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Staging for Patients With Malignant Pleural Mesothelioma After Extrapleural Pneumonectomy
ASCTS 2010 Abstracts
Single Interspace Video Assisted Thoracoscopic Lobectomy—Analysis of Technique and Comparison With Standard Lobectomy G. Crouch ∗ , E. Slimani, M. Venkataraman, C. Jurisevic
Worthington, A.
Department of Cardiothoracic Surgery, Royal Adelaide Hospital, Adelaide, Australia Background: Video Assisted Thoracoscopic (VAT) lobectomy has been an increasingly accepted technique in the management of early stage non-small cell lung cancer [1]. Its proposed benefits focus on decreased morbidity particularly length of stay, acute post-operative pain, chronic pain and subsequently decreased mortality [2]. We review our novel technique using a single interspace approach over the accepted triangulation approach. We compare the outcomes to standard thoracotomies at the same institution and the VATS literature. Methods: In a single institution, single surgeon, retrospective analysis of prospectively collected data between 2001 and 2009, 473 lobectomies were performed, 96 via a novel technique of VATS lobectomy utilising a single interspace approach and 377 lobectomies via thoracotomy. The VAT lobectomies were introduced in 2006 as a preference for stages I and II disease. Data was prospectively collected focusing particularly on tumour stage, length of stay and post-operative complications. Results: The demographics and comorbidities were similar in both groups. Mean ages were 65.3 and 66.1 years in the VATS and thoracotomy groups respectively. The conversion rate from VAT to standard lobectomy was 6.25% (six cases). There was no difference in the distribution of lobe resected. There was a trend to later stage tumours in the open group although this is reduced with intention to treat analysis (stages I, II, III: 50%, 49%, 1% VATS vs 40%, 50%, 10% Open). While there was no statistical difference between the two approaches regarding post operative complications, there was a trend favouring the VATS approach with mortality (0.0% VATS vs 2.65% Open), pneumonia (0.0% vs 2.1% p0.11), respiratory failure ((0.0 vs 1.9% p0.18), atrial fibrillation (6.0% vs 11.1% p0.16) and MI (0.0% vs 0.3% p0.9). Prolonged air leak was similar at 7% for VATS and 6.6% for thoracotomy (p0.35). LOS was shorter in the VATS group at 6.9 vs 7.7 days (p0.12) Conclusions: VATS lobectomy using a single interspace approach is technically feasible and as safe as standard thoracotomy. It also compares favourably to published data on the standard triangulation approach VATS lobectomy. The majority of data for post-operative complications trends in favour of single interspace VATS. The technical aspects and advantages of single interspace VAT lobectomy with regard to peri-operative pain as well as chronic pain will be discussed.
References [1] Whitson BA, Groth SS, Duval SJ, Swanson SJ, Maddaus M. Surgery for early-stage non-small cell lung cancer: a systematic review of the video-assisted thoracoscopic surgery
271
versus thoracotomy approaches to lobectomy. Ann Thorac Surg 2008;86(December (6)):2008–16 [discussion 2016-8]. [2] Shaw JP, Dembitzer FR, Wisnivesky JP, Litle VR, Weiser TS, Yun J, et al. Video-assisted thoracoscopic lobectomy: state of the art and future directions. Ann Thorac Surg 2008;85(February (2)):S705–9.
doi:10.1016/j.hlc.2010.11.047 Staging for Patients With Malignant Pleural Mesothelioma After Extrapleural Pneumonectomy Christopher Cao a,b,∗ , Tristan D. Yan a,b , Catherine Kennedy a,b , P. Nicholas Hendel a,b , Paul G. Bannon a,b , Brian C. McCaughan a,b a The
University of Sydney, Department of Cardiothoracic Surgery, Royal Prince Alfred Hospital, Sydney, Australia b The Baird Institute for Applied Heart and Lung Surgical Research, Sydney, Australia Introduction: Malignant pleural mesothelioma (MPM) is a relatively uncommon disease with a dismal prognosis. This study aimed to evaluate the surgical outcomes associated with extrapleural pneumonectomy (EPP) for patients with MPM and assess the applicability of the updated TNM staging system. Methods: Prospectively collected data from 80 patients who underwent EPP from October 1994 to May 2010 were assessed from our institution. Statistical analysis was performed using the Kaplan–Meier method for a number of baseline patient characteristics and clinicopathological data, including age, gender, laterality of disease, histology, use of positron emission tomography, date of surgery, adjuvant therapy, completeness of cytoreduction, lymph node involvement and asbestos exposure. Results The mean age of patients was 57 years. Sixty-three patients had epithelial tumours. Six patients received neoadjuvant chemotherapy and 30 patients received adjuvant radiotherapy. Perioperative morbidity and mortality rates were 38% and 5.9%, respectively. The median survival was 21 months, with a three-year survival of 31%. The updated Brigham Women’s Hospital staging system appeared to be applicable for patients with MPM in our institution. Discussion: Results of the present study indicate that selected patients with MPM may achieve long-term survival after EPP, especially as part of a multi-modality therapy. The recently updated BWH staging system appears to have some value in providing prognostic information for patients who undergo EPP. doi:10.1016/j.hlc.2010.11.048
ABSTRACTS
Heart, Lung and Circulation 2011;20:250–284
Single Interspace Video Assisted Thoracoscopic Lobectomy—Analysis of Technique and Comparison With Standard Lobectomy G. Crouch ∗ , E. Slimani, M. Venkataraman, C. Jurisevic
Worthington, A.
