Abstracts 4. Gemeinsamer Jahreskongress der ... - SWISS KNIFE

More documents

Recommendations

Info

swissknife spezial 06 12.06.2006 13:39 Uhr Seite 22 resection area (n=16) or port sites (n=2). In 17 patients (81%) postoperative complications occurred such as infections (n=10, 48%), arrhythmia (n=4, 19%), bleeding (n=2, 10%) and patch avulsion (n=1, 5%). Overall 1-year-survival was 46%. In the trimodal treatment group 1year-survival was 72% and 25% after 2 years. Tumor recurrence was seen in 12 patients (57%), in 11 cases (52%) local recurrence and in 9 cases (45%) distant metastasis. Tumor recurrence was detected in 44% after one and 75% after two years. 3At diagnosis the majority of patients have already advanced stage disease and palliative approachs remain the only option. In the subpopulation of patients with early stage disease which underwent trimodal therapy 30% were free of recurrence after two years. Compared to historic collectives distant metastasis was more frequent. Future directions with more powerful tools for early detection and more effective systemic therapy will further improve longterm survival. 11.02 R. Wirth 1 , R. Kuster 2 , C. Öhlschlegel 3 , W. Nagel 2 1 Department of Surgery, Kantonsspital St.Gallen, 9000 St.Gallen/CH, 2 Klinik für Chirurgie, Kantonsspital St.Gallen, St.Gallen/CH, 3 Pathology, Kantonsspital St.Gallen, St.Gallen/CH Extrapleurale Pleuropneumonektomie – erste Erfahrungen im Rahmen eines multimodalen Regimes Objective: Maligne Pleuramesotheliome (MPM) stellen eine seltene und aggressive Erkrankung mit einer steigenden Inzidenz dar. Die single-modale Therapie konnte keine Verbesserung der medianen Überlebenszeit aufzeigen. Ziel der vorliegenden Arbeit lag in der Überprüfung des peri- und postoperativen Verlaufes im Rahmen eines trimodalen Therapieansatzes. Methods: Retrospektive Untersuchung von 11 konsekutiven Patienten (alle männlich), welche aufgrund eines MPM, zwischen 2002-05 behandelt wurden. Analyse sowohl des prä- und perioperativen Verlaufes wie auch der postoperativen Mortalität und Morbidität nach extrapleuraler Pleuropneumonectomie (EPP) nach median 6 Monaten (Range 1-35). Results: Das mediane Alter lag bei 61 Jahren (Range 48-67). Eine Asbestexposition konnte in 91% der Fälle bestätigt werden. Thorakale Schmerzen (64%), Gewichtsverlust (64%) und Dyspnoe (55%) waren die am häufigsten geäusserten Symptome. Bei 82% der Patienten lag präoperativ ein Pleuraerguss vor, dessen Zytologie erbrachte nur in 33% einen positiven Befund. Alle Patienten wurden im Rahmen des trimodalen Regimes neoadjuvant mit 3 Zyklen Cisplatin/Alimta (82%) resp. Cisplatin/Gemzar (18%) vorbehandelt. Ergänzend an die EPP erfolgte bei 2 Patienten eine Thoraxwand- und bei einem eine Leberteilresektion. Die mediane OP-Dauer lag bei 380 Minuten (Range 195-500). Eine R0-Resektion war in 73% möglich. Bei 73% der Patienten lag ein T3, bei 18% ein T4 und bei 9% ein T1-Stadium vor. Positive Lymphknoten zeigten 3 von 11 Patienten. Histologisch lag in 46% der Fälle eine epitheliale, in 36% eine gemischte und in 18% eine desmoplastische Differenzierung vor. Zu Major- oder Minorkomplikationen kam es in 91% wobei persistierende thorakale Schmerzen (63%) und Vorhofflimmern (45%) am häufigsten vorkamen. In 36% war eine Folge-OP aufgrund von Komplikationen notwendig. Ein Patient verstarb 2 Tage postoperativ an einem Myokardinfarkt. Bei 63% der Patienten erfolgte adjuvant eine Radiatio. Im Verlauf zeigten 46% der Patienten ein Rezidiv des Tumors. Im weiteren Verlauf verstarben 2 Patienten tumorbedingt nach 7.5 resp. 15.1 Monaten. Conclusion: Die EPP stellt im Rahmen eines trimodalen Regimes bei ausgewählten Patienten eine sichere chirurgische Therapie dar, wobei jedoch die postoperative Phase durch persistierende Thoraxschmerzen stark eingeschränkt wird. Die Mortalität kann durch frühes Erkennen von Komplikationen deutlich minimiert werden. 11.03 P. Kestenholz 1 , A. Soltermann 2 , H. Steinert 3 , W. Weder 4 1 Department for Surgery, Division for thoracic surgery, 8091 Zurich/CH, 2 Department of Pathology, Institut for clinical Pathology, 8091 Zurich/CH, 3 Department for Radiology, Division for Nuclear Medicine, 8091 Zurich/CH, 4 Department of Thoracic Surgery, University of Zurich, Zurich/CH FDG PET/CT in malignant pleural mesothelioma: is there a histological difference between hot and cold areas? Objective: The role of a FDG PET/CT scan to evaluate the effect of induction chemotherapy in malignant pleural mesothelioma is unknown. The FDG uptake in the tumour varies at different sites. A behaviour which is oncological undetermined. The aim of this study is to investigate areas with high and low FDG uptake using histology. Methods: Patients with malignant mesothelioma who underwent talc pleurodesis at the time of diagnosis and who underwent induction chemotherapy followed by