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Hasan Volkan Kara



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    EP1.18 - Treatment of Locoregional Disease - NSCLC (ID 208)

    • Event: WCLC 2019
    • Type: E-Poster Viewing in the Exhibit Hall
    • Track: Treatment of Locoregional Disease - NSCLC
    • Presentations: 1
    • Moderators:
    • Coordinates: 9/08/2019, 08:00 - 18:00, Exhibit Hall
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      EP1.18-10 - Bilateral Mediastinal Lymphadenectomy Is Associated with Better Survival in Stage IA-IIIB Non-Small Cell Lung Cancer (ID 2695)

      08:00 - 18:00  |  Author(s): Hasan Volkan Kara

      • Abstract
      • Slides

      Background

      Studies have shown that, mediastinal lymph node dissection improves survival in non-small cell lung cancer. However, the role of bilateral lymph node dissection is yet to be elucidated. The aim of this study was to analyze the impact of bilateral mediastinal lymphadenectomy on survival in operable and inoperable non small-cell lung cancer (NSCLC) patients.

      Method

      Between May Between March 2010 and December 2017, 1344 patients with potentially operable non-small cell lung cancer were evaluated. Of those 560 patients(41.7%) underwent video-assisted mediastinoscopic bilateral mediastinal lymphadenectomy(VAMLA) including removal of upper paratreacheal, lower paratracheal, subcarinal lymph node dissection via cervical incision, As the preference of surgeon, 510 patients(37.9%) underwent mediastinoscopic biopsy before planned operation. Of 1344 patients, 801(59.6%) were found to have no mediastinal lymph nodal involvement after bilateral lymphadenectomy or mediastinoscopy. Of those, 690 patients(51.3%) underwent anatomical lung resection. The patients who had negative VAMLA/mediastinoscopy results underwent anatomic pulmonary resection and systematic lymph node dissection/systematic sampling.

      Result

      The 5-year survival rate in all patients was 44% for bilateral lymphadenectomy patients and 35.1% for patients who had unilateral mediastinal lymphadenectomy patients(p=0.001). Among the patients who had pulmonary resection (pstage IA-IIIA), The 5-year survival was 88% for BML patients and 61% for patients who had mediastinal lymph node sampling(P=0.02). By multivariable analysis, BML was associated with better survival (odds ratio, 0.64; 95% confidence interval, 0.27-0.83; P=0.02). After propensity matching of two groups, BML provided independently better survival (odds ratio, ; 95% confidence interval, 0.34-0.82; P=0.03)

      Conclusion

      ML was associated with improved survival in resectable (pIA-IIIA) or non-resectable (pIIIA-IIIB) NSCLC patients.

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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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      P1.17-42 - The Importance of Lymphatic and Vascular Invasion in Stage 1 Non-Small Cell Lung Cancer and Definition of a Totally Curable Tumors (ID 2681)

      09:45 - 18:00  |  Author(s): Hasan Volkan Kara

      • Abstract

      Background

      A number of non-anatomic prognostic factors have been reported for resected non-small cell lung carcinoma. Certain histopathologic properties of the tumor such as lymphatic and vascular invasion could help to predict the patients with excellent survival.

      Method

      A retrospective study was conducted on 550 surgically resected stage 1 non-small cell lung carcinomas, and the following prognostic factors were evaluated in univariate analysis: age, gender, size of tumor, histologic type of tumor, grade of differentiation, lymphatic invasion, vascular invasion, and perineural invasion. The mean follow-up time was 69 months(range;10 to 181 months).

      Result

      Lymphatic vessel invasion, perineural invasion, blood vessel invasion, size of tumor(i.e.,T1a, T1b, T1c) of the tumor were found to be significant prognostic factors (p=0.001, p=0.006, p<0.001 and p=0.029 respectively). According to multivariate analyses, two factors were selected as prognostic indicators: (1) lymphatic invasion (p=0.027;OR:2.27;95%confidence interval:1.097-4.7), (2) vessel invasion (p =0.013;OR:2.021;95%confidence interval:1.16-3.53). By combining these factors we identified a poor and excellent prognostic subgroups of patients with stage I disease. The patients with 1A1 disease without lymphatic or blood vessel invasion had 100% of 5-year survival

      Conclusion

      Our study showed that lymphatic vessel and blood vessel invasion of the tumor could be prognostic factors, along with anatomical determinants. The patients with stage 1A1 tumors who had no lymphatic or blood vessel invasion seem to be totally cured by surgical resection.

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    P2.18 - Treatment of Locoregional Disease - NSCLC (ID 191)

    • Event: WCLC 2019
    • Type: Poster Viewing in the Exhibit Hall
    • Track: Treatment of Locoregional Disease - NSCLC
    • Presentations: 1
    • Moderators:
    • Coordinates: 9/09/2019, 10:15 - 18:15, Exhibit Hall
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      P2.18-16 - VATS Lobectomy and Chest Wall Resection for NSCLC (ID 1034)

      10:15 - 18:15  |  Author(s): Hasan Volkan Kara

      • Abstract

      Background

      The classic surgical approach in patients with NSCLC invading the chest wall is lobectomy and chest wall resection by thoracotomy in the majority of patients. However, this approach can be performed by video-assisted thoracoscopic surgery (VATS) or robotic surgery (RATS) as a result of increased experience and technological developments. The aim of this study was to evaluate the feasibility of the technique and its results in patients undergoing lung and chest wall resection by means of minimally invasive surgery.

      Method

      The data of patients who underwent anatomical lung resection using VATS or RATS for NSCLC in three academic hospitals between 2013-2018 were prospectively recorded and reviewed retrospectively. Fourteen patients, all but three males with a median age of 62 ± 6.0 years, undergoing lung and chest wall resection were included in the study. Surgical results were evaluated.

      Result

      Neoadjuvant/induction treatment was chemo-radiotherapy in three and chemotherapy in two patients. The preferred surgical technique was RATS in two patients, and multiportal VATS in 10 and uniportal VATS approach in two patients. Upper lobectomy was performed in 11 patients, lower in two patients and upper lobe posterior segmentectomy in one patient. Standard small incision for chest wall resection was performed in four, Hybrid approach in 10 patients. Five patients had one, 6 patients had two, two patients had three and one patient had four ribs resections. Chest wall reconstruction was not necessary in any of the patients. The mean operation time was 96.4 ± 21.8 minutes. Complications were observed in 5 (35.7%) of the patients without mortality. The most common complication was prolonged, >5 days, air leak in four patients (28.6%). Ten patients (71.4%) were classified as T3N0, one patient (7.1%) as T4N0, one patient (7.1%) as T4N1, and two patients (14.1%) as T3N0M1. Surgical margins were reported as tumor-free (R0) in all patients. Adjuvant chemotherapy was given in eight patients (57.1%). The two-year survival rate was 66.8%.

      Conclusion

      Lobectomy and chest wall resection with minimally invasive surgery is a safe and feasible method in patients with NSCLC with chest wall invasion. Compared with thoracotomy, it provides equivalent oncologic outcomes as well as less postoperative pain, smaller incision, and faster recovery.