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128 Primary lung cancer surgery should be done by VATS (video assisted thoracoscopic surgery)
S44 127 PulMiCC (Pulmonary Metastasectomy in Colorectal Cancer) trial T. Treasure. On behalf of the PulMiCC Investigators, CORU, University College London, London, United Kingdom PulMiCC is a randomised trial supported by a grant from Cancer Research UK. The Chief Investigator is Professor Tom Treasure, Consultant Cardiothoracic Surgeon, University College London, the study is being co-ordinated by the Clinical Trials and Evaluation Unit (CTEU) at the Royal Brompton Hospital, London ([email protected]) and the patient reported outcomes are being co-ordinated by the Cancer Research UK Psychosocial Oncology Group (CR UK POG), University of Sussex. Approximately 12 centres in the UK are participating. Briefly, PulMiCC is comparing active monitoring with active monitoring and pulmonary metastasectomy. The rationale for the trial is that there is no randomised evidence as to whether pulmonary metastasectomy improves survival. Published data reporting five year survival rates following pulmonary metastasectomy vary from 30% up to 50%. Post operative morbidity is infrequently reported in detail, and is usually stated to be minimal however quality of life following surgery is not reported and postoperative complications such as respiratory insufficiency may adversely affect quality of life. The aim of this feasibility study is to determine whether it will be possible to recruit sufficient patients in order to conduct a larger trial powered to detect statistical differences in survival. This current study will also assess survival, relapse-free survival, lung function, quality of life and costs. After randomisation to either: active monitoring or active monitoring plus pulmonary metastasectomy, all patients will be followed up 3 monthly during year 1, 6 monthly during year 2 and then annually up to 5 years. Investigations will be according to routine practice but lung function and CEA measurements will be performed at each visit. CT scans will be performed at 3 months, 1 year, 2 years and 3 years. Patients will be assessed for quality of life and anxiety at baseline and at 3, 6, 12 and 24 months.
Figure: PulMiCC (Pulmonary Metastasectomy in Colorectal Cancer) trial.
Posters, 9th Annual BTOG Conference, 2011: Surgery 128 Primary lung cancer surgery should be done by VATS (video assisted thoracoscopic surgery) V. Mehta, E. Royston, J. Nicholson, R. Sayeed, E. Black. Department of Cardiothoracic Surgery, John Radcliffe Hospital, Oxford, United Kingdom Objectives: The technique of VATS lung resection for some time now has been accepted as safe, sound and reliable. The small number of cases performed in the UK may be symptomatic of NHS investment, time, equipment and training. We present outcomes from our first 2 years of VATS lung resection programme to encourage wider UK adoption. Methods: We invested in 1.3 full time VATS enthusiastic thoracic surgeons, one operating camera stack and some VATS instruments. All patients with operable lung cancer who were fit enough were offered surgery. We retrospectively reviewed our surgical database, inpatient records, x-rays and pathology reports for all patients undergoing lung resection. We compared VATS outcomes with thoracotomy, over the last 2 years. Results: Over 2 years, a total of 180 patients underwent lung cancer resection. Excluding pneumonectomies, chest wall involvement and sleeve resections there were 121 patients. Of these 72 (60%) patients underwent VATS lung resection, 49 (40%) patients underwent open thoracotomy and 16 (13%) patients were converted to thoracotomy. Mean age for lung cancer resection was 69.5 yr (46 85), females were 52% (n = 63). Of 56 patients who had completed VATS 43 were lobectomies, 1 bi-lobectomy, 9 segmental resections, 2 wedge resections and 1 unresectable due to multiple metastasis. The 16 conversions were performed for: dense adhesions (8 patients), bleeding (4), difficult dissection (2), jammed stapler (1) and poor lung isolation (1). The median duration of chest drainage was 3 days for successful VATS and 4 days for thoracotomy while it was 5 days in patients who underwent conversion. Median length of stay was 6, 7 and 7 for VATS, thoracotomies and conversions respectively. There were no differences in nodal harvesting between the groups (mean of 4 stations). Conclusion: With limited investment VATS lung resection rate of 46% has been achieved. VATS should be the standard of care for primary lung cancer surgery in the UK.
Figure: PulMiCC (Pulmonary Metastasectomy in Colorectal Cancer) trial.
Posters, 9th Annual BTOG Conference, 2011: Surgery 128 Primary lung cancer surgery should be done by VATS (video assisted thoracoscopic surgery) V. Mehta, E. Royston, J. Nicholson, R. Sayeed, E. Black. Department of Cardiothoracic Surgery, John Radcliffe Hospital, Oxford, United Kingdom Objectives: The technique of VATS lung resection for some time now has been accepted as safe, sound and reliable. The small number of cases performed in the UK may be symptomatic of NHS investment, time, equipment and training. We present outcomes from our first 2 years of VATS lung resection programme to encourage wider UK adoption. Methods: We invested in 1.3 full time VATS enthusiastic thoracic surgeons, one operating camera stack and some VATS instruments. All patients with operable lung cancer who were fit enough were offered surgery. We retrospectively reviewed our surgical database, inpatient records, x-rays and pathology reports for all patients undergoing lung resection. We compared VATS outcomes with thoracotomy, over the last 2 years. Results: Over 2 years, a total of 180 patients underwent lung cancer resection. Excluding pneumonectomies, chest wall involvement and sleeve resections there were 121 patients. Of these 72 (60%) patients underwent VATS lung resection, 49 (40%) patients underwent open thoracotomy and 16 (13%) patients were converted to thoracotomy. Mean age for lung cancer resection was 69.5 yr (46 85), females were 52% (n = 63). Of 56 patients who had completed VATS 43 were lobectomies, 1 bi-lobectomy, 9 segmental resections, 2 wedge resections and 1 unresectable due to multiple metastasis. The 16 conversions were performed for: dense adhesions (8 patients), bleeding (4), difficult dissection (2), jammed stapler (1) and poor lung isolation (1). The median duration of chest drainage was 3 days for successful VATS and 4 days for thoracotomy while it was 5 days in patients who underwent conversion. Median length of stay was 6, 7 and 7 for VATS, thoracotomies and conversions respectively. There were no differences in nodal harvesting between the groups (mean of 4 stations). Conclusion: With limited investment VATS lung resection rate of 46% has been achieved. VATS should be the standard of care for primary lung cancer surgery in the UK.