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CLC011 POSTER Surgical treatment and survival of brronchioloalveolar lung cancer
Abstracts of the 5th International Congress on Lung Cancer, Patras, Greece, 24–27 January 2007 survival in patients undergoing induction chemotherapy and surgery for stage IIIA-N2 NSCLC. Methods: From 2003 to 2006, 15 patients (10 male, 5 female main age 60) received induction chemotherapy (MVP) before surgery for histologically proven stage IIIA-N2 NSCLC. Results: 93% (n= 14)had complete anatomic lung resection plus radical mediastinal lemphadenectomy, 7% (n=1) had unresectable lesions. Operative mortality was 0%. Pathologic review of 14 specimens (5 pneumonectomies, 9 lobectomies/ belobectomies/ sleevelobectomies) and nodes revealed that 20.5% were T0N0, 10.2% T1N0, 10.2% T2N0, 17,9% T0-1N1, 15,4% T2N1-T3N0, 1,2% T3N1, 23.1% T1-2-3N2 and T4N2. Univariate analysis showed a 5-year survival rate of 94% for pT0N0, 48% for T0-1N1, and 0% for T1-2-3N2. Multivariate analysis showed a significant prognostic factor for pT0N0 vs all remaining stages (p<0.000). Conglusions: In patients undergoing induction chemotherapy and surgery p T0N0 is associated with an impressive 94% 5-year survival. The preoperative identification of such a subset of patients should be the goal future trials.
CLC011
POSTER
Surgical treatment and survival of brronchioloalveolar lung cancer Athanassiadis G., Andronadi V., Pavlidu Ch., Ekonomou K., Vasilaki M., Zoganas L. Thoracosurgery Clinic, ‘Hellenic Red Cross’ Hospital, Greece Objectives: In recent years the prevalence of adenocarcinoma among lung cancers has risen worldwide. We studied whether there is a similar tendency for the bronchioloalveolar carcinoma (BAC). Is it possible to confirm the statement that BAC is multiple cancer among non- smoking women? Methods: Between 2001-2006, 14 lung resections for adenocarcinoma were carried out. Of these 37.1% were BAC. We effected 8 lobectomies, 3 pneumonectomies and 3 wedge resections. Results: The preoperative CT suspected three multiple tumors, but only two were confirmed by postoperative pathology. The tumor was indicated to be in stage I or II in 6 cases by surgery, 8 cases by pathology. 6 tumors were in stage I/A. for the overall group of 37.1% of patients the 5-year survival rate for wedge resections (41%) was lower than that for major resections (64%) (p=0,41). Conglusions: Bronchioloalveolar carcinoma (BAC) has favourable survival, particularly in women. Because of its slow growth, the patients are operated on at an early stage. In spite of this, resection smaller than lobectomy is recommended only as compromise. The high proportion of non- smoking women may suggest genetic or hormonal etiological factor for BAC.
CLC012
POSTER
Surgical treatment of metastases of malignant melanomas in the lung Athanassiadis G., Pavlidu Ch., Andronadi V., Ekonomou K., Zoganas L. Thoracosurgery Clinic, ‘Hellenic Red Cross’ Hospital, Greece Goal: To analyse the results from the surgical treatment of malignant melanomas in the lung. Material and Method: From January 2003 until January 2006, we treated in our clinic 6 patients with metastases of malignant melanoma in the lung (5 with metastases in the lung and 1 in the bronchus). Metastases in the lung are mostly parenchymal and the patient’s progress depends on their number and on whether they can be resected. The endobronchial metastases are far rarer. Results: There were no perioperative or postoperative complications. In the case of the melanoma developed in the bronchus, the diagnosis was based on the histological picture. Postoperatively, all patients are followed-up in an oncology center, and two of them receive adjuvant treatment. Conclusions: The metastases of malignant melanomas in the lung are mostly related to the parenchyma; the endobronchial cases are far rarer. The investigation must always follow the direction of the metastatic disease, especially in case of the unpredictable and most aggressive progress of the malignant melanoma.
