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riad Amin Abdeljalil
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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: 1
- Moderators:
- Coordinates: 1/28/2021, 00:00 - 00:00, ePoster Hall
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P04.06 - Early Surgical and Oncological Outcomes After Single Port Video Assisted Thoracoscopic Surgery Lung Resection; KHCC Experience (ID 1377)
00:00 - 00:00 | Presenting Author(s): riad Amin Abdeljalil
- Abstract
Introduction
Video-assisted thoracoscopic surgery (VATS) has been accepted as a safe and effective surgical approach for pulmonary resection. Typically, most surgeons use multiple incisions, including an access incision and several port incisions during conventional VATS to complete various types of resection. With the improvement of endoscopic instruments and surgical techniques, some authors have proposed that pulmonary resection can be accomplished with only a single incision. The potential advantages of the single-port technique includes less postoperative pain, fewer paresthesia, better cosmetic results, and greater patient satisfaction.
In recent years, single-port video-assisted thoracoscopic surgery (VATS) for lung resection has become increasingly common. The objective of this study is to assess the Early surgical and oncological outcomes after single port video assisted Thoracoscopic surgery ( VATS ) lung resection in King Hussein Cancer Center .
Methods
A total of 263 patients with Non-Small Cell Lung Cancer (NSCLC), pulmonary metastasis who underwent single port VATS limited or major lung resection and patients who underwent surgery for diagnosis of lung, pleura or mediastinal pathology from November 2016 to July 2020 were retrospectively reviewed for Patients’ characteristics, perioperative outcomes, pathologic result, and postoperative follow-up data of single port thoracoscopic surgery. Early surgical and oncological outcomes were analyzed.
Results
A total of 263 patients; 208 (79%) underwent surgery with curative intent and 55 (21%) underwent diagnostic procedures. Patients who underwent surgery for curative intent were divided into two groups; 72 (35%) with lung cancer underwent single port VATS lung resection and 136 (65%) with pulmonary metastasis underwent single port VATS pulmonary metastasectomies.
We further divided the patients according to the type of resection into limited (segmentectomy and wedge resection) 150 patients (72%) , lobectomy 43 patients (21%) and complex resection ( locally advanced, bilobectomy and resection enblock with chest wall, diaphragm or pericardium and one case with resection of small part of left atrium) 15 patients (7%).
The rate of R0 resection were 97.8% and 100% for pulmonary metastasectomies group and lung cancer resection group respectively.
10% were the rate of complications (8.4%,1.1% and 1.1% for pulmonary, cardiac and wound complications respectively); With significant increase in the pulmonary complication rate for lung cancer resection group; P value 0.034 and in the complex resection group; P value <0.001.
3- year DFS were 75% , 90.3% for pulmonary metastasectomies and lung cancer resection groups respectively . P 0.279
3- year OS were 91.7% ,82.4% for pulmonary metastasectomies and lung cancer resection respectively. P 0.716
mean, median follow up time 29,24 months respectively.
Median length of stay 1 day for pulmonary metastasectomy and 3 days for lung cancer resection ; P <0.001.
Conclusion
all the single-port VATS procedures were successfully performed in our center. No perioperative severe complication or death was noted even with more complex procedures.
The immediate oncological outcomes in term of complete R0 resection were excellent.
Nevertheless, the middle- and long-term efficacies of these procedures for lung cancer still require evidences from further follow-up.
In our view, the single-port VATS is safe and feasible, and thus warrants further clinical applications.
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P22 - Mesothelioma, Thymoma and Other Thoracic Malignancies - Case Reports (ID 136)
- Event: WCLC 2020
- Type: Posters
- Track: Mesothelioma, Thymoma and Other Thoracic Malignancies
- Presentations: 2
- Moderators:
- Coordinates: 1/28/2021, 00:00 - 00:00, ePoster Hall
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P22.02 - Outcome of Heart Rupture Repair During Huge Mediastinal Mass Resection (ID 870)
00:00 - 00:00 | Presenting Author(s): riad Amin Abdeljalil
- Abstract
Introduction
Heart rupture is a very unusual intraoperative complication. Herein we present a case of a thymoma resection complicated by right ventricular rupture. The main aim of this study is to review the incidence of intraoperative cardiac arrest and complications of open chest cardiac massage. We also aim to review the significance of early and persistent rehabilitation in the postoperative patient.
Methods
it's a case report for this pt. underwent sternotomy, thymectomy, then revision due to bleeding complicated by right ventricular rupture and repair.
