O-178 Morbidity and mortality of pneumonectomy for lung cancer:Neoadjuvant chemotherapy does not increase the risk of postoperative complications

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Morbidity and mortality of pnegrnonsctomy for lung cancer: NeoadJuvant chemotherapy does not Increase ths risk of postoperative compllceUons

M. GIo_aowski. M ZmijeJvski. R Wlodarcryk. K Piech. M Tumid. K Zajda. D Kowalski. M Murawska. A Pietraszek The Maria Curie-Sldodowska

between typical and atypical can~noid. 3) The incidence of local recurrence is associated with surgical resection in atypical caroinoid tumors T~lOal c

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Memoria/ Cancer Center and/nstYtute of Oncology, Warsaw, Poland Background: Recent reports suggest that neoadjuvant therapy for lung cancer may increase the risk of posts)neumonectomy complications The aim of this study was to evaluate morbidly and mortality of pneumonectomy and the possible influence of neoadjuvant chemotherapy Ms/hods: We reviewed all patients undergoing pneumonoctomy for lung can car at a single institution between 1997 and 2003. oomparlng the complication rates between patients wRh and v~thout nooadJuvant chemotherapy. Statistical analysis included Fisher's exact test. Student's t test and Mann Whithpy test. Rssults: 137 patients underwent pnoumonectomy for lung cancer: 38 ( 28%) received nooadjovant chemotherapy. 32J137 (23%) pneumonoctomies were extended: 22 intrapercarcial (3 w~h atnal resection). 9~0(Izableural. 1 with chest well rasection There no significant cifferences in patient age. se~. histology, performance status, preoperative FEV-I. and type of pneumonectomy ( extended vs not. right vs left. lymphadenectomy vs sampling) between the groups with and without neoadjuvant tTeatment Total mortality rate was ,5 8%: total morbidly rate was 35 8% after pneumonectomy with no significant cifference between the groups (5 1%vs7 9% p 068: 354%vs368% p 1) 8 patients died in the postoperative pedod: we observed 11 cases of postoperatwo bleeding recluirlng rethoracotomy. 3 of postpnoumonectorny empyema; 10 of pneumonia. 4 of chylotherax. 1 myocardial infarct. 15 sopravenblcular arrhytmias. 1cerebral sb'oke, lgasthc perforation. 2 of psychiathc cNsturbanoes and 3 cases of vocal cord paralysis. The mocian length of hospital stay was 12 days (12 vs 13 in the groqos). Penoperatrve blood Izansfus~ons were significantly greater in the nooadJuvant treatment group (,o<0.001). There was no s~grlficant difference in the rate of post~)neumonectomy complications after left vs right pneumonectomy (p

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Conduslons: In our experience neoadjuvant chemotherapy does not increase the overall mortality and morbidity after pneumonoctomy for lung cancer There is no significant diffrence between right and left pneumonectomy in regard to postoperative complications Neoadjuvant chemotherapy increases the amount of perioperatJve blood transfusions "[yplcel and atypical cerclnold tumors (NEC grades 1 and 2): Prognostic factors In metastases and local recurrence J. Matilla Gortz~loz I . M. Garc~'a Yusto. N. MorenoMata. R Rodriguoz. J Maf~. R An-abal. A Varela. R Moreno~alsalobre. E: Mamhers ITharac/c

Surge~ R a ~ y Cajal Hosptfal, Madrid, Spain, 2Thoracic Surge~ Unlvers~tary Hospttal, Valladol/d, Spare, 3 Thotac/c Surge~ Gregono MarathOn Hospital, Madrid, Spain, ~Thoracic Surgery, D, Neg#n Hosptfal, Las Palmas, Spare, ~ Thotac/c Surge~ Un/versttary Hospital, A//canto, Spare, ~ Thorac/c Surge~ Carlos Haya Hospital, M~laga, Spain, 7 Thoracic Surgery, Puerta de H/erro Hosp/taJ, Madrid, Spa/n, eThoractc Surge/y, La Pnncesa Hospital, g Madnd, Spa/n, EMETNE SEPAR, Barce/ona, Spare ObJsctlve: To determine the influence of several prognostic factors in typical and atypical carcinold lung tumors (NEC 1 and 2) in the presence of metastases and local recurrence. Msthods: 765 patients treated surgically 569 Typical car~noid (TC). 92 atypical carclnold (AC). 40 large call noureendocrlno carcinomas (LCNEC) and 62 small call nouroendocrlne carcinomas (SCNEC) were collected for us from 1980 to 2002 The clinical variables considered to comparative analysis were: tumor size. factor T. nodal af~ctation, pathologic stage, rase~on and survival The statistical analysis was performed with an SPSS program (Statistical Package for Social Sciences) 12.5; Chi test and Student's t tests were camod out. Survrval was calculated by the KaplarPMeior method. Lo~rank tests were used for comparisons of ~nctions of survrval between factors. A p value ~< 0.05 was considered significant. Results: 9/569 (1 6%) patients with TC and 1,5,'92 (163%) with AC had metastatic recurrence Co 0 0000): 5/569 (0 8.7%) typical and 3/92 (3 2%) atypical had local recurrence (p 0 1541) Survival at ,5 and 10 years, patients without/with metastases: typical ceroinoid: 96 and 95 27% / 100 and 33 33% (p 0 000(3): atypical carcinoid: 92 98. and 92 g8%U31 2,5 and 0% Co 0 0000) Alive with metastases: typical ceroinoid 5/9 (,55 5%) (7 to 43 months): atypical caroinoid 3,'15 (20%) (35 to 60 months) Influence of prognostic factors in the presence of metastases and local recurrence. (Table v~th p). Conclusions: 1) In the presence of metastases: the gradual loss of structure of histological pattern had statistical s~gr~ficance; the tumoral size in typical carolnoid, stage (size and nodal affectation) in atypical carcinoid. 2) The treatment of metastases is asscolated with Iong~erro survival, with dfferences

