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Complete En Bloc Resection of Thoracic Tumors with Vascular Reconstruction Is Superior to Limited Resection and Radiation Therapy
Vol. 223, No. 4S2, October 2016
Scientific Poster Presentations: 2016 Clinical Congress
undergoing CEA. This carried with it higher cardiac morbidity, while 30-day mortality and stroke rates were similar between both groups. Adjusted comparisons yielded no significant differences in outcomes, however, signifying non-inferiority of CAS over CEA. This suggests treatment for carotid artery disease, even in high-risk patients, should remain individualized. Complete En Bloc Resection of Thoracic Tumors with Vascular Reconstruction Is Superior to Limited Resection and Radiation Therapy Ramoncito A David, MD, Shanda H Blackmon, MD, MPH, FACS, Thomas C Bower, MD, FACS, Bradley J Stish, MD, Yolanda I Garces, MD, Mark S Allen, MD, FACS, KR Shen, MD, William S Harmsen, Kristin M Fruth, Jan L Kasperbauer, MD, FACS Mayo Clinic, Rochester, MN INTRODUCTION: Traditional surgical principles mandating en bloc and R0 resection often preclude removal of tumors that invade the aorta and great vessels. The objective of our study was to determine the safety and benefit of radical resection of complex tumors invading the aorta or great vessels compared to limited resection or nonoperative management. METHODS: Patients with tumors invading the aorta or great vessels from January 1994 to January 2014 were identified utilizing 2 prospectively collected databases. Data was retrospectively collected, including patient factors and operative details for surgical patients. The primary end-points were all-cause mortality at 2 years and recurrence-free survival (RFS) at 2 years. Kaplan-Meier (K-M) analysis was performed to compare outcomes. RESULTS: Thirty patients were identified and separated into 3 treatment groups: limited resection (LR, n ¼ 13), radical resection with vascular reconstruction (RR, n ¼ 9), or radiation therapy (RT, n ¼ 8). Mean age at initiation of treatment was 61 years (range 24 to 82) and median follow-up was 39.2 months. Within the operative group, R0 resection was more common in the RR group compared with the LR group (77.8% vs 30.8%). K-M estimates of overall survival at 2 years were: RT 87.5%, RR 77.8%, and LR 56.3%. RFS rates at 2 years were RR 100%, LR 100%, and RT 75%. Table. K-M overall survival 6 months
K-M overall survival 24 months
RFS 12 months
RFS 24 months
Overall (N ¼ 30)
89.76% (79.42, 100.0)
69.57% (52.70, 90.09)
92.86% (80.30, 100.0)
92.86% (78.19, 100.0)
Limited resection (N ¼ 13)
91.67% (77.29, 100.0)
56.25% (33.56, 94.28)
100.0%
100.0%
Nonoperative radiation (N ¼ 8)
87.50% (67.34, 100.0)
87.50% (51.82, 100.0)
75.00% (42.59, 100.0)
75.00% (33.69, 100.0)
Radical resection (N ¼ 9)
88.89% (70.56, 100.0)
77.78% (51.97, 100.0)
100.0%
100.0%
Variable
Note: Analysis includes only operative patients with R0 resection and nonoperative patients who were radiologically disease-free at the conclusion treatment.