CLC013
POSTER
Resection of the main carina, in case of infiltration from non-microcellular lung cancer Athanassiadis G., Pavlidu Ch., Zogana S., Vasilaki M., Zoganas L. Thoracosurgery Clinic, ‘Hellenic Red Cross’ Hospital, Greece Goal of the Paper: The infiltration of the main carina by a tumor, and of the tissue thereby, (it is usually a tumor infiltrating the upper lobar or the truncal
S5
bronchus), is not a very rare phenomenon and constitutes 2% of lung cancers (neglected cancer). Therefore, we present our experience in handling and treating such cases (n.m.l.c.), following the method of pneumonectomy with simultaneous ‘sleevelike’ excision of the main bronchus, and, in fact, excision of the main carina combined with tracheoplasty. Material: From 2003 to date, 2006, we have applied the method in ten cases (-10-), six men (-6-) and four women (-4-), aged from 52 to 70. The histological type of the specific tumors was mainly squamous epithelium, mostly of low differentiation, and a smaller number of adenic carcinomas, also of low differentiation most of the times, though more aggressive to the tissues. Method: We applied the method of pneumonectomy, combined with a ‘sleevelike excision’ of the main bronchus, in fact carinectomy, with parallel tracheoplasty, where the site resected in the form of a spindle, was closed by a No.4.0 prolene stitch (plastic, ‘meander-like and over & over’ suture). In all these operations, we used a double tracheal tube, which allowed us to achieve better ventilation or occlusion of the lung, depending on its maneuvering by the surgeon. Results: Nine (9) out of ten (10) patients survived and were successfully treated post-op. We had one (1) death, of a 70-year old patient, the sixteenth (16) day post-op, because of aspiration. Tracheostomy was required for one (-1-) out of the ten (-10-) patients. Average hospital days were 14. Conclusion: The combined method of pneumonectomy with simultaneous ‘sleeve-like’ excision of the main bronchus (sleeve-ectomy), and actually resection of the main carina (carinectomy), and parallel tracheoplasty, when there is infiltration of the main carina by a tumor (n.m.l.c.), makes these severe cases operable, in fact with very successful postoperative results.
CLC014
ORAL
Impact of PET scans in lung cancer surgery: Leeds UK experience Papagiannopoulos K. Leeds Teaching Hospitals, UK Introduction: 27 Although experience with PET scans is relatively new, and availability is not universal we present our initial experience with 128 patients with Non small cell lung cancer. Methods: 43 Between Jan 2005 and May 2006 data was retrospectively collected on all patients with suspected lung cancer who had a PET scan as part of their initial workup. Initial staging was correlated with final pathological TNM staging following surgical biopsy or radical treatment. Results: 103 PET scan upstaged the disease in 24 patients (20%). There was no uptake in 15 patients (12%) and Uptake was equivocal in 2(1.6%). All patients with equivocal uptake and 4 from no uptake group underwent surgery. 1 out of 4 in the no uptake group proved malignant (false negative (1/15=6%) and 1 out of 2 from the equivocal uptake proved malignant. Of the remaining 103 patients with positive uptake, 47 underwent surgical resections and 56 were referred to oncology because of advanced disease and co morbidity. Final histology from the surgical group revealed 4 benign cases; a false positive PET result of 8%. Conclusion: 49 PET or fusion PET-CT has better specificity and sensitivity as compared to CT alone. Upstage due to Nodal disease should be confirmed histologically ? Tumor false positive results are unavoidable. Intraoperative frozen section could prevent unnecessary major resections ? Each patient still requires an individual management strategy; the role of a Multidisciplinary Team remains invaluable.
