Sleeve Lobectomy Research Articles

Extended sleeve lobectomy for centrally located non-small-cell lung cancer: a 20-year single-centre experience.

Extended sleeve lobectomy (ESL), an atypical bronchoplasty with resection of more than 1 lobe, might be technically demanding but has certain theoretical advantages, including the avoidance of pneumonectomy. However, clinical outcomes after ESL are not well known. Between March 1995 and December 2015, 540 patients with centrally located non-small-cell lung cancer underwent sleeve resection. Among them, 63 patients underwent an ESL procedure. We retrospectively analysed those patients in terms of hospital mortality, postoperative complications and local recurrence and compared clinical outcomes with patients who underwent simple sleeve lobectomy in the same period. The 63 patients were classified into 4 groups: anastomosis between the right main and lower bronchi (n = 14), anastomosis between the right main and upper bronchi (n = 37), anastomosis between the left main and basal segmental bronchi (n = 4) and anastomosis between the left main and upper divisional bronchi (n = 8). No operative deaths occurred within 30 days, but there were 2 in-hospital deaths from postoperative acute lung injury. Ten (16%) patients had anastomosis-related complications including 3 strictures, 5 bronchopleural fistulas and 2 pulmonary vein thromboses. There were no significant differences in in-hospital mortality (3% vs 3%, P = 0.67), anastomosis-related complications (16% vs 9%, P = 0.07) and loco-regional recurrence rate (8% vs 10%, P = 0.63) between ESL and simple sleeve lobectomy. According to our findings, ESL is a safe and feasible procedure that does not compromise oncological principles. It can be considered an appropriate alternative to pneumonectomy and should be considered in patients with centrally located tumours.

Left sleeve lobectomy versus left pneumonectomy for the management of patients with non-small cell lung cancer.

BackgroundThe study was conducted to compare the outcomes of sleeve lobectomy (SL) and pneumonectomy (PN) for management of the left lung in patients with non‐small cell lung cancer (NSCLC).MethodsOne hundred and thirty‐five patients who underwent left SL (n = 87) or left PN (n = 48) for NSCLC from January 2006 to December 2011 were enrolled in this retrospective study. Left SL was performed when technically possible. The clinicopathological features and treatment outcomes in both groups were compared. Survival was evaluated using the Kaplan–Meier method, and significant differences were calculated using the log‐rank test. Multivariate analysis was conducted using the Cox proportional hazards model to analyze significant variables associated with the outcomes of left SL.ResultsThere were no significant differences in general clinicopathological features (age, gender, lymph node metastasis, pathological stage, and complications of bronchial fistula) between patients who underwent left SL and left PN. The operation duration was markedly longer and the extent of bleeding was greater for left SL than left PN; however patients who underwent left SL achieved significantly longer overall survival than patients who underwent left PN. The outcomes of left SL were only associated with pathological stage.ConclusionsOur results indicate that left SL may offer superior survival than left PN in selected patients. If anatomically feasible, left SL may be a preferred alternative to left PN for NSCLC patients. Pathological stage is an important factor to determine the outcome of SL.

Reimplantation of the upper lobe bronchus after lower sleeve lobectomy or bilobectomy: long-term results.

The advantages of a bronchial sleeve resection are well established. A clear majority of reported cases are of upper lobe sleeve resection. Reimplantation of the upper lobe bronchus after a lower sleeve lobectomy or bilobectomy (the so-called Y-sleeve resection) is infrequent. Related technical peculiarities are the main issues. We present our experience and results in this setting. Between 1989 and 2015, we performed 28 Y-sleeve resections of the left lower lobe (n = 18) or right middle and lower lobes (n = 10). The lung-sparing reconstructive operation was performed for non-small-cell lung cancer in 23 cases, for bronchial carcinoid tumour in 4 cases and for a cystic adenoid carcinoma in 1 case. Anastomotic reconstruction was performed by interrupted 4-0 absorbable sutures (monofilament material). All the resections were complete (R0). Postoperative mortality was 3.6%. The rate of major complications was 10.7% (1 myocardial infarction, 1 anastomotic stenosis requiring dilatation and 1 anastomotic fistula). Among the 23 patients with non-small-cell lung cancer (18 men and 5 women; mean age 58 ± 12 years), 8 were Stage I, 9 were Stage II and 6 were Stage IIIa. At a mean follow-up of 46 months, the recurrence rate was 32%. There were 2 loco-regional recurrences. No endobronchial or perianastomotic recurrence occurred. The 3- and 5-year overall and disease-free survival rates of patients with non-small-cell lung cancer were 76.3% and 55.1% and 68.7% and 62.9%, respectively. A Y-sleeve resection with reimplantation of the upper load bronchus is a technically feasible and oncologically adequate operation.