extrapleural pneumonectomy were included. A FDG PET/CT scan was performed prior to surgery. Biopsies were taken at areas of maximum (SUV max) and low FDG uptake at the extrapleural pneumonectomy specimen by the surgeon. The biopsies were assessed by the pathologist in a blinded fashion. The following criteria were evaluated in a semi-quantitative manner: tumour type, tumour mass, vitality of tumour cells, vascularisation and chronic inflammation. Results: Fourteen patients were analysed so far. H&E staining did not show a difference at areas with high and low FDG uptake in respect to tumour burden, vitality of tumour cells, chronic inflammation or neo-vascularisation. The results of the immunohistological staining are pending. Conclusion: Surprisingly conventional histological staining did not show any differences between areas of high or low FDG uptake in malignant pleural mesothelioma after talc pleurodesis and induction chemotherapy. The results of the immunohistological analysis may deliver further information. 11.04 D. Petermann 1 , G. Allenbach 2 , S. Schmidt 3 , I. Letovanec 4 , M. Christodoulou 1 , A. Bischof Delaloye 2 , J. Prior 5 , H.B. Ris 6 1 Chirurgie Thoracique et Vasculaire, CHUV, 1011 Lausanne/CH, 2 Médecine Nucléaire, Centre Hospitalier Universitaire Vaudois, Lausanne/CH, 3 Service De Radiologie, Centre Hospitalier Universitaire Vaudois, Lausanne/CH, 4 Pathologie, Centre Hospitalier Universitaire Vaudois, Lausanne/CH, 5 Médecine Nucléaire, Centtre Hospitalier Universitaire Vaudois, Lausanne/CH, 6 Service De Chirurgie Thoracique et Vasculaire, CHUV, 1011 Lausanne/CH 22 swiss knife 2006; special edition Value of PET in planning full-thickness chest wall resections for malignant diseases Objective: To assess the usefulness of positron emission tomography (PET) for planning surgical resections for patients with chest wall malignancies. Methods: We retrospectively evaluated patients who had full-thickness chest wall resection for tumors performed at our institution between January 2004 and December 2005. Out of 27 patients, 16 had pre-operative PET for planning of the resection. The tumor size measured by PET was compared to CT or MRI findings as well to the pathological results. For each modality the tumor size was measured by assessing the two largest perpendicular tumor extensions in the chest wall plane and the tumor size was calculated accordingly. Linear regression analysis and Wilcoxon signed rank test were performed in order to compare the tumor size measurements obtained by PET, CT or MRI and histology, respectively. Results: There were 12 women and 4 men with a mean age of 57 years. Ten patients had chest wall tumors related to breast cancer, 4 to metastasis and 2 to chest wall sarcoma. The mean chest wall defect after resection was 94cm2 (range 25-227cm2). CT and MRI findings consistently overestimated the tumor size as compared to histology (p 70 years Objective: Advanced age does not exclude patients from lung resection but has been associated with a high perioperatory mortality, especially after pneumonectomy (P). Sleeve resec
swissknife spezial 06 12.06.2006 13:39 Uhr Seite 23 tion (SR) could be an option in order to reduce the postoperatory mortality. We retrospectively evaluated the 30 days-morbidity and mortality after sleeve resection and pneumonectomy in patients > 70 years. Methods: The clinical records of patients with pneumonectomy or sleeve lobectomy performed at our institution between 1999-2005 were reviewed. 140 patients were assessed. SR were considered in 57 patients, and P in 83. Eleven patients > 70 years underwent pneumonectomy and 16 sleeve resections. The median age in P and SR group was 73 years (range 70-79) and 74.5 years (range 70-81), respectively (p=0.23). NSCLC was the predominant indication. The P and SR population revealed diabetes in 18% and 12.5%, COPD in 45% and 19%, and coronary artery disease in 9% and 31.5%, respectively (p=0.8). Results: The 30 days mortality after P and SR was 18% and 0%, respectively. Minor complications after P and SR was 19% (2 arythmia) and 50% (3 pneumonia, 5 arythmia), respectively. Major complications were 19% (1 myocardial infarction, 1 acute pulmonary oedema) and 12.5% (2 myocardial infarction), respectively. Conclusion: Sleeve resection in elderly patients > 70 years is associated with a lesser mortality than with pneumonectomy and should be preferred over pneumonectomy if possible. 11.08 T.C. Roth 1 , T. Weber 1 , B. Hoksch 1 , F. Jungling 2 , M. Korner 3 , R.A. Schmid 1 1 Division of General Thoracic Surgery, University Hospital, 3010 Berne/CH, 2 Division of Nuclear Medicine, University Hospital, 3010 Berne/CH, 3 Division of Pathology, University Hospital, 3010 Berne/CH Hoarseness caused by cancer metastasis to the vagus nerve Objective: Intraneural metastase are rarely reported. Methods: A 42-year-old woman complained of hoarseness and cough. Laryngoscopy revealed paresis of the left vocal cord. 19 years earlier, a malignant melanoma of the left lower limb had been excised, associated with inguinal lymph node dissection and local chemotherapy. 