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P3.04-033 Digital Drainage System Reduces Chest Tube Duration and Hospitalization after Anatomic Pulmonary Resections for Malignancies
January 2017
balance variables potentially affecting chest tube duration between Group Clamping and Group Control. Analyses were performed to compare chest tube duration and postoperative hospital stay between the two groups. Variables linked with chest tube duration were gender, operation side, VATS and chylothorax, which were assessed using multivariable logistic regression analysis in whole cohort. Results: The rate of thoracocentesis after chest tube removal did not increase in Group Clamping compared with Group Control in whole cohort (0.5% vs. 1.5%, P¼0.386). The rates of pyrexia were also comparable in two groups (2.3% vs. 3.2%, P¼0.685). After propensity score matching, 61 cases remained in each group. Group Clamping showed shorter chest tube duration (4.0 days vs. 4.8 days, P¼0.001) and shorter postoperative stay (5.7 days vs. 6.4 days, P¼0.025) compared with Group Control. Factors significantly associated with shorter chest tube duration were being female, left lobectomy, chest tube clamping, VATS and absence of chylothorax (P<0.05). Conclusion: This study suggests that chest tube clamping may decrease the length of chest tube duration and postoperative hospital stay while maintaining patient safety. Keywords: lung cancer surgery, chest tube clamping, chest tube duration, postoperative stay
P3.04-032 Sternal Reconstruction with a CustomMade Titanium Neosternum after Resection of a Solitary Breast Cancer Metastasis Topic: Miscellaneous II Ihsan Alloubi,1 Rachid Marouf2 1Thoracic Surgery, CHU Oujda, Oujda/Morocco, 2Thoracic Surgery CHU Oujda, Oujda/Morocco Background: Bone is the most common metastatic site of breast cancer; and sternal metastasis usually occurs in an isolated setting. We report an extremely rare case of a patient who underwent subtotal sternal resection, followed by reconstruction using a new total titanium custom-made neosternum and the complete coverage of the surgical wound by latissimus dorsi flap suggest that these procedures may be useful in reconstructing large defects in the chest wall. Methods: A 47-year-old female with history of breast carcinoma and been given a left-sided conservative surgery 4 years ago with chemotherapy and radiotherapy.
Abstracts
S1403
She’s presented with a progressively enlarging mass of her anterior chest wall and dull pain in the upper-mid chest. Computed tomography revealed an osteolytic lesion in the bone marrow of the sternum. The tumor extended across the destroyed cortex involving some of the costal cartilage and most of the sternal body. Diagnosis of invasive ductal carcinoma was made by echo-guided core biopsy. 18-Fluoro-Desoxy-Glucose (FDG) positron-emission tomography (FDG-PET) showed hypermetabolic left breast mass without distant metastasis. Results: Sternal resection was performed successfully and a custom-made titanium neosternum was designed based on three dimensional simulation from preoperative chest computed tomography to reconstruct the anterior chest wall. Postoperative care was uneventful during a 10-day in-hospital stay. After a 6-month followup, the patient denied any shortness of breath, chest pain or limitation on her daily activities. The chest was stable without any paradoxical motion. Chest X-ray did not show any material dysfonction, pleural effusion or lung abnormalities. Conclusion: This new material used in our sternal reconstruction may extend the existing range of indications of sternectomy for cancer with curative intent.
