Journal Thoracic Oncology

Abstracts Journal of Thoracic Oncology • Volume 12 Issue S1 January 2017
POSTER SESSION 3 – P3.04: SURGERY
MISCELLANEOUS I –
WEDNESDAY, DECEMBER 7, 2016
P3.04-021 READMISSION RATE IS NOT INCREASED WITH
SHORTENED HOSPITAL STAY AFTER LUNG CANCER SURGERY
Kei Yarimizu 1 , Kazuki Hayasaka 2 , Katsuyuki Suzuki 2 , Satoshi Shiono 1
1 Thoracic Surgery, Yamagata Prefectural Central Hospital, Yamagata/Japan,
2 Department of Thoracic Surgery, Yamagata Prefectural Central Hospital,
Yamagata/Japan
Background: In health economics, keeping costs down is a great concern. Early
discharge has been enabled after surgery for lung cancer by clinical pathways,
preoperative rehabilitation and the introduction of Enhanced Recovery After
Surgery (ERAS) protocols. However, even if a shortened hospitalization has
a benefit for hospital management, it has not been clarified whether it has
a good influence on the patient’s recovery after surgery. In this study, we
examined the relationship between a shortened hospitalization and patient
recovery after lung cancer surgery; in particular, we focused on the rate of
rehospitalization within 30 days after discharge. Methods: We investigated
the postoperative course of 318 patients who underwent lung cancer surgery
from April 2013 through February 2016. Based on the execution of ERAS, we
divided the patients into a shortened group (ERAS performed) and a usual
group (ERAS not performed), and compared the rates of rehospitalization and
postoperative complications. Results: There were 202 men and 116 women,
and their median age was 71 years. The shortened group contained 90 cases,
and the usual group contained 228 cases. Limited resections were carried out
in 19 of 90 patients in the shortened group and in 72 of 228 patients in the
usual group (p=0.06). The median duration of postoperative hospitalization
was 4 days in the shortened group and 6 days in the usual group (p < 0.001).
The incidence of complications was 23.3% (21/90) in the shortened group and
28.0% (64/228) in the usual group (p = 0.38). The rate of rehospitalization
within 30 days after surgery was 6.7% (6/90) in the shortened group vs 4.4%
(10/228) in the usual group (p = 0.40). In addition, one case in each group
required rehospitalization within one week after discharge; thus, there was
no significant difference in incidence between groups. Conclusion: Health
economics is different throughout the world. The timing of discharge depends
on the discretion of each institution. Although this study was carried out in a
non-randomized setting, we revealed that a shortened hospital stay did not
increase the postoperative complication and readmission rates of patients
who underwent surgery for lung cancer. Shortening of hospital stay by the
introduction of ERAS and other challenges could provide a benefit for patient
and hospital management.
Keywords: lung cancer, Enhanced Recovery After Surgery (ERAS) protocols,
rehospitalization, shortened hospital stay
POSTER SESSION 3 – P3.04: SURGERY
MISCELLANEOUS I –
WEDNESDAY, DECEMBER 7, 2016
P3.04-022 UNEXPECTED RESIDUAL CARCINOMA IN THE
BRONCHIAL STUMP AFTER SURGERY FOR LUNG CANCER
Yohei Kameda 1 , Michihiko Tajiri 1 , Junya Morita 1 , Kimihisa Shiino 1 , Yoko
Kojima 2 , Hiromasa Arai 1 , Koji Okudela 2 , Yoichi Kameda 3 , Munetaka Masuda 4
1 General Thoracic Surgery, Kanagawa Cardiovascular and Respiratory Center,
Yokohama/Japan, 2 Yokohama City University Graduate School of Medicine,
Yokohama/Japan, 3 Pathology, Kanagawa Cardiovascular and Respiratory Center,
Yokohama/Japan, 4 Surgery, Yokohama City University Graduate School of Medicine,
Yokohama/Japan
Background: Surgery for lung cancer should result in no residual carcinoma
in pulmonary vessels and the bronchial stump of the isolated lung.
Intraoperative frozen diagnosis of the surgical bronchial stump is usually
not scheduled unless there is a short distance between the tumor and the
predetermined bronchial cutting line in postoperative chest computed
tomography (CT). Rarely, unexpected microscopic residual carcinoma in
the surgical bronchial stump is observed after surgery. Additional radiation
therapy for the bronchial stump in such cases is controversial because of the
high risk for bronchopleural fistula. Methods: From April 2000 to March 2015,
1169 consecutive patients with non-small lung cancer underwent surgeries
(133 segmentectomy, 986 lobectomy, 13 bilobectomy, 37 pneumonectomy)
for non-small cell lung cancer at our hospital. Among these cases, 7 (0.6%)
had a bronchial stump with residual cancer cells. The clinicopathological
characteristics and outcomes of these patients were investigated
retrospectively. Results: Six of the 7 cases had undergone lobectomy
and one received pneumonectomy. Histologically, there were 4 cases of
adenocarcinoma and 3 of squamous cell carcinoma. Four cases were stage
IIIA (pT1aN2M0, pT3N2M0, pT2aN2M0, pT1bN2M0), two were IIA (pT1aN1M0,
pT2aN1M0), and one was IB (pT2aN0M0). All cases had lymphatic invasion
microscopically. All 7 cases developed recurrence or distant metastasis. One
had local recurrence at the bronchial stump and 6 had distant metastasis (2
in brain, and 1 each in lymph nodes, chest wall, ribs, and pericardium). Three
cases received postoperative treatment of radiotherapy for the bronchial
stump only, radiotherapy for the mediastinum and chemotherapy, and
cytotoxic chemotherapy only, respectively. Bronchopleural fistula did not
occur as an adverse effect. Six of the patients died due to cancer progression.
