Takuya Nagashima, H Ito, M Nito, A Wada, M Hashimoto, J Osawa, J Samejima, H Nakayama
2017 Interactive Cardiovascular and Thoracic Surgery  
Objectives: The aim of this study was to compare the preoperative location and resection of small lung nodules located by radiotracer vs hookwire. Methods: We reviewed patients with subsolid nodules or smaller than 1 cm, deeper than 1 cm below the visceral pleura, or both, resected by VATS or thoracotomy. Preoperative computed tomography (CT) location was performed. From 1 July 2013 to 1 July 2015 nodules were located with hookwire and from 1 July 2015 to 30 November 2016 the nodules were
more » ... nodules were located with the injection of 0.2ml 99m Tc-labelled macroaggregate human albumin ( 99m Tc-MAA). During surgery, in group located with 99m Tc-MAA a handheld gamma probe was used to detect the hot spot where the radioactive tracer was located and the area was resected. Results: During the study period, 45 patients (28 men; median age 63.6 years) needed preoperative location. Hookwire was undertaken in 20 patients (14 men; 63.8 years) and 99m Tc-MAA was undertaken in 25 (15 men; median age 63.4 years). No differences were observed in the characteristics of the patients and the nodules, type of surgery, surgical time nor complications and pathology outcomes between both techniques. No patient with pneumothorax or pulmonary haemorrhage needed pleural drainage before surgery. We observed a greater surgical margin in the pathology analysis in nodules located with 99m Tc-MAA (2.37 mm vs 6.23 mm, P=0.004). Conclusions: Radiotracer location of small lung nodules is a simple and feasible procedure with similar outcomes than hookwire localization. Radiotracer location with 99m Tc-MAA allows greater surgical margin than hookwire location. Objectives: To investigate the effectiveness of a novel course teaching videoassisted thoracoscopic surgery (VATS) through intensive operation observations at an ultra-high-volume centre. Methods: Courses in Uniportal VATS at a specialist unit performing >8000 major lung resections annually (40-50 daily on average) were attended by over 230 surgeons from around the world for 2 weeks each from 2013-2016. An online survey preserving responder anonymity was completed by 156 attendees (67.8%). Results: Attendees included 37% from Western Europe, 18% from Eastern Europe, and 17% from Latin America. Open thoracic surgery experience for over 5 years was reported by 67%, but 79% had fewer than 5 years of VATS experience. During the course, 70% observed over 30 uniportal VATS operations (including 38% observing over 50), and 69% attended an animal wetlab. Handson application in the wetlab of what was observed during the course was appreciated by 84% of those attending. Although 72% of responders attended the course less than 12 months ago, there was a strong trend for greater proportions of lobectomies being done by VATS after the course; and for those performing VATS lobectomy, significantly more used fewer ports, took less time to complete the operation, and had lower rates of conversion. Prior to the course, 51% reported problems with tissue retraction during VATS, 51% with instrumentation, 54% with stapler application, and 43% with assistant coordination -but after the course, the percentages reporting improvement in these categories were 56%, 57%, 58%, and 53% respectively. Of those who had attended other VATS courses before, 87% preferred this high-volume course and none preferred the other(s). After the course, 26% of responders received promotions in their careers, and 98% would recommend the course to colleagues. Conclusions: High-volume operation observation represents an effective modality for surgeons to demonstrably improve VATS proficiency in a short period of time. Disclosure: A. Sihoe: Medela AG (Baar, Switzerland) -pending research supplies support; previous travel assistance P-249 Objectives: Pathologic N2 (pN2) non-small cell lung cancer (NSCLC) has shown poor prognosis, about 30% at 5 years. However recent advance in diagnostic tools, minimal invasive surgery, chemotherapy, and radiotherapy may improve the prognosis of pN2 disease. In this study, we evaluate