P3.04-033 Digital Drainage System Reduces Chest Tube Duration and Hospitalization after Anatomic Pulmonary Resections for Malignancies Topic: Miscellaneous II Pedro Araujo,1 Alberto Dela Vega,1 Letícia Lauricella,1 Benoit Bibas,1 Paulo Pêgo-Fernandes,2 Ricardo Terra1 1Cirurgia Torácica Oncológica, Instituto Do Câncer Do Estado de São Paulo - Icesp, São Paulo/Brazil, 2Cirurgia Torácica, Intituto Do Coração Do Hospital Das Clínicas Da Fmusp, São Paulo/Brazil Background: The management of the chest tube after anatomic lung resections is critical to determine the length of stay and the cost of the hospitalization. The new digital chest drainage systems promise to reduce the intervals to chest tube removal and to patient’s discharge from hospital. This study aims to compare the conventional water seal and the new digital drainage systems regarding chest tube duration and hospitalization. Methods: Between July 2015 and May 2016 consecutive patients submitted to elective pulmonary lobectomy, segmentectomy or bilobectomy for malignancies in the
S1404
Cancer Institute of University of São Paulo (ICESP) used the digital drainage system Thopaz®. On the historic control group we included patients submitted to the same types of resection in our hospital between July 2014 and June 2015. All of them used the conventional water seal system. The groups were balanced for type of pulmonary resection and open versus minimally invasive techniques. Chest tubes were removed when the recorded airflow was less than 10 mL/min for the last 6 hours on the digital group and when there were no instantaneous air leaks during the daily rounds on the water seal group. The pleural drainage should be less than 400 ml/24 h for both groups. The patients were discharged from hospital according the same routine assistance protocols. Results: We included 110 patients. In each group, 50 lobectomies, 4 segmentectomies and 1 inferior bi-lobectomy were performed; thoracotomy was used in 19 patients and minimally invasive approaches in 36 cases per group. The groups were similar regarding gender (p¼0.700), ASA Physical Status Classification System (p¼0.838) and the Thoracic Surgery Scoring System (p¼0.501). More patients had COPD in digital group (52.7%) than in water seal (30.9%) (p¼0.033). Patients in the digital group were younger (median 65 years, IR:57-71) than in conventional group (median 70 years, IR:62-76) (p¼0.016). The digital group had shorter chest tube interval (2 days, IR:1-4) than water seal (4 days, IR:3-5) (p¼0.001). The same occurred on hospitalization: 4 days (IR:3-7) for digital and 5 days (IR:4-7) for conventional group (p¼0.06). The morbidity was similar between groups, either for general (p¼1.000) or for surgical complications (p¼0.818). Conclusion: Patients undergoing anatomic lung resections for malignancies who were managed postoperatively with a digital drainage system experienced shorter chest tube duration and hospitalization, compared to those with conventional water seal drainage. Keywords: Thoracic Surgery, lobectomy, Chest drainage system, segmentectomy
P3.04-034 Differences between Pleurodesis Using Talc and Silver Nitrate at Different Times of Pleural Disease in Mice Topic: Miscellaneous II Rodrigo Sabbion,1 Ricardo Terra,2 Lisete Teixeira,1 Carolina Bonizzio,1 Milena Acencio,3 Paulo Pêgo-Fernandes1 1Cirurgia Torácica, Intituto Do Coração Do Hospital Das Clínicas Da Fmusp, São Paulo/
Journal of Thoracic Oncology
Vol. 12 No. 1S
Brazil, 2Thoracic Surgery, University of Sao Paulo Medical School, Sao Paulo/Brazil, 3Cardiopneumology, Heart Institute (Incor), São Paulo/Brazil Background: Recurrent malignant pleural effusion occurs in approximately 50% of patients with metastatic tumors and their therapy is essentially palliative. The most used method is the chemical pleurodesis. However, we don’t know what would be the ideal time to submit the patient to the procedure, neither what the best sclerosing agent. The objective is to analyze if the progression of the pleural neoplastic disease is associated with the degree of fibrosis in mice subjected to pleurodesis with talc and nitrate, in animals injected with 10 thousand Lewis’s cells intrapleural. Methods: In this experimental study we used twenty C56-BL mice, with pleural cancer induced by injection of 10.000 Lewis cells/ml of 0.9% saline. On the third day of pleural disease, half of the animals were subjected to plerodese, 5 of them with talc at a concentration of 400mg/kg (called Group 3 Talc-“GT3”) and other 5 with silver nitrate in a concentration of 0.05% (called nitrate Group-“GN3”). On the seventh day of pleural disease, the remaining subjects were again divided into 2 groups of 5 animals (GT7andGN7) and subjected to plerodesis with the same substances and concentrations. All animals were sacrificed 7 days after pleurodesis, regardless of which group they belonged. Results: All animals were pleural implants of cancer cells. Regarding the macroscopic findings were graded fibrosis in score been validated in other studies ranging from 0 (no fibrosis) to 4 (complete symphysis). In GT3 group, 2 animals had a score 2, and 2 animals obtained score 0.5. In the nitrate group (GN3) 3 animals had a score 0. In animals underwent pleurodesis after 7 days of illness, the talc group (GT7), 3 animals received a score of 0,2 and 2.5 respectively; the nitrate group (GN7) received scores of 0.5, 1 and 2. Microscopically, all had the presence of fibroblasts and fibrosis on visceral pleura. 