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169: Stenting of central airway tumours with the flexible bronchoscope
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Poster abstracts, 13th Annual British Thoracic Oncology Group Conference, 2015: Surgery
Table 1 (abstract 168).
No. of cryotherapy procedures No. of patients undergoing repeat cryotherapy sessions Status October 2014
Patients with primary lung cancer
Patients with oesophageal cancer
22/30 in 17 patients 5 of total 17 8/17 patients deceased, average survival post initial cryotherapy procedure of 163 days
8/30 in 3 patients 2 of 3 patients 3 patients surviving, 7 months to 2 years post initial cryotherapy
procedures performed in the management of malignant airway disease. Our experience has shown that with prompt referral and intervention, endoluminal cryotherapy can be performed safely with few complications, allowing maximum improvement in both symptoms and quality of life in advanced airway disease. Going forward there is much scope for the promotion of increased medical awareness regarding cryotherapy’s safe and effective role in malignant airway disease, and hopefully increased referral to thoracic surgical centres with extension of cryotherapy services to this patient group. Disclosure: All authors have declared no conflicts of interest. 169 Stenting of central airway tumours with the flexible bronchoscope R.M. Venn *, K. Patel, M.Z. Montefort, S.A. Hervey, N. Sharma, J.R.W. Wilkinson. Thoracic Medicine, Eastbourne District General Hosptial, Eastbourne, United Kingdom Introduction: Several forms of endobronchial therapy for obstructing airway tumours exist but there is no controlled trial evidence to guide their use. They can require extensive resources, such as prosthetics, rigid bronchoscopes and general anaesthesia and are, at least in the UK, not widely available. Our department has offered a service using just the flexible bronchoscope and conscious sedation to apply electrocautery (diathermy) and insert self-expanding endobronchial stents, without rigid tubes or a general anaesthetic. Methods: The treatments have the potential to improve pulmonary function, preserving or enhancing a patient’s performance status and avoiding or treating lung collapse. We reviewed our patients’ diagnoses, survival and other outcomes. Results: • There were 36 patients, aged from 41 to 80 (median 70); numbers of men and women were roughly equal. • 56% had a single site stented, others two or more. At least 90% had patency confirmed at procedure. • Most (95%) patients had primary lung cancer. Of these, 16 (44%) were squamous cell carcinoma, 6 (17%) small cell. The great majority of the rest were non-small cell lung cancer; three were non-lung cancer and one a benign stenosis. • Survival was 71% at 30 days, 30% at six months and 16% at one year. There was one inpatient death. • Sixteen (46%) of the cancer patients had anti-cancer therapy, mostly radiotherapy. • Four patients had a further procedure, two for stent migration. Conclusion: We consider survival and subsequent cancer treatment (for which, in general, patients will need reasonable fitness) to be markers of efficacy. Most patients survived at least 30 days; slightly less than half went on to have chemo/radiotherapy. We believe our results demonstrate that, although good patient selection is important, endobronchial stenting is a viable treatment option for palliating advanced lung cancer, where the goals are to relieve symptoms and maximise performance status. Disclosure: All authors have declared no conflicts of interest.
Surgery 170 Novel thoraco-abdominal analysis technology can measure early respiratory changes following lung cancer resection G. Elshafie1 *, W. De Boer2 , R. Steyn1 , E. Bishay1 , M. Kalkat1 , P. Rajesh1 , R. Wilson2 , B. Naidu3 . 1 Department of Thoracic Surgery, Heart of England Foundation Trust, Birmingham, United Kingdom, 2 PneumaCare Limited, Cambridge, United Kingdom, 3 Medical School, University of Birmingham, Birmingham, United Kingdom Introduction: Pulmonary complications (atelectasis, pneumonia) are common following lung cancer resection and are a major cause of morbidity. Identifying complications early and ‘at risk’ patients may allow us to target more effective therapy. Thus we evaluated the viability of a novel portable device to measure dynamic regional thoraco-abdominal function immediately after lung resection. Methods: Structured Light Plethysmography (SLP) measures both rib cage and abdominal motion using a light grid which is simultaneously ‘seen’ by a digital vision system. Grid movement during breathing is analysed and displayed in terms of regional thoraco-abdominal movement parameters as well as a 3D reconstruction. Measurements were made during quiet breathing, before and up to 4 days post operatively.
Figure 1. Percentage contribution of right versus left chest wall motion to overall chest wall motion before (left) and one day after (right) left VATS lung resection.
Figure 2. Percentage Relative Expired Contribution of right versus left chest wall motion compared to overall chest wall motion before (left) and one day after (right) right thoracotomy lung resection.
