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

P01:16
PNEUMONECTOMY FOR NON-SMALL CELL LUNG CANCER IN ICELAND: EARLY COMPLICATIONS
AND LONG TERM SURVIVAL
Thorsteinsson Hunbogi 1 , Jonsson Steinn 2 , Alfredsson Hordur 3 , Isaksson Helgi 4 , Gudbjartsson Tomas 3
1) 2) 3) Fac. of medicine, University of Iceland, Dpt. of pulmonology, Dpt. of cardiothoracic surgery,
4) Dpt. of pathology, Iceland
Objective
Pneumonectomy is required for large or central non small cell lung cancer (NSCLC). This study aims to investigate
the indications, complications and surgical outcome of pneumonectomy for NSCLC in Iceland.
Material and methods
A retrospective study of all pneumonectomies performed for NSCLC in Iceland 1988-2007. Clinical information was
retreived from medical records and all cases staged using the TNM staging system. Survival and prognostic factors
were evaluated using Cox multivariate analysis.
Results
77 patients (64% males) with mean age of 62.3 yrs. were operated on, 44% on the right side. Mediastinoscopy
was performed in 31% of cases. Most patients were stage I or II (58%), but 17% and 21% were stage III A and IIIB,
respectively. Mean operating time was 161 min., bleeding 1,1 L and hospital stay 11 days. Atrial fibrillation/flutter
(21%), pneumonia (6%), empyema (5%) and respiratory failure (5%) were the most common complications. Three
(3.9%) patients died within 30 and 8 (10.4%) within 90 days of surgery. Five year survival was 21%. Age (HR 1.035),
airway obstruction (HR 2.9), large cell- or adenocarcinoma histology (HR 2.21) and TNM stage IV vs. I (HR 16.5)
were independent predictors of poor survival. Operation in the later 10 year period predicted improved survival (HR
0.55, p= 0,03).
Conclusions
Pneumonectomies for NSCLC in Iceland have a low rate of complications and operative mortality. Long term survival,
however, is lower than expected, possibly related to insufficient preoperative staging, with only 1 out of 3 patients
undergoing mediastinoscopy prior to pneumonectomy.
P01:17
MEDIASTINOSCOPY – INDICATIONS AND EARLY COMPLICATIONS.
Olafsdottir Thora Sif 1 , Gudmundsson Gunnar 2 , Björnsson Jóhannes 3 , Gudbjartsson Tomas 1 ,
1) Department of surgery, 2) Department of pulmonary medicine, 3) Department of Pathology, Landspitali, Iceland
Introduction
Mediastinoscopy is an important tool for staging lung cancer and evaluating mediastinal pathology. The objective of
this retrospective study was to investigate the indications and safety of mediastinoscopy in a well defined cohort of
patients.
Material and methods
All patients that underwent mediastinoscopy in Iceland between 1983-2007 were included. Clinical information was
obtained from patient charts and pathology reports were reviewed. For comparison the study-period was divided
into 5-year periods.
Results
282 operations were performed but in 34 cases data was missing, leaving 248 patients for analysis (mean age 59
yrs, range 11-89, 150 males). A steady increase was seen in the number of operations, or 16 compared to 85 during
the first and last periods, respectively (p500 ml (0,8%). There were two operative deaths, one due to a major intraoperative bleeding from a
mediastinal tumor that infiltrated the aortic arch and one from a post-operative pseudomonas pneumonia.
Conclusions
The number of mediastinoscopies is increasing in Iceland, especially as a part of lung cancer staging. Mediastinoscopy
is a safe procedure with low mortality and morbidity.
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