2 blades each group (GT3 GN3, and GT7 GN7) were stained with picrosirius method for evaluating local fibrosis, and all had positive staining method including quantitation amount sufficient to further study. The animal control cutting blade, with only pleural disease had negative results. Conclusion: Animals with this number of implanted cells have sufficient survival and satisfactory answer to pleurodesis so we can quantify it according to the available methods. There was no weight loss or significant reduction in activity of the animals during time. Apparently, there is a greater amount of fibrosis in animals submitted to pleurodesis with talc. Keywords: silver nitrate, pleurodesis, pleural effusion
balance variables potentially affecting chest tube duration between Group Clamping and Group Control. Analyses were performed to compare chest tube duration and postoperative hospital stay between the two groups. Variables linked with chest tube duration were gender, operation side, VATS and chylothorax, which were assessed using multivariable logistic regression analysis in whole cohort. Results: The rate of thoracocentesis after chest tube removal did not increase in Group Clamping compared with Group Control in whole cohort (0.5% vs. 1.5%, P¼0.386). The rates of pyrexia were also comparable in two groups (2.3% vs. 3.2%, P¼0.685). After propensity score matching, 61 cases remained in each group. Group Clamping showed shorter chest tube duration (4.0 days vs. 4.8 days, P¼0.001) and shorter postoperative stay (5.7 days vs. 6.4 days, P¼0.025) compared with Group Control. Factors significantly associated with shorter chest tube duration were being female, left lobectomy, chest tube clamping, VATS and absence of chylothorax (P<0.05). Conclusion: This study suggests that chest tube clamping may decrease the length of chest tube duration and postoperative hospital stay while maintaining patient safety. Keywords: lung cancer surgery, chest tube clamping, chest tube duration, postoperative stay
P3.04-032 Sternal Reconstruction with a CustomMade Titanium Neosternum after Resection of a Solitary Breast Cancer Metastasis Topic: Miscellaneous II Ihsan Alloubi,1 Rachid Marouf2 1Thoracic Surgery, CHU Oujda, Oujda/Morocco, 2Thoracic Surgery CHU Oujda, Oujda/Morocco Background: Bone is the most common metastatic site of breast cancer; and sternal metastasis usually occurs in an isolated setting. We report an extremely rare case of a patient who underwent subtotal sternal resection, followed by reconstruction using a new total titanium custom-made neosternum and the complete coverage of the surgical wound by latissimus dorsi flap suggest that these procedures may be useful in reconstructing large defects in the chest wall. Methods: A 47-year-old female with history of breast carcinoma and been given a left-sided conservative surgery 4 years ago with chemotherapy and radiotherapy.
Abstracts
S1403
She’s presented with a progressively enlarging mass of her anterior chest wall and dull pain in the upper-mid chest. Computed tomography revealed an osteolytic lesion in the bone marrow of the sternum. The tumor extended across the destroyed cortex involving some of the costal cartilage and most of the sternal body. Diagnosis of invasive ductal carcinoma was made by echo-guided core biopsy. 18-Fluoro-Desoxy-Glucose (FDG) positron-emission tomography (FDG-PET) showed hypermetabolic left breast mass without distant metastasis. Results: Sternal resection was performed successfully and a custom-made titanium neosternum was designed based on three dimensional simulation from preoperative chest computed tomography to reconstruct the anterior chest wall. Postoperative care was uneventful during a 10-day in-hospital stay. After a 6-month followup, the patient denied any shortness of breath, chest pain or limitation on her daily activities. The chest was stable without any paradoxical motion. Chest X-ray did not show any material dysfonction, pleural effusion or lung abnormalities. Conclusion: This new material used in our sternal reconstruction may extend the existing range of indications of sternectomy for cancer with curative intent.
