Journal Thoracic Oncology

Abstracts Journal of Thoracic Oncology • Volume 12 Issue S1 January 2017
POSTER SESSION 1 - P1.08: SURGERY
SURGERY FOR LOCALLY ADVANCED AND ADVANCED NSCLC –
MONDAY, DECEMBER 5, 2016
POSTER SESSION 1 - P1.08: SURGERY
SURGERY FOR LOCALLY ADVANCED AND ADVANCED NSCLC –
MONDAY, DECEMBER 5, 2016
P1.08-080 BILOBECTOMY FOR LUNG CANCER: ANALYSIS OF
INDICATIONS, POSTOPERATIVE RESULTS AND LONG-TERM
OUTCOMES
Domenico Galetta, Alessandro Borri, Roberto Gasparri, Francesco Petrella,
Lorenzo Spaggiari
Division of Thoracic Surgery, European Institute of Oncology, Milan/Italy
Background: Bilobectomy for lung cancer is considered a high risk procedure
for the increased postoperative complication rate and the negative impact on
survival. We analyzed the safety and the oncologic results of this procedure.
Methods: We retrospectively reviewed patients who underwent bilobectomy
for lung cancer between October 1998 and December 2015. Age, gender,
bilobectomy type and indication, complications, pathology, stage, and
survival were analyzed. Results: Bilobectomy was performed on 166 patients
(122 men; mean age, 62 years. There were 87 upper-middle and 79 middle-lower
bilobectomies. Indications were tumor extending across the fissure in 37
(22.3%) patients, endobronchial tumor in 44 (26.5%), extrinsic tumor or nodal
invasion of bronchus intermedius in 70 (42.2%), and vascular invasion in 15
(10%). An extended resection was performed in 25 patients (15.1%). Induction
therapy was performed in 47 patients (28.3%). Thirty-day mortality was 1.2%
(n=2). Overall morbidity was 43.4%. Mean chest tube persistence was 7 days
(range, 6-46 days). Overall 5-year survival was 58%. Significance differences
in survival were observed among different stages (stage I, 70%; stage II,
55%; stage III, 40%; p=.0003) and the N status (N0, 69%; N1, 56%; N2, 40%;
p=.0005). Extended procedure (p=.0003) and superior bilobectomy (p=.0008)
adversely influenced survival. Multivariate analysis demonstrated that an
extended resection (p=.01), an advanced N disease (p=.02), and an upper-mild
lobectomy (p=.02) adversely affected prognosis. Conclusion: Bilobectomy is
associated with a low mortality and an increased morbidity. Survival relates
to disease stage and N factor. Optimal prognosis is obtained in patients with
lower-middle lobectomy without extension of the resection.
Keywords: lung tumor, Bilobectomy, Surgery
P1.08-082 SURGICAL TECHNIQUES AND LONG-TERM RESULTS OF
THE PULMONARY ARTERY RECONSTRUCTION IN PATIENTS WITH
LUNG CANCER
Domenico Galetta, Alessandro Borri, Roberto Gasparri, Francesco Petrella,
Lorenzo Spaggiari
Division of Thoracic Surgery, European Institute of Oncology, Milan/Italy
Background: Pulmonary artery (PA) reconstruction for lung cancer is
technically feasible with low morbidity and mortality. We assessed our
experience with partial or circumferential resection of PA during lung
resection. Methods: Between 1998 and 2015, we performed PA angioplasty
in 150 patients with lung cancer. Seventy-five patients received induction
chemotherapy (IC). Partial PA resection was performed in 146 cases. PA
reconstruction was performed by running suture in 113 and using a pericardial
patch in 33. A circumferential PA resection was performed in 4 patients and
reconstruction was made in PTFE and by a custom-made bovine pericardial
conduit each. Bronchial sleeve resection was associated in 56 cases. Thirtytwo
patients had stage I disease, 43 stage II, 51 IIIA, and 17 IIIB. Seven patients
had a complete response after IC. Results: Thirty-day mortality was 3.3%
(n=5); two of these patients had a massive hemoptysis leading to death;
33 patients had pulmonary complications, 28 cardiac, 17 air leaks. Overall
5- and 10-year survival was 50% and 39%, respectively. Five- and 10-year
survival for stages I and II versus stage III was, respectively, 66% versus
32% and 56% versus 20% (p