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Do Kyun Kang



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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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      P1.15-13 - Subxiphoid Uniportal Thoracoscopic Thymectomy Without Carbon Dioxide Insufflation in the Patients with Thymoma (Now Available) (ID 3044)

      09:45 - 18:00  |  Presenting Author(s): Do Kyun Kang

      • Abstract
      • Slides

      Background

      Thymectomy is the most important treatment for anterior mediastinal mass and myasthenia gravis. Until now, different surgical approaches have been described to perform thymectomy, from median sternotomy to robotic thymectomy. But there is no consensus on the best approach of thymectomy. Depending on approach to perform thymectomy, the advantages and disadvantages are different. Currently, the lateral intercostal approach in video-assisted thoracoscopic surgery thymectomy (VATS thymectomy) is the most frequently performed surgical approach for thymectomy. But this approach has difficulty to identify the contralateral phrenic nerve and intercostal nerve impairment. Recently, to overcome shortcomings of VATS thymectomy, subxiphoid single-port thymectomy (SPT) was introduced. We have performed modified subxiphoid SPT using our own manufacturing sternal retractor without carbon dioxide insufflation under one-lung ventilation. We report the initial operative results of modified subxiphoid SPT.

      Method

      Subjects of this study were patients who underwent thymectomy or extended thymectomy at Inje University Haeundae Paik Hospital between July 2016 and November 2018. We reviewed the medical records of these patients retrospectively. Indication of thymectomy is anterior mediastinal mass without tumor invasion. In our department, we performed thymectomy for anterior mediastinal mass in the absence of myasthenia gravis. And extended thymectomy, which involves the removal of all adipose tissue involve anterior to the phrenic nerve, was performed for myasthenia gravis. Subxiphoid uniportal thoracoscopic thymectomy was attempted first in July 2016. From this time, thymectomy for anterior mediastinal mass or extended thymectomy for MG were preformed via SPT with sternal retraction. All surgical procedures were performed by a single surgeon. 29 patients who underwent thymectomy or extended thymectomy were enrolled. Information of patient demographics, intraoperative, postoperative data were collected and retrospectively evaluated.

      Result

      The patient’s demographics and results of operative outcome of subxiphoid SPT are presented in table 1.

      Table 1

      Thymectomy

      Extended thymectomy

      No. of patients

      21

      8

      Age (years)

      55.23±13.04

      44.62±16.47

      Sex (male/female)

      10/11

      3/5

      BMI

      24.72±3.60

      24.87±3.57

      Mass size(cm)

      3.85±1.73

      2.13±0.38

      Operative time(min)

      143.57±51.96

      184.38±43.30

      Blood loss in operation(ml)

      246.90±262.76

      183.75±147.45

      Drain after operation(ml)

      488.67±308.05

      1506.13±1203.80

      Duration of chest tube(day)

      2.81±1.12

      5.00±2.39

      HD after operation(day)

      6.05±2.87

      8.38±2.39

      Conversion to other approach

      3

      0

      Conclusion

      The benefit of subxipohid approach with sternal retraction is that it makes it easier to identify the contra-lateral phrenic nerve. Also, our procedure has 3 advantages when compared with carbon dioxide insufflation subxiphoid single-port thymectomy. First, because we do not insufflate carbon dioxide, there is no need to worry about hypotension. Second, we do not use air tight trocar, so we use more instruments and have more flexibility in them. Finally, sternum retraction provides more optimal space for the surgery. Single-port thymectomy through the subxiphoidal incision using sternal retractor under one-lung ventilation without carbon dioxide insufflation was feasible.

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    P2.17 - Treatment of Early Stage/Localized Disease (ID 189)

    • Event: WCLC 2019
    • Type: Poster Viewing in the Exhibit Hall
    • Track: Treatment of Early Stage/Localized Disease
    • Presentations: 1
    • Now Available
    • Moderators:
    • Coordinates: 9/09/2019, 10:15 - 18:15, Exhibit Hall
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      P2.17-40 - Analysis of 7 Years Experiences of Uniportal Video-Assisted Thoracic Surgery for Stage I and II Lung Cancer (Now Available) (ID 3034)

      10:15 - 18:15  |  Presenting Author(s): Do Kyun Kang

      • Abstract
      • Slides

      Background

      Recently, video-assisted thoracic surgery (VATS) has been accepted as a feasible, safe and effective approach for the treatment of early lung cancer. With the evolution of the VATS technique, uniportal VATS for early lung cancer has been performed and its advantages has been reported including less postoperative pain, less paresthesia and favorable cosmetic results because only one intercostal space is involved. We analyzed our experiences to evaluate results of uniportal VATS in patients with early lung cancer

      Method

      We analyzed retrospectively medical records of patients who underwent surgical treatments for stage I and II lung cancer at our institute between March 2011 and December 2018. There were 126 patients in multiportal group (MG) and 102 patients in uniportal group (UG). All patients underwent the lobectomy and mediastinal lymph nodes dissection. Multiport VATS was performed through 3 small incisions (2cm, 2cm and 4-5cm). Uniportal VATS was performed through only one 4-5cm sized incision (Figure 1).

      wound.jpg

      Result

      There was no difference between both groups in gender, age, underlying diseases, location of tumor, TNM stage, cell type and the number of dissected lymph nodes. The mean tumor size of UG was slightly smller than that of MG (2.5 vs 3.0 cm, p=0.02). The mean operation time of UG was shorter than that of MG (189 vs 214 minutes, p=0.01). The mean duration of tube drainage and hospital stay of UG was shorter than those of MG (tube drainage: 5.3 vs 6.7 days, p=0.01, hospital saty: 8.1 vs 11.1 days, p<0.01). There were 7 hospital mortalities in MG and 1 hospital mortality in UG (p=0.06). The cause of hospital mortality was ARDS in all patients. There were 4 complications (empyema, pneumothorax, chylothorax and persistent air leak) in MG and 4 complications (chylothorax, pneumothorax in 2 and pleural effusion) in UG. The 5-year disease free survival rate was 77% in MG and 90 % in UG (p=0.59). The 5-year survival rate was 81% in MG and 99% in UG. However, there was no statistically significant difference.

      Conclusion

      In our study, uniportal VATS showed similar results with a smaller incision when compared to multiport VATS in the surgical treatment for stage I and II lung cancer. Uniportal VATS might be one of options in the surgery for stage I and II lung cancer.

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