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P1.08-064 Surgery for Malignant Pulmonary Tumor Invading Proximal Left Main Pulmonary Artery
S770
was shorter than 180 days and other 23 patients were metachronous group. Results: Among 42 patients with DPM, there were no significant differences in basic characteristics. Median overall survival was 118.97 ± 6.39 months. There was no significant difference in overall survival between synchronous group and metachronous group (p ¼ 0.921). Multivariate analysis revealed that higher lung cancer stage, postoperative therapy due to lung cancer, liver cirrhosis, and history of hypertension were independent factors for overall survival.
Journal of Thoracic Oncology
Vol. 12 No. 1S
P1.08-064 Surgery for Malignant Pulmonary Tumor Invading Proximal Left Main Pulmonary Artery Topic: Surgery for Locally Advanced and Advanced NSCLC Fumihiro Tanaka,1 Yusuke Nabe,2 Akihiro Taira,2 Taiji Kuwata,2 Soichi Oka,2 Yasuhiro Chikaishi,2 Ayako Hirai,2 Kazue Yoneda,2 Yuko Tashima,2 Koji Kuoroda,2 Naoko Imanishi2 1Thoracic Surgery, University of Occupational and Environmental Health, Kitakyuushuu/Japan, 2Second Department of Surgery (Chest Surgery), University of Occupational and Environmental Health, Japan, Kitakyusyu/Japan Background: Surgery for tumor invading proximal left main pulmonary artery (PA) may be technical challenge, and the current study conducted to assess its feasibility. Methods: Patients who received surgery for malignant pulmonary tumor invading left main PA, PA proximal to the first branch (usually A3), from 2011 through 2015 in our institute were retrospectively reviewed. Results: Among 32 eligible patients (Table 1), 31 (97%) patients received complete resection with pneumonectomy (n¼4) or lobectomy with PA-reconstruction (n¼27). Pericardiotomy was necessary for proximal control of
Characteristics of Patients (n¼32) No. of Patients %
Conclusion: Lung cancer stage and underlying liver cirrhosis were strongly related to overall survival in patients with DPM involving lung cancer and HCC. Absence of hypertension showed better prognosis in those patients. Keywords: lung cancer, hepatocellular carcinoma, double primary malignancies
Age, median (range) Sex, Female / Male Histology Primary lung cancer Lung metastasis Mode of lung resection Upper lobectomy Pneumonectomy Exploratory thoracotomy Pericardiotomy PA-resection Circumferential resection Partial resection PA-reconstruction Direct closure Patch closure (with pericardium) Vascular conduit (pulmonary vein) Bronchial sleeve resection Morbidity Arrythmia Prolonged air leak ARDS Mortality
70 years (47-85) 6 / 26 19% / 81% 30 2
94% 6%
27 4 1 12 31 18 13 27 25 1 1 11 7 5 2 1 0
84% 13% 3% 38% 97%
84%
34% 22%
0%
January 2017
main PA in 12 patients, and combined bronchial sleeve resection and reconstruction were performed in 11 patients. Postoperative complications occurred in 7 patients, but a > grade 3 complication (ARDS) occurred in only one patient who received pneumonectomy. There was no operative or in-hospital death. Conclusion: Lobectomy with PA-resection and reconstruction was feasible to avoid pneumonectomy for tumor invading proximal left PA. Keywords: lung tumor, Angioplasty, Left main pulmonary artery
P1.08-065 Resection of Isolated Brain Metastasis Improves Outcome of Non-Small-Cell Lung Cancer (NSCLC) Patients: A Retrospective Multicenter Study Topic: Surgery for Locally Advanced and Advanced NSCLC Julia Fuchs,1 Martin Früh,2 Alexandros Papachristofilou,3 Lukas Bubendorf,4 Catherine Schill,5 Lorenz Jost,6 Alfred Zippelius,1 Sacha Rothschild1 1Medical Oncology, University Hospital Basel, Basel/Switzerland, 2Kantonsspital St. Gallen, St. Gallen/Switzerland, 3Radiation Oncology, University Hospital Basel, Basel/Switzerland, 4Insitute of Pathology, University Hospital Basel, Basel/Switzerland, 5 Medical Oncology, Kantonsspital Baselland Liestal, Liestal/Switzerland, 6Medical Oncology, Kantonsspital Baselland Bruderholz, Basel/Switzerland Background: Metastatic non-small cell lung cancer (NSCLC) is an incurable disease. Selected patients with solitary brain metastasis from NSCLC can achieve long-term survival following metastasectomy. We analyzed the outcome of all consecutive and unselected patients undergoing resection of brain metastases in two cancer centers in Switzerland to assess safety and efficacy of brain metastasis resection in NSCLC. Methods: 119 consecutive NSCLC patients undergoing surgical resection of brain metastases from two centers in Switzerland (University Hospital Basel, Cantonal Hospital St. Gallen) between 2000 and 2014 were analyzed. Measured outcomes were extent of resection, resection status, postoperative complications and overall survival (OS). We used the log-rank test to compare unadjusted survival probabilities and multivariable Cox regression to investigate potential prognostic factors with respect to OS.
