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177 The effect of lung cancer resection on chest wall mechanics of COPD patients
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Poster abstracts of the 14th Annual British Thoracic Oncology Group Conference 2016 / Lung Cancer 91, Suppl. 1 (2016) S1–S71
24% followed by Shrewsbury and Telford Hospitals, 18%. 4 were excluded (alternate diagnoses). Out of the 41, 95.1% were typical, 40 patients underwent intervention with curative intent, 37 involving surgical resections and 3 using bronchoscopy therapy. 1 died postoperatively. 2 patients (pT1b pN2 M0 with R1 resection (atypical) and (pT1a pN0 M0) with R0 resections (typical)) had recurrence of disease with bone and lung relapse respectively. 81% of R0 resections were achieved. True reflection of follow up details could not be assessed accurately other than confirmation of recurrence or nonrecurrence. Conclusion: In our cohort of patients, 5% had recurrence of pulmonary carcinoid. Different localities of patient follow up made it difficult to accurately assess the general practice of follow up consultations and surveillance scans. Further studies using this preliminary data should be attempted at developing the best strategies for follow up care. Disclosure: All authors have declared no conflicts of interest. 177
The effect of lung cancer resection on chest wall mechanics of COPD patients
G. Elshafie, M. Kalkat, R. Steyn, E. Bishay, P. Rajesh, B. Naidu. Thoracic Surgery, Heartlands Hospital, Birmingham, United Kingdom Introduction: The lung volume reduction effect of lobectomy for lung cancer in COPD patients is widely recognized. The dynamic changes in chest wall mechanics in these patients has not been described. Methods: 5 COPD and 6 Non-COPD patients with suspected lung cancer were recruited to the study. Using Optoelectronic plethysmography, we measured their chest motion before and after lung resection. Results: Tidal volume at rest in the COPD group improved 6 months following surgery (0.68±0.26 L), secondary to an increased contribution of the upper rib cage (18±5%) and the diaphragm (6±2%), with a reduction in contribution from the abdomen (−23±6%). This contrasts with the findings in the Non-COPD group where there is a reduction in the contribution of the upper rib cage (−3±6%). No significant difference in chest wall motion was detected between VATS and thoracotomy approaches 6 months after surgery. Conclusion: The LVRS like effects of lung resection in COPD patients are associated with significant improvements in chest wall mechanics. This study provides a valuable insight into the mechanism of symptomatic benefits of lung resection in this group of patients. Disclosure: All authors have declared no conflicts of interest. 178
Postchemotherapy resection of malignant mediastinal germ cell tumours – does persistent malignancy matter?
M. Di Martino, A. Dhanji, J. Shamash, A. Wood, K. Lau. Cardiothoracic Surgery, BartsHealth NHS Trust, London, United Kingdom Introduction: Malignant mediastinal germ cell tumours are associated with poor prognosis. Chemotherapy often only achieves partial response. In a subset of patients, there is complete tumour necrosis, or transformation into mature teratoma, without any evidence of residual malignancy, whilst in other cases there is persistent malignancy within the tumour. In this study we investigate whether persistent malignancy following chemotherapy adversely affects survival after resection of the tumour, and whether it should influence the surgical decision. Methods: 15 consecutive patients (14 male: 1 female, median age 28 (range 21–46) underwent median sternotomy for excision of remnant malignant germ cell tumours following chemotherapy, in a single institution between May 2009 and July 2014. The preoperative histological diagnosis was non-seminomatous germ cell tumour in 14 patients, and seminomatous germ cell tumour in 1 patient. All patients underwent chemotherapy with partial biochemical or mor-
phological response. The median size of the mediastinal mass following chemotherapy was 9 cm (range 2–18 cm). Results: All patients underwent median sternotomy and excision of mediastinal mass. The median interval from diagnosis to surgery was 4 months (range 2–18 months). There were no deaths or major complications. The median postoperative length of stay was 4 days (range 3–11 days). Surgical pathology showed only necrosis or mature teratoma in 8 (53.3%) patients (group A), and persistent malignancy in 7 (46.7%) patients (group B). Three patients with persistent malignancy received further post-operative chemotherapy. The median followup was 31 months. 5 (33%) patients developed recurrent disease during the follow-up period: 2 (25%) in group A and 3 (42.9%) in group B, p=0.43. The 30-month survival was 80% for group A and 85% for group B, p=0.79. Conclusion: Persistent malignancy following chemotherapy for malignant mediastinal germ cell tumours does not necessarily portend a poor prognosis, and should not contraindicate surgical resection. Disclosure: All authors have declared no conflicts of interest. 179