P3.04-033 Digital Drainage System Reduces Chest Tube Duration and Hospitalization after Anatomic Pulmonary Resections for Malignancies Topic: Miscellaneous II Pedro Araujo,1 Alberto Dela Vega,1 Letícia Lauricella,1 Benoit Bibas,1 Paulo Pêgo-Fernandes,2 Ricardo Terra1 1Cirurgia Torácica Oncológica, Instituto Do Câncer Do Estado de São Paulo - Icesp, São Paulo/Brazil, 2Cirurgia Torácica, Intituto Do Coração Do Hospital Das Clínicas Da Fmusp, São Paulo/Brazil Background: The management of the chest tube after anatomic lung resections is critical to determine the length of stay and the cost of the hospitalization. The new digital chest drainage systems promise to reduce the intervals to chest tube removal and to patient’s discharge from hospital. This study aims to compare the conventional water seal and the new digital drainage systems regarding chest tube duration and hospitalization. Methods: Between July 2015 and May 2016 consecutive patients submitted to elective pulmonary lobectomy, segmentectomy or bilobectomy for malignancies in the
S1404
Cancer Institute of University of São Paulo (ICESP) used the digital drainage system Thopaz®. On the historic control group we included patients submitted to the same types of resection in our hospital between July 2014 and June 2015. All of them used the conventional water seal system. The groups were balanced for type of pulmonary resection and open versus minimally invasive techniques. Chest tubes were removed when the recorded airflow was less than 10 mL/min for the last 6 hours on the digital group and when there were no instantaneous air leaks during the daily rounds on the water seal group. The pleural drainage should be less than 400 ml/24 h for both groups. The patients were discharged from hospital according the same routine assistance protocols. Results: We included 110 patients. In each group, 50 lobectomies, 4 segmentectomies and 1 inferior bi-lobectomy were performed; thoracotomy was used in 19 patients and minimally invasive approaches in 36 cases per group. The groups were similar regarding gender (p¼0.700), ASA Physical Status Classification System (p¼0.838) and the Thoracic Surgery Scoring System (p¼0.501). More patients had COPD in digital group (52.7%) than in water seal (30.9%) (p¼0.033). Patients in the digital group were younger (median 65 years, IR:57-71) than in conventional group (median 70 years, IR:62-76) (p¼0.016). The digital group had shorter chest tube interval (2 days, IR:1-4) than water seal (4 days, IR:3-5) (p¼0.001). The same occurred on hospitalization: 4 days (IR:3-7) for digital and 5 days (IR:4-7) for conventional group (p¼0.06). The morbidity was similar between groups, either for general (p¼1.000) or for surgical complications (p¼0.818). Conclusion: Patients undergoing anatomic lung resections for malignancies who were managed postoperatively with a digital drainage system experienced shorter chest tube duration and hospitalization, compared to those with conventional water seal drainage. Keywords: Thoracic Surgery, lobectomy, Chest drainage system, segmentectomy
P3.04-034 Differences between Pleurodesis Using Talc and Silver Nitrate at Different Times of Pleural Disease in Mice Topic: Miscellaneous II Rodrigo Sabbion,1 Ricardo Terra,2 Lisete Teixeira,1 Carolina Bonizzio,1 Milena Acencio,3 Paulo Pêgo-Fernandes1 1Cirurgia Torácica, Intituto Do Coração Do Hospital Das Clínicas Da Fmusp, São Paulo/
Journal of Thoracic Oncology
Vol. 12 No. 1S
Brazil, 2Thoracic Surgery, University of Sao Paulo Medical School, Sao Paulo/Brazil, 3Cardiopneumology, Heart Institute (Incor), São Paulo/Brazil Background: Recurrent malignant pleural effusion occurs in approximately 50% of patients with metastatic tumors and their therapy is essentially palliative. The most used method is the chemical pleurodesis. However, we don’t know what would be the ideal time to submit the patient to the procedure, neither what the best sclerosing agent. The objective is to analyze if the progression of the pleural neoplastic disease is associated with the degree of fibrosis in mice subjected to pleurodesis with talc and nitrate, in animals injected with 10 thousand Lewis’s cells intrapleural. Methods: In this experimental study we used twenty C56-BL mice, with pleural cancer induced by injection of 10.000 Lewis cells/ml of 0.9% saline. On the third day of pleural disease, half of the animals were subjected to plerodese, 5 of them with talc at a concentration of 400mg/kg (called Group 3 Talc-“GT3”) and other 5 with silver nitrate in a concentration of 0.05% (called nitrate Group-“GN3”). On the seventh day of pleural disease, the remaining subjects were again divided into 2 groups of 5 animals (GT7andGN7) and subjected to plerodesis with the same substances and concentrations. All animals were sacrificed 7 days after pleurodesis, regardless of which group they belonged. Results: All animals were pleural implants of cancer cells. Regarding the macroscopic findings were graded fibrosis in score been validated in other studies ranging from 0 (no fibrosis) to 4 (complete symphysis). In GT3 group, 2 animals had a score 2, and 2 animals obtained score 0.5. In the nitrate group (GN3) 3 animals had a score 0. In animals underwent pleurodesis after 7 days of illness, the talc group (GT7), 3 animals received a score of 0,2 and 2.5 respectively; the nitrate group (GN7) received scores of 0.5, 1 and 2. Microscopically, all had the presence of fibroblasts and fibrosis on visceral pleura. 2 blades each group (GT3 GN3, and GT7 GN7) were stained with picrosirius method for evaluating local fibrosis, and all had positive staining method including quantitation amount sufficient to further study. The animal control cutting blade, with only pleural disease had negative results. Conclusion: Animals with this number of implanted cells have sufficient survival and satisfactory answer to pleurodesis so we can quantify it according to the available methods. There was no weight loss or significant reduction in activity of the animals during time. Apparently, there is a greater amount of fibrosis in animals submitted to pleurodesis with talc. Keywords: silver nitrate, pleurodesis, pleural effusion