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Serkan Enön
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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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P1.15-12 - A Different Aspect to Tumor Size Dilemma in Thymoma's TNM Staging Classification (Now Available) (ID 1827)
09:45 - 18:00 | Author(s): Serkan Enön
- Abstract
Background
Thymic epithelial tumors including thymomas are relatively rare thoracic neoplasms; though thymomas are the most common tumors of anterior mediastinum in adults. Among the TNM classifications of many solid tumors, tumor size is included in definition of T descriptor and as a key for staging it plays an important role in predicting prognosis and affects clinical decision making. However, TNM or the other classifications of thymomas do not take tumor size into consideration.
Method
Between 2004 and 2018, 204 consecutive patients with thymic epithelial tumors underwent surgical resection in Department of Thoracic Surgery, Ankara University Medical School. One hundred and forty-three patients with thymoma were included in the study. When survival analysis was performed, sixteen cases were excluded due to missing datas of either survival and/or tumor diameter. Remaining 127 patients were classified into two groups: a. largest tumor diameter (LTD), b. mean tumor diameter (largest diameter+shortest diameter/2) (MTD). Then each were divided into three subgroups ( LTDa/ MTDa ≤5cm; LTDb/ MTDb 5.1-10 cm; LTDc/ MTDc >10 cm). LTDa, LTDb and LTDc subgroups contained 47 (37%), 60 (47.3%) and 20 (15.7%) patients; while MTDa, MTDb and MTDc subgroups had 66 (52%), 56 (44.1%) and 5 (3.9%) patients respectively.
Result
There were 78 males and 65 females, with a mean age of 49.6 years (10-78). Results of the survival analysis according LTD and MTD subgroups are shown in Table 1. In survival analysis, there were significant differences in the presence of MG, resection status (R0 vs R1), T status and the Masaoka-Koga staging (p=0.018, p=0.001, p=0.015, p = 0.003), respectively. In survival analysis for MTD subgroups, survival decreased as the tumour size increased. In LTD group, the only difference which was close to statistical significance was in R0 group for 10 years OS (p=0.051).
Table 1: 10-year survival according to tumor diameter groups
ConclusionLargest Tumor Diameter (LTD)
Mean Tumor Diameter* (MTD)
≤5cm
5.1-10cm
p value
≤5cm
5.1-10cm
p value
10 years overall survival (%)
(LTD:107(48/59) patients, MTD:122 (66/56))
87.6
80
0.246
91.2
74.8
0.088
10 years disease-free survival (%)
(LTD:94 (40/54) patients, MTD:107 (56/51))
75.5
56.5
0.113
82.6
41.9
0.052
10 years overall survival in R0 resection (%)
(LTD:91(37/54) patients, MTD:104 (53/51))
95.2
81.1
0.051
96.8
75.9
0.027
10 years disease-free survival in R0 resection (%)
(LTD:82 (34/48) patients, MTD:93 (48/45))
75.2
57.7
0.159
82.4
43.1
0.095
In this study, complete resection was the most powerful prognostic factor for thymoma as reported by Ruffini et al. Though complet resection is associated with better survival, tumor size is an essential factor on decision of complete resection. Therefore, the largest or mean tumor size should be a criterion in the thymoma TNM staging system.
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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
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P2.15-07 - Bimanual Examination Is Indispensable in the Surgery of Lung Metastatic Tumors! (Now Available) (ID 1828)
10:15 - 18:15 | Author(s): Serkan Enön
- Abstract
Background
Thoracic computed tomography (Th CT) is used to evaluate the surgical outcome of lung metastatic tumors. However, Th CT is often inadequate on the detection of millimetric lesions and it alone is a problematic for guiding complete resection. It is recommended for complete resection that the intraoperative bimanual palpation of the lung to be used with care and meticulously. In addition, there are studies for minimally invasive surgical methods may be an alternative to thoracotomy where bimanual evaluation is not possible. In this study, we aimed to evaluate the number of radiological and pathological metastases in patients who underwent metastasectomy with muscle conservative thoracotomy (MCT).
Method
Between 2008 and 2018, 204 patients with metastatic lung tumors who underwent metastasectomy were included in the Department of Thoracic Surgery, Ankara University Faculty of Medicine. Preoperative Th CT imaging of all patients was evaluated in a multidisciplinary council. The relationship between the numbers of metastases detected by pathological examination of patients and the number of pulmonary nodules reported as 'metastasis' in preoperative Th CT was retrospectively analyzed.
Result
55% (n: 111) of the patients were F, 45% (n: 93) were M, mean age was 46.4 (13-77). %25 (n:52) of two hundred and four patients had bilateral, 3% (n: 8) of the patients had 3 and 1% (n: 4) of the patients had 4 metastasectomy with MCT due to contralateral lung metastasis or re-metastasectomy. The number of pulmonary nodules detected in Th CT was 740 (mean: 2,6), although the number of pulmonary nodules resected was 1503 (mean: 5,29). In histopathological evaluation of these nodules, 1120 (mean: 3,94) were reported as metastases. 2,03 fold of the nodules detected in Th CT were detected by bimanual intraoperative examination and 1.5 fold of nodules detected in Th CT were pathologically assessed as metastasis. Primary tumor numbers and histologies of 1120 metastatic nodules respectively; 42% (n: 475) were epithelial tumors and 58% (n: 645) were mesenchymal tumors.
Conclusion
In this study, 740 pulmonary nodules were reported in Th CT of 204 patients. However, 763 additional pulmonary nodules were detected by bimanual palpation. 49.8% (380/763) of 763 additional pulmonary nodules were metastatic. Although minimally invasive surgery is a successful method for the surgery of many thoracic malignancies, bimanuel palpation of the lung with open surgery is still an effective method for the complete resection of pulmonary metastases. Bimanual examination is indispensable especially in the pulmonary metastasectomy of sarcomas.