Video-assisted thoracic surgery double sleeve lobectomy for non-small cell lung cancer: a report of seven cases

Background: Video-assisted thoracic surgery (VATS) double sleeve lobectomy has been rarely reported. We aimed to summarize the techniques and outcomes of this challenging procedure for non-small cell lung cancer (NSCLC) involving both the bronchus and pulmonary artery. Methods: From May 2012 to December 2016, seven patients were selected for VATS double sleeve lobectomy at our center, including four cases of left upper lobectomy and three cases of right upper lobectomy. Surgical procedures were performed with four ports for the first patient and three ports for the other patients. The “hollow out” process was designed for hilum dissection. The main pulmonary artery and interlobar artery were then blocked using two releasable atraumatic endoscopic Bulldog Clamps. Bronchovascular reconstruction was accomplished by the “two-needle-holder suturing technique” through directly watching a video monitor. Low-molecular heparin was subcutaneously administered during the first week after surgery. Results: The operations were uneventful. Surgical duration ranged from 250 to 480 min (median, 318 min) with blood loss between 30 to 200 mL (median, 200 mL). The average number of the dissected lymph nodes was 13 (range, 11–19). Two patients developed postoperative pneumonia with no mortalities. Prolonged air leak (>5 days) was observed in three patients. The median postoperative hospital stay was 15.5 days (range, 5–33 days). There were two cases of adenosquamous cell carcinoma and five cases of squamous cell carcinoma. One patient died of hemoptysis 50 days after surgery, and one died of metastatic lung cancer 2 years after surgery. The other five patients were alive without local recurrence at 4–58 months of follow-up. Conclusions: VATS bronchovascular double sleeve lobectomy is technically difficult but feasible for skilled thoracoscopic surgeons in experienced centers. More data are encouraged to assess the long-term outcomes of this new procedure.

Clinical Experience of Thoracoscopic Sleeve Lobectomy Using a Novel Needle Holder

Thoracoscopic bronchoplasty requires high technique to control stitching during bronchial reconstruction. Improved quality of suturing instrument may contribute to overcome this difficulty of bronchial anastomosis. Recently, a unique and expected articulated instrument for suturing has been launched on endoscopic surgery. We have successfully performed two cases of thoracoscopic sleeve lobectomy using this instrument.

Initial experience of sleeve lobectomy under complete video-assisted thoracic surgery.

Review the initial results of a single-center complete video-assisted thoracoscopic surgery (VATS) sleeve lobectomy and discuss the key procedure of this operation, in addition to its safety and feasibility. Retrospectively analyze the perioperative data of 11 patients who accepted complete VATS sleeve lobectomy between May 2013 and Jun 2017 in Peking University Third Hospital, try to evaluate the safety of this procedure. All the patients were followed up and their oncological recurrence and metastasis were observed, and feasibility of VATS sleeve lobectomy for lung cancer was evaluated. All of the 11 cases underwent complete VATS sleeve lobectomy successfully and there is no conversion to thoracotomy. The mean operative time was 338min (range from 243 to 511min), the mean time of bronchial anastomotic was 63min (range from 40 to 96min), the mean blood loss was 205mL (range from 50 to 400mL), and the mean number of lymph nodes dissected is 22.1. There was no other complication except one patient suffered from high-risk pulmonary embolism, and no anastomotic leakage and stricture was found. The mean hospital stay postoperation was 8.7 days. The time of follow-up was between 2 and 38 months, only one out of the 11 cases died of bone metastasis, and the other 10 survived till now. One of these 10 patients had local recurrence 24 months after operation, and one suffered adenocarcinoma of esophageal-gastric junction at 15 months postoperation. The rest of eight patients all survived to June 2017 and no local recurrence and metastasis was found. The mean survival time was 14.8 months. Complete VATS sleeve lobectomy is a safe and feasible procedure, but the advantage of perioperative and long-term survival need prospective randomized controlled large sample trial to be confirmed.

