Virtual Library
Start Your Search
Takayoshi Yamamoto
Author of
-
+
P04 - Early Stage/Localized Disease - Perioperative Therapy (Neoadjuvant Therapy, Surgery, Adjuvant Therapy) (ID 113)
- Event: WCLC 2020
- Type: Posters
- Track: Early Stage/Localized Disease
- Presentations: 2
- Moderators:
- Coordinates: 1/28/2021, 00:00 - 00:00, ePoster Hall
-
+
P04.04 - Thrombus Formation at Stump of Pulmonary Vein after Pulmonary Lobectomy: A Prospective Multi-institutional Study (ID 1341)
00:00 - 00:00 | Presenting Author(s): Takayoshi Yamamoto
- Abstract
Introduction
Cerebral infarction is a minor but critical complication after pulmonary lobectomy for lung cancer. Recent reports suggested postoperative cerebral infarction is caused by thrombus formed at the stump of pulmonary vein and the risk is the highest after left upper lobectomy (LUL). In this study, thrombosis at the stump of pulmonary vein and incidence of cerebral infarction was prospectively investigated in patients who underwent pulmonary lobectomy for lung cancer.
Methods
Patients who were planned for pulmonary lobectomy for lung cancer were enrolled in this study since May 13, 2015. Exclusion criteria were less than 20 years old, history of cerebral infarction, atrial fibrillation and induction treatments. Asymptomatic cerebral infarction was examined by contrast-enhanced(CE-) brain MRI, and also excluded. Any procedures such as ligation or usage of staplers was allowable for transection of pulmonary vein. Thrombus formation was examined within 3 month before surgery (control), 1 – 4 week and 11 – 13 month after surgery by CE-chest CT. Incidence of cerebral infarction was observed until 12 month after surgery, and CE-MRI was performed in 11-13 month after surgery to examine asymptomatic cerebral infarction. Endpoint of this study was to prove higher incidence of thrombus formation (primary) and higher incidence of cerebral infarction (secondary) in LUL cases. Planned number of accrual patients was set 600 by statistical consideration with a two-sided significance level of 5% and power of 80% when the thrombus formation was 10% in LUL while 1% in other lobectomies. Interim analysis was planned just after the data center received final clinical review form of the 300th patients.
Results
According to the results of the interim analysis, the Effectiveness and Safety Evaluation Committee advised discontinuation of new accrual of patients and early publication of the results on September 4, 2019. Thirteen patients were excluded from the interim analysis due to issue in formality, and 287 were investigated. They were 67.6 years of mean age, 22.7 of mean body-mass index, and comprised 181 (63.1%) males and 199 smokers (69,3%). 112 (39%) had oral medicines such as anti-coagulant, anti-platelet or anti-hypertensive, and these populations were equivalently distributed in the LUL patients and others. During the study period, the thrombus was recognized in 17 out of 75 LUL patients (22.7%) whereas it was in 4 out of 212 others (1.9%) (p<0.00549). Incidence of cerebral infarction was observed in 1 of the LUL patients (1.3%) and in 8 of others (3.8%) (p = 0.332). There was no cerebral infarction case in 15 patients who had anti-coagulants.
Conclusion
Thrombus is frequently formed at the stump of the left superior pulmonary vein after LUL. Our study showed no relationship between the thrombosis and cerebral infarction, however, it is still a potential risk to be confirmed in a large cohort.
-
+
P04.09 - Real-Time CT Guided Video-Assisted Thoracoscopic Partial Resection of Peripheral Small-Sized Lung Tumors in Hybrid OR –A Phase 2 Trial– (ID 1022)
00:00 - 00:00 | Author(s): Takayoshi Yamamoto
- Abstract
Introduction
This study aims to evaluate the feasibility and safety of real-time CT guided video-assisted thoracoscopic (VATS) partial resection for impalpable small pulmonary nodules. Lung cancer or malignancy suspected lesions were eligible if the lesions were defined as GGO-dominant (>50%) tumor with a diameter of 3cm or lower (GGO-dominant type), or tumor of 2cm or lower which was located deeper than the diameter of the tumor from visceral pleura (Deep solid type).
Methods
This single-center phase 2 trial was performed between April in 2018 and March in 2019. First, several surgical clips (first markers) were put on the visceral pleura nearly around the tumor through 3-ports VATS approach. The location information between the concerned tumor and the first markers were obtained by cone-beam CT (CBCT), and then the second marker was put just on the tumor based on the image. Pulmonary resection was performed according to the second marker guided by automated staplers. The primary endpoint was complete macroscopic resection rate, and secondary endpoints were complete microscopic resection rate and safety.
Results
The 22 nodules of 9 men and 11 women with a mean age of 64.3 years were eligible. The tumors were located in the right upper/middle/lower lobe in 3/1/5 patients and the left upper/lower lobe in 5/8 patients. Seven nodules (31.8%) were GGO-dominant types and 15 nodules (68.2%) were deep solid types. CBCT clearly could detect all nodules. The mean localization time was 17.4 (90%CI, 14.5-20.2) minutes, and mean operation time was 110.7 (90%CI, 96.4-125.0) minutes. Complete macroscopic resection was accomplished in 19 patients (95.0%, p=0.047), and all patients accomplished complete microscopic resection. Postoperative air leakage and bleeding were observed in one respectively (5%).
Conclusion
CBCT is a safe and useful guide for VATS partial resection for impalpable peripheral pulmonary nodules.
