SATS 2009 Final Program - Scandinavian Association for Thoracic ...

S01:5
THE NEW TNM STAGING SYSTEM FOR LUNG CANCER - A REVIEW OF 511 PATIENTS OPERATED AT
KAROLINSKA UNIVERSITY HOSPITAL.
Bergman Per 1 , Brodin Daniel 2 , De Petris Luigi 3
1) Dept of Cardiothor Surgery and Anesthesiology, Karolinska, 2) Dept of Lung Medicine, Karolinska,
3) KS Biomic Center, Karolinska Institutet, Sweden
Objective
In spite of diagnostical progress and more systematically lymph node dissection during lung cancer surgery, lung
cancer is still the leading cause of cancer death in both sexes. It is a significant public health problem and has
continuously increased in incidence and particulary in women with 3.6%/year for the last decade. The TNM staging
system plays hereby a predominant role in the choice of treatment and for the prediction of the prognosis.
Methods
A comparison between the old staging system (sixth edit.) and the new staging system (seventh. edit.) was made
among 511 patients operated for lung cancer at Karolinska during 1982-2002. Of particular interest was the median
survival time (Kaplan Meier method) and the difference between the old subgroup IA (tumor size 3 cm) and the new
subgroups IA-a ( 2 cm) and IA-b (>2 - 3 cm). The T-stage (tumor size) is in these groups a decisive factor.
Results
Comparing the old subgroup IA (91 month + 9.6) with the new subgroups IA-a and IA-b, there was a unexpected,
significant difference between the median survival time comparing the new subgroups IA-a (110 month + 8,01)
respectively IA-b (64 month + 6,1) indicating that patients with tumor size > 2 cm have a more severe prognosis
than tumor sized 2 cm. Conclusion: The new staging system seems to better elucidate the prognostic importance of
tumor size than the previous edition. These findings are also in accordance with several other published studies.
S01:6
NON-SELECTIVE CYCLOOXYGENASE (COX) INHIBITION DECREASES SHUNT DURING ONE-LUNG
VENTILATION FOR THORACIC SURGERY.
Rimeika Danguole 1 , Lindahl Sten G 1 , Wiklund Claes U 1
1) Karolinska University Hospital, Sweden
Background
Prostacyclin has been shown to exert modulating effects on hypoxic pulmonary vasoconstriction (HPV). The
purpose of this study was to investigate if cyclooxygenase inhibition decreases shunt fraction and improves arterial
oxygenation during one-lung ventilation (OLV).
Methods
Altogether 32 patients exposed to OLV for thoracic surgery were randomly assigned to receive 75 mg diclofenac
or saline intravenously after induction of anesthesia. Measurements were done during two-lung ventilation (TLV)
in supine and lateral position, after 5, 15 and 30 minutes of OLV before surgical ligation of pulmonary vessels
and finally after TLV was re-established.There were no differences between groups in patient characteristics or
preoperative conditions. Cardiac index, mixed venous oxygen tension, PaCO2 and mean pulmonary arterial pressure
were similar in the groups.
Results
In the placebo group the shunt fraction increased from 12 % during TLV to 37 % at 15 minutes of OLV and 38 %
at 30 minutes of OLV. In the diclofenac treated group shunt fraction increased from 12 % at TLV to 27 % after 15
minutes of OLV and to 29 % at 30 minutes of OLV. Shunt fraction was significantly improved in the diclofenac group
compared with the placebo group, at 15 minutes of OLV (P = 0.043). Conclusion: It was concluded that COXinhibition
with diclofenac augments hypoxic pulmonary vasoconstriction and decreases shunt fraction during OLV
for thoracic surgery.
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