Journal Thoracic Oncology

Abstracts Journal of Thoracic Oncology • Volume 12 Issue S1 January 2017
POSTER SESSION 1 - P1.08: SURGERY
MINIMAL INVASIVE SURGERY –
MONDAY, DECEMBER 5, 2016
POSTER SESSION 1 - P1.08: SURGERY
MINIMAL INVASIVE SURGERY –
MONDAY, DECEMBER 5, 2016
P1.08-048 COMPARISON OF PULMONARY FUNCTION AFTER
ROBOTIC-ASSISTED VIDEO-THORACOSCOPIC LOBECTOMIES VS
SEGMENTECTOMIES
Maria Echavarria 1 , Anna Cheng 1 , Frank Velez 1 , Emily Ng 1 , Carla Moodie 2 , Joseph
Garrett 2 , Jacques-Pierre Fontaine 2 , Eric Toloza 2
1 University of South Florida, Tampa/FL/United States of America, 2 Thoracic
Oncology, Moffitt Cancer Center, Tampa/United States of America
Background: Lobectomy is the standard surgical procedure for early stage
lung cancer, but sub-lobar resection is being debated. We compared
pulmonary function after robotic-assisted video-assisted Thoracoscopic
(R-VATS) segmentectomy versus lobectomy; comparison using robotic
instruments hasn’t been published. Methods: We retrospectively analyzed
prospectively collected data from 251 consecutive patients who underwent
lobectomy (N=208) and segmentectomy (N=43) via R-VATS by one surgeon.
Unpaired Student’s t-test and Chi-square tests were used to determine
statistical significance(p≤ 0.05). Majority of patients had no prior lung
surgery. We used “Predicted(PFT)=Preop(PFT)x(1-(Segments x 0.0556))”,
where 0.0556=1seg/18seg. For patients with prior resections, the number of
segments previously resected was taken into account(1seg/(18-Prior
resection)). Results:
P1.08-049 CT GUIDED LABELING WITH INDOCYANINE GREEN OF
SMALL LUNG NODULES FOR SUBLOBAR RESECTION UTILIZING
ROBOTIC ASSISTED THORASCOPIC SURGERY (RATS)
K Adam Lee 1 , Lee Fox 2 , Andrew Hall 2 , Vincent Turiano 2
1 Thoracic Surgery and Lung Center, Jupiter Medical Center, Jupiter/FL/United States
of America, 2 Radiology, Jupiter Medical Center, Jupiter/FL/United States of America
Background: Localization of deep and small pulmonary lung nodules
undergoing a wedge or sublobar resection may be challenging during
thoracoscopy, and may necessitate greater resection or conversion to
thoracotomy. Particularly in robotic surgery, with the absence of tactile
feedback. Percutaneous CT guided Indocyanine Green injection provides
a means to pinpoint these nodules. Methods: A retrospective study of 40
consecutive patients who underwent preoperative CT-guided localization of
solitary pulmonary nodules with ICG. Nodules < 15mm were 21/40 (52.5%), <
20mm 30/40 (75%), and < 30mm 38/40 (95%). A 22-gauge spinal needle (BD,
NJ) or Chiba needle (Cook, IA) was positioned into or adjacent to the nodule.
0.4cc Indocyanine Green was injected and the inner stylet withdrawn. The
Xi daVinci robot (Intuitive Surgery, CA) was docked and the firefly filter of
the 8mm camera was activated, and the nodule illuminates in a flouresence
green color. A wedge or sublobar resection was performed, with progression
to lobectomy when indicated. Results: CT guidance successfully localized
the nodules in 100% of 40 patients employing this technique. Success was
measured in nodule illumination as seen by the surgeon upon activation of the
camera filter and confirmed on frozen and permanent section by pathology.
Initial wedge resection for diagnosis prior to lobectomy and sublobar
resection for decreased PFTs or decrease cardiac function were performed
by Robotic Assisted Thoracoscopy (RATS). There were no conversions to
thoracotomy. Diagnosis were adenocarcinoma in 18 patients (45%), squamous
cell carcinoma in 7 patients (17.5%), carcinoid in 1 patient (2.5%), metastatic
in 8 patients (20%), and benign in 6 patients (15%). There were no 30 or 90
day mortalities. A chest tube reinsertion in one patient for pneumothorax.
Economically the cost for the vial of ICG is $79.56 compared to a fiducil marker
at a cost of $128.00. Thoracic Surgery has access to CT scanners, without an
extra cost, electromagnetic navigation systems come with significant added
costs. Conclusion: Percutaneous CT guided labeling with ICG is quick and
economical for the localization of small and deep nodules undergoing RATS
wedge or sublobar resection. This technique may be supportive in preserving
lung parenchyma and reduce the need for conversion to thoracotomy,
maintaining minimal invasive thoracic surgery, especially where palpation or
tactile feedback is absent.
Keywords: pulmonary nodules, sublobar resection, Minimal Invasive thoracic
surgery, CT guided labeling
POSTER SESSION 1 - P1.08: SURGERY
MINIMAL INVASIVE SURGERY –
MONDAY, DECEMBER 5, 2016
P1.08-050 VATS LOBECTOMY IN LOCALLY ADVANCED NSCLC: A
SINGLE CENTRE EXPERIENCE
Davide Tosi, Lorenzo Rosso, Paolo Mendogni, Alessandro Palleschi, Ilaria
Righi, Matteo Montoli, Francesco Damarco, Mario Nosotti
Fondazione IRCCS Ca’ Granda Policlinico, Milan/Italy
Preoperative FEV1(%) and DLCO(%) were statistically significant between the
two groups. Also, FEV1 and DLCO were lower in segmentectomy patients. As
expected, predicted changes between preoperative and postoperative values
were significant. Predicted post-operative FEV1 and DLCO did not show any
significant difference between the two groups. Conclusion: While preoperative
PFTs were significantly lower in segmentectomy patients compared
to lobectomy patients, predicted post-operative PFTs do not differ
significantly. Predicted changes for FEV1 and DLCO are significantly less in
segmentectomy. Thus, negate the difference in pre-operative PFTs. In
conclusion, R-VATS segmentectomy preserves lung function and may be
considered a viable alternative
Keywords: Robotic surgery lobectomy segmentectomy
Background: VATS lobectomy has become the gold standard in early
stage lung cancer treatment, but its role is still debated in case of locally
advanced disease (tumor larger than 5 cm, chest wall involvement, hilar
adenopathy, need for sleeve resection). The aim of this study was to evaluate
the main differences between VATS lobectomy performed for early stage
NSCLC and the ones performed for locally advanced disease. Methods: We
retrospectively analyzed patients that underwent VATS lobectomy for tumor
resection in our centre, from July 2011 till December 2015. Patients included
in the study were similar for demographic characteristics and for number of
resected lymph nodes. We performed 136 VATS lobectomies: 124 following
standard indications (group A); 12 following “extended” indications (group B).
Group B is composed by: 3 VATS sleeve lobectomy; 3 VATS lobectomy followed
by limited chest wall resection (hybrid technique); 6 VATS lobectomy for
NSCLC larger than 5cm. We evaluated the conversion rate to open surgery, the
intraoperative blood loss, the operation lenght, the chest drain maintenance
and the length of hospitalization. Results: Intra-operative conversion rate
was higher in group A than in Group B, but not statistically different (13,7%
vs 9%; p>0,05). No differences were detected in the intraoperative blood
loss. Instead we observed differences in terms of operation length, of chest
drain maintenance (4,8 vs 7,4 days; p