Idea Transcript
23rd European Conference on General Thoracic Surgery
31 May – 3 June 2015 Lisbon Congress Center, Lisbon, Portugal
23rd European Conference on General Thoracic Surgery
TABLE OF CONTENTS Sunday, 31 May 2015 Database and Quality Certification Session
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Monday, 1 June 2015 Session I/ Brompton ESTS Lecture Session II/ Videos I Session III/ Pulmonary Non Neoplastic Session IV/ Pulmonary Neoplastic I Pediatric Congenital Thoracic Malformations Session Session V/ Young Investigators Award ESTS-IASLC Joint Session Biology Club VATS/RATS Session Session VI/ Innovative/Experimental Oscar Night Videos
10 20 22 28 36 49 54 69 74 82 90 100
Tuesday, 2 June 2015 ESTS– EACTA Joint Session Session VIII/ Mixed Thoracic I Session IX/ Pulmonary Neoplastic II ESTS – Portuguese - Brazilian Joint Session Session X/ Mixed Thoracic II Session XI/ Videos II Session XII/ Interesting Cases Session XIII/ Esophagus/Mediastinum Session XIV/ Airway/Transplantation Session XV/ Chest Wall/Diaphragm/Pleura ESTS-STS Joint Session Session XVI/ MITIG VATS Session
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106 112 129 141 146 163 169 173 185 195 206 211
Lisbon – Portugal – 2015
TABLE OF CONTENTS
Wednesday, 3 June 2015 ESTS-CATS Joint Session
226 232
Posters
239
Nurse Symposium-Oral
410
Nurse Symposium-Posters
426
List of Authors
441
Session XVII/ Videos III
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23rd European Conference on General Thoracic Surgery
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ABSTRACTS
SUNDAY, 31 MAY 2015 13:00 - 14:30 DATABASE AND QUALITY CERTIFICATION SESSION F-001 THE IMPACT OF ADJUVANT CHEMOTHERAPY IN ATYPICAL CARCINOID OF THE LUNG. A PROPENSITY SCORE ANALYSIS OF THE EUROPEAN SOCIETY OF THORACIC SURGEONS LUNG NEUROENDOCRINE DATABASE Pier Luigi Filosso1, A. Evangelista2, F. Guerrera1, P. Thomas3, S. Welter4, P. Moreno Casado5, F. Venuta6, E. Rendina7, A. Brunelli8, L. Ampollini9, F. Ardissone10, W. Travis11, M. Nosotti12, D. Sagan13, F. Raveglia14, O. Rena15, S. Margaritora16, I. Sarkaria17, E.S.O.T.S. Lung Neuroendocrine Working Group1 1 Thoracic Surgery, University of Turin, Turin, Italy 2 Unit of Cancer Epidemiology, CPO Piedmont, Turin, Italy 3 Thoracic Surgery North Hospital, APHM - Aix-Marseille University, Marseille, France 4 Thoraxchirurgie und Thorakale Endoskopie, Ruhrlandklinik Essen, Essen, Germany 5 Thoracic Surgery, University Hospital Reina Sofia, Cordoba, Spain, 6 Thoracic Surgery, University of Rome Sapienza, Rome, Italy 7 Thoracic Surgery, University of Rome Sapienza, St. Andrea Hospital, Rome, Italy 8 Department of Thoracic Surgery, St. James’s University Hospital Bexley Wing, Leeds, United Kingdom 9 Department of Surgical Sciences, Thoracic Surgery, University Hospital of Parma, Parma, Italy 10 Thoracic Surgery Unit, University of Turin, Orbassano, Italy 11 Pathology, Memorial Sloan Kettering cancer Center, New York, United States of America 12 Thoracic Surgery And Lung Transplantation, Fondazione Cà Granda Ospedale Maggiore Policlinico, Milan, Italy 13 Thoracic Surgery, Medical University of Lublin, Lublin, Poland 14 Thoracic Surgery, AO San Paolo, Milan, Italy 15 Thoracic Surgery Unit, University of Eastern Piedmont, Novara, Italy 16 Department of General Thoracic Surgery, Catholic University, Rome, Italy 17 Thoracic Surgery, University of Pittsburgh Schools of the Health Sciences, Pittsburgh, United States of America Objectives: Atypical Carcinoids (ACs) of the lung are uncommon neoplasms with a biological behavior still not entirely understood. The efficacy of adjuvant regimens remains unclear, since these tumors do not seem completely responsive to chemo-radiotherapy. Moreover, local or distant relapses are not unusual in ACs. The aim of this study is to evaluate the impact of adjuvant treatment in resected ACs.