Prediction of Long-Term Survival After Lung Cancer Surgery for Elderly Patients in The Society of Thoracic Surgeons General Thoracic Surgery Database

Prior risk models using the STS General Thoracic Surgery database (STS-GTSD) have been limited to 30-day outcomes. We have now linked STS data to Medicare data and sought to create a risk prediction model for long-term mortality after lung cancer resection in patients older than 65 years. The STS-GTSD was linked to Medicare data for lung cancer resections from 2002 to 2013 as previously reported. Successful linkage was performed in 29,899 lung cancer resection patients. Cox proportional hazards modeling was used to create a long-term survival model. Variable selection was performed using statistically significant univariate factors and known clinical predictors of outcome. Calibration was assessed by dividing the cohort into deciles of predicted survival and discrimination assessed with a C-statistic corrected for optimism via 1,000 bootstrap replications. Median age was 73 years (interquartile range, 68 to 78 years), and 48% of the patients were male. Of the 29,094 patients with nonmissing pathologic stage, 69% were stage I, 18% stage II, 11% stage III, and 2% stage IV. Procedure performed was lobectomy in 69%, bilobectomy in 3%, pneumonectomy in 3%, segmentectomy in 7%, sleeve lobectomy in 1%, and wedge resection in 17%. Thoracoscopic approach was performed in 47% of resections. The final Cox model reveals that stage and age are the strongest predictors of long-term survival. Even after controlling for stage, wedge resection, segmentectomy, bilobectomy, and pneumonectomy are all associated with increased hazard of death in comparison with lobectomy. Thoracoscopic approach is associated with improved long-term survival in comparison with thoracotomy. Other modifiable predictive factors include smoking and low body mass index. Calibration of the model demonstrates excellent performance across all survival deciles and a C-statistic of 0.694. The STS-GTSD-Medicare long-term risk model includes several novel factors associated with mortality. Although medical factors predict long-term survival, age and stage are the strong predictors. Despite this, procedure choice and thoracoscopic/open approach are potentially modifiable predictors of long-term survival after lung cancer resection.

Differential effects of operative complications on survival after surgery for primary lung cancer

ObjectiveComplications adversely affect survival after lung cancer surgery. We tested the hypothesis that effects of complications after lung cancer surgery on survival vary substantially across the spectrum of postoperative complications. MethodsThe Society of Thoracic Surgeons General Thoracic Surgery Database was linked to Medicare data for lung cancer resections from 2002 through 2013. Linkage was achieved for 29,899 patients. A survival model was created that included operative complications as explanatory variables and adjusted for relevant baseline covariates. Because of violation of the proportional hazard assumption, we used time-varying coefficient Cox modeling for the complication variables. ResultsMedian patient age was 73 years, and 48% were male. Procedures performed were lobectomy in 69%, wedge in 17%, segmentectomy in 7%, bilobectomy in 3%, pneumonectomy in 3%, and sleeve lobectomy in 1%. Most frequent complications were atrial arrhythmia (14%), pneumonia (4.3%), reintubation (3.8%), delirium (2%), and acute kidney injury (1.4%). In the early period (0-90 days), 12 complications are associated with worse survival. From 3 to 18 months after surgery, only 4 complications are associated with survival: delirium, blood transfusion, reintubation, and pneumonia. After 18 months, only sepsis and blood transfusion are associated with a significant late hazard. ConclusionsOur analysis confirmed the presence of differential magnitude and time-varying effects on survival of individual complications after lung cancer surgery. We conclude that the derived time-dependent hazard ratios can serve as objective weights in future models that enhance performance measurement and focus attention on prevention and management of complications with greatest effects.

Uniportal sleeve lobectomy for lung cancer.