Department of Cardiothoracic Surgery, Royal Adelaide Hospital, Adelaide, Australia Background: Video Assisted Thoracoscopic (VAT) lobectomy has been an increasingly accepted technique in the management of early stage non-small cell lung cancer [1]. Its proposed benefits focus on decreased morbidity particularly length of stay, acute post-operative pain, chronic pain and subsequently decreased mortality [2]. We review our novel technique using a single interspace approach over the accepted triangulation approach. We compare the outcomes to standard thoracotomies at the same institution and the VATS literature. Methods: In a single institution, single surgeon, retrospective analysis of prospectively collected data between 2001 and 2009, 473 lobectomies were performed, 96 via a novel technique of VATS lobectomy utilising a single interspace approach and 377 lobectomies via thoracotomy. The VAT lobectomies were introduced in 2006 as a preference for stages I and II disease. Data was prospectively collected focusing particularly on tumour stage, length of stay and post-operative complications. Results: The demographics and comorbidities were similar in both groups. Mean ages were 65.3 and 66.1 years in the VATS and thoracotomy groups respectively. The conversion rate from VAT to standard lobectomy was 6.25% (six cases). There was no difference in the distribution of lobe resected. There was a trend to later stage tumours in the open group although this is reduced with intention to treat analysis (stages I, II, III: 50%, 49%, 1% VATS vs 40%, 50%, 10% Open). While there was no statistical difference between the two approaches regarding post operative complications, there was a trend favouring the VATS approach with mortality (0.0% VATS vs 2.65% Open), pneumonia (0.0% vs 2.1% p0.11), respiratory failure ((0.0 vs 1.9% p0.18), atrial fibrillation (6.0% vs 11.1% p0.16) and MI (0.0% vs 0.3% p0.9). Prolonged air leak was similar at 7% for VATS and 6.6% for thoracotomy (p0.35). LOS was shorter in the VATS group at 6.9 vs 7.7 days (p0.12) Conclusions: VATS lobectomy using a single interspace approach is technically feasible and as safe as standard thoracotomy. It also compares favourably to published data on the standard triangulation approach VATS lobectomy. The majority of data for post-operative complications trends in favour of single interspace VATS. The technical aspects and advantages of single interspace VAT lobectomy with regard to peri-operative pain as well as chronic pain will be discussed.
References [1] Whitson BA, Groth SS, Duval SJ, Swanson SJ, Maddaus M. Surgery for early-stage non-small cell lung cancer: a systematic review of the video-assisted thoracoscopic surgery
271
versus thoracotomy approaches to lobectomy. Ann Thorac Surg 2008;86(December (6)):2008–16 [discussion 2016-8]. [2] Shaw JP, Dembitzer FR, Wisnivesky JP, Litle VR, Weiser TS, Yun J, et al. Video-assisted thoracoscopic lobectomy: state of the art and future directions. Ann Thorac Surg 2008;85(February (2)):S705–9.
doi:10.1016/j.hlc.2010.11.047 Staging for Patients With Malignant Pleural Mesothelioma After Extrapleural Pneumonectomy Christopher Cao a,b,∗ , Tristan D. Yan a,b , Catherine Kennedy a,b , P. Nicholas Hendel a,b , Paul G. Bannon a,b , Brian C. McCaughan a,b a The
University of Sydney, Department of Cardiothoracic Surgery, Royal Prince Alfred Hospital, Sydney, Australia b The Baird Institute for Applied Heart and Lung Surgical Research, Sydney, Australia Introduction: Malignant pleural mesothelioma (MPM) is a relatively uncommon disease with a dismal prognosis. This study aimed to evaluate the surgical outcomes associated with extrapleural pneumonectomy (EPP) for patients with MPM and assess the applicability of the updated TNM staging system. Methods: Prospectively collected data from 80 patients who underwent EPP from October 1994 to May 2010 were assessed from our institution. Statistical analysis was performed using the Kaplan–Meier method for a number of baseline patient characteristics and clinicopathological data, including age, gender, laterality of disease, histology, use of positron emission tomography, date of surgery, adjuvant therapy, completeness of cytoreduction, lymph node involvement and asbestos exposure. Results The mean age of patients was 57 years. Sixty-three patients had epithelial tumours. Six patients received neoadjuvant chemotherapy and 30 patients received adjuvant radiotherapy. Perioperative morbidity and mortality rates were 38% and 5.9%, respectively. The median survival was 21 months, with a three-year survival of 31%. The updated Brigham Women’s Hospital staging system appeared to be applicable for patients with MPM in our institution. Discussion: Results of the present study indicate that selected patients with MPM may achieve long-term survival after EPP, especially as part of a multi-modality therapy. The recently updated BWH staging system appears to have some value in providing prognostic information for patients who undergo EPP. doi:10.1016/j.hlc.2010.11.048
ABSTRACTS
Heart, Lung and Circulation 2011;20:250–284