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IntraoperaUve rapid detection of lymph node mlcromstastasls using flow cytomeb'y In non-small cell lung cancer

Y. Minamlya. M. Ito. H. Saito. H. Imal. H. Kawal. J. Ogawa. Al~ta Un/versrty

School ot Med/cme, Alota C~ty, Japan ObJedlve: The objective of this study was to determine whether cytokerafin (Cl~-positive call dete~on using flow cytometry (FCM) to diagnose nodal metastases could provide detection in a time frame suitable for intTaoperetiva decision making in non-small cell lung cancer (NSCLC) Methods: We studied 100 lymph nodes from 20 patients with NSCLC Five lymph nodes from each patient were randomly selected for this study The lymph nodes were divided into three pieces in a longitudinal section One piece was for FCM. one piece was for imrnunohistochomical staining, and one piece was for conventional homatoxylin & eosin staining. CK~osltive calls were detected with FCM and immunohistochemistry using antiCK antibody AE1/AE3. We considered CK~)osltive calls in lymph nodes with the capsule removed to be tumor calls in FCM. Results: CK~)osltivo nodes were detected by FCM within forty minutes. Eight of 100 lymph nodes wore positrve (8%) and four of 20 patients were node positive in conventional histological e0(amination Thirty-threa of 100 lymph nodes were positive (33%) and 13 of 20 patients were node pusrdve in immunohistochemicel CK staining On the other hand. 38 of 100 lymph nodes (38%) were positive and 14 of 20 patients were node positive in FCM CK-positive cell detection All posithte nodes in conventional and immunohistochemistTy were also posrdve in FCM Conclusion: In our study, we were able to rapidly detect CK~)ositJve nodes in patients wtth NSCLC. FCM detect)on of CK~)os~tive calls was correlated w~h the immunotlstochomical detect)on of CK positrve calls in the lymph node. Furthermore. the sensitivity of the FCM method was higher than that of a conventional histological examination and the immunohistochomical method. Our preliminary study indicates that we can apply FCM detect)on of CK. positive cells to ihtraoperatlve rapid ciagnosls of nodal metastases in NSCLC. [0~]

Devsloplng a strategy to Increase lung cancer ressctlon ratss

N O'Rourke S Buchanan West of Scotland Lung Cancer Network,

G/asc_:jow, UK Background: Scotland leads the international tables for beth incidence and mortal~:y from lung cancer and the survival gap v~th Europe is continuing to w/den. National audit data demonstrate that treatment rates in general are low in Scotland and that specifically surgical resection rates fall short of European and North American figures. The Scottish data for 1995 showed a 12% resection rate while updated figures published in 2002 had ~ l e n to 10.1%. The 2002 data also demonstrated statistically significant differences in survrval between different geographical areas, with these hospitals with higher resection rates having better survival The West of Scotland Lung Cancer Network aims to increase lung cancer survival in the region and is now developing a stTategy to increase lung cancer resection rates Method: From 2003 the Lung Cancer network has been under/airing prospective audit of all new lung cancer patients diagnosed within the region This data records time to diagnosis, stage of disease, performance status. ca-morbidity, whether multidisciplinary teams have pianned the management. treatment given and outcome. Data collect)on for the frst year has been completed for 12 hospitals in the region and for the purposes of our surgical strategy we have analysed resection rates with respect to access to surgeons in different hospitals. We have also recorded time between presentation and surgery, highlighting where there are delays in the system which may in