Abstracts
S771
Results: Median age was 60.5 years, 56% were male, 74% were smokers, 55% had adenocarcinoma. Median OS of the whole cohort was 18.0 months. 1-year survival rate was 63%, 12% of patients were alive after 5 years. In total, 146 brain metastases were resected; the maximum number of resected metastases was 4 (median: 1). Median diameter of resected metastases was 25 millimeters (range, 6-70 mm). About half of metastases were localized in the frontal cortex or the cerebellum. 86% of patients received postoperative radiotherapy. 63% of patients were treated with whole brain radiation, 12.6% received stereotactic radiotherapy. Median dose of postoperative radiotherapy was 30 Gy. Patients not receiving adjuvant radiotherapy (n¼11) had a significantly worse outcome (median OS 9.0 vs. 20.2 months, p¼0.002). Patients with more than one brain metastasis (n¼21) had a significantly worse outcome compared to those with a solitary metastasis (median OS 13.5 vs. 19.5 months, p¼0.006). Also patients with extracerebral metastases (n¼33) had a significantly poorer outcome (median OS 14.0 vs. 23.1 months, p¼0.005). Patients with non-squamous histology (n¼98) had a better outcome than patients with squamous cell carcinoma (median OS 22.6 vs. 12.0 months, p¼0.019). 21% of patients experienced postoperative complications, including need for surgical reintervention (5.8%), neurological deficits (4.2%), infection (4.2%), stroke (3.4%) and others (11.8%). The occurrence of postoperative complications was not associated with outcome. In the multivariate analysis existence of extracerebral metastases and resection of more than one brain metastasis were independent negative prognostic factors. Conclusion: Patients with isolated brain metastasis from NSCLC in the absence of extracranial metastasis should be evaluated for metastasectomy. Prospective trials are needed to characterize the patient population experiencing the greatest benefit from a surgical procedure. Keywords: Brain metastasis, metastasectomy, Radiotherapy, Prognosis
P1.08-066 Prognostic Factors of Post-Recurrence Survival in Patients with Completely Resected Stage III-N2 Non-Small Cell Lung Cancer Topic: Surgery for Locally Advanced and Advanced NSCLC Kyung Wook Shin, Sukki Cho, Sung Won Yum, Hyo-Jun Jang, Kwhanmien Kim, Sanghoon Jheon
was shorter than 180 days and other 23 patients were metachronous group. Results: Among 42 patients with DPM, there were no significant differences in basic characteristics. Median overall survival was 118.97 ± 6.39 months. There was no significant difference in overall survival between synchronous group and metachronous group (p ¼ 0.921). Multivariate analysis revealed that higher lung cancer stage, postoperative therapy due to lung cancer, liver cirrhosis, and history of hypertension were independent factors for overall survival.
Journal of Thoracic Oncology
Vol. 12 No. 1S
P1.08-064 Surgery for Malignant Pulmonary Tumor Invading Proximal Left Main Pulmonary Artery Topic: Surgery for Locally Advanced and Advanced NSCLC Fumihiro Tanaka,1 Yusuke Nabe,2 Akihiro Taira,2 Taiji Kuwata,2 Soichi Oka,2 Yasuhiro Chikaishi,2 Ayako Hirai,2 Kazue Yoneda,2 Yuko Tashima,2 Koji Kuoroda,2 Naoko Imanishi2 1Thoracic Surgery, University of Occupational and Environmental Health, Kitakyuushuu/Japan, 2Second Department of Surgery (Chest Surgery), University of Occupational and Environmental Health, Japan, Kitakyusyu/Japan Background: Surgery for tumor invading proximal left main pulmonary artery (PA) may be technical challenge, and the current study conducted to assess its feasibility. Methods: Patients who received surgery for malignant pulmonary tumor invading left main PA, PA proximal to the first branch (usually A3), from 2011 through 2015 in our institute were retrospectively reviewed. Results: Among 32 eligible patients (Table 1), 31 (97%) patients received complete resection with pneumonectomy (n¼4) or lobectomy with PA-reconstruction (n¼27). Pericardiotomy was necessary for proximal control of
Characteristics of Patients (n¼32) No. of Patients %
Conclusion: Lung cancer stage and underlying liver cirrhosis were strongly related to overall survival in patients with DPM involving lung cancer and HCC. Absence of hypertension showed better prognosis in those patients. Keywords: lung cancer, hepatocellular carcinoma, double primary malignancies
Age, median (range) Sex, Female / Male Histology Primary lung cancer Lung metastasis Mode of lung resection Upper lobectomy Pneumonectomy Exploratory thoracotomy Pericardiotomy PA-resection Circumferential resection Partial resection PA-reconstruction Direct closure Patch closure (with pericardium) Vascular conduit (pulmonary vein) Bronchial sleeve resection Morbidity Arrythmia Prolonged air leak ARDS Mortality