Predictors of mortality in thoracic surgery for high risk patients with lung cancer
H. Al-Najjar 1 , P. Foden 2 , R. Shah 1 , P. Crosbie 1 , R. Booton 1 , M. Evison 1 . 1 Manchester Thoracic Oncology Centre, University Hospital of South Manchester, Manchester, United Kingdom; 2 Department of Medical Statistics, University Hospital of South Manchester, Manchester, United Kingdom Introduction: Surgical resection is the best curative option in patients with appropriately staged lung cancer. Risk scores and physiological assessments are employed to predict mortality and morbidity risk with surgery. This is most crucial in patients deemed high-risk. Physiological parameters employed include spirometry (FEV1%), diffusion (DLCO%), Cardiopulmonary Exercise Testing (VO2max absolute value, % and VECO2) as well as predicted post-operative (PPO) values for all of these tests using segment counting to discriminate depending on surgery planned. We aim to look at these physiological parameters alongside age and body-mass Index (BMI) in a select group of high-risk patients to see which individual parameters best predict mortality post-operatively. Methods: Patients operated on for thoracic malignancy who had CPET were eligible for inclusion. We retrospectively analysed all patients who underwent CPET at University Hospital of South Manchester, a tertiary Thoracic Oncology Centre, between 01/01/2013 and 31/12/2013 to identify those meeting the inclusion criteria. Physiology reports, clinical correspondence and survival databases were analysed. Results: 93 patients with thoracic malignancy had CPET assessment
Poster abstracts of the 14th Annual British Thoracic Oncology Group Conference 2016 / Lung Cancer 91, Suppl. 1 (2016) S1–S71
24% followed by Shrewsbury and Telford Hospitals, 18%. 4 were excluded (alternate diagnoses). Out of the 41, 95.1% were typical, 40 patients underwent intervention with curative intent, 37 involving surgical resections and 3 using bronchoscopy therapy. 1 died postoperatively. 2 patients (pT1b pN2 M0 with R1 resection (atypical) and (pT1a pN0 M0) with R0 resections (typical)) had recurrence of disease with bone and lung relapse respectively. 81% of R0 resections were achieved. True reflection of follow up details could not be assessed accurately other than confirmation of recurrence or nonrecurrence. Conclusion: In our cohort of patients, 5% had recurrence of pulmonary carcinoid. Different localities of patient follow up made it difficult to accurately assess the general practice of follow up consultations and surveillance scans. Further studies using this preliminary data should be attempted at developing the best strategies for follow up care. Disclosure: All authors have declared no conflicts of interest. 177
The effect of lung cancer resection on chest wall mechanics of COPD patients
G. Elshafie, M. Kalkat, R. Steyn, E. Bishay, P. Rajesh, B. Naidu. Thoracic Surgery, Heartlands Hospital, Birmingham, United Kingdom Introduction: The lung volume reduction effect of lobectomy for lung cancer in COPD patients is widely recognized. The dynamic changes in chest wall mechanics in these patients has not been described. Methods: 5 COPD and 6 Non-COPD patients with suspected lung cancer were recruited to the study. Using Optoelectronic plethysmography, we measured their chest motion before and after lung resection. Results: Tidal volume at rest in the COPD group improved 6 months following surgery (0.68±0.26 L), secondary to an increased contribution of the upper rib cage (18±5%) and the diaphragm (6±2%), with a reduction in contribution from the abdomen (−23±6%). This contrasts with the findings in the Non-COPD group where there is a reduction in the contribution of the upper rib cage (−3±6%). No significant difference in chest wall motion was detected between VATS and thoracotomy approaches 6 months after surgery. Conclusion: The LVRS like effects of lung resection in COPD patients are associated with significant improvements in chest wall mechanics. This study provides a valuable insight into the mechanism of symptomatic benefits of lung resection in this group of patients. Disclosure: All authors have declared no conflicts of interest. 178
Postchemotherapy resection of malignant mediastinal germ cell tumours – does persistent malignancy matter?
