Journal Thoracic Oncology

Abstracts Journal of Thoracic Oncology • Volume 12 Issue S1 January 2017
in wedge resection (p=0.581).
Conclusion: This study showed that GGA dominant T1a may be treated by
wedge resection where possible. The consolidation dominant T1b did not
benefit from sublobar resection. In patients with GGA dominant T1b or
consolidation dominant T1a, anatomical segmentectomy with curative
intension may provide better prognosis.
Keywords: segmentectomy, Ground Glass Appearance, sublobar resection
OA15: SUBLOBAR RESECTIONS FOR EARLY STAGE NSCLCTUESDAY, DECEMBER 6, 2016 -
16:00-17:30
OA15.03 COMPARISON OF PROGNOSIS BETWEEN LOBECTOMY AND
SUBLOBAR RESECTION FOR CLINICAL STAGE I NON-SMALL CELL
LUNG CANCER WITH INTERSTITIAL LUNG DISEASE
Yasuhiro Tsutani, Takeshi Mimura, Yuichiro Kai, Masaoki Ito, Yoshinori
Handa, Norifumi Tsubokawa, Keizo Misumi, Hideaki Hanaki, Yoshihiro Miyata,
Morihito Okada
Hiroshima University, Hiroshima/Japan
Background: The prognosis after standard lobectomy for non-small cell lung
cancer (NSCLC) with interstitial lung disease (ILD) is poor. This study aimed
to compare the prognosis after lobectomy and sublobar resection for early
NSCLC with ILD. Methods: Among 794 consecutive patients with clinical
stage I NSCLC who underwent complete resection, 107 patients with ILD on
high-resolution computed tomography (HRCT), which was defined according
to the American Thoracic Society, European Respiratory Society, Japanese
Respiratory Society, and Latin American Thoracic Association classification,
were identified. Results: Overall survival (OS) was significantly worse for
patients with possible usual interstitial pneumonia (UIP) or UIP pattern
than those with inconsistent with UIP pattern (3-year OS, 64.5% vs. 82.1%,
respectively; P = 0.031). No significant difference existed in OS between
lobectomy and sublobar resection for all patients with ILD (3-year OS, 67.1%
vs. 81.9%, respectively; P = 0.14). Although in patients with inconsistent
with UIP pattern, OS was similar between lobectomy and sublobar resection
groups (3-year OS, 81.1% vs. 83.6%, respectively; P = 0.87), OS was better for
patients who underwent sublobar resection than lobectomy in patients
with possible UIP or UIP patterns (3-year OS, 81.0% vs. 50.5%, respectively;
P = 0.069). Multivariate Cox analysis demonstrated that preoperative
diffusing capacity of the lung for carbon monoxide (P = 0.018), not the surgical
procedure (P = 0.14), was an independent prognostic factor for OS. Conclusion:
Sublobar resection can be an alternative choice for clinical stage I NSCLC with
ILD especially for UIP or possible UIP patterns on HRCT.
Keywords: non-small cell lung cancer, interstitial lung disease, sublobar
resection
OA15: SUBLOBAR RESECTIONS FOR EARLY STAGE NSCLC
TUESDAY, DECEMBER 6, 2016 - 16:00-17:30
OA15.05 ANATOMICAL PULMONARY SEGMENTECTOMY AND
SUB-SEBMENTECTOMY FOR LUNG CANCER USING THE NOVEL
FLUORESCENCE TECHNIQUE WITH VITAMIN B2
Ryuichi Waseda 1 , Yasuhiko Tatsuzawa 2 , Isao Matsumoto 3 , Hirofumi
Takemura 3
1 Department of General Thoracic, Breast, and Pediatric Surgery, Fukuoka
University, Fukuoka/Japan, 2 Saiseikai Kanazawa Hospital, Kanazawa/Japan,
3 Kanazawa University, Kanazawa/Japan
Background: The identification of an accurate segment is essential for
successful anatomic pulmonary segmentectomy. We have previously developed
a new fluorescence technique using a PDD endoscope system TM and vitamin
B2 for identification of pulmonary segments in animal experiments. In this
study, we applied this technique clinically to examine the efficacy and safety in
anatomical pulmonary segmentectomy and sub-segmentectomy for pulmonary
malignancies. Methods: Our technique requires two key instruments, a PDD
endoscope system TM (KARL STORZ GmbH and Co., Tuttlingen, Germany)
as a fluorescence sensing device and vitamin B2 solution as a fluorescent
substance. 17 patients with small lung nodules were enrolled in this study.