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ABSTRACTS
Abstracts 001 - 002
Lisbon – Portugal – 2015
23rd European Conference on General Thoracic Surgery
ABSTRACTS
Methods: This is a retrospective study, including ACs operated between 1992 and 2012, in 17 institutions worldwide. Stage I tumors were excluded from the analysis. Overall survival (OS), calculated from date of resection, was estimated by the Kaplan-Meier method. Propensity Score (PS) for the likelihood of having been submitted to adjuvant chemotherapy (CT) was estimated based on the following variables: age, gender, smoking history, previous malignancy, ECOG Performance Score (ECOG-PS), pTNM stage, resection status and year of surgery. PS-adjusted and Multivariable-adjusted OS comparisons by adjuvant chemotherapy were assessed using the Cox regression model. Results: Overall, 75 cases were encompassed in the final analysis: 19 (25 %) received adjuvant chemotherapy. The median follow-up (FU) was 51 months; FU completeness was 89 %. At the end of the study, 24 patients died (5 in the CT group). Patients receiving adjuvant-CT showed a slightly better survival (HR 0.80, P= 0.66 Figure 1). PS-adjusted analyses demonstrated no significative effect of adjuvant chemotherapy on OS (adjuvant-CT yes vs no HR: 0.97, 95%CI 0.34- 2.79, P= 0.95, Table 1). Sensitive analysis performed using multivariable Cox model showed similar results (HR 1.06, 95%CI 0.29 -3.76 P= 0.93). Age and advanced pTNM stages were independent predictors.
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HR (95%CI)
P
Adjuvant Chemotherapy YES vs NO (Crude)
0.66. (0.29 to 2.15)
0.501
Adjuvant Chemotherapy YES vs NO (PS adjusted)
0.97 (0.34 to 2.79)
0.95
Adjuvant Chemotherapy YES vs NO (adjusted for the 1.06(0.29 to 3.76) below factors)
0.93
Age (per 1 year increase)
1.06 (1.00 to 1.12)
0.039
Male gender
1.14 (0.42 to 3.15)
0.79
Smoke
2.76 (0.91 to 8.3)
0.072
Previous Malignancy
2.89 (0.86 to 9.66)
0.086
ECOG PS>=2
1.06 (0.93 to 4.01)
0.09
III vs II
2.06 (0.61 to 6.96)
0.24
IV vs II
8.12 (1.5 to 43.88)
0.015
Resection status (R0 vs R1)
0.75 (0.09 to 6.43)
0.79
Year of Surgery 1999-2005 vs 1992-1998
0.99 (0.21 to 4.77)
0.99
2006-2012 vs 1992-1998
1.12 (0.26 to 4.82)
0.87
pTNM
Conclusion: Our results did not demonstrate any CT significant advantage on survival in resected ACs. Multi-institutional randomized clinical trials are needed to find optimal treatment for advanced stage tumors. Disclosure: No significant relationships.
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ABSTRACTS
Abstracts 001 - 002
Lisbon – Portugal – 2015
23rd European Conference on General Thoracic Surgery
ABSTRACTS
F-002 THE EUROPEAN THORACIC DATA QUALITY PROJECT: COMPOSITE DATA-QUALITY SCORE TO MEASURE QUALITY OF INTERNATIONAL MULTI-INSTITUTIONAL DATABASES Michele Salati1, P-E. Falcoz2, A. Brunelli3 1 Thoracic Surgery, Ospedali Riuniti Ancona, Ancona, Italy 2 Thoracic Surgery, NHC - Universty of Strasbourg, Strasbourg, France 3 Department of Thoracic Surgery, St. James’s University Hospital Bexley Wing, Leeds, United Kingdom Objectives: To describe the methodology for the development of data quality metrics in multi-institutional databases, deriving a cumulative data quality score (Composite Data-quality Score). The ESTS-database was used to create and apply the metrics. The Units contributing to the ESTSdatabase were ranked for the quality of data uploaded using the CDS. Methods: We analyzed data obtained from 96 Units contributing with at least 100 major lung resections (January 2007-December 2014). The Units were anonymized assigning a casual numeric code. The following metrics were developed for measuring the data quality of each Unit: •
record-cumulative-Completeness (COM); rate of present variables on 16 expected variables for all the records uploaded [1-null values / total expected values, the concept of “null value” was defined for each variable]
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record-cumulative-Reliability (REL); rate of consistent checks on 9 checks tested for all the records uploaded [1-inconsistent controls / total possible consistent controls, specific consistency control queries were defined]
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These two metrics were rescaled using mean ad standard deviation of the entire dataset and summed, obtaining:
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Composite Data-quality Score (CDS): [COM rescaled+REL rescaled], it measures the cumulative data quality.
