92.3%, 87.5% and 75%, respectively.

      Table 1: Results
      Total N=17 n (%)
      Age (Mean, years)* 46.8 +/- 17.2
      Male Gender 11 (64.7)
      Race:
      Caucasian 9 (52.9)
      African American 7 (41.2)
      Hispanic 1 (5.9)
      Preoperative Chemotherapy 1 (5.9)
      Tumor location:
      Left atrium 11 (64.7)
      Left and right atrium 1 (5.9)
      Mediastinum 3 (17.6)
      Aorta 2 (11.8)
      Surgical Procedure:
      Autotransplant 8 (47)
      Valve replacement:
      - Aortic 1 (50)
      - Pulmonic 1 (50)
      Area of Reconstruction:
      Left Atrium 8 (47)
      Left and right atrium 2 (11.8)
      Right Ventricle and Pulmonary Artery 1 (5.9)
      Aorta 1 (5.9)
      Left main coronary artery 1 (5.9)
      Postoperative Complications:
      Tamponade 2 (11.8)
      Right Ventricular Heart Failure (RVAD) 1 (5.9)
      Left Ventricular Heart Failure (IABP) 1 (5.9)
      Bi-ventricular Heart Failure 1 (5.9)
      Junctional Bradycardia 1 (5.9)
      Tracheostomy (ventilator dependence) 1 (5.9)
      Vocal cord paralysis 1 (5.9)
      Postoperative Outcomes:
      Recurrent tumor 3 (17.6)
      Deceased 1 (5.9)

      Conclusion

      Thoracic paragangliomas are rare and surgically challenging tumors due to their
      anatomical proximity with surrounding structures. Complete surgical excision is the elective treatment. Surgical
      mortality is reasonable for this complex disease and long-term outcomes are favorable in patients with complete
      resection.

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    P2.15 - Thymoma/Other Thoracic Malignancies (ID 185)

    • Event: WCLC 2019
    • Type: Poster Viewing in the Exhibit Hall
    • Track: Thymoma/Other Thoracic Malignancies
    • Presentations: 1
    • Now Available
    • Moderators:
    • Coordinates: 9/09/2019, 10:15 - 18:15, Exhibit Hall
    • +

      P2.15-08 - Multicenter Experience with Complete Surgical Resection of Primary Pulmonary Artery Sarcoma (Now Available) (ID 2006)

      10:15 - 18:15  |  Author(s): Vinod Ravi

      • Abstract
      • Slides

      Background

      Pulmonary artery sarcoma is a rare and aggressive malignancy and survival is extremely limited without surgical resection. Treatment options for surgical resection are not standardized. We sought to examine our series of complete resections and clinical outcomes over an 18 year experience.

      Method

      From 1999 to 2017, we evaluated 17 patients (mean age 56 +/- 12. 9 years) with pulmonary artery sarcoma across three institutions. Fourteen (82.7%) underwent complete surgical resection.

      Result

      All 14 patients underwent complete resection of the pulmonary artery sarcoma. Six patients (42.9%) had previously undergone surgical resection and were referred for recurrent disease. Seven patients (50%) underwent neoadjuvant chemotherapy or radiation. Reconstruction of the pulmonary artery trunk was performed with a pulmonary artery allograft, and reconstruction of the right or left main pulmonary artery was performed with a Dacron interposition graft. Additional endarterectomy was performed in two patients with disease extending into the PA branches. Lung resection was performed in five patients (35.8%). Total length of stay was 9.7 +/- 4.6 days including 5.3 +/- 4.2 days in the ICU. Mean survival was 2 +/- 2.8 years. Tumor histology is summarized in table 1.

      Pulmonary artery sarcomas N=17
      Male gender

      14 (82.65%)

      Age at operation (mean ± SD)

      56 ± 12.9

      Operative 14/17 (82.4%)
      Pre-op chemo only 4/14 (23.5%)
      Pre-op XRT only 1/14 (5.9%)
      Chemo & XRT 2/14 (11.8%)
      Recurrent Disease 6/14 (42.9%)
      Lung Resection/Pneumonectomy 5/12
      ICU Length of stay (mean ± SD) 5.3 ± 4.2

      Total length of stay (mean ± SD)

      9.7 ± 4.6
      Years alive from surgery (mean ± SD) 2 ± 2.8

      Histology/Pathology

      Cases (n)

      High Grade Sarcoma

      n= 5

      High Grade Angiosarcoma n= 2
      Leiomyosarcoma n= 2
      High Grade Intimal Sarcoma n= 2
      High Grade Spindle Cell Sarcoma n= 1
      Pleomorphic Sarcoma n= 1
      Undifferentiated Sarcoma n= 1
      Conclusion

      Surgical resection of pulmonary artery sarcomas offers improved long-term outcomes compared to non-surgical management. Complete resection and reconstruction is preferred compared to endarterectomy. Prompt and accurate diagnosis is important for optimal management.

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