Over the last years video-assisted thoracic surgery (VATS) has become more popular as it has a number of advantages comparing to the classical thoracotomy (less postoperative pain, reduced blood loss, cosmetic effect, etc.) A short time ago it was generally thought that it was impossible to make certain surgeries (including bronchoplasty) through single port approach. However, improvement of manual skills, more advanced stapling devices, tools and surgical needles have made it possible to perform surgeries practically of any extent observing the oncological principles of operational intervention.

P3.16-038 Experience of 180 Bronchial Sleeve Resections for Malignant Tumors

Sleeve lobectomy can expand the indications to radical organ-saving operations and avoiding pneumonectomy increase the number of operated ones, and also significantly improve the quality of life and rehabilitation conditions of patients, which is of special importance for persons with limited functional reserves. One surgical team performed 180 bronchial sleeve resections for malignant neoplasms of the lung. In all cases an invagination technique was used to form an anastomosis per 1 cartilage semicircle. There were 168 (93,3%) patients with primary tumors and 12 (6,7%) with solid metastatic lesions. Non-small cell lung cancer (NSCLC) was performed in 149 (88.7%) cases, carcinoid tumors - in 19 (11.3%) cases. Ia stage was diagnosed in 7.4%, Ib stage in 6.7%, IIa in 25.5%, IIb in 16.1%, IIIa in 37.6% and IIIb - 6.7% of cases. There were 80.6% (145) males and 19.4% (35) females. The average age of patients was 56.9 (from 18 to 82 years). 21 variants of bronchoplastic reconstructions was performed, lobectomy - in145 (80,6%) patients, bilobectomy – in 24 (13,3%), segmentectomy – in 6 (3,3%), isolated resection of bronchus – in 5 (2,8%) patients. In common 63 (35%) bronchoangioplasty interventions were performed. Resection of the pulmonary artery was performed in 49 cases (40 - circular, 9 - edge), vena cava resection - in 9 patients (6 - circular, 3 - edge), segmental arteries were resected in 5 patients (3 - circular, 2 - edge). In all cases of NSCLC extended ipsilateral mediastinal lymph node dissection was performed. Complications were noted in 35 patients (19.4%): pneumonia (6.1%), atelectasis of the lobe (0.6%), insufficiency of bronchial sutures (3.9%), granulation stenosis of bronchial anastomosis (1.1 %), PE (1.7%), chylothorax (1.1%), recurrent nerve paresis (1.1%), cardiac rhythm disturbances (1.7%), hemothorax (1.7%), AMI (0.6%). Postoperative mortality was in 3.9% cases. The cause of death in 3 patients was massive PE, in 1 - AMI, in 3 - failure of bronchial sutures. Long-term results were obtained in 128 patients. The one-year observed survival rate in patients after reconstructive resections was 90.6%, 3-year - 57.4%, 5-year - 42.4% (with median 48.8 months). One-year recurrence-free survival was 89.1%, 3-year - 63.8%, 5-year - 51.6% Median relapse-free survival was 55.2 months. Using the invagination technique for the bronchial anastomoses is characterized by the simplicity of technical execution and is accompanied by satisfactory immediate and long-term results.

