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206 The role of VATS segmentectomy for early stage lung cancer
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Poster abstracts, 12th Annual British Thoracic Oncology Group Conference, 2014: Surgery
significantly more therapy contacts (7 vs 4) (p = 0.005) following thoracotomy, more therapists required (9 vs 6) (p = 0.016), and a longer therapy time of 170(±115) minutes vs 90(±93) (p < 0.001). Also more patients mobilised on POD 1 (89% vs 80%), and more modalities for sputum and lung volume issues were required (p = 0.007, p < 0.001). Although they required less physiotherapy in general, 70% of VATS patients still required assistance of 2 staff to mobilise on POD 1, and 41% received ongoing treatment on postoperative day 2 or beyond for mobility or pulmonary problems. Conclusion: Patients undergoing VATS lobectomy required less physiotherapy, and had fewer complications, leaving hospital earlier than their thoracotomy counterparts. Many VATS lobectomy patients did however require physiotherapy for specific postoperative problems, and based on the findings of this study we would recommend routine physiotherapy assessment following VATS lobectomy on postoperative day 1. 205 Adjuvant chemotherapy for non-small cell lung cancer: Does VATS lobectomy deliver on its promises? I. Paul *, R. Al-Saudi, P. Mhandu, Z. El-Dean, A.N. Graham, K.G. McManus. Dept of Thoracic Surgery, Royal Victoria Hospital, Belfast, UK Background: Best available evidence suggests that video-assisted thoracic surgery (VATS) lobectomy is less morbid than open lobectomy with fewer complications and shorter length of hospital stay. It is predominantly offered to patients for clinical stage IA lung cancer. Despite this, a subgroup of patients will have nodal disease when adjuvant therapy will carry benefit. We hypothesised that VATS lobectomy patients are more likely to receive adjuvant chemotherapy when indicated compared to open lobectomy. Methods: From 2003 to 2013, all VATS lobectomies for lung cancer by a single surgeon were compared with a separate single surgeon’s practice who adopts a standard thoracotomy approach. Results: 93 patients underwent VATS lobectomy for non-small cell lung cancer and 119 underwent thoracotomy. The VATS group, 19 (20.4%) were pathological stage II or above compared to 39 (32.8%) in the thoracotomy group. 63.2% (12/19) of stage II or above patients in the VATS group were offered adjuvant chemotherapy compared to 53.8% (21/39) in the thoracotomy group (NS). The average time from surgery to commencement of chemotherapy was similar (62 vs 65 days). The failure to complete chemotherapy was 12.5% in VATS lobectomy patients compared to 15% in the thoracotomy group (NS). Conclusions: Contrary to expectation, VATS lobectomy did not improve adjuvant chemotherapy rates compared to thoracotomy. It is not clear from this study whether VATS allows surgery on less fit patients or whether improved post thoracotomy management is delivering patients to the oncologists in better physical condition. 206 The role of VATS segmentectomy for early stage lung cancer M. Will *, R. Ramaesh, D. Smith, W.S. Walker. Royal Infirmary of Edinburgh, Scotland, UK Introduction: VATS segmentectomy has an increasing role in the management of early stage lung cancer and is the focus of ongoing clinical trials. It is also likely to play a role to achieve diagnosis in lesions of uncertain aetiology. The technique is more complex and we describe our experience of VATs segmentectomy in this group. Methods: We retrospectively reviewed our database for cases of VATS segmentectomies between February 2008 and October 2013. Data was collected on basic epidemiology, indication for surgery, pathology and staging. Pre-operative pulmonary function was also recorded. We also collated intra-operative data as well as perioperative complications and follow-up data. Results: There were a total of 28 VATS segmentectomies (52% of VATS segmentectomies in the study period) with a final diagnosis
of lung cancer (27 non-small cell, 1 small cell). 16 patients underwent mediastinoscopy prior to the procedure. 54% of cases were performed by trainees. 24 patients had N1 nodes and 17 had N2 nodes removed intraoperatively. Three proceeded to completion lobectomy at the same time and one converted to open for bleeding. Four major and 14 minor complications were noted. The median length of stay post-operatively was 6 days. In 20 cases, the final pathological stage matched the clinical staging. Complete resection (R0) was achieved in 96% of cases. No-intra-operative deaths were recorded and three deaths noted on long term follow-up. Conclusion: VATS segmentectomies can be performed safely and taught to trainees in managing early stage lung cancer. We show that complete resection margins were achieved in the majority of patients with a low rate of conversion to open. The majority of the lung field can be resected in this manner which is likely to be used more widely. Long term follow up and results of ongoing trials are required to be sure oncological equivalence to lobectomy can be achieved. 