CONCLUSIONS: When feasible, complete resection of aortic or great vessel tumor invasion can result in similar long-term survival and
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improved RFS compared to radiation therapy. Incomplete resection is not recommended based on morbidity and poor long-term survival. Frequency of Debridement in Chronic Venous Lower Extremity Ulcer vs Diabetic Foot Ulcers Thais Polanco, MD, Nicolle Ilonzo, MD, Eleonora Koshchak, Lawrence Markel, John Lantis, MD, FACS Mount Sinai St. Luke’s-West Hospital, New York, NY INTRODUCTION: Debridement is commonly defined as the process of removing necrotic, devitalized tissue, and foreign material from a wound. The aim of this study is assess the frequency of debridement and its influence on time of healing in patients with chronic VLU vs DFU. METHODS: A retrospective chart review was performed on 68 patients (DFU¼ 39 patients and VLU¼29 patients), with a total of 85 wounds (VLU n¼35 or DFU n¼50 etiology). Each patient had at least 1 debridement in our tertiary wound care clinic during a 1-year period. Size of wound and date of debridement were recorded. RESULTS: Pre-debridement median wound size for VLU group was 3 cm2 (range 0.5-150 cm2) vs DFU group 3.4 cm2 (range,0.12-27 cm2). There was a higher frequency (p<0.05) of serial debridements in the DFU vs VLU groups. The median number of debridements was 21 DFU and 7 for VLU at each patient visit. Seventy-two percent of total study visits in the DFU vs 41% of total study visits in VLU had debridement (p<0.05). After initial debridement, there was a decrease in wound size by 42% in DFU vs 23% in VLU patients by week 4 (p<0.05). A total of 61% of wounds healed at 12-weeks (34/50 (68%) DFU vs 18/35 (51%) VLU). There was a non-significant difference in time to heal in the 2 groups (median¼6 weeks for VLU and DFU). CONCLUSIONS: Frequent debridements per patient correlated with a higher rate of complete wound closure. However, it did not correlate with a shorter time to heal in comparing DFU vs VLU groups. Incidence and Risk Factors of Spinal Cord Ischemia after Thoracic Stent Grafting Juan I Pardo, MD, Eduardo Magarinos, Hernan Bertoni, German Girela Instituto Fleni, Sanatorio la Torre, Buenos Aires, Argentina INTRODUCTION: The aim of this paper is to analyze retrospective the incidence of spinal cord ischemia (IM) and identify the factors contributing to its development during endovascular repair of the descending thoracic aorta in patients requiring full coverage of it. METHODS: Between April 1999 and December 2014 thoracic endovascular aortic repair was performed in 176 patients. Sixtytwo of them (48 male and 14 female) were treated with stent graft in the thoracic aorta from the aortic arch to the celiac trunk due to true aneurysms (n¼13), aortic dissections ( n ¼42), intramural hematoma (n¼4), post-traumatic pseudoaneurysms (n¼2), and aortic ulcer (n¼1). All procedures were performed under general anesthesia and invasive strict control of blood pressure.
Scientific Poster Presentations: 2016 Clinical Congress
undergoing CEA. This carried with it higher cardiac morbidity, while 30-day mortality and stroke rates were similar between both groups. Adjusted comparisons yielded no significant differences in outcomes, however, signifying non-inferiority of CAS over CEA. This suggests treatment for carotid artery disease, even in high-risk patients, should remain individualized. Complete En Bloc Resection of Thoracic Tumors with Vascular Reconstruction Is Superior to Limited Resection and Radiation Therapy Ramoncito A David, MD, Shanda H Blackmon, MD, MPH, FACS, Thomas C Bower, MD, FACS, Bradley J Stish, MD, Yolanda I Garces, MD, Mark S Allen, MD, FACS, KR Shen, MD, William S Harmsen, Kristin M Fruth, Jan L Kasperbauer, MD, FACS Mayo Clinic, Rochester, MN INTRODUCTION: Traditional surgical principles mandating en bloc and R0 resection often preclude removal of tumors that invade the aorta and great vessels. The objective of our study was to determine the safety and benefit of radical resection of complex tumors invading the aorta or great vessels compared to limited resection or nonoperative management. METHODS: Patients with tumors invading the aorta or great vessels from January 1994 to January 2014 were identified utilizing 2 prospectively collected databases. Data was retrospectively collected, including patient factors and operative details for surgical patients. The primary end-points were all-cause mortality at 2 years and recurrence-free survival (RFS) at 2 years. Kaplan-Meier (K-M) analysis was performed to compare outcomes. RESULTS: Thirty patients were identified and separated into 3 treatment groups: limited resection (LR, n ¼ 13), radical resection with vascular reconstruction (RR, n ¼ 9), or radiation therapy (RT, n ¼ 8). Mean age at initiation of treatment was 61 years (range 24 to 82) and median follow-up was 39.2 months. Within the operative group, R0 resection was more common in the RR group compared with the LR group (77.8% vs 30.8%). K-M estimates of overall survival at 2 years were: RT 87.5%, RR 77.8%, and LR 56.3%. RFS rates at 2 years were RR 100%, LR 100%, and RT 75%. Table. K-M overall survival 6 months
K-M overall survival 24 months
RFS 12 months
RFS 24 months
Overall (N ¼ 30)
89.76% (79.42, 100.0)
69.57% (52.70, 90.09)
92.86% (80.30, 100.0)
92.86% (78.19, 100.0)
Limited resection (N ¼ 13)
91.67% (77.29, 100.0)
56.25% (33.56, 94.28)
100.0%
100.0%
Nonoperative radiation (N ¼ 8)
87.50% (67.34, 100.0)
87.50% (51.82, 100.0)
75.00% (42.59, 100.0)
75.00% (33.69, 100.0)
Radical resection (N ¼ 9)
88.89% (70.56, 100.0)
77.78% (51.97, 100.0)
100.0%
100.0%
Variable
Note: Analysis includes only operative patients with R0 resection and nonoperative patients who were radiologically disease-free at the conclusion treatment.
