Sara Volpi, B Kirmani, T Win, G Aresu, A Peryt, A Coonar
2017 Interactive Cardiovascular and Thoracic Surgery  
Objectives: Resection of tumour spread on a very thin visceral pleura (e.g. malignant pleural mesothelioma) might be challenging and collateral damage to the lung parenchyma might occur. We aimed to develop an operative technique, which might facilitate the parenchyma-sparing destruction of the visceral pleura. In the current experimental work, effects of a neodym-YAG laser on the visceral pleura in an ex-vivo porcine lung model were investigated. Methods: We investigated the pleural effects of
more » ... a neodym-YAG-Laser (Limax V R 120, KLS Martin, Tuttlingen, Germany) on 20 lungs of European pigs with a mean weight of 196 kg (range 170-230). The laser was applied on a standardized length of 5 cm in 4 different settings: group I (80 W, 6 s), group II (80 W, 12 s), group III (120 W, 6 s) and group IV (120 W, 12 s). All treated areas were removed for histological examination. Results: In all lungs, macroscopic laser effects were observed. Mean pleural thickness of the native lungs was 81.02±9.58 mm. Increasing power level and longer application duration resulted in significantly enhanced laser destruction effects (P < 0.001, ANOVA). To quantify the thermal effect with regard to pleural thickness, ratio of carbonization zone to pleura thickness was measured for each section (C/P ratio). The most prominent effect was reached in group IV with a 17.35 fold carbonization zone compared to the pleura thickness (P < 0.001, ANOVA). Conclusions: Our study shows that increasing power levels and longer application of the laser lead to a significantly increased carbonization and destruction zone. Further in-vivo human studies should evaluate the feasibility of laser in the surgical treatment of MPM. Disclosure: No significant relationships. Objectives: The data related to the treatment of locally advanced (T4) nonsmall cell lung cancer (NSCLC) requiring resection of cardiac structures are rather scarce. The purpose of the study was to evaluate the benefit of surgery in such patients. Methods: We retrospectively reviewed our database of all 98 patients who underwent en bloc lung and heart resection for NSCLC between January 1996 and December 2015. Results: Age ranged from 34 to 73 years with a mean age of 59 years. The disease was staged as pT4N0-1M0 in 36 cases, as pT4N2M0 in 62 cases. Left atrium (LA) was resected in 80 cases using stapling device or a vascular clamp. In 18 cases LA was resected using cardiopulmonary bypass. Both right and left atria were resected in 6 patients. Additional vascular structures such as the superior vena cava, truncus pulmonalis or aorta were resected in 18 cases. Carinal wedge or sleeve resection was performed in 27 cases. Postoperative morbidity and mortality rates were 40.8% and 12.2%, respectively. The 5-year OS for all (pT4N0-2M0) patients was 20.0%. Patients with pT4N0-1M0 had a higher survival rate (21.7%) compared with pT4N2M0 patients (16.7%). However, the difference was not statistically significant (P > 0.05). Conclusions: Our results suggest that long-term survival achievable in patients with locally advanced (pT4) NSCLC requiring LA resection even in presence of N2 disease. Disclosure: No significant relationships. Objectives: Arterial thromboembolisms, including cerebral infarction, mesenteric arterial infarction, and renal infarction, are fatal complications following anatomical lung resections for malignancies, especially left upper lobectomy (LUL). We hypothesized that the anatomical characteristics of the left superior pulmonary vein (LSPV) influence the incidence of arterial thromboembolism. The objective of this study was to evaluate the risk factors of arterial thromboembolisms following LUL for malignancies. Methods: Between January 2013 and September 2016, 1179 consecutive anatomical lung resections for malignancies were performed at our institution, 6 of which were complicated with arterial thromboembolism within 30 days after surgery. Of the 6 patients (0.51%), 5 had a cerebral infarction, and 1 had a renal thromboembolism. Of 213 LUL patients, 5 patients experienced arterial thromboembolisms (2.3%). In the 54 patients of LUL whom we could follow up with perioperative imaging tests, we measured the cross-sectional area of the LSPV orifice and the length of LSPV stump using thin-slice CT preoperatively. Results: The incidence of postoperative atrial thromboembolism was significantly higher in LUL than in non-LUL (83.3% vs 17.7%, OR = 23.1; P < 0.001). In LUL, the cross-sectional area (mm 2 ) of orifice of LSPV was larger in those complicated by arterial thromboembolism (250±52.7 vs 166±45.1, P < 0.001). There was no significant difference in the length of LSPV stump after LUL between 2 groups (20.5±5.6 vs 16.5±4.4, P=0.097). Additional analyses revealed the cutoff point for the prediction of arterial thromboembolism was the LSVP crosssectional area of 220 mm 2 with a sensitivity of 80% and specificity of 85.7%. The area under the curve was 0.88 (95% CI 0.70-1). Conclusions: LUL was a risk for arterial thromboembolism. In LUL cases, a cross-sectional area of the LSPV orifice higher than 220 mm 2 may predict the incidence of arterial thromboembolism after lobectomy. Objectives: Pleurectomy/decortication (PD) for malignant pleural mesothelioma (MPM) is performed to improve survival and to result in better pulmonary function. Our aim was to analys e spirometric outcomes following PD. Methods: Ninety-five patients underwent PD between 2005 and 2016. Thirty were alive. Three were undergoing chemotherapy and not fit to undergo spirometry, and 3 could not be reached. In 24, spirometry was performed and compared with preoperative values. Demographic data, side, surgical technique (extended/total vs partial PD), histology, T stage, adjuvant radiation, survival longer than 2 years, recurrence, FEV1 (% and L), FVC (% and L), change in FEV1 and FVC between preoperative and recent values were recorded and analysed. Student t-test and Chi square were performed for statistics. Results: Average age was 56±10 years (26-75, 10 females, 17 right). Thirteen extended and 11 partial PD were performed. Average hospital stay was 6.9±3.4 days. Twenty-one patients had epithelioid and 13 had T3-4 tumours. Twenty-three had adjuvant chemotherapy, while 7 had adjuvant high dose radiation. Thirteen were alive beyond 2 years. Median follow-up/survival was 28.7 months (6.4-83). Average preoperative and recent FEV1 (l) were 2.18±0.82 and 1.84±0.61 respectively (P=0.004). Average decrease in FEV1 was 12% (-46 to + 48). In 6 patients, recent FEV1 (L) was increased compared with preoperative values. Average preoperative and recent FVC (L) were 2.77±0.99 and 2.29±0.7 respectively (P=0.014). Although preoperative values were similar between genders, recent FEV1 and FVC (L) were better in men (P=0.015 and P=0.002). Preoperative FVC was significantly lower in patients with T3-4 tumours. In 6 who had improved recent FEV1 (L), preoperative FEV1 (L) values were significantly lower (1.53±0.41 vs 2.39±0.81, P=0.003). Conclusions: P/D results in good pulmonary function independent of survival time. In 25% of patients, pulmonary function improved postoperatively. Preservation or improvement in pulmonary function justifies P/D in resectable MPM patients regardless of survival expectations. Disclosure: H. Batirel: Johnson and Johnson P-194 OCCULT N2 DISEASE IDENTIFIED AFTER LUNG CANCER SURGERY HAS A POOR OUTCOME AND IS NOT SIMILAR TO pN0-N1 DISEASE
doi:10.1093/icvts/ivx280.194 fatcat:q3tmkr4crfcsfcfvfpy3sei75e