The patient with lymph node metastasis is alive and under treatment with TKI
therapy. In all cases, bronchial wall thickness suggesting tumor invasion was
not found on a preoperative CT scan, and preoperative bronchoscopic findings
showed a normal bronchial mucosa. Conclusion: In surgical cases of non-small
cell lung cancer, microscopic residual cancer at the surgical bronchial stump
was found at a rate of 0.6%. Such cases tended to have relapse as distant
metastasis, rather than local recurrence. Preoperative evaluation of bronchial
invasion is straightforward, but the postoperative treatment strategy is
uncertain. In postoperative follow-up, systemic evaluation of the local region
and distal organs is necessary.
POSTER SESSION 3 – P3.04: SURGERY
MISCELLANEOUS I –
WEDNESDAY, DECEMBER 7, 2016
P3.04-023 PERIOPERATIVE MANAGEMENT OF ANTIPLATELET
THERAPY IN PATIENTS WITH CORONARY STENT WHO NEED
THORACIC SURGERY
Shunki Hirayama 1 , Takeshi Matsunaga 2 , Kazuya Takamochi 1 , Shiaki Oh 1 , Kenji
Suzuki 1
1 Department of General Thoracic Surgery, Juntendo University School of Medicine,
Tokyo/Japan, 2 General Thoracic Surgery, Juntendo University School of Medicine,
Tokyo/Japan
Background: Guidelines recommend delaying noncardiac surgery in patients
after coronary stent procedures for 6 -12 months after drug-eluting stents
(DES) and for 6 weeks after bare metal stents (BMS). It is often replaced by
bridging heparin for the prevention of perioperative stent thrombosis in
Japan, although there is no evidence for heparin replacement. The aim of this
study was to investigate the perioperative complication between the patients
with continuation of antiplatelet therapy (APT) and that with substitution
of heparin after interruption of APT in thoracic surgery. Methods: A
retrospective study was done on 75 patients after coronary stent procedures
performed thoracic surgery with APT or bridging heparin in perioperative
from June 2008 to October 2015. We evaluated the perioperative outcomes
between the patients with APT (APT group) and that with bridging heparin
interrupting APT (non APT group). Results: Males were 13 cases (76%) and
median age was 73.5 years in APT group. Fifteen cases (88%) with APT
had angina in past history. The type of stent was drug eluting stent (71%),
bare metal stent (24%) and biological absorption stent (6%) in APT group.
Surgical procedures with wide wedge resection (12%), segmentectomy (12%),
lobectomy (71%), and others (6%) were performed in APT group. Median
operative time was 119 minutes and median operative blood loss was 18ml
in APT group. There was no difference with operative time and blood loss in
APT group compared in non APT group (p=0.128 and p=0.923). Cardiovascular
events was not observed in both groups. One case had Hemothorax and
reoperation in APT group and one case had hemosputum in non APT group.
There was no difference in complication in both groups. Perioperative death
was not observed in both groups. Conclusion: There was no difference
between the patients with and without the discontinuation of antiplatelet
agent in perioperative cardiovascular and embolic events. On the other hand,
it seems that the compensatory of bleeding to continue antiplatelet agent is
too large, because a few cases were forced completion pneumonectomy and
acute exacerbation of interstitial pneumonia due to bleeding. Among the
patients with coronary stent undergoing thoracic surgery, it might be less the
benefits of the surgery with continuation of antiplatelet agent.
Keywords: Thoracic Surgery, antiplatelet therapy, coronary stent
POSTER SESSION 3 – P3.04: SURGERY
MISCELLANEOUS I –
WEDNESDAY, DECEMBER 7, 2016
P3.04-024 LONG-TERM OUTCOME OF SUBLOBAR RESECTION
VERSUS LOBECTOMY FOR STAGE I AND II NON-SMALL CELL LUNG
CANCER
Su Kyung Hwang, Seung-Il Park, Dong-Wan Kim, Yong-Hee Kim, Se Hoon Choi,
Hyeong Ryul Kim
Department of Thoracic and Cardiovascular Surgery, Asan Medical Center,
University of Ulsan College of Medicine, Seoul/Korea, Republic of
Background: Lobectomy is conventional lung resection surgery for lung
S734 Journal of Thoracic Oncology • Volume 12 Issue S1 January 2017