the outcome of surgical resection followed by postoperative adjuvant therapy for NSCLC with pN2 disease. Methods: The patients with pN2 disease underwent surgical resection followed by adjuvant treatment at single institute. A retrospective medical record review was performed. Risk factor of overall survival (OS) and recurrence free survival (RFS) was determined with multivariate Cox regression model. Results: From 2004 to 2014, 680 patients underwent surgical resection for NSCLC with pN2. Among them, 155 patients (22.8%) received adjuvant chemotherapy, 125 patients (18.4%) received adjuvant radiotherapy and 295 patients (43.4%) received adjuvant chemoradiotherapy. The mean age was 60.9±10 years and 446 patients were men (65.6%). Lobectomy was performed in 537 patients (79%), bilobectomy in 56 (8.2%), pneumonectomy in 51 (7.5%). Complete resection was accomplished in 607 patients (89.3%). Extranodal invasion was found in 247 patients (36.3%). Local recurrence occurred in 63 patients (9.3%), distant recurrence in 255 (37.5%). With a mean follow-up of 35±30.1 months, median OS and RFS were 65±5.1 months and 23.3±2.1 months, respectively. Five-year OS rate and RFS rate were 51.8% and 34.5%, respectively. Older age, male, low DLCO, incomplete resection, more number of metastatic LNs, no postoperative adjuvant therapy were associated with worse OS. Incomplete resection, more number of metastatic LN, extranodal invasion, non-squamous cell carcinoma, no postoperative adjuvant therapy were associated with poorer RFS. Conclusions: In this study, surgical resection followed by postoperative adjuvant therapy showed better outcomes than previously reported. Complete surgical resection and postoperative adjuvant therapy may be important for prognosis. Objectives: Bronchopleural fistula remains a rare but serious complication after anatomic lung resection. To prevent this complication, several biological materials have been used. Although it is difficult to use some materials under thoracoscopic surgery, free pericardial fat is relatively easy to handle. Bronchial fistula usually occurred within one or 2 months after surgery. Therefore we evaluated the status of pericardial fat pad at 6 months after surgery using the volume analyser. Methods: The bronchial stump of 10 consecutive patients with lung cancer who underwent right lower lobectomy and mediastinal lymph node dissection in thoracoscopic surgery between May 2015 and April 2016 was covered with free pericardial fat pad. Bronchial closure was performed with commercial mechanical staplers in all patients. When free pericardial fat pad was resected, it was put under saline in syringe, and the increased volume was measured. After that, it was sewn with only one stich around the bronchial stump and reinforced with fibrin glue. It took only about 5 min to resect, saw and reinforce it. Six months after surgery computed tomography was performed, and the residual volume of the fat was analysed with the volume analyser SYNAPSE VINCENT by Fujifilm. Then, the residual ratio (residual fat volume/resected fat volume) was calculated. We investigated clinical results. Results: The mean volume of resected fat was 8.4 ml (3.5-12 ml). There was no complication during preparation of free pericardial fat pad. In all cases, the residual fat was identified on computed tomography. The mean volume of residual fat was 4.0 ml (0.4-7.0 ml) and the mean residual ratio was 46.1% (13.3-60.6%). There was no postoperative complication including bronchopleural fistula. Conclusions: At 6 months after surgery, free pericardial fat pad remained demonstrably. Moreover it is easy and safe to handle under thoracoscopic surgery, so it can be a useful method to prevent bronchopleural fistula. Disclosure: No significant relationships. P-251 TRACHEAL RESECTION WITH CICATRICIAL STENOSIS AND TRACHEOSTOMY Vladimir Parshin, O. Mirzoyan, Z. Berikkhanov, A. Parshin Surgery, FMSMU, Moscow, Russian Federation i65 Abstracts/Interactive CardioVascular and Thoracic Surgery Downloaded from https://academic.oup.com/icvts/article-abstract/25/suppl_1/ivx280.250/4557440 by guest on 30 July 2018
doi:10.1093/icvts/ivx280.250 fatcat:l5l4tvwfjjagzfqfxlal6jmqya