Results: 9 male patients with a mean age of 72 years (range 63 82), who underwent lung resection either via VATS (n: 4)
Poster abstracts, 13th Annual British Thoracic Oncology Group Conference, 2015: Surgery
Table 1 (abstract 168).
No. of cryotherapy procedures No. of patients undergoing repeat cryotherapy sessions Status October 2014
Patients with primary lung cancer
Patients with oesophageal cancer
22/30 in 17 patients 5 of total 17 8/17 patients deceased, average survival post initial cryotherapy procedure of 163 days
8/30 in 3 patients 2 of 3 patients 3 patients surviving, 7 months to 2 years post initial cryotherapy
procedures performed in the management of malignant airway disease. Our experience has shown that with prompt referral and intervention, endoluminal cryotherapy can be performed safely with few complications, allowing maximum improvement in both symptoms and quality of life in advanced airway disease. Going forward there is much scope for the promotion of increased medical awareness regarding cryotherapy’s safe and effective role in malignant airway disease, and hopefully increased referral to thoracic surgical centres with extension of cryotherapy services to this patient group. Disclosure: All authors have declared no conflicts of interest. 169 Stenting of central airway tumours with the flexible bronchoscope R.M. Venn *, K. Patel, M.Z. Montefort, S.A. Hervey, N. Sharma, J.R.W. Wilkinson. Thoracic Medicine, Eastbourne District General Hosptial, Eastbourne, United Kingdom Introduction: Several forms of endobronchial therapy for obstructing airway tumours exist but there is no controlled trial evidence to guide their use. They can require extensive resources, such as prosthetics, rigid bronchoscopes and general anaesthesia and are, at least in the UK, not widely available. Our department has offered a service using just the flexible bronchoscope and conscious sedation to apply electrocautery (diathermy) and insert self-expanding endobronchial stents, without rigid tubes or a general anaesthetic. Methods: The treatments have the potential to improve pulmonary function, preserving or enhancing a patient’s performance status and avoiding or treating lung collapse. We reviewed our patients’ diagnoses, survival and other outcomes. Results: • There were 36 patients, aged from 41 to 80 (median 70); numbers of men and women were roughly equal. • 56% had a single site stented, others two or more. At least 90% had patency confirmed at procedure. • Most (95%) patients had primary lung cancer. Of these, 16 (44%) were squamous cell carcinoma, 6 (17%) small cell. The great majority of the rest were non-small cell lung cancer; three were non-lung cancer and one a benign stenosis. • Survival was 71% at 30 days, 30% at six months and 16% at one year. There was one inpatient death. • Sixteen (46%) of the cancer patients had anti-cancer therapy, mostly radiotherapy. • Four patients had a further procedure, two for stent migration. Conclusion: We consider survival and subsequent cancer treatment (for which, in general, patients will need reasonable fitness) to be markers of efficacy. Most patients survived at least 30 days; slightly less than half went on to have chemo/radiotherapy. We believe our results demonstrate that, although good patient selection is important, endobronchial stenting is a viable treatment option for palliating advanced lung cancer, where the goals are to relieve symptoms and maximise performance status. Disclosure: All authors have declared no conflicts of interest.
Surgery 170 Novel thoraco-abdominal analysis technology can measure early respiratory changes following lung cancer resection G. Elshafie1 *, W. De Boer2 , R. Steyn1 , E. Bishay1 , M. Kalkat1 , P. Rajesh1 , R. Wilson2 , B. Naidu3 . 1 Department of Thoracic Surgery, Heart of England Foundation Trust, Birmingham, United Kingdom, 2 PneumaCare Limited, Cambridge, United Kingdom, 3 Medical School, University of Birmingham, Birmingham, United Kingdom Introduction: Pulmonary complications (atelectasis, pneumonia) are common following lung cancer resection and are a major cause of morbidity. Identifying complications early and ‘at risk’ patients may allow us to target more effective therapy. Thus we evaluated the viability of a novel portable device to measure dynamic regional thoraco-abdominal function immediately after lung resection. Methods: Structured Light Plethysmography (SLP) measures both rib cage and abdominal motion using a light grid which is simultaneously ‘seen’ by a digital vision system. Grid movement during breathing is analysed and displayed in terms of regional thoraco-abdominal movement parameters as well as a 3D reconstruction. Measurements were made during quiet breathing, before and up to 4 days post operatively.
Figure 1. Percentage contribution of right versus left chest wall motion to overall chest wall motion before (left) and one day after (right) left VATS lung resection.
Figure 2. Percentage Relative Expired Contribution of right versus left chest wall motion compared to overall chest wall motion before (left) and one day after (right) right thoracotomy lung resection.
Results: 9 male patients with a mean age of 72 years (range 63 82), who underwent lung resection either via VATS (n: 4)