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112P POST-PNEUMONECTOMY CAVITY: IS THERE STILL A CAVITY?
S48 Conclusions: Increasing proportion of lobectomies, including those performed for malignant diseases, is done by VATS. With proper patient selection conversion to thoracotomy is rarely needed. Faster recovery compared to open lobectomy can be expected. Still, longer follow-up is warranted to evaluate survival data after cancer VATS lobectomies. 111P SHORT-TERM AND LONG-TERM RESULTS OF SURGICAL MANAGEMENT IN ELDERLY LUNG CANCER PATIENTS (OVER 70 YEARS): OUR EXPERIENCE D.V. Bazarov, S.P. Grisorieva, V.D. Parshin Thoracic Division, National Research Centre of Surgery, Moscow, Russian Federation Background: Lung cancer is mainly disease in advanced age. Operability of lung cancer patients (LCP) in the age of 69 years varies from 10% to 30%, and in patients over 70 years does not exceed 4%. The aim of this study was to evaluate results of operations in LCP over 70 years. Methods: From 1975 to 2008, 142 lung cancer patients over 70 years were operated. There were 114 male and 28 female, the most senior patient was 84 years old. The central localization of a cancer was present in 77 patients, and peripheral in 65. Distribution of patients through stages was the following: stage I in 19 patients, stage II in 65, stage III in 44, and stage IV in 7. Seven patients had metastatic tumours. The vast majority of patients were operated from epidermoid cancer and adenocarcinoma, 92 and 35 patients, accordingly. A total of 143 operations in 142 patients included 71 lobectomy, 7 bilobectomy, 25 pneumonectomy, 27 marginal excisions (5 patients had precision removal of tumour and 3 patients endoscopic operations), 2 bronchoplastic lobectomy and 11 explorative thoracotomy with biopsy. Results: As short-term results, various complications after operations were observed in 23 cases (16%). Ten patients have died (7%). Mortality was due to pleural empyema (3), pneumonia (2), pulmonary embolism (2), postoperative bleeding (1), pulmonarycardiac failure (1), and gastric hemorrhage (1). Long-term results demonstrated 3-year survival rate of 65%, after pneumonec52%, lobectomy 72%, and marginal excisions 75%. tomy 5%, The 5-year survival rate was 34%, after pneumonectomy lobectomy 41%, and marginal excisions 52%. A median survival was 47 months. Conclusions: Elderly and senile age is not contraindication for surgical treatment of lung cancer. It is necessary to consider functional reserves of cardiovascular and respiratory systems and comorbid diseases. The volume of operation in this group of LCP should not exceed lob- or bilobectomy. 112P POST-PNEUMONECTOMY CAVITY: IS THERE STILL A CAVITY? D. Stavroulias, L. Ampollini, V. Balestra, F. Gussago, E. Internullo, L. Cattelani, P. Carbognani, M. Rusca Surgical Science, Thoracic Surgery, Parma, Italy Background: Mediastinal shift is common after pneumonectomy and herniation of the remaining lung into the opposite hemithorax has been consequently reported. We present a complete left lung herniation into the contralateral hemithorax after intrapericardial right pneumonectomy for NSCLC. Methods: A 60-year-old man with a 40 pack/year smoking history, was admitted for recurrent hemoptysis. He had no history of previous disorders. Physical examination and routine laboratory tests showed normal results. A mass lesion in the right hilum was observed on chest X-ray. Chest CT-scan revealed a 6-cm tumour mass infiltrating the inferior and median lobe adjacent to the inferior pulmonary vein at its origin and right pulmonary artery.
Early and locally advanced NSCLC Results: Fiberoptic bronchoscopy disclosed an obstruction of the intermediate bronchus just below the origin of the superior lobar bronchus; pathology results of the biopsy showed squamous cell carcinoma. He underwent a postero-lateral right thoracotomy; a centrally located tumour invading the pericardium was observed on exploration. An intrapericardial right pneumonectomy was performed; an intercostal muscle flap was placed on the bronchial stump. The postoperative course was uneventful and the patient was discharged on day 9. The histological exam revealed R0 resection with pathologic stage T3 N0 M0 squamous cell carcinoma. Follow-up consisted in a physical examination every 3 months during the first two years and then every six months through year 5; and it’s going on yearly. A chest radiograph was always performed and a gradual mediastinal shift was progressively noted. After 5-year period, a chest CT-scan was performed: a complete hernia of the left lung into the right side with mediastinal structures displacement was visible. Conclusions: The patient is well-being and disease-free; no respiratory symptoms or dyspnea are present. In case of severe symptoms secondary to postpneumonectomy syndrome, different treatment options have been used, such as bronchial stent positioning and intrapleural prostheses insertion. 113P THE THIRD PRIMARY THE SECOND METACHRONOUS LUNG CANCER IN THE SAME PATIENT S. Kaya1 , G. Findik1 , H. Turut2 , K. Aydogdu1 Thoracic Surgery, Ataturk Chest Diseases and Thoracic Surgery Center, Ankara, Turkey, 2 Thoracic Surgery, Rize University School of Medcine, Rize, Turkey 1
