Journal Thoracic Oncology

Abstracts Journal of Thoracic Oncology • Volume 12 Issue S1 January 2017
Yamagata/Japan
Background: Computed tomography (CT) can reveal small pulmonary nodules
of ≤ 2 cm. Nodules with a consolidation-to-tumor ratio (C/T ratio) ≤ 0.5 on
thin-section chest CT are generally recognized as noninvasive lung cancer.
However, estimations of C/T ratios on CT may vary between observers. Threedimensional
(3D) imaging can provide more accurate information than 2D-CT
for distinguishing noninvasive lung cancers. The aims of this study were to
determine the 3D-C/T ratios of small pulmonary nodules on 3D-CT images and
explore the relationship between 3D-C/T ratios and the histopathological
invasiveness of lung cancers. Methods: This was a retrospective analysis
of a total of 82 patients with lung adenocarcinoma who had a ground glass
opacity (GGO) on CT and underwent surgery from April 2013 to March 2016.
We constructed 3D tumor images and calculated the 3D-C/T ratios of GGOs
using a 3D analysis system (SYNAPSE VINCENT ® ; Fuji Film). The relationships
between 3D-C/T ratio and histopathological indicators of invasiveness were
evaluated. Pathological noninvasive cancer was defined as follows: no lymph
node metastasis (n[-]), no lymphatic invasion (ly[-]), no vascular invasion (v[-]),
and no pleural invasion (pl[-]). Results: 10 (12%) of 82 tumors were found to
be invasive by histopathology, with the following positive indicators: n(+) in 5
(6%), ly(+) in 3 (4%), v(+) in 2 (2%), and pl(+) in 6 (7%). The median 3D-C/T ratio
was 0.39. The mean 3D-C/T ratios by pathological findings were as follows:
n(+) 0.74 vs n(-) 0.35 (p < 0.01), ly(+) 0.74 vs ly(-) 0.36 (p = 0.06), v(+) 0.58 vs
v(-) 0.37 (p = 0.27), and pl(+) 0.57 vs pl(-) 0.35 (p = 0.04). The 3D-C/T ratios of
invasive cancer vs noninvasive cancer were 0.71 and 0.34, respectively (p <
0.01). By ROC curve analysis, a 3D-C/T ratio cutoff value of 0.43 provided a
sensitivity and specificity of 100% and 61%, respectively, for the diagnosis
of invasive cancer. Conclusion: This was a pilot study that evaluated the
usefulness of 3D-CT imaging for assessing the invasiveness of small lung
adenocarcinomas. A prospective observational study of 3D-CT imaging for
diagnosing invasive lung adenocarcinoma is warranted.
Keywords: C/T ratio, noninvasive lung adenocarcinoma, 3D-CT imaging,
SYNAPSE VINCENT®; Fuji Film
POSTER SESSION 3 – P3.04: SURGERY
MISCELLANEOUS I –
WEDNESDAY, DECEMBER 7, 2016
P3.04-006 THE EFFECT OF PREOPERATIVE MULTI-DISCIPLINARY
SUPPORT COMMENCED AT OUTPATIENT CLINIC ON LUNG CANCER
PATIENTS
Masafumi Kataoka 1 , Daisuke Okutani 1 , Ema Mitsui 1 , Miwa Baba 2 , Tamami
Okutani 3 , Haruyuki Kawai 4 , Kazuhiro Watanabe 4 , Takefumi Niguma 1 , Masashi
Koizumi 5 , Toshie Hiramatsu 6 , Michiyo Kayahara 6 , Sachiko Suda 6 , Toshinori
Ohara 1
1 Surgery, Okayama Saiseikai General Hospital, Okayama/Japan, 2 Anesthesiology,
Okayama Saiseikai General Hospital, Okayama/Japan, 3 Rehabilitation, Okayama
Saiseikai General Hospital, Okayama/Japan, 4 Internal Medicine, Okayama Saiseikai
General Hospital, Okayama/Japan, 5 Operation Room, Okayama Saiseikai General
Hospital, Okayama/Japan, 6 Nursing Department, Okayama Saiseikai General
Hospital, Okayama/Japan
Background: We assessed the effect of preoperative multi-disciplinary
support, commenced at the outpatient clinic of our hospital, on patients
with lung cancer. Methods: Since 2013, coaching on respiratory rehabilitation
is being provided to the lung cancer patients at our outpatient clinic. In
2014, preoperative multi-disciplinary support was introduced in addition
to rehabilitation support. Multi-disciplinary team consisted of an
anesthesiologist, a nutritionist, pharmacist, medical social worker, and
nurse. We examined 54 cases of primary lung cancer patients, undergoing
video-assisted lobectomy. Patients were classified into three groups: ‘no
support’; ‘rehabilitation alone’, and ‘preope rative support’. The ‘no support’
group received no preoperative support and included the last consecutive
18 cases before the introduction of preoperative support.The ‘rehabilitation
alone’ group included 18 consecutive cases, when no other support was
available. The ‘preoperative support’ group included 18 consecutive cases,
starting from the first patient receiving multi-disciplinary preoperative
support. Results: Data are presented in the following order: ‘no support’,
‘rehabilitation alone’, and ‘preoperative support’. Morbidity rates were 27.8%,
16.6%, and 0%, respectively. The number of days of postoperative hospital
stay were 11.3/10, 8.7/8, and 6.9/7 (average/median), respectively and there
was a significant difference among the groups (p=0.000266). Univariate
and multivariate analysis were performed according to the following
parameters: age, sex, stage, operation time, blood loss, days of raised body
temperature, postoperative complications, days of antibiotic treatment,
days with a chest drain, day of first walk postoperatively, clinical path, and
preoperative support. In univariate analysis, the number of days with a chest
drain, the day of first walk postoperatively, clinical path, and preoperative
support correlated with the postoperative stay in hospital. In multivariate
analysis, preoperative support was most strongly associated with a shorter
postoperative stay according to logistic regression analysis with backward
stepwise deletion. Moreover, there was a reduction in the overall medical
expenses per patient, in the preoperative support group (p=0.0405).
