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delphine Mitilian



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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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      P2.17-30 - Superior Vena Cava Resection and Prosthetic Replacement for NSCLC: Is It Worthwhile? (Now Available) (ID 2541)

      10:15 - 18:15  |  Author(s): delphine Mitilian

      • Abstract
      • Slides

      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.

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