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Elie Fadel
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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: 2
- Now Available
- Moderators:
- Coordinates: 9/09/2019, 10:15 - 18:15, Exhibit Hall
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P2.17-24 - Minimally Invasive Surgery for Lung Cancer Improves Short Term Outcomes in Patients with History of Head and Neck Carcinoma (ID 2309)
10:15 - 18:15 | Author(s): Elie Fadel
- Abstract
Background
Lung cancer resections are at high risk for major complications in patients with history of head and neck carcinoma (HNC). We initiated a minimally invasive video assisted thoracic surgery (VATS) program since 2014. Our objective was to determine whether VATS lobectomy had better short term outcome than open lobectomy in this subset of patients.
Method
We performed a retrospective monocentric analysis of consecutive standard lobectomies performed for lung cancer in patients with history of HNC at our institution between January 2010 and December 2017. Patients with more complex procedures were excluded. Patients’ characteristics and short term outcome were compared between VATS and open lobectomy (OL) groups. Quantitative data were compared using parametric test when normally distributed and using non-parametric test when not normally distributed. Qualitative data were compared using Chi2 or exact Fischer’s test when appropriate. P<0.05 was considered significant.
Result
Among 85 patients, 52 underwent an OL and 33 VATS lobectomy. There was no significant difference between the two groups regarding age, sex ratio, HNC location, history of HNC treatment, pathology and stage of lung cancer, history of coronary artery disease, respiratory function or neutrophil to lymphocyte ratio. Postoperative death occurred in 2 patients only in the OL group. In the VATS group, there was a significant decrease in proportion of postoperative life-threatening complications requiring hospitalization in intensive care unit (12/52 vs. 1/33, P=0.01). The main results are reported in the Table.
Conclusion
We found that minimally invasive thoracic surgery was associated with better short term outcomes compared to open surgery for lung cancer resection in patients with history of HNC. Therefore, we suggest that standard lobectomy in patients with history of HNC should be performed by VATS procedure. Further studies are required to confirm our finding.
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P2.17-30 - Superior Vena Cava Resection and Prosthetic Replacement for NSCLC: Is It Worthwhile? (Now Available) (ID 2541)
10:15 - 18:15 | Author(s): Elie Fadel
- Abstract
Background
Direct involvement of superior vena cava (SVC) by NSCLC requires en-bloc tumor resection with complete vascular clamping and prosthetic replacement. We present our experience with this highly demanding procedure in order to determine whether this complex surgery is warranted
Method
Since 1980, complete en-bloc resection of NSCLC invading the SVC followed by prosthetic replacement was performed in 48 patients (30 squamous, 18 non-squamous) in our Department. Patients with partial resection of the SVC with or without patch reconstruction, less complex procedure, were excluded. There were 38 male and 10 female with a mean age of 57 years (range, 38-82 years). N2, N3 disease and distant metastasis diagnosed on preoperative workup were considered as a surgical contraindication. Neoadjuvant therapy was given to 17 patients including chemotherapy (n=11), radiotherapy (n=1) or both (n=5). Surgical approach was a right thoracotomy (n=40), median sternotomy (n=5) or an anterior cervico-thoracotomy (n=3). Although vascular shunt was never used, in one patient a VA-ECMO was necessary for ventilation difficulties. Lung resection was carinal pneumonectomy (n=15), pneumonectomy (n=14), upper bilobectomy (n=1), lobectomy (n=16) or a sublobar resection (n=2). Mean SVC clamping time was 31.6 minutes (range, 10 to 120 minutes). On definitive histology, an R0 resection was achieved in 41 (85%) patients, and lymph node involvement was pN0 in 8, pN1 in 23, pN2 in 14 and pN3 in 3 patients. Tumor size ranged from 1.9 cm to 17 cm with a medium size of 5.2 cm. 31 patients received adjuvant therapy including chemotherapy (n=5), radiotherapy (n=1) or both (n=25).
Result
Postoperative death occurred in 5 patients (10%), all of them underwent a right pneumonectomy (p=0.02). 13 other patients experienced postoperative complications. No neurologic events related to SVC clamping occurred. Graft thrombosis occurred in 2 patients who died postoperatively from bronchopleural fistula. With a median survival of 24 months, 3, 5 and 10 years survival rates were 45%, 40% and 35%, respectively. During follow-up, recurrence occurred in 31 patients and was mostly systemic (n=26). Disease free survival at 3, 5 and 10 years were 37%, 37% and 30%, respectively. By univariate analysis, only incomplete resection was found to be associated with poorer survival (p=0.04).
Conclusion
In highly selected patients with NSCLC involving SVC, complete en-bloc resection and prosthetic replacement is feasible in expert center with acceptable mortality mainly due to right pneumonectomy. Good long-term survival is obtained provided a complete R0 resection is achieved.
