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Yongjin Chang
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EP1.17 - Treatment of Early Stage/Localized Disease (ID 207)
- Event: WCLC 2019
- Type: E-Poster Viewing in the Exhibit Hall
- Track: Treatment of Early Stage/Localized Disease
- Presentations: 1
- Now Available
- Moderators:
- Coordinates: 9/08/2019, 08:00 - 18:00, Exhibit Hall
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EP1.17-23 - Omentopexy for Post-Pneumonectomy Bronchopleural Fistula in Patients with Non-Small Cell Lung Cancer After Salvage Radiotherapy (Now Available) (ID 2970)
08:00 - 18:00 | Author(s): Yongjin Chang
- Abstract
Background
Preoperative chemotherapy or radiotherapy could affect bronchial mucosa blood flow and also the normal healing process of bronchial stump after surgical resection. Otherwise, bronchopleural fistula (BPF) is the worst and time consuming complication in lung cancer surgery. Pneumonectomy is reported as a high risk surgery of BPF. Here, we report our successful treatment experience of BPF using omentum after salvage radiotherapy in NSCLC patient.
Method
Retrospective medical chart review
Result
A sixty-four years old male patient who had a history of chronic obstructive pulmonary disease diagnosed as squamous carcinoma in left upper lobe, clinical stage of T2aN1M0. Because interlobar artery invasion was suspicious, the patient was treated with radical radiotherapy. After 6600cGy of radiotherapy, the lesion showed marked response. Thus we decided to perform curative surgical resection, pneumonectomy. The patient had discharged in postoperative day 11 and the pathologic report was ypT1aN0M0. But after 1 week from discharge, the patient readmitted and complained of dyspnea and profound sputum. In bronchoscopy, fistula was seen. We performed the second operation. Due to hard fibrosis, direct closure of bronchial stump was not possible. Thus, we covered the stump site with omental flap in multilayers. The patient discharged uneventfully and now in disease free status almost after 2 years from initial operation.
Conclusion
Neoadjuvant radiation therapy and pneumonectomy are risk factors for post-operative BPF. Direct closure with buttressing biocompatible flap is the treatment of choice. But if direct closure is not possible, double-layered omentopexy could be an alternative treatment strategy.
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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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P2.17-18 - Acute Respiratory Distress Syndrome After Curative Surgical Resection for Lung Cancer (Now Available) (ID 2129)
10:15 - 18:15 | Author(s): Yongjin Chang
- Abstract
Background
Bilateral lung infiltration is the most dreadful sign after lung cancer surgery. Either it is post -operative pneumonia or exacerbation of underlying lung disease (Interstitial lung disease), the lungs gradually shut down and finally develop ARDS (Acute Respiratory Distress Syndrome). Here, we report our experience and treatment outcome of post-operative ARDS after curative surgical resection for lung cancer.
Method
From October 2008 to April 2017, the patients who underwent curative surgical resection for primary lung cancer were analyzed. We retrospectively reviewed medical records in two hospitals.
Result
A total of 2140 patients were enrolled. Among them, 1246 were male (58.2%) and 894 were female (41.8%). The mean age was 64.5±10.0. In surgical procedures, 1496 (70%) cases of lobectomy, 117 (5.5%) cases of segmentectomy, 201 (9.4%) cases of wedge resection, 71 (3.3%) cases of bilobectomy, and 31 (1.4%) cases of pneumonectomy were performed. Combined procedures (lobectomy with wedge resection) were 222 (10.4%) cases. With Berlin definition of ARDS, a total of 29 (1.4%) patients were diagnosed. In table 1, we compared two groups and analyzed risk factors using univariable analysis. In multivariable analysis (table 2), advanced age, %VC(vital capacity), and underlying lung disease were associated with ARDS. Of 29 ARDS patients, 19 (65.5%) patients died in spite of maximum treatment. Broad antibiotics (96.6%), and steroid therapy (86.2%) were most applied treatments. We compared the patient’s characteristics and the timing of treatment between two groups (survivor / non-survivor). But, there was no clinical significance.
Conclusion
In conclusion, ARDS after lung cancer surgery is rare but fatal. Advanced age, low vital capacity, and patient’s underlying lung diseases are possible risk factors for ARDS after surgery. In practice, various treatments including broad antibiotics and steroid therapy are applied to treat or control this disaster. But still, mortality is extremely high and their role is uncertain.