Sleeve lobectomy for lung cancer

Considerable progress has been made in the field of lung cancer surgery since the first sleeve lobectomy was performed 70 years ago. Technology has advanced significantly and a multitude of lung cancer treatments and diagnostic tests is now available. These advancements have led to improved surgical treatments and understanding of this disease. Historically, pneumonectomy was considered the procedure of choice for central or locally advanced non-small cell lung cancer (NSCLC). Sleeve lobectomy was conceived only as an alternative for patients with limited cardiopulmonary reserve. However, the advantages of bronchoplastic resections for NSCLC have long been established (Thomas et al. J R Coll Surg Edinb. 1956;1:169–186; Allison et al. Ann R Coll Surg. 1954; 25:20–22; Thomas et al. Thorax. 1960;15:9–11; Weisel et al. J Thorac Cardiovasc Surg. 1979;78(6):839–849; Jensik et al. J Thorac Cardiovasc Surg. 1972;64(3):400–412. Many reliable studies have published convincing results over the years demonstrating superior outcomes over pneumonectomy when sleeve lobectomy is extended to patients with normal cardiopulmonary reserve (Gaissert et al. Thorac Cardiovasc Surg. 111(5):948–953, 1996). Not only does sleeve lobectomy surgery preserve lung function, but literature over the years has clearly shown this procedure to be associated with comparable morbidity, decreased mortality, and favorable long-term survival and enhanced quality of life (Weisel et al. J Thorac Cardiovasc Surg. 1979;78:839–849; Jensik et al. J Thorac Cardiovasc Surg. 1972;64:400–412, Ferguson et al. Ann Thorac Surg. 2003;76:1782–1788). In this review, we highlight patient selection factors and current indications for considering sleeve lobectomy. In addition, we describe our sleeve lobectomy surgical techniques and review post-operative management strategies and potential associated complications. We also discuss the long-term outcomes, recurrence, and survival rates associated with sleeve lobectomy in more recently available published series.

Long-segment pulmonary artery resection to avoid pneumonectomy: long-term results after prosthetic replacement.

Resection of a long pulmonary artery (PA) segment infiltrated by tumour and reconstruction by conduit interposition or wide patch is a challenging but feasible option to avoid pneumonectomy. Our goal was to report the long-term results of our experience with this type of operation using various techniques and materials. Between 1991 and 2015, 24 patients underwent sleeve resection of a long PA segment or extended resection (>2.5 cm) of 1 aspect of the circumference of the PA associated with lobectomy for centrally located lung cancer. Materials used for conduit reconstruction (20 patients) included pulmonary vein in 12 patients, autologous pericardium in 4, porcine pericardium in 3 and bovine pericardium in 1. Patches used in 4 patients consisted of porcine pericardium (2 patients) and pulmonary vein (2 patients). Twenty-three patients underwent left upper lobectomy without associated bronchoplasty. One patient underwent bronchovascular left upper sleeve lobectomy. The postoperative morbidity rate was 29.1%. No complications related to the reconstructive procedure occurred. There were no postoperative deaths. Complete patency of the reconstructed PA was shown in all patients by postoperative contrast computed tomography performed every 6 months. Pathological tumour stage ranged from I to IIIA. Five-year overall survival and disease-free survival rates were 69.9% and 52.7%, respectively, at a median follow-up of 41 months. Resection of the long PA segment followed by conduit or wide patch reconstruction is a feasible, safe and effective option to avoid pneumonectomy. Different biological materials can be used to provide adequate tissue characteristics; the choice is made on a case-by-case basis. Long-term results confirm the oncological reliability of this operation.

Manschettenresektion im Vergleich zur Pneumonektomie bei Bronchialkarzinom

Pagès PB et al. Sleeve lobectomy may provide better outcomes than pneumonectomy for non-small cell lung cancer. A decade in a nationwide study. J Thorac Cardiovasc Surg 2017; 153: 184 – 195.e3

Bronchial sleeve anastomosis and primary closures with the da Vinci system: an advanced minimally invasive technique

Background: Bronchial division using a stapler may lead to a positive or suboptimal bronchial margin during anatomical resections if the tumour is close to the lobar orifice. Primary suture closure of the bronchus, instead of stapling, or bronchial sleeve anastomosis may provide a better marginal distance in such cases. One of the advantages of minimally invasive robotic surgery (da Vinci System Intuitive Surgical, Sunnyvale, CA, USA) is the complete transfer of surgeon’s capability inside the thoracic cavity. In this study, we analysed primary bronchial closure or bronchial anastomosis techniques performed using robot-assisted thoracoscopic surgery (RATS). Methods: In total, 296 patients underwent robot-assisted thoracoscopy in our centre between January 2012 and June 2017. Among these, 203 underwent anatomical lung resections. Surgical bronchial closure techniques were performed on nine patients. The indications for bronchial closure, details of surgery and peri- and postoperative characteristics were analysed in this study. Results: We performed primary suture closure in three patients, sleeve lobectomy in five and isolated partial bronchotomy and bronchial closure in one. Although we used prolene sutures in the first three patients, we preferred to use V-loc sutures (barbed sutures; Medtronic, Covidien New Haven, CT, USA) in the more recent patients. The mean docking time was 16.3±5.8 min (range, 10–25 min), and the mean operation duration was 101.1±24.2 min. The duration of drainage was 3.6±1 days, and the mean length of postoperative stay in hospital was 6.2±1.6 days. All patients underwent R0 resections. Conclusions: Bronchial closure without staplers is a safe method in experienced hands in robotic surgery. Negative surgical margins of the bronchus can be achieved in lung tumours that are close or extending over the lobar bronchus by higher technical capabilities of robotic surgery. We believe V-loc sutures have a potential place in bronchial closure in minimally invasive surgery.