M. Di Martino, A. Dhanji, J. Shamash, A. Wood, K. Lau. Cardiothoracic Surgery, BartsHealth NHS Trust, London, United Kingdom Introduction: Malignant mediastinal germ cell tumours are associated with poor prognosis. Chemotherapy often only achieves partial response. In a subset of patients, there is complete tumour necrosis, or transformation into mature teratoma, without any evidence of residual malignancy, whilst in other cases there is persistent malignancy within the tumour. In this study we investigate whether persistent malignancy following chemotherapy adversely affects survival after resection of the tumour, and whether it should influence the surgical decision. Methods: 15 consecutive patients (14 male: 1 female, median age 28 (range 21–46) underwent median sternotomy for excision of remnant malignant germ cell tumours following chemotherapy, in a single institution between May 2009 and July 2014. The preoperative histological diagnosis was non-seminomatous germ cell tumour in 14 patients, and seminomatous germ cell tumour in 1 patient. All patients underwent chemotherapy with partial biochemical or mor-
phological response. The median size of the mediastinal mass following chemotherapy was 9 cm (range 2–18 cm). Results: All patients underwent median sternotomy and excision of mediastinal mass. The median interval from diagnosis to surgery was 4 months (range 2–18 months). There were no deaths or major complications. The median postoperative length of stay was 4 days (range 3–11 days). Surgical pathology showed only necrosis or mature teratoma in 8 (53.3%) patients (group A), and persistent malignancy in 7 (46.7%) patients (group B). Three patients with persistent malignancy received further post-operative chemotherapy. The median followup was 31 months. 5 (33%) patients developed recurrent disease during the follow-up period: 2 (25%) in group A and 3 (42.9%) in group B, p=0.43. The 30-month survival was 80% for group A and 85% for group B, p=0.79. Conclusion: Persistent malignancy following chemotherapy for malignant mediastinal germ cell tumours does not necessarily portend a poor prognosis, and should not contraindicate surgical resection. Disclosure: All authors have declared no conflicts of interest. 179
Predictors of mortality in thoracic surgery for high risk patients with lung cancer
H. Al-Najjar 1 , P. Foden 2 , R. Shah 1 , P. Crosbie 1 , R. Booton 1 , M. Evison 1 . 1 Manchester Thoracic Oncology Centre, University Hospital of South Manchester, Manchester, United Kingdom; 2 Department of Medical Statistics, University Hospital of South Manchester, Manchester, United Kingdom Introduction: Surgical resection is the best curative option in patients with appropriately staged lung cancer. Risk scores and physiological assessments are employed to predict mortality and morbidity risk with surgery. This is most crucial in patients deemed high-risk. Physiological parameters employed include spirometry (FEV1%), diffusion (DLCO%), Cardiopulmonary Exercise Testing (VO2max absolute value, % and VECO2) as well as predicted post-operative (PPO) values for all of these tests using segment counting to discriminate depending on surgery planned. We aim to look at these physiological parameters alongside age and body-mass Index (BMI) in a select group of high-risk patients to see which individual parameters best predict mortality post-operatively. Methods: Patients operated on for thoracic malignancy who had CPET were eligible for inclusion. We retrospectively analysed all patients who underwent CPET at University Hospital of South Manchester, a tertiary Thoracic Oncology Centre, between 01/01/2013 and 31/12/2013 to identify those meeting the inclusion criteria. Physiology reports, clinical correspondence and survival databases were analysed. Results: 93 patients with thoracic malignancy had CPET assessment