Regarding our surgical technique, after identification of the target segmental
or sub-segmental bronchus, vitaminB2 solution is injected via the bronchus.
The target segment is identified as a fluorescent segment with the PDD
endoscope system TM . The identified segment is resected with an electric
cautery, stapling devices, or combination of them. In case patient’s lung has
severe abnormal change such as emphysema or fibrosis, another technique
is indicated. After ligation of the target segmental or sub-segmental artery,
vitaminB2 solution is systemically administrated with intravenous injection.
The target segment is identified as a defect of fluorescence with the PDD
endoscope system TM . Following outcomes were collected; success rate of
identifying the pulmonary segments, pathological evaluation of dissection
margin, duration of chest drainage, and perioperative complications. Results:
A total of 18 procedures were performed using this technique. Performed
segmentectomy or sub-segmentectomy were as follows; Right S1, S2, S3,
S2a+3b, S6, S9, Left S1+2, S3, S4+5, S6, S8a+9b, S9+10. Resected nodules were
14 primary lung cancers, 1 MALT-lymphoma, 1 metastatic lung cancer, and 2
benign lung nodules. Histology of primary lung cancer was adenocarcinoma
in all 14 cases. Pathological stage of lung cancer was 12 stageIA (pT1a; 10, pT1b;
2), 1 stageIIA (pT1aN1), and 1 stageIIIA (pT1aN2). The success rate of identifying
pulmonary segments was 100%. Dissection of segmental border was performed
with only electric cautery in 12 procedures, and with both of electric cautery
and stapling device in 6 procedures. In all cases, no cancer cells were found on
the resection margin pathologically. Mean drainage time was 1.7 days (1-4 days).
Regarding perioperative complications, veno-vagal reflex was occurred after
systemic injection of vitaminB2 in one case, and 1 delayed pneumothorax was
found in one case. Conclusion: Our novel fluorescence technique involving a
PDD endoscope system TM and vitaminB2 allowed performing accurate and safe
pulmonary segmentectomy and sub-segmentectomy.
Keywords: Surgery for lung cancer, Pulmonary segmentectomy, New
technique
OA15: SUBLOBAR RESECTIONS FOR EARLY STAGE NSCLC
TUESDAY, DECEMBER 6, 2016 - 16:00-17:30
OA15.06 THE EFFICACY OF LUNG VOLUME ANALYZER
FOR MEASURING RESECTION MARGIN IN PULMONARY
SEGMENTECTOMY FOR MALIGNANT DISEASES
Yasuo Sekine 1 , Takamasa Yun 2 , Takahide Toyoda 2 , Daisuke Kaiho 2 , Eitetsu
Koh 1 , Toshiko Kamata 1
1 Department of General Thoracic Surgery, Tokyo Women’s Medical University
Yachiyo Medical Center, Yachiyo/Japan, 2 Department of General Thoracic Surgery,
Kimitsu Central Hospital, Kisarazu/Japan
Background: Although the confirmation of an appropriate resection
margin from the tumor is crucial for reducing the risk of local recurrence
after lung segmentectomy for pulmonary malignancies, there has been no
method of measurement. We established a novel approach for performing
segmentectomy by using an infrared thoracoscopy with transbronchial
instillation of indocianine green (ICG), and improved this method by adding
an advanced computer technology via lung volume analyzer for obtaining
an appropriate resection margin. Methods: Preoperatively, each patient
underwent multislice enhanced computed tomography (CT) using 320-slice
scanners for pulmonary angiography and virtual bronchoscopy, and to create
several virtual segmentectomies by using Volume Analyzer Synapse VINCENT
(Fujifilm co., Tokyo, Japan). We measured the shortest distance from the
tumor to the resection margin in each simulated segmentectomy and selected
the most appropriate area of sublobar resection based on the adequate
resection margin of approximately 2 cm from the tumor. We prospectively
performed segmentectomy in 17 patients and compared between simulated
distance and actual distance measured from the specimen. Results: The
average number of created patterns of virtual segmentectomy in each
case was 4.1 ± 1.0. The mean distance of resection margin in selected virtual
segmentectomy was 19.3 ± 9.7 mm. On the other hand, actual shortest
distance in resected specimen was 25.4 ± 8.1 mm, which was significantly
longer than simulated distance (p=0.027). There was no tumor recurrence
in all patients. Conclusion: Lung volume analyzer was an excellent tool for
selecting an ideal area of sublobar resection with an appropriate resection
margin.
S154 Journal of Thoracic Oncology • Volume 12 Issue S1 January 2017