Background: Multiple primary lung cancer (MPLC) referres to having more than one lung tumor in the organsim. The probability of the developing second primary lung cancer in different time periods in the same patient is a quite rare entity; moreover, to the best to our knowledge the third primary lung cancer has not been reported so far. Case Report: A 67 year-old-man was hospitalised with synchronous pulmonary masses 8 years before. Mass was located in the left upper lobe and diagnosed as squamous/adenosquamous cell carcinoma (with the component of bronchioalveolar type). He underwent left upper lobectomy with lymph node dissection (LND). Just after 39 months, a new metachronous mass in the right upper lobe was idagnosed as squamous cell carcinoma and resected with right upper lobectomy with LND. The patient was admitted to our clinic 49 months after this operation with the complaints of dyspnea and hemoptysis. Bronchoscopy revealed squamous cell carcinoma in the right intermediate bronchus. A chemotherapy programme was planned. Conclusions: Patients with pulmonary neoplasms have an increased risk for developing a second cancer of the lung either synchronously or at different times (metachronous). Every patient with lung cancer should be closely followed-up by virtue of chance of second, even third primary lung cancer. 114P HYPOFRACTIONATED RADIOTHERAPY WITH STEREOTACTIC LOCALIZATION IN EARLY STAGE NON-SMALL CELL LUNG CANCER (NSCLC) F. Salvi1 , E. Donini1 , A. Baldissera1 , C. Degli Esposti1 , O. Martelli1 , F. Monari1 , F. Spagnolli1 , G. Frezza1 , M. Palombarini2 , R. Romagnoli2 1 U.O. Radioterapia, Ospedale Bellaria, Bologna, Italy, 2 Struttura Semplice Fisica Sanitaria, Ospedale Bellaria, Bologna, Italy Background: To evaluate the response rate, survival and the toxicity of hypofractionated radiotherapy in patients affected by early stage NSCLC treated in a dedicated frame with stereotactic fiducials.
Early and locally advanced NSCLC Results: Fiberoptic bronchoscopy disclosed an obstruction of the intermediate bronchus just below the origin of the superior lobar bronchus; pathology results of the biopsy showed squamous cell carcinoma. He underwent a postero-lateral right thoracotomy; a centrally located tumour invading the pericardium was observed on exploration. An intrapericardial right pneumonectomy was performed; an intercostal muscle flap was placed on the bronchial stump. The postoperative course was uneventful and the patient was discharged on day 9. The histological exam revealed R0 resection with pathologic stage T3 N0 M0 squamous cell carcinoma. Follow-up consisted in a physical examination every 3 months during the first two years and then every six months through year 5; and it’s going on yearly. A chest radiograph was always performed and a gradual mediastinal shift was progressively noted. After 5-year period, a chest CT-scan was performed: a complete hernia of the left lung into the right side with mediastinal structures displacement was visible. Conclusions: The patient is well-being and disease-free; no respiratory symptoms or dyspnea are present. In case of severe symptoms secondary to postpneumonectomy syndrome, different treatment options have been used, such as bronchial stent positioning and intrapleural prostheses insertion. 113P THE THIRD PRIMARY THE SECOND METACHRONOUS LUNG CANCER IN THE SAME PATIENT S. Kaya1 , G. Findik1 , H. Turut2 , K. Aydogdu1 Thoracic Surgery, Ataturk Chest Diseases and Thoracic Surgery Center, Ankara, Turkey, 2 Thoracic Surgery, Rize University School of Medcine, Rize, Turkey 1
Background: Multiple primary lung cancer (MPLC) referres to having more than one lung tumor in the organsim. The probability of the developing second primary lung cancer in different time periods in the same patient is a quite rare entity; moreover, to the best to our knowledge the third primary lung cancer has not been reported so far. Case Report: A 67 year-old-man was hospitalised with synchronous pulmonary masses 8 years before. Mass was located in the left upper lobe and diagnosed as squamous/adenosquamous cell carcinoma (with the component of bronchioalveolar type). He underwent left upper lobectomy with lymph node dissection (LND). Just after 39 months, a new metachronous mass in the right upper lobe was idagnosed as squamous cell carcinoma and resected with right upper lobectomy with LND. The patient was admitted to our clinic 49 months after this operation with the complaints of dyspnea and hemoptysis. Bronchoscopy revealed squamous cell carcinoma in the right intermediate bronchus. A chemotherapy programme was planned. Conclusions: Patients with pulmonary neoplasms have an increased risk for developing a second cancer of the lung either synchronously or at different times (metachronous). Every patient with lung cancer should be closely followed-up by virtue of chance of second, even third primary lung cancer. 114P HYPOFRACTIONATED RADIOTHERAPY WITH STEREOTACTIC LOCALIZATION IN EARLY STAGE NON-SMALL CELL LUNG CANCER (NSCLC) F. Salvi1 , E. Donini1 , A. Baldissera1 , C. Degli Esposti1 , O. Martelli1 , F. Monari1 , F. Spagnolli1 , G. Frezza1 , M. Palombarini2 , R. Romagnoli2 1 U.O. Radioterapia, Ospedale Bellaria, Bologna, Italy, 2 Struttura Semplice Fisica Sanitaria, Ospedale Bellaria, Bologna, Italy Background: To evaluate the response rate, survival and the toxicity of hypofractionated radiotherapy in patients affected by early stage NSCLC treated in a dedicated frame with stereotactic fiducials.