CLC015
POSTER
Suspected lung cancer with negative CT guided needle biopsy and positive PET scan followed by radical lobectomy with no cancer evidence in final histology; medical success or failure Papagiannopoulos K. Leeds Teaching Hospitals, UK Introduction: 21 Although PET scan is increasingly becoming a necessity in assessment for lung cancer caution should be exercised when interpreting it’s results. Methods: 56 A 76 year old male smoker was investigated for lethargy. Clinical examination revealed clubbing. Imaging studies revealed a right upper lobe mass with a smaller nodule in the right lower lobe. Needle biopsy was negative for malignancy. A PET scan was strongly positive for cancer with mild uptake in right hilar and paratracheal nodes. Results: 39 At mediastinoscopy the nodes were negative for malignancy. The patient underwent radical surgery with right upper lobe lobectomy, wedge resection of right lower lobe nodule and systematic lymph nodal dissection. Final histology revealed no malignancy in the resected specimens.
CLC011
POSTER
Surgical treatment and survival of brronchioloalveolar lung cancer Athanassiadis G., Andronadi V., Pavlidu Ch., Ekonomou K., Vasilaki M., Zoganas L. Thoracosurgery Clinic, ‘Hellenic Red Cross’ Hospital, Greece Objectives: In recent years the prevalence of adenocarcinoma among lung cancers has risen worldwide. We studied whether there is a similar tendency for the bronchioloalveolar carcinoma (BAC). Is it possible to confirm the statement that BAC is multiple cancer among non- smoking women? Methods: Between 2001-2006, 14 lung resections for adenocarcinoma were carried out. Of these 37.1% were BAC. We effected 8 lobectomies, 3 pneumonectomies and 3 wedge resections. Results: The preoperative CT suspected three multiple tumors, but only two were confirmed by postoperative pathology. The tumor was indicated to be in stage I or II in 6 cases by surgery, 8 cases by pathology. 6 tumors were in stage I/A. for the overall group of 37.1% of patients the 5-year survival rate for wedge resections (41%) was lower than that for major resections (64%) (p=0,41). Conglusions: Bronchioloalveolar carcinoma (BAC) has favourable survival, particularly in women. Because of its slow growth, the patients are operated on at an early stage. In spite of this, resection smaller than lobectomy is recommended only as compromise. The high proportion of non- smoking women may suggest genetic or hormonal etiological factor for BAC.
CLC012
POSTER
Surgical treatment of metastases of malignant melanomas in the lung Athanassiadis G., Pavlidu Ch., Andronadi V., Ekonomou K., Zoganas L. Thoracosurgery Clinic, ‘Hellenic Red Cross’ Hospital, Greece Goal: To analyse the results from the surgical treatment of malignant melanomas in the lung. Material and Method: From January 2003 until January 2006, we treated in our clinic 6 patients with metastases of malignant melanoma in the lung (5 with metastases in the lung and 1 in the bronchus). Metastases in the lung are mostly parenchymal and the patient’s progress depends on their number and on whether they can be resected. The endobronchial metastases are far rarer. Results: There were no perioperative or postoperative complications. In the case of the melanoma developed in the bronchus, the diagnosis was based on the histological picture. Postoperatively, all patients are followed-up in an oncology center, and two of them receive adjuvant treatment. Conclusions: The metastases of malignant melanomas in the lung are mostly related to the parenchyma; the endobronchial cases are far rarer. The investigation must always follow the direction of the metastatic disease, especially in case of the unpredictable and most aggressive progress of the malignant melanoma.
