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OA15.06 The Efficacy of Lung Volume Analyzer for Measuring Resection Margin in Pulmonary Segmentectomy for Malignant Diseases
January 2017
cancer was 12 stageIA (pT1a; 10, pT1b; 2), 1 stageIIA (pT1aN1), and 1 stageIIIA (pT1aN2). The success rate of identifying pulmonary segments was 100%. Dissection of segmental border was performed with only electric cautery in 12 procedures, and with both of electric cautery and stapling device in 6 procedures. In all cases, no cancer cells were found on the resection margin pathologically. Mean drainage time was 1.7 days (1-4 days). Regarding perioperative complications, venovagal reflex was occurred after systemic injection of vitaminB2 in one case, and 1 delayed pneumothorax was found in one case. Conclusion: Our novel fluorescence technique involving a PDD endoscope systemTM and vitaminB2 allowed performing accurate and safe pulmonary segmentectomy and sub-segmentectomy. Keywords: Surgery for lung cancer, Pulmonary segmentectomy, New technique
Abstracts
S303
adequate resection margin of approximately 2 cm from the tumor. We prospectively performed segmentectomy in 17 patients and compared between simulated distance and actual distance measured from the specimen. Results: The average number of created patterns of virtual segmentectomy in each case was 4.1 ± 1.0. The mean distance of resection margin in selected virtual segmentectomy was 19.3 ± 9.7 mm. On the other hand, actual shortest distance in resected specimen was 25.4 ± 8.1 mm, which was significantly longer than simulated distance (p¼0.027). There was no tumor recurrence in all patients. Conclusion: Lung volume analyzer was an excellent tool for selecting an ideal area of sublobar resection with an appropriate resection margin. Keywords: infrared thoracoscopy, indocianine green, lung cancer, virtual segmentectomy
OA15.06 The Efficacy of Lung Volume Analyzer for Measuring Resection Margin in Pulmonary Segmentectomy for Malignant Diseases
OA15.07 Is Necessary Completion Lobectomy in NSCLC ( 2cm) with Visceral Pleural Invasion or Lymphovascular Invasion after Sublobar Resection?
Yasuo Sekine,1 Takamasa Yun,2 Takahide Toyoda,2 Daisuke Kaiho,2 Eitetsu Koh,1 Toshiko Kamata1 1 Department of General Thoracic Surgery, Tokyo Women’s Medical University Yachiyo Medical Center, Yachiyo/ Japan, 2Department of General Thoracic Surgery, Kimitsu Central Hospital, Kisarazu/Japan
Youngkyu Moon, Mi Hyoung Moon, Young Kyoon Kim, Kyo-Young Lee, Jae Kil Park, Sook Whan Sung The Catholic University of Korea, Seoul St. Mary’s Hospital, College of Medicine, Seoul/Korea, Democratic People’s Republic of
Background: Although the confirmation of an appropriate resection margin from the tumor is crucial for reducing the risk of local recurrence after lung segmentectomy for pulmonary malignancies, there has been no method of measurement. We established a novel approach for performing segmentectomy by using an infrared thoracoscopy with transbronchial instillation of indocianine green (ICG), and improved this method by adding an advanced computer technology via lung volume analyzer for obtaining an appropriate resection margin. Methods: Preoperatively, each patient underwent multislice enhanced computed tomography (CT) using 320slice scanners for pulmonary angiography and virtual bronchoscopy, and to create several virtual segmentectomies by using Volume Analyzer Synapse VINCENT (Fujifilm co., Tokyo, Japan). We measured the shortest distance from the tumor to the resection margin in each simulated segmentectomy and selected the most appropriate area of sublobar resection based on the
Background: The standard surgical treatment of stage I non-small cell lung cancer is anatomical lobectomy. However, in some cases, small peripheral lung cancer (2cm) is treated by sublobar resection. The purpose of this study was to define the necessity of completion lobectomy when the tumor was revealed as non-small cell lung cancer with pleural invasion or lymphovascular invasion after sublobar resection. Methods: We retrospectively reviewed 271 consecutive patients who underwent curative resection for stage I nonesmall cell lung cancer of 2 cm or less. We analyzed clinicopathological findings and survival between two groups with either invasion-positive tumor (tumor with visceral pleural invasion or lymphovascular invasion) or invasion-negative tumor (tumor without visceral pleural invasion and lymphovascular invasion): sublobar resection group and lobectomy group. Results: Except for age and pulmonary function, there were no differences in clinocopathological characteristics between sublobar resection group and lobectomy group with invasion-positive tumor or invasion-negative