Clinical presentation, radiological features and surgical details were taken from medical notes and hospital databases. A literature review searching for similar presentations was completed.
Results
A 57-year-old previously healthy gentleman presented complaining of a new onset shortness of breath of two months duration. A large mediastinal mass was found on chest imaging and biopsy revealed a thymoma. patient received neoadjuvant CAP regimen chemotherapy then sternotomy and thymectomy enblock with anterior pericardium. Post-thymectomy, the patient continued to be hypotensive in recovery despite aggressive fluid resuscitation. He was sent again to theatre, aggressive fluid resuscitation continued and the bleeding source was identified and controlled but intraoperative asystole developed. During internal cardiac massage, the right ventricle ruptured with a 3 cm defect which was successfully repaired with pericardial patch without bypass machine due to unavailability in our cancer center. The patient remained dependent on mechanical ventilation through tracheostomy for a total of two months, was discharged from ICU to the surgical floor 66 days after the operation and weaned off ventilator support 85 days after the operation after having undergone respiratory and physical rehabilitation. patient is doing very well now with excellent performance and free of tumor recurrence 30 months after surgery.
Conclusion
Right ventricular rupture is rarely described in the literature outside the context of myocardial infarction and valvular heart disease. neoadjuvant CAP regimen chemotherapy, Cardiopulmonary resuscitation attempts and tumor proximity to the heart are proposed causes in our case. We also highlight the improved survival and outcome in post-surgical patients who receive early and aggressive physical rehabilitation and respiratory physiotherapy.
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P22.05 - Chest Wall and Diaphragm Reconstruction; a Technique not well Established in Literature (ID 2716)
00:00 - 00:00 | Presenting Author(s): riad Amin Abdeljalil
- Abstract
Introduction
Primary tumors of the chest wall are rare, heterogeneous group of neoplasms with an incidence of 2% of the population and arise from the bone, soft tissue or cartilage of the chest wall. These can be benign or malignant and radiological features of soft tissue involvement and cortical destruction are specific distinguishing features of malignancy.
Wide local resection of the tumor with negative margins is the most important step in treatment. Reconstruction is challenging sometimes especially if complex resection done.
Here, we describe a technique that is not well established in literature in reconstructing a chest wall defect involving the lower costal margin and diaphragm.
Methods
It's a surgical technique description
Clinical presentation, radiological features and surgical details were taken from medical notes and hospital databases. A literature review searching for similar presentations was completed.
Results
27-year-old male patient, with a history of left chest wall Ewing sarcoma ten years ago. on regular follow ups, presented with right chest wall 5 cm mass, anterior to the anterior axillary line, firm, non-tender, fixed to the chest wall and without overlying skin changes.
CT of the chest showed right chest wall mass involving the right tenth rib laterally with large soft tissue component indenting the liver surface.
biopsy showed recurrent primitive Neuroectodermal tumor (PNET)/Ewing Sarcoma.
Patient received three cycles of neoadjuvant chemotherapy with mild regression of soft tissue component of the bony lesion from 5.5cm to 3.5cm.
Then the patient underwent right thoracotomy, chest wall wide local resection of the mass including the tenth rib, part of the ninth and eleventh ribs with 4cm margins anteriorly and posteriorly, plus resection part of the diaphragm and abdominal wall.
We used a single patch of Dulex/Polytetrafluoroethylene (PTFE) mesh for chest wall reconstruction. After placing the mesh into a satisfactory position, we reconstructed the diaphragm by suturing the diaphragm directly into the middle part of the inner surface of the mesh using continuous runs of ethibond to avoid high or low insertion of the diaphragm if we fix it to ribs itself.
The edges of the mesh were then secured with interrupted runs of prolene 0 to the eighth and 12th ribs. Primary closure of the muscle over the mesh, then suturing of the subcutaneous tissue and skin.
Conclusion
The treatment for most primary chest wall tumors is wide excision. After radical chest wall resection, skeletal reconstruction when appropriate to preserve the reconstruction is the essential element for successful management.
We describe a chest wall and diaphragm reconstruction for a recurrent chest wall tumor, using a single patch of Polytetrafluoroethylene (PTFE) mesh with diaphragm implanted into the middle of the mesh surface to avoid stretching the diaphragm too much by high or low insertion which will affect the diaphragm function.
There were no operative complications.
The patient received post-operative radiotherapy with good functional and cosmetic results. there is no recurrence 18 months after surgery.
We concluded that this is a safe technique resulting in stable reconstruction after full-thickness chest wall resections involving the diaphragm.