207 The epidemiology of lung resections changes over a ten year period R. Ramaesh *, M. Will, R. Collins, W.S. Walker. Royal Infirmary of Edinburgh, Scotland, UK Introduction: Lung cancer is Scotland’s most common cancer and accounts for the largest proportion of cancer related deaths in the country. Lung resection offers the best hope for long-term survival. Our aim is to describe the current epidemiology of lung resections and elucidate changes in surgical practise over the last 10 years. Methods: The South East of Scotland Lung Cancer Audit Database was searched to identify patients with confirmed diagnosis of primary lung cancer, within five counties encompassing a population of 962,040 (2012 data). Data was collected on age at diagnosis, sex, postcode, pathological stage of disease, histological classification as well as the type of surgery undertaken and the patient’s preoperative health. Socio-economic deprivation was calculated using the Scottish Index for Multiple Deprivation (SIMD) score and patients were grouped into their respective quintiles. Results: There has been an overall reduction in the incidence of lung cancer, across all socioeconomic groups 761 per million per year in 2001 to 381 per million per year in 2012, although incidences are significantly higher in the poorest quintile compared to the richest (OR = 2.8, p < 0.0001). There was no difference in the resection rate or over the study period (12% in 2001 v 13.6% in 2012 [p = 0.258]) or between social groups (p = 0.341). There was a significant reduction in pneumonectomy and increase in sublobar resection over the last 10 years (p < 0.001). In the later years patients were significantly older (mean 69 vs 66, p = 0.03) and an increasing proportion were at earlier lung cancer stage (p < 0.001). In the later cohort, 57% of procedures were done via video assisted surgery. Discussion: This is the first study to describe the epidemiology of lung resection for primary malignant lung disease and chart trends in practises over the last 10 years. Despite better imaging modalities and public awareness campaigns, the overall rate of resection still remains low and has not increased significantly in the past 10 years. Nowadays patients presenting for surgery are older, at earlier lung cancer stage and more likely to undergo lung sparing, video assisted resections. 208 A new number for the VATS lobectomy learning curve M. Berman *, A. Brunswicker, J. Taghavi, M. Van Leuven, F. Van Tornout, W. Bartosik. Department Thoracic Surgery, Norfolk and Norwich University Hospital, UK Objective: A prospective study of the first 50 consecutive VATS lobectomies performed by an experienced thoracic surgeon to evaluate the learning curve for VATS lobectomy. Methods: All 50 consecutive VATS lobectomies performed from 2010 to date were included. Operative time, conversion rate,
Poster abstracts, 12th Annual British Thoracic Oncology Group Conference, 2014: Surgery
significantly more therapy contacts (7 vs 4) (p = 0.005) following thoracotomy, more therapists required (9 vs 6) (p = 0.016), and a longer therapy time of 170(±115) minutes vs 90(±93) (p < 0.001). Also more patients mobilised on POD 1 (89% vs 80%), and more modalities for sputum and lung volume issues were required (p = 0.007, p < 0.001). Although they required less physiotherapy in general, 70% of VATS patients still required assistance of 2 staff to mobilise on POD 1, and 41% received ongoing treatment on postoperative day 2 or beyond for mobility or pulmonary problems. Conclusion: Patients undergoing VATS lobectomy required less physiotherapy, and had fewer complications, leaving hospital earlier than their thoracotomy counterparts. Many VATS lobectomy patients did however require physiotherapy for specific postoperative problems, and based on the findings of this study we would recommend routine physiotherapy assessment following VATS lobectomy on postoperative day 1. 205 Adjuvant chemotherapy for non-small cell lung cancer: Does VATS lobectomy deliver on its promises? I. Paul *, R. Al-Saudi, P. Mhandu, Z. El-Dean, A.N. Graham, K.G. McManus. Dept of Thoracic Surgery, Royal Victoria Hospital, Belfast, UK Background: Best available evidence suggests that video-assisted thoracic surgery (VATS) lobectomy is less morbid than open lobectomy with fewer complications and shorter length of hospital stay. It is predominantly offered to patients for clinical stage IA lung cancer. Despite this, a subgroup of patients will have nodal disease when adjuvant therapy will carry benefit. We hypothesised that VATS lobectomy patients are more likely to receive adjuvant chemotherapy when indicated compared to open lobectomy. Methods: From 2003 to 2013, all VATS lobectomies for lung cancer by a single surgeon were compared with a separate single surgeon’s practice who adopts a standard thoracotomy approach. Results: 93 patients underwent VATS lobectomy for non-small cell lung cancer and 119 underwent thoracotomy. The VATS group, 19 (20.4%) were pathological stage II or above compared to 39 (32.8%) in the thoracotomy group. 