10 years later, an invasive ductal carcinoma (T1 N1 M0 G2) of the right breast was diagnosed. Treatment included lumpectomy with axillary lymph node dissection and adjuvant radiochemotherapy. 4 years after this procedure, tumor relapse and necessitated a radical rightsided mastectomy with adjuvant chemotherapy. Thereafter, no recurrence of both cancers was observed. In order to clarify the origin of the isolated recurrent pharyngeal nerve palsy a CT of the chest and abdomen was performed. The CT revealed only some paratracheal lymph nodes. The suspicion of lymph nodes metastases was not confirmed in the mediastinoscopy. 6 month later, it was decided to perform a FDG-PET, which clearly depicted a solitary focal uptake in the hilar region of the left lung. In view of discrepant CT and PET findings, a diagnostic thoracoscopy was performed. During this procedure, a suspicious thickened-hardened area of the vagus nerve at the aortic arch were excised. Histologic examination showed extensive intraneural infiltration of the vagus nerve by a solid adenocarcinoma, compatible with a metastasis of the invasive ductal carcinoma. Results: The vast majority of malignant tumors metastasize to the brain, whereas metastases to cerebral nerves outside the base of the skull or peripheral nerves are rare. If peripheral nerves are affected by metastatic lesions, dysfunction is preferentially caused by direct nerve compression or secondary infiltration of the nerve by extraneurally located metastases. Only few cases of intraneurally located metastases have been described. Our case is exceptional, because the only clinical symptom was a vocal cord paresis, no lymph node metastases or evidence of any tumor manifestation were found and the solitary metastasis was strictly located inside the nerve, which may implicate a hematogenous tumor spread. Conclusion: Although rarely observed, solitary metastatic lesions of cerebral and peripheral nerves should be considered as metastatic sites in patients with a history of malignancy. FDG- PET may help to detect small lesions which are not visualized by CT-scan. 11.09 O. Pittet1, D. Michod 2 , T. Krueger 3 , H.B. Ris 4 , C. Widmann 2 1 Service De Chirurgie Viscérale, Centre Hospitalier Universitaire Vaudois, 1011 Lausanne/CH, 2 Department of Cellular Biology and Morphology, Univeristé de Lausanne, Lausanne/CH, 3 Service De Chirurgie Thoracique, Centre Hospitalier Universitaire Vaudois, Lausanne/CH, 4 Service De Chirurgie Thoracique et Vasculaire, CHUV, 1011 Lausanne/CH TAT-RasGAP 317-326 peptide selectively enhances the photodynamic effect of m-THPC on human malignant mesothelioma cells Objective: Photodynamic therapy (PDT) has been tested as a new treatment modality for pleural mesothelioma, however, tumor selectivity is still insufficient for its clinical application. TAT-RasGAP 317-326 peptide has the potential to specifically sensitise tumour cells to the cytotoxic action of several genotoxins. We hypothesised that the PDT effect on human mesothelioma (H-Meso1) cells may be selectively enhanced in the presence of TAT-RasGAP 317- 326. Methods: H-meso1 cells and human fibroblasts, respectively, were exposed to different treatment modalities: light delivery, mTHPC + TAT-RasGAP 317-326, TAT-RasGAP 317-326 + light delivery (control groups); mTHPC + light delivery, mTHPC + TAT-RasGAP 317-326 + light delivery. mTHPC was added to the culture medium at a fixed concentration of 0.04 mg/ml for 24 hours. Non-thermal light delivery was performed at 652 nm with a fluence of 3J/cm2 and a fluence rate of 40mW/cm2. TAT-RasGAP 317-326 was added to the culture medium at a concentration of 20 mm. Apoptosis rate was determined by scoring the number of cells displaying pycnotic nuclei.H-meso1 cells and human fibroblasts, respectively, were exposed to different treatment modalities (control groups, PDT only and PDT + the peptide). mTHPC was added to the culture medium at a fixed concentration for 24 hours. Light delivery was performed with a fluence of 3J/cm2. TAT-RasGAP 317-326 was added to the culture medium at a concentration of 20 mm. Apoptosis rate was determined by scoring the number of cells displaying pycnotic nuclei. Results: H-meso-1 cells revealed an apoptosis rate of 7.5% in control groups. After mTHPC- PDT, the apoptosis rate was higher than in controls (14.9%, p
Page 1 and 2: swissknife spezial 06 12.06.2006 13
Page 21: swissknife spezial 06 12.06.2006 13

Abstracts 4. Gemeinsamer Jahreskongress der ... - SWISS KNIFE

You also want an ePaper? Increase the reach of your titles

Delete template?

Save as template?