CLC013
POSTER
Resection of the main carina, in case of infiltration from non-microcellular lung cancer Athanassiadis G., Pavlidu Ch., Zogana S., Vasilaki M., Zoganas L. Thoracosurgery Clinic, ‘Hellenic Red Cross’ Hospital, Greece Goal of the Paper: The infiltration of the main carina by a tumor, and of the tissue thereby, (it is usually a tumor infiltrating the upper lobar or the truncal
S5
bronchus), is not a very rare phenomenon and constitutes 2% of lung cancers (neglected cancer). Therefore, we present our experience in handling and treating such cases (n.m.l.c.), following the method of pneumonectomy with simultaneous ‘sleevelike’ excision of the main bronchus, and, in fact, excision of the main carina combined with tracheoplasty. Material: From 2003 to date, 2006, we have applied the method in ten cases (-10-), six men (-6-) and four women (-4-), aged from 52 to 70. The histological type of the specific tumors was mainly squamous epithelium, mostly of low differentiation, and a smaller number of adenic carcinomas, also of low differentiation most of the times, though more aggressive to the tissues. Method: We applied the method of pneumonectomy, combined with a ‘sleevelike excision’ of the main bronchus, in fact carinectomy, with parallel tracheoplasty, where the site resected in the form of a spindle, was closed by a No.4.0 prolene stitch (plastic, ‘meander-like and over & over’ suture). In all these operations, we used a double tracheal tube, which allowed us to achieve better ventilation or occlusion of the lung, depending on its maneuvering by the surgeon. Results: Nine (9) out of ten (10) patients survived and were successfully treated post-op. We had one (1) death, of a 70-year old patient, the sixteenth (16) day post-op, because of aspiration. Tracheostomy was required for one (-1-) out of the ten (-10-) patients. Average hospital days were 14. Conclusion: The combined method of pneumonectomy with simultaneous ‘sleeve-like’ excision of the main bronchus (sleeve-ectomy), and actually resection of the main carina (carinectomy), and parallel tracheoplasty, when there is infiltration of the main carina by a tumor (n.m.l.c.), makes these severe cases operable, in fact with very successful postoperative results.
CLC014
ORAL
Impact of PET scans in lung cancer surgery: Leeds UK experience Papagiannopoulos K. Leeds Teaching Hospitals, UK Introduction: 27 Although experience with PET scans is relatively new, and availability is not universal we present our initial experience with 128 patients with Non small cell lung cancer. Methods: 43 Between Jan 2005 and May 2006 data was retrospectively collected on all patients with suspected lung cancer who had a PET scan as part of their initial workup. Initial staging was correlated with final pathological TNM staging following surgical biopsy or radical treatment. Results: 103 PET scan upstaged the disease in 24 patients (20%). There was no uptake in 15 patients (12%) and Uptake was equivocal in 2(1.6%). All patients with equivocal uptake and 4 from no uptake group underwent surgery. 1 out of 4 in the no uptake group proved malignant (false negative (1/15=6%) and 1 out of 2 from the equivocal uptake proved malignant. Of the remaining 103 patients with positive uptake, 47 underwent surgical resections and 56 were referred to oncology because of advanced disease and co morbidity. Final histology from the surgical group revealed 4 benign cases; a false positive PET result of 8%. Conclusion: 49 PET or fusion PET-CT has better specificity and sensitivity as compared to CT alone. Upstage due to Nodal disease should be confirmed histologically ? Tumor false positive results are unavoidable. Intraoperative frozen section could prevent unnecessary major resections ? Each patient still requires an individual management strategy; the role of a Multidisciplinary Team remains invaluable.
CLC015
POSTER
Suspected lung cancer with negative CT guided needle biopsy and positive PET scan followed by radical lobectomy with no cancer evidence in final histology; medical success or failure Papagiannopoulos K. Leeds Teaching Hospitals, UK Introduction: 21 Although PET scan is increasingly becoming a necessity in assessment for lung cancer caution should be exercised when interpreting it’s results. Methods: 56 A 76 year old male smoker was investigated for lethargy. Clinical examination revealed clubbing. Imaging studies revealed a right upper lobe mass with a smaller nodule in the right lower lobe. Needle biopsy was negative for malignancy. A PET scan was strongly positive for cancer with mild uptake in right hilar and paratracheal nodes. Results: 39 At mediastinoscopy the nodes were negative for malignancy. The patient underwent radical surgery with right upper lobe lobectomy, wedge resection of right lower lobe nodule and systematic lymph nodal dissection. Final histology revealed no malignancy in the resected specimens.