63.2% (12/19) of stage II or above patients in the VATS group were offered adjuvant chemotherapy compared to 53.8% (21/39) in the thoracotomy group (NS). The average time from surgery to commencement of chemotherapy was similar (62 vs 65 days). The failure to complete chemotherapy was 12.5% in VATS lobectomy patients compared to 15% in the thoracotomy group (NS). Conclusions: Contrary to expectation, VATS lobectomy did not improve adjuvant chemotherapy rates compared to thoracotomy. It is not clear from this study whether VATS allows surgery on less fit patients or whether improved post thoracotomy management is delivering patients to the oncologists in better physical condition. 206 The role of VATS segmentectomy for early stage lung cancer M. Will *, R. Ramaesh, D. Smith, W.S. Walker. Royal Infirmary of Edinburgh, Scotland, UK Introduction: VATS segmentectomy has an increasing role in the management of early stage lung cancer and is the focus of ongoing clinical trials. It is also likely to play a role to achieve diagnosis in lesions of uncertain aetiology. The technique is more complex and we describe our experience of VATs segmentectomy in this group. Methods: We retrospectively reviewed our database for cases of VATS segmentectomies between February 2008 and October 2013. Data was collected on basic epidemiology, indication for surgery, pathology and staging. Pre-operative pulmonary function was also recorded. We also collated intra-operative data as well as perioperative complications and follow-up data. Results: There were a total of 28 VATS segmentectomies (52% of VATS segmentectomies in the study period) with a final diagnosis
of lung cancer (27 non-small cell, 1 small cell). 16 patients underwent mediastinoscopy prior to the procedure. 54% of cases were performed by trainees. 24 patients had N1 nodes and 17 had N2 nodes removed intraoperatively. Three proceeded to completion lobectomy at the same time and one converted to open for bleeding. Four major and 14 minor complications were noted. The median length of stay post-operatively was 6 days. In 20 cases, the final pathological stage matched the clinical staging. Complete resection (R0) was achieved in 96% of cases. No-intra-operative deaths were recorded and three deaths noted on long term follow-up. Conclusion: VATS segmentectomies can be performed safely and taught to trainees in managing early stage lung cancer. We show that complete resection margins were achieved in the majority of patients with a low rate of conversion to open. The majority of the lung field can be resected in this manner which is likely to be used more widely. Long term follow up and results of ongoing trials are required to be sure oncological equivalence to lobectomy can be achieved. 207 The epidemiology of lung resections changes over a ten year period R. Ramaesh *, M. Will, R. Collins, W.S. Walker. Royal Infirmary of Edinburgh, Scotland, UK Introduction: Lung cancer is Scotland’s most common cancer and accounts for the largest proportion of cancer related deaths in the country. Lung resection offers the best hope for long-term survival. Our aim is to describe the current epidemiology of lung resections and elucidate changes in surgical practise over the last 10 years. Methods: The South East of Scotland Lung Cancer Audit Database was searched to identify patients with confirmed diagnosis of primary lung cancer, within five counties encompassing a population of 962,040 (2012 data). Data was collected on age at diagnosis, sex, postcode, pathological stage of disease, histological classification as well as the type of surgery undertaken and the patient’s preoperative health. Socio-economic deprivation was calculated using the Scottish Index for Multiple Deprivation (SIMD) score and patients were grouped into their respective quintiles. Results: There has been an overall reduction in the incidence of lung cancer, across all socioeconomic groups 761 per million per year in 2001 to 381 per million per year in 2012, although incidences are significantly higher in the poorest quintile compared to the richest (OR = 2.8, p < 0.0001). There was no difference in the resection rate or over the study period (12% in 2001 v 13.6% in 2012 [p = 0.258]) or between social groups (p = 0.341). There was a significant reduction in pneumonectomy and increase in sublobar resection over the last 10 years (p < 0.001). In the later years patients were significantly older (mean 69 vs 66, p = 0.03) and an increasing proportion were at earlier lung cancer stage (p < 0.001). In the later cohort, 57% of procedures were done via video assisted surgery. Discussion: This is the first study to describe the epidemiology of lung resection for primary malignant lung disease and chart trends in practises over the last 10 years. Despite better imaging modalities and public awareness campaigns, the overall rate of resection still remains low and has not increased significantly in the past 10 years. Nowadays patients presenting for surgery are older, at earlier lung cancer stage and more likely to undergo lung sparing, video assisted resections. 208 A new number for the VATS lobectomy learning curve M. Berman *, A. Brunswicker, J. Taghavi, M. Van Leuven, F. Van Tornout, W. Bartosik. Department Thoracic Surgery, Norfolk and Norwich University Hospital, UK Objective: A prospective study of the first 50 consecutive VATS lobectomies performed by an experienced thoracic surgeon to evaluate the learning curve for VATS lobectomy. Methods: All 50 consecutive VATS lobectomies performed from 2010 to date were included. Operative time, conversion rate,