CONCLUSIONS: When feasible, complete resection of aortic or great vessel tumor invasion can result in similar long-term survival and
e213
improved RFS compared to radiation therapy. Incomplete resection is not recommended based on morbidity and poor long-term survival. Frequency of Debridement in Chronic Venous Lower Extremity Ulcer vs Diabetic Foot Ulcers Thais Polanco, MD, Nicolle Ilonzo, MD, Eleonora Koshchak, Lawrence Markel, John Lantis, MD, FACS Mount Sinai St. Luke’s-West Hospital, New York, NY INTRODUCTION: Debridement is commonly defined as the process of removing necrotic, devitalized tissue, and foreign material from a wound. The aim of this study is assess the frequency of debridement and its influence on time of healing in patients with chronic VLU vs DFU. METHODS: A retrospective chart review was performed on 68 patients (DFU¼ 39 patients and VLU¼29 patients), with a total of 85 wounds (VLU n¼35 or DFU n¼50 etiology). Each patient had at least 1 debridement in our tertiary wound care clinic during a 1-year period. Size of wound and date of debridement were recorded. RESULTS: Pre-debridement median wound size for VLU group was 3 cm2 (range 0.5-150 cm2) vs DFU group 3.4 cm2 (range,0.12-27 cm2). There was a higher frequency (p<0.05) of serial debridements in the DFU vs VLU groups. The median number of debridements was 21 DFU and 7 for VLU at each patient visit. Seventy-two percent of total study visits in the DFU vs 41% of total study visits in VLU had debridement (p<0.05). After initial debridement, there was a decrease in wound size by 42% in DFU vs 23% in VLU patients by week 4 (p<0.05). A total of 61% of wounds healed at 12-weeks (34/50 (68%) DFU vs 18/35 (51%) VLU). There was a non-significant difference in time to heal in the 2 groups (median¼6 weeks for VLU and DFU). CONCLUSIONS: Frequent debridements per patient correlated with a higher rate of complete wound closure. However, it did not correlate with a shorter time to heal in comparing DFU vs VLU groups. Incidence and Risk Factors of Spinal Cord Ischemia after Thoracic Stent Grafting Juan I Pardo, MD, Eduardo Magarinos, Hernan Bertoni, German Girela Instituto Fleni, Sanatorio la Torre, Buenos Aires, Argentina INTRODUCTION: The aim of this paper is to analyze retrospective the incidence of spinal cord ischemia (IM) and identify the factors contributing to its development during endovascular repair of the descending thoracic aorta in patients requiring full coverage of it. METHODS: Between April 1999 and December 2014 thoracic endovascular aortic repair was performed in 176 patients. Sixtytwo of them (48 male and 14 female) were treated with stent graft in the thoracic aorta from the aortic arch to the celiac trunk due to true aneurysms (n¼13), aortic dissections ( n ¼42), intramural hematoma (n¼4), post-traumatic pseudoaneurysms (n¼2), and aortic ulcer (n¼1). All procedures were performed under general anesthesia and invasive strict control of blood pressure.