P1.08-072 The Result of Completion Pneumonectomy for the Local Recurrent Lung Cancer after Radical Lobectomy

Abstract

Retrospective review on the result of completion pneumonectomy (CP) for the local recurrent non-small cell lung cancer (NSCLC) following the radical lobectomy, performed by a single institution. From 1995 to 2015, 12 consecutive patients underwent CP for cure of loco-regional recurrent NSCLC. Eleven out of these were the cases with recurrent tumor at resection margin of previous surgery and the rest was the case with multiple metastatic tumors within the ipsilateral remaining lung lobe. The right CP was performed for 5 patients (41.6%) and the left for 7 (58.3%). Operative mortality was 0% and major complications occurred to 3 patients (25%). The operations were performed by the posterolateral thoracotomy for 7 patients, and 5 by the anterior approaches (median sternotomy or hemi-clamshell thoracotomy). The control of hilar components was achieved through an intra-pericardial route in all cases. In two cases, the infiltration of the recurrent tumors were confirmed in the carinal bifurcation. Thus, the completion “sleeve” pneumonectomy was performed. The complete resections were achieved in all patients. Mean observation period was 1313 days after CP at the time of this investigation. Four patients deceased including 2 cancer re-relapse death and 2 cancer unrelated death. There are 8 survivors for more than one year after CP including 4 patients surviving without cancer relapse (mean survival time [MST] of 1214 days) and 4 surviving with either local or distant cancer relapse (MST = 1354 days). Among those 4 survivors with cancer relapse, 3 patients were treated with molecular targeted drugs after gene-mutation survey for susceptibility of specific molecular targeted drugs using tumor specimen harvested from CP surgery. Another patient with cancer relapse was found to be unsuitable for any type of molecular targeted drugs, thus treated with cisplatin based conventional anti-cancer protocol. Five year survival rate for the entire series was 66.7%. Completion pneumonectomy has been considered as a complex and high risk surgical procedure, however, due to the recent progresses made in the surgical techniques and post-operative management, the CP in the setting of locally recurrent NSCLC became safe and favorable treatment option. More importantly, tumor specimen obtained by the CP can be used for selecting the updated molecular target drugs which might be helpful for patient’s long term survival.