A postoperative questionnaire was administered to patients and their
families. Results showed that patients recognized the effect of preoperative
interventions on outcome and a shift in patient attitude, from a passive to an
active mindset, was observed. Conclusion: Preoperative rehabilitation and
nutritional support improve physiological function; anesthesiologist and
pharmacist review identify problems and improve strategy; and hearing and
explanation by nursing staff increase problem-solving capacity and coping
mechanisms of patients. These effects may result in a shorter hospital stay.
Keywords: perioperative care, multi-disciplinary support, lung cancer
POSTER SESSION 3 – P3.04: SURGERY
MISCELLANEOUS I –
WEDNESDAY, DECEMBER 7, 2016
P3.04-007 DETECTION OF BRAIN METASTASIS IN RESECTED LUNG
CANCER WITH THE NEW POSTOPERATIVE FOLLOW-UP PROGRAM
Rie Nakahara 1 , Haruhisa Matsuguma 1 , Ikuma Wakamatsu 1 , Kohei Yokoi 2
1 Division of Thoracic Surgery, Tochigi Cancer Center, Utsunomiya, Tochigi/Japan,
2 Thoracic Surgery, Nagoya University Graduate School of Medicine, Nagoya/Japan
Background: In our previous study, follow-up brain MRI for the detection of
early brain metastasis was examined every 2 months during the first 6 months
after operation until 1995. In the study, asymptomatic brain metastases
were found at the frequency of 2.3%. After that, the follow-up program was
changed as follows; brain MRI performed on a postoperative patient at two
points of 2-3 months (early check time) and 5-6 months (late check time) after
operation. We reviewed the detection rate of brain metastasis in the new
program. Methods: Between January 1996 and December 2009, 954 patients
with primary lung cancer underwent complete surgical resection. Of 954
cases, 712 received brain MRI in accordance with the new follow-up program.
The frequency, the point of brain metastases detection, treatment for
brain metastases, and prognosis were reviewed. Results: Of total 712 cases,
24(3.4%) patients with brain metastases were detected as initial recurrence
lesion with follow-up MRI. Seven of these 24 cases were detected at the point
of early check time (early group). The remaining 17 cases were detected at
the point of late check time (late group). In the early group, 3 patients had a
single metastasis and 1 had three lesions. The remaining 3 had more than four
lesions. On the other hand, 10 of 17 late group had a single metastasis and
5 had two or three lesions, and the remaining 2 had more than four lesions.
In early group, the pathological stagings were 2 stage1, 3 stage2, 2 stage3.
All cases of solitary metastasis and 1case of three metastatic lesions were
treated with stereotactic radiosurgery (SRS). Two cases with more than four
lesions were treated with whole brain radiotherapy (WBRT). In late group, the
pathological stagings were 5 stage1, 5 stage2, 7 stage3. All but 2 cases were
treated with SRS. The overall median survival time from thoracic surgery was
17 months in early group and 20 months in late group. Two cases from the
late group were recurrence free for 104 and 81 months. Conclusion: In early
group, they frequently had multiple brain metastases and were treated with
WBRT. On the other hand, in late group, a single metastasis was discovered
in many patients and was treated with SRS. Among them, some patients had
long recurrence-free survival. From these results, we changed postoperative
follow-up program for detection of the brain metastasis to check at only one
point of 5-6 months after operation.
Keywords: lung cancer surgery, Brain metastasis, follow-up program
POSTER SESSION 3 – P3.04: SURGERY
MISCELLANEOUS I –
WEDNESDAY, DECEMBER 7, 2016
P3.04-008 CATS: COMPUTED TOMOGRAPHY-ASSISTED
THORACOSCOPIC SURGERY - A NOVEL APPROACH IN PATIENTS
WITH DEEP INTRAPULMONARY LESIONS OF UNKNOWN DIGNITY
Peter Hohenberger 1 , Michael Kostrewa 2 , Kerim Kara 3 , Nils Rathmann 2 ,
Christian Manegold 4 , Charalambos Tsagogiorgas 5 , Stefan Schoenberg 2 ,
Steffen Diehl 2 , Eric Rößner 6
1 Div.Of Surgical Oncology & Thoracic Surgery, Mannheim University Medical Center,
Mannheim/Germany, 2 Mannheim University Medical Center, Institute of Clinical
Radiology and Nuclear Medicine, Mannheim/Germany, 3 Medical Faculty Mannheim,
University of Heidelberg, Fraunhofer Project Group for Automation in Medicine
and Biotechnology, Mannheim/Germany, 4 Mannheim University Medical Center,
Thoracic Oncology, Department of Surgery, Mannheim/Germany, 5 Mannheim
University Medical Center, Department of Anesthesia and Intensive Care Medicine,
Mannheim/Germany, 6 Mannheim University Medical Center, Department of
Copyright © 2016 by the International Association for the Study of Lung Cancer
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