Right upper sleeve lobectomy after chemotherapy for N2 disease

Right upper sleeve lobectomy after chemotherapy for N2 disease

Surgical resection for advanced lung cancer using the hemi-clamshell approach.

The hemi-clamshell (HCS) approach consists of partial sternotomy with antero-lateral thoracotomy. This study evaluated the utilities and outcomes of the HCS approach in advanced lung cancer patients. We retrospectively investigated 45 patients who underwent surgery for advanced lung cancer via the HCS procedure between 2000 and 2014, the indications for surgery being tumour invasion extending to the aorta arch in 5, descending aorta in 9, main pulmonary artery in 5, superior vena cava in 6, right or left atrium in 4, apical thoracic dome in 7 patients and mediastinal lymphadenopathy for left-sided lung cancer in 12. Preoperative chemo-radiation induction therapy was given to 33 of these patients. We performed 34 lobectomies, including 8 sleeve lobectomies, 10 pneumonectomies and 1 wedge resection of the lung. Cardiovascular reconstruction of the aortic arch was performed in 3, descending aorta in 4, subclavian arteries in 4, superior vena cava in 5, atrial wall in 4 and pulmonary artery in 12 patients with some overlap. En bloc chest wall resection was performed in 7 patients. Lymphadenectomy in the pre-tracheal and subcarinal areas was routinely performed. Forty-two operations (93%) were complete resections. No postoperative mortalities occurred and the 5-year survival rate for all patients was 53%. The HCS approach is suitable for advanced lung cancer, including invasion of mediastinal structures, the apical dome and mediastinal lymph nodes. It provides a wide view of the mediastinum and apex of the chest, and safe access to the thoracic great vessels, resulting in better long-term survival rates.

Video-assisted thoracoscopic surgery bronchial sleeve lobectomy.

A sleeve lobectomy (SL) is considered a valid option instead of a pneumonectomy in patients affected by central non-small cell lung cancer (NSCLC). In the last few years, the improvement of video-assisted thoracoscopic surgery (VATS) has allowed experienced surgeons to carry out this challenging operation by a minimally invasive approach. A full pre-operative assessment enclosing a flexible fiber-optic bronchoscopy evaluation and a multidisciplinary team discussion of the clinical case must be accomplished. There is no strictly an indication for the number of thoracoscopic ports: VATS SL is reported from 1 to 3-4 incisions. A significant variability in the technique of the anastomosis is documented and depends on the personal use and ability of the surgeon. However the operational principles are the same of an open SL: free bronchial margins at the frozen section examination, tension-free anastomosis, avoid luminal disparity and en-bloc resection. Due to the extent of the tumour, VATS SL can be associated to other complex resections like arterioplasty, or double sleeve (bronchial and artery) mainly on the left side. A patient underwent a VATS SL must be enrolled in an enhanced recovery pathway (ERP): physiological rehabilitation is a key point to achieve good outcomes and avoid complications.

Pulmonary carcinoids - analysis of early and long-term surgical treatment outcomes in a group of 90 patients.