cancer was 12 stageIA (pT1a; 10, pT1b; 2), 1 stageIIA (pT1aN1), and 1 stageIIIA (pT1aN2). The success rate of identifying pulmonary segments was 100%. Dissection of segmental border was performed with only electric cautery in 12 procedures, and with both of electric cautery and stapling device in 6 procedures. In all cases, no cancer cells were found on the resection margin pathologically. Mean drainage time was 1.7 days (1-4 days). Regarding perioperative complications, venovagal reflex was occurred after systemic injection of vitaminB2 in one case, and 1 delayed pneumothorax was found in one case. Conclusion: Our novel fluorescence technique involving a PDD endoscope systemTM and vitaminB2 allowed performing accurate and safe pulmonary segmentectomy and sub-segmentectomy. Keywords: Surgery for lung cancer, Pulmonary segmentectomy, New technique
Abstracts
S303
adequate resection margin of approximately 2 cm from the tumor. We prospectively performed segmentectomy in 17 patients and compared between simulated distance and actual distance measured from the specimen. Results: The average number of created patterns of virtual segmentectomy in each case was 4.1 ± 1.0. The mean distance of resection margin in selected virtual segmentectomy was 19.3 ± 9.7 mm. On the other hand, actual shortest distance in resected specimen was 25.4 ± 8.1 mm, which was significantly longer than simulated distance (p¼0.027). There was no tumor recurrence in all patients. Conclusion: Lung volume analyzer was an excellent tool for selecting an ideal area of sublobar resection with an appropriate resection margin. Keywords: infrared thoracoscopy, indocianine green, lung cancer, virtual segmentectomy
OA15.06 The Efficacy of Lung Volume Analyzer for Measuring Resection Margin in Pulmonary Segmentectomy for Malignant Diseases
OA15.07 Is Necessary Completion Lobectomy in NSCLC ( 2cm) with Visceral Pleural Invasion or Lymphovascular Invasion after Sublobar Resection?
Yasuo Sekine,1 Takamasa Yun,2 Takahide Toyoda,2 Daisuke Kaiho,2 Eitetsu Koh,1 Toshiko Kamata1 1 Department of General Thoracic Surgery, Tokyo Women’s Medical University Yachiyo Medical Center, Yachiyo/ Japan, 2Department of General Thoracic Surgery, Kimitsu Central Hospital, Kisarazu/Japan
Youngkyu Moon, Mi Hyoung Moon, Young Kyoon Kim, Kyo-Young Lee, Jae Kil Park, Sook Whan Sung The Catholic University of Korea, Seoul St. Mary’s Hospital, College of Medicine, Seoul/Korea, Democratic People’s Republic of
Background: Although the confirmation of an appropriate resection margin from the tumor is crucial for reducing the risk of local recurrence after lung segmentectomy for pulmonary malignancies, there has been no method of measurement. We established a novel approach for performing segmentectomy by using an infrared thoracoscopy with transbronchial instillation of indocianine green (ICG), and improved this method by adding an advanced computer technology via lung volume analyzer for obtaining an appropriate resection margin. Methods: Preoperatively, each patient underwent multislice enhanced computed tomography (CT) using 320slice scanners for pulmonary angiography and virtual bronchoscopy, and to create several virtual segmentectomies by using Volume Analyzer Synapse VINCENT (Fujifilm co., Tokyo, Japan). We measured the shortest distance from the tumor to the resection margin in each simulated segmentectomy and selected the most appropriate area of sublobar resection based on the
Background: The standard surgical treatment of stage I non-small cell lung cancer is anatomical lobectomy. However, in some cases, small peripheral lung cancer (2cm) is treated by sublobar resection. The purpose of this study was to define the necessity of completion lobectomy when the tumor was revealed as non-small cell lung cancer with pleural invasion or lymphovascular invasion after sublobar resection. Methods: We retrospectively reviewed 271 consecutive patients who underwent curative resection for stage I nonesmall cell lung cancer of 2 cm or less. We analyzed clinicopathological findings and survival between two groups with either invasion-positive tumor (tumor with visceral pleural invasion or lymphovascular invasion) or invasion-negative tumor (tumor without visceral pleural invasion and lymphovascular invasion): sublobar resection group and lobectomy group. Results: Except for age and pulmonary function, there were no differences in clinocopathological characteristics between sublobar resection group and lobectomy group with invasion-positive tumor or invasion-negative