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Hruyuki Kawai
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EP1.15 - Thymoma/Other Thoracic Malignancies (ID 205)
- Event: WCLC 2019
- Type: E-Poster Viewing in the Exhibit Hall
- Track: Thymoma/Other Thoracic Malignancies
- Presentations: 1
- Now Available
- Moderators:
- Coordinates: 9/08/2019, 08:00 - 18:00, Exhibit Hall
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EP1.15-13 - Prognosis of Colorectal Cancer Cases That Underwent Lung and Liver Metastasectomy and Therapeutic Outcomes of Brain Metastasis (Now Available) (ID 1331)
08:00 - 18:00 | Author(s): Hruyuki Kawai
- Abstract
Background
The resectability is often debated in cases of lung and liver metastases. Further, we had reported previously that the incidence of brain metastasis is significantly higher in colorectal cancer with lung metastasis than cases with liver metastasis (lung: 7.7%, liver: 1.6%). We compared and investigated the therapeutic outcomes of cases of lung, liver and brain metastasis.
Method
Between 2002 and 2013, we retrospectively studied the prognosis of 90 cases of colorectal cancer cases that underwent lung metastasectomy, and 148 cases that underwent liver metastasectomy. The course of treatment in 8 cases of subsequent brain metastasis was also evaluated.
Result
The 5-year survival rate (5-SR)for 90 cases of lung metastasectomy overall was 66.7%. 63 cases were initial metastasis and the 5-SR was 66.7%. Out of these, there were 7 cases of synchronous metastasis with a 5-SR of 57.1%, and 56 cases of metachronous metastasis with a 5-SR of 67.9%, indicating no significant difference. The regions of secondary recurrence after lung resection were as follows: lung: 28 (cases), liver: 7, brain: 3, mediastinal lymph nodes: 5, other: 5.
The 5-SR for 148 cases of liver metastasectomy overall was 54.7%. 141 cases were initial metastasis and the 5-SR was 55.3%. Cases who underwent lung metastasectomy had a significantly higher survival rate (p=0.0068). Out of these, 70 cases were synchronous metastasis with a 5-SR of 35.7%, and 71 cases were metachronous metastasis with a significantly higher 5-SR of 67.9% (p=0.011). The regions of secondary recurrence after liver resection were as follows: lung: 47 (cases), liver: 66,brain: 2, abdominal lymph nodes: 9, dissemination: 6, other: 7.
While there were 5 cases of subsequent brain metastasis after lung resection, no subsequent brain metastasis was found after liver resection. All but one of the 8 cases of brain metastasis after lung resection were treated with surgery or CyberKnife. The total survival period was 1141 - 3848 days (median: 1913.5 days), and the survival period after detection of brain metastasis was 15 - 852 days (median: 401 days). In addition, all cases were experiencing associated symptoms when brain metastasis was detected, and only one patient was undergoing regular examinations to detect brain metastasis.
Conclusion
While appropriate surgical intervention is recommended in cases of lung metastasis and metachronous liver metastasis,it is debatable in cases of synchronous liver metastasis. Cases of lung metastasis should give attention to brain metastasis and recieve early detection and intervention.
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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
- Now Available
- Moderators:
- Coordinates: 9/08/2019, 08:00 - 18:00, Exhibit Hall
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EP1.18-01 - Effectiveness of Video-Assisted Surgery and Pre-Operative Multi-Disciplinary Support for Preserving Respiratory Function (Now Available) (ID 853)
08:00 - 18:00 | Author(s): Hruyuki Kawai
- Abstract
Background
Evaluation of post-operative respiratory function after lung resection is very important because it greatly affects the quality of life (QOL).
Method
The predicted post-operative lung VC was calculated according to the number of 42 sub-segments of the lung. The % predicted post-operative VC (%PR) was defined as (number of resected segments)/42 × 100. The % real reduction (%RR) was defined as (pre-operative VC- post-operative VC)/ (pre-operative VC) ×100. Furthermore, we defined %PR-%RR as the index of post-operative reduction of respiratory function (RI).Using RI, we investigated the differences in respiratory function between 22 cases of open-thoracic surgery and 96 cases of thoracoscopic surgery and among 3 different pre-operative support groups, namely, no preoperative support (Non; 39 cases), pre-operative rehabilitation support (Reha; 20 cases), and multi-disciplinary support (Multi; 59 cases). Pre-operative rehabilitation support is coaching for respiratory rehabilitation provided to patients by the rehabilitation physicians and physical therapists at our outpatient clinic. In addition to rehabilitation support, multi-disciplinary support was provided by a multi-disciplinary team consisted of an anesthesiologist, a nutritionist, a pharmacist, a medical social worker, and a nurse.
Result
The %PR for lobectomy was 9.31 and that of segmentectomy was 2.48; there was a significant difference between them (p = 0.0151). The average RI for open-thoracotomy and video-assisted thoracotomy was -0.80 and 9.16, respectively. Pulmonary function was significantly preserved in patients with thoracoscopic surgery compared with that in patients with open-thoracic surgery (p = 0.00221). With respect to pre-operative support, the average RI for the Non, Reha, and Multi groups was 5.31, 8.79, and 11.61, respectively. There were significant differences among the three groups (p = 0.00991).
Conclusion
It is difficult to evaluate the respiratory function after lung resection, because the resected lung volume and pre-operative respiratory function may vary among patients. To reduce the fluctuation according to the resected lung volume in each case, the ratio of predicted % reduction and real % reduction (RI) was used to compare the preserved degree of respiratory function for each classified group.
The comparison of RI, calculated from the pre-operative and 1-year post-operative VC, proved the preservation of respiratory function by thoracoscopic surgery and pre-operative support.