IntroductionOver the years, pulmonary carcinoids have been treated as locally malignant tumors because of the favorable prognosis. It is currently known that the clinical course of the disease is mainly dependent on the carcinoid subtype.AimTo analyze the early and long-term surgical treatment outcomes for typical and atypical carcinoids.Material and methodsA total of 90 patients were treated surgically for pulmonary carcinoid tumors in the years 2007–2015. Typical carcinoids were diagnosed in 69 (77%) cases, while atypical carcinoids – in 21 (23%); 67 patients underwent lobectomy, 3 – sleeve lobectomy, 9 – bilobectomy, 2 – pneumonectomy, 1 – segmentectomy, and 8 – wedge resection.ResultsNone of the patients died in the postoperative period. Complications occurred in 14.4% of patients. The most common complications included: arrhythmias (5.6%), prolonged air leak (3.3%), and residual pneumothorax (3.3%). Among the 21 patients with atypical carcinoids, N1 metastasis was found in 1 (4.8%) patient, while N2 – in 5 (23.8%) patients. In the group of 69 patients with typical carcinoids, N1 metastasis was revealed in 7 (10.1%) patients and N2 metastases – in 2 (2.9%) patients. The probability of 5-year survival in patients with typical and atypical carcinoids was 96% and 83%, respectively. During the follow-up period 7 (7.8%) patients, including 6 with atypical carcinoids, experienced local recurrence; distant metastasis occurred in 8 (8.9%) cases, including 6 with atypical carcinoids.ConclusionsAlthough radical surgical treatment provides excellent long-term outcomes, it should be noted that patients with pulmonary carcinoids (especially with the atypical subtype) may experience local recurrence and distant metastases even many years after surgery.

ED04.01 Surgery in Bronchopulmonary Typical and Atypical Carcinoids

ED04.01 Surgery in Bronchopulmonary Typical and Atypical Carcinoids

P1.04-005 Efficacy of Photodynamic Therapy Combined with a Guide Sheath Method in Lung Cancer Patients with Endobronchial Stenosis

Photodynamic therapy (PDT) using a second generation of photosensitizier, talaporfin sodium was useful for the curative or palliative treatment of lung cancer. However, it is required for interventional pulmonologist to perform accurate PD-laser irradiation in some lung cancer case. We hypothesized that all-direction type PD-laser probe covered with a guide sheath (GS) (GS-PDT) made it possible to secure its probe and fix its position in the endobronchial lesion, to enhance the effect of PDT by avoiding direct contact with the tumor lesion, thus preventing its probe from contact with blood. We evaluated the efficacy and safety of this irradiation technique for the lung cancer patients with endobronchial stenosis. Before the procedure, we evaluated the extent of tumor lesion by auto-fluorescence video-bronchoscope (BF TYPE-F260, Olympus, Japan). As a photosensitizer, talaporfin sodium (Laserphyrin, Meiji Pharma, Japan) was administered at 40mg/m2 intravenously 6 hours before irradiation. PDT was performed by using video-bronchoscope (EB-530T, FUJI MEDICAL, Japan) to visualize PD-laser light clearly by adjusting FICE（Flexible spectral Imaging Color Enhancement）mode. We irradiated 664nm laser light to the target bronchus with endobronchial stenosis utilizing an all-direction type laser probe covered with a GS (disposable K203 guide sheath kit, Olympus, Japan) at each dose of 100J/cm2 (150mW) for 11 minutes and 7 seconds under fluoroscopic guidance. After one month, we evaluated the endoscopic efficacy of this method. Between December 2014 and April 2015, we performed GS-PDT for three patients with pathologically diagnosed lung cancer, 1 squamous cell carcinoma, 1 adenocarcinoma and 1 small cell carcinoma. Stage IA squamous cell carcinoma patient with endobronchial stenosis underwent definitive therapy. Stage IA adenocarcinoma patient with endobronchial wall spread of tumor to proximal respiratory tract underwent a combination of induction chemo-radiotherapy followed by sleeve left upper lobectomy as for definitive therapy to reduce the extent of lung resection. Stage IIIA limited-stage small-cell lung cancer patient with the stenosis of right main and upper lobe bronchus underwent palliative therapy to improve oxygenation and to prevent obstructive pneumonia. One month after GS-PDT, we confirmed the endoscopic response (1 complete response, 2 partial responses). No PDT-related complications occurred. New GS-PDT method was safe and could be an effective technique to accurately irradiate the lung cancer patients with endobronchial stenosis.