IBS06.03 Japanese Data

Abstract

Backgrounds Annual surveys of cardiothoracic surgery throughout Japan has been conducted by the Japanese Association for Thoracic Surgery (JATS) since 1986 in order to establish the statistics for the number of procedures by operative category1. Regarding malignant pleural mesothelioma (MPM), however, only annual case numbers of both diffuse and localized MPM have been registered since 1996. From 2009 onward, surgical technique, 30-day mortality, and in-hospital mortality have been also described. According to the JATS survey, all-kind of surgery for MPM increased 76% during 1996 and 2016: 164 cases in 1996 and 289 cases in 2016. JATS survey also revealed dramatic increase of pleurectomy/decortication (P/D) cases during 2009 to 2016: proportion of P/D surgery in all curative-intent surgery was 1.4% (2/142) in 2009 and 53.3% (73/137) in 2016. Methods In 2011, the National Clinical Database (NCD) of Japan adopted an annual web-based nationwide data collection system2. Since NCD is associated with the Japanese Surgical Board Certification System, it contains detailed perioperative clinical information such as preoperative patient characteristics, operation time, blood loss, intraoperative accidents, pathological TNM stages, postoperative adverse events, redo-surgery, 30-day and in-hospital mortality, cause of death, and so on. Approximately 10 million surgical procedures from >5000 hospitals have been collected by 2017. An NCD specifically for general thoracic surgery was launched in 20143. This time, we conducted an analysis on MPM surgery in Japan using the Japan NCD. Results (Table 1) In the period of 4 years between 2014 and 2017, a total of 622 curative-intent surgery was performed in Japan. Median age was 66 years (IQR, 61-71), and 87.6% were male. A median BMI was 22.6 (20.3-24.8), and 77.3% was ECOG PS0. Induction therapy was given in 40.8% of patients. Extrapleural pneumonectomy was performed in 279 patients (44.9%) and P/D in 343 (55.1%). Blood transfusion was required in 320 (51.4%) patients (Figure 1). Injury of major intrathoracic organ occurred in 22 (3.5%) patients. Morbidity rate was 40.0% (249/622). Thirty-day mortality and in-hospital mortality were 1.1% and 3.2%, respectively (Table 1). Conclusion In addition to the above JATS survey and Japan NCD, a nationwide, prospective, observational study of patients with MPM has just completed 2-year’s patient accrual4. It is promising that these Japanese data will substantially contribute to understanding MPM in near future. 1 Thoracic and cardiovascular surgery in Japan in 2016. Committee for Scientific Affairs, The Japanese Association for Thoracic Surgery, Shimizu S, Endo S, Natsugoe S, et al. Gen Thorac Cardiovasc Surg 2019; 67: 377-411. 2 http://www.ncd.or.jp/ 3 Development of an annually updated Japanese national clinical database for chest surgery in 2014. Endo S, Ikeda N, Kondo T, et al. Gen Thorac Cardiovasc Surg 2016; 64: 569-576. 4 Shintani Y, Hasegawa S, Takuwa T, et al. Prospective registry database of patients with malignant mesothelioma: Directions for a future Japanese registry-based lung cancer study. J Thorac Dis 2018; 10: 1968-71Table 1Table 1EPP (n=279)P/D (n=343)Total (n=622)age (median, IQR)65 (59-69)67 (63-73)66 (61-71)male sex250 (89.6%)295 (86.0%)545 (87.6%)BMI (median, IQR)22.3 (20.2-24.2)23 (20.4-25.1)22.6 (20.3-24.75)PS 0215 (77.1%)266 (77.6%)481 (77.3%) 157 (20.4%)65 (19.0%)122 (19.6%) 2-45 (1.8%)10 (2.9%)15 ( 2.4%)unknown2 (0.7%)2 (0.6%)4 ( 0.6%)Induction therapy103 (36.9%)151 (44.0%)254 (40.8%)Blood transfusion159 (57.0%)161 (46.9%)320 (51.4%)Major organ injury12 ( 4.3%)10 (2.9%)22 ( 3.5%)Morbidity126 (45.2%)123 (35.9%)249 (40.0%)30-day mortality3 (1.1%)4 (1.2%)7 ( 1.1%)in-hospital mortality9 (3.2%)11 (3.2%)20 ( 3.2%) Open table in a new tab malignant pleural mesothelioma, national database