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Hidenao Kayawake



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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
    • Now Available
    • Moderators:
    • Coordinates: 9/09/2019, 10:15 - 18:15, Exhibit Hall
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      P2.18-15 - Surgical Outcomes of Pneumonectomy After Induction Therapy for Non-Small-Cell Lung Cancer (Now Available) (ID 905)

      10:15 - 18:15  |  Author(s): Hidenao Kayawake

      • Abstract
      • Slides

      Background

      The mortality of pneumonectomy after induction therapy (IT) for locally advanced non-small-cell lung cancer (NSCLC) is reported to be as high as 26%. However, pneumonectomy after IT has also been reported of having an acceptable safety and favorable outcomes. We retrospectively reviewed the postoperative outcomes of this procedure.

      Method

      Between April 2004 and September 2016, of 179 patients who underwent neoadjuvant therapy, 20 consecutive patients (11.2%) underwent pneumonectomies for locally advanced NSCLC after IT in our institution. Perioperative management, mortality, postoperative complications and survival were retrospectively analyzed.

      Result

      Eighteen patients were men, and the median age was 64 years (range, 38 to 79). Clinical stages (7th edition of TNM classification) were as follows: Stage IIA(n=2), Stage IIB(n=1), StageIIIA(n=15), and StageIIIB(n=2). There were 7 right and 13 left resections. Three patients underwent pneumonectomy after induction chemotherapy and 17 underwent after induction chemoradiation. A pathological complete response(Ef.3)due to IT was obtained in 8 patients (40%). In all cases the bronchial stumps were covered with autologous tissue including pedunculated intercostal muscle or mediastinal fat pad. There were no deaths within 30 days. However, one patient died within 90 days after transferring to a rehabilitation hospital. Postoperative complications of all grades were seen in 15 patients (75%), with major complications (Clavien-Dindo classification ≥IIIa) in 5 patients (25%). Major complications were all late-phase empyema, one with BPF and 4 without BPFs, which were all cured with surgical interventions. 5-year overal and recucurence free suvavals were 56.1 % and 47.4%, respectively. The average observation period of alive patients was 2500 days (range, 836 to 5144 days).survival.jpg

      Conclusion

      Our results suggest that pneumonectomy after IT for locally advanced NSCLC is a feasible and valuable treatment option. However, due to a high complication rate, surgery by experienced surgeons and careful postoperative management are essential for successful outcomes.

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