70 years (47-85) 6 / 26 19% / 81% 30 2
94% 6%
27 4 1 12 31 18 13 27 25 1 1 11 7 5 2 1 0
84% 13% 3% 38% 97%
84%
34% 22%
0%
January 2017
main PA in 12 patients, and combined bronchial sleeve resection and reconstruction were performed in 11 patients. Postoperative complications occurred in 7 patients, but a > grade 3 complication (ARDS) occurred in only one patient who received pneumonectomy. There was no operative or in-hospital death. Conclusion: Lobectomy with PA-resection and reconstruction was feasible to avoid pneumonectomy for tumor invading proximal left PA. Keywords: lung tumor, Angioplasty, Left main pulmonary artery
P1.08-065 Resection of Isolated Brain Metastasis Improves Outcome of Non-Small-Cell Lung Cancer (NSCLC) Patients: A Retrospective Multicenter Study Topic: Surgery for Locally Advanced and Advanced NSCLC Julia Fuchs,1 Martin Früh,2 Alexandros Papachristofilou,3 Lukas Bubendorf,4 Catherine Schill,5 Lorenz Jost,6 Alfred Zippelius,1 Sacha Rothschild1 1Medical Oncology, University Hospital Basel, Basel/Switzerland, 2Kantonsspital St. Gallen, St. Gallen/Switzerland, 3Radiation Oncology, University Hospital Basel, Basel/Switzerland, 4Insitute of Pathology, University Hospital Basel, Basel/Switzerland, 5 Medical Oncology, Kantonsspital Baselland Liestal, Liestal/Switzerland, 6Medical Oncology, Kantonsspital Baselland Bruderholz, Basel/Switzerland Background: Metastatic non-small cell lung cancer (NSCLC) is an incurable disease. Selected patients with solitary brain metastasis from NSCLC can achieve long-term survival following metastasectomy. We analyzed the outcome of all consecutive and unselected patients undergoing resection of brain metastases in two cancer centers in Switzerland to assess safety and efficacy of brain metastasis resection in NSCLC. Methods: 119 consecutive NSCLC patients undergoing surgical resection of brain metastases from two centers in Switzerland (University Hospital Basel, Cantonal Hospital St. Gallen) between 2000 and 2014 were analyzed. Measured outcomes were extent of resection, resection status, postoperative complications and overall survival (OS). We used the log-rank test to compare unadjusted survival probabilities and multivariable Cox regression to investigate potential prognostic factors with respect to OS.
Abstracts
S771
Results: Median age was 60.5 years, 56% were male, 74% were smokers, 55% had adenocarcinoma. Median OS of the whole cohort was 18.0 months. 1-year survival rate was 63%, 12% of patients were alive after 5 years. In total, 146 brain metastases were resected; the maximum number of resected metastases was 4 (median: 1). Median diameter of resected metastases was 25 millimeters (range, 6-70 mm). About half of metastases were localized in the frontal cortex or the cerebellum. 86% of patients received postoperative radiotherapy. 63% of patients were treated with whole brain radiation, 12.6% received stereotactic radiotherapy. Median dose of postoperative radiotherapy was 30 Gy. Patients not receiving adjuvant radiotherapy (n¼11) had a significantly worse outcome (median OS 9.0 vs. 20.2 months, p¼0.002). Patients with more than one brain metastasis (n¼21) had a significantly worse outcome compared to those with a solitary metastasis (median OS 13.5 vs. 19.5 months, p¼0.006). Also patients with extracerebral metastases (n¼33) had a significantly poorer outcome (median OS 14.0 vs. 23.1 months, p¼0.005). Patients with non-squamous histology (n¼98) had a better outcome than patients with squamous cell carcinoma (median OS 22.6 vs. 12.0 months, p¼0.019). 21% of patients experienced postoperative complications, including need for surgical reintervention (5.8%), neurological deficits (4.2%), infection (4.2%), stroke (3.4%) and others (11.8%). The occurrence of postoperative complications was not associated with outcome. In the multivariate analysis existence of extracerebral metastases and resection of more than one brain metastasis were independent negative prognostic factors. Conclusion: Patients with isolated brain metastasis from NSCLC in the absence of extracranial metastasis should be evaluated for metastasectomy. Prospective trials are needed to characterize the patient population experiencing the greatest benefit from a surgical procedure. Keywords: Brain metastasis, metastasectomy, Radiotherapy, Prognosis
P1.08-066 Prognostic Factors of Post-Recurrence Survival in Patients with Completely Resected Stage III-N2 Non-Small Cell Lung Cancer Topic: Surgery for Locally Advanced and Advanced NSCLC Kyung Wook Shin, Sukki Cho, Sung Won Yum, Hyo-Jun Jang, Kwhanmien Kim, Sanghoon Jheon