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Katsuo Kojima
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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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P2.17-28 - Examination of the Indication and Validity of Segmental Resection as Intentional and Palliative Limited Resection for Lung Cancer (Now Available) (ID 2482)
10:15 - 18:15 | Presenting Author(s): Katsuo Kojima
- Abstract
Background
Segmental resection with lymph node dissection as intentional limited resection is now regarded as the effective surgical procedure for early lung cancer from the view point of curability and preservation of respiratory function. But the curability of this procedure for more advanced cancer is not well known. We may show it by investigating the detailed results of all segmental resection cases as intentional and palliative limited resection.
Method
We targeted 167 cases who passed more than five years after operation among 240 lung cancer cases on whom we have performed segmental resection with lymph node dissection between January in 2003 and March in 2019. It was decided that the indication of segmental resection as intentional limited resection was cStage 0, IA1 and IA2 (UICC 8th) with meeting the SUVmax value of FDG-PET was 1.5 or less (=group A). Segmental resection as palliative limited resection was performed on cStage IB or less patients who had difficulty in lobectomy because of poor respiratory function, multiple lung cancer or presence of serious other disease, etc, (=group B). We investigated prognosis and pathological recurrent factors in both groups, and we considered each indication of segmental resection as intentional or palliative limited resection again.
Result
Group A contains 102 cases and 5-year survival rate was 97% (All death cases died of other disease). In group A, local recurrence occurred in 1 case (pStage IA1, surgical margin insufficient) but distant metastasis did not occur. Group B contains 65 cases and 5-year survival rate was 71% (The original death from lung cancer was 5 cases among 17 death cases). In group B, local recurrence occurred in 4 cases (pStage IA2: 1(surgical margin insufficient), pStage IB: 2, pStage IIIA: 1), distant metastasis occurred in 6 cases (pStage IA3: 1, pStage IB: 1, pStage IIIA: 3, pStage IIIB: 1) and 3 cases on which postoperative adjuvant chemotherapy had been performed had no recurrence (pStage IB: 1, pStage IIB: 2). Recurrence of pStage IA3 was only 1 case (10% in all pStage IA3 cases, Sm, distant metastasis). The multivariable analysis of pathological recurrent factors (pStage, p, v, ly) in group B (except for 3cases on which postoperative adjuvant chemotherapy was performed) showed that lymphatic involvement had a significant influence on recurrence (p-value / Hazard ratio: lymphatic involvement: 0.03 / 6.49, more than pStage II: 0.37 / 2.50).
Conclusion
We are convinced that the current indication of our intentional limited resection to be almost proper but we have thought that we should include a part of Stage IA3 depending on a condition. In palliative limited resection cases, postoperative adjuvant chemotherapy should be considered if possible when pathological result show lymphatic involvement or more than pStage II.