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The CDS was used to rank the contributors.
Results: As reported in table-1, the COM of ESTS-database contributors varied from 98.59% to 43.03% and the REL from 100% to 86.98. Combining the rescaled metrics, the obtained CDS ranged between 2.67 (highest quality) to -7.85 (lowest quality). Comparing the rating using the COM to the one obtained using the CDS, 93% of Units changed their position. The larger movement was a fall down of 66 position in the list.
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Conclusion: We described a reproducible method for data quality assessment in clinical multi-institutional databases. The CDS is a unique indicator able to describe data quality and to compare it among Centers. It has the potential of objectively lead projects of data quality management and improvement.
Disclosure: No significant relationships.
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ABSTRACTS
Abstracts 001 - 002
Lisbon – Portugal – 2015
23rd European Conference on General Thoracic Surgery
ABSTRACTS
MONDAY, 1 JUNE 2015 08:30 - 10:30 SESSION I: BROMPTON B-003 ANALYSIS OF THE MOST COMMON MAJOR INTRAOPERATIVE COMPLICATIONS DURING VIDEO-ASSISTED THORACOSCOPIC SURGERY ANATOMICAL RESECTIONS - ON BEHALF OF MINIMALLY INVASIVE THORACIC INTEREST GROUP - EUROPEAN SOCIETY OF THORACIC SURGEONS Herbert Decaluwé1, R.H. Petersen2, H.J. Hansen2, C. Piwkowski3, F. Augustin4, A. Brunelli5, T. Schmid4, K. Papagiannopoulos5, J. Moons1, D. Gossot6 1 Thoracic Surgery, University Hospitals Leuven, Leuven, Belgium 2 Department of Cardiothoracic Surgery, Rigshospitalet, Copenhagen, Denmark 3 Thoracic Surgery, Karol Marcinkowski University of Med Sciences, Poznan, Poland 4 Operative Medizin, University of Innsbruck, Innsbruck, Austria 5 Department of Thoracic Surgery, St. James’s University Hospital Bexley Wing, Leeds, United Kingdom 6 Thoracic, IMM, Paris, France Objectives: Multicentric evaluation of the frequency and nature of intraoperative major complications during video assisted thoracoscopic (VATS) anatomical resections. Methods: Six European centers submitted their series of consecutive anatomical lung resections intended to be performed by VATS. Conversions to thoracotomy, vascular injuries and major intraoperative complications were studied in relation to the surgeons’ experience. Major complications included immediately life threatening complications (e.g. blood loss of more than 2 litres), injury to proximal airway or other organs, or complications leading to unplanned additional anatomical resections. Results: 3077 patients were analyzed. Most resections (88%) were performed for bronchial carcinoma. There were two intraoperative deaths. In-hospital mortality was 1.4%. Conversion to open thoracotomy was observed in 171 cases (5.6%), in 21.6% for oncologic reasons, in 26.3% for technical reasons and in 46.8% for complications. Vascular injuries were reported in 88 (2.86%) patients and led to conversion in 69 (2.24%). Forty-two (1.36%) peroperative major complications were identified. These consisted of erroneous transection of bronchovascular structures (n=7); lesions to gastro-intestinal organs (n=5) or proximal airway (n= 5); complications requiring additional unplanned major surgery (n=11) or immediately life-threatening complications (n=14). A panel discussed these cases. Recommendations will be submitted for
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Lisbon – Portugal – 2015
ABSTRACTS
Disclosure: No significant relationships.
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Conclusion: Intraoperative major complications during VATS anatomical lung resections are infrequent, but do occur, both in less and more experienced hands.
Abstracts 003 - 009
publication. Comparing surgeon’s early experience (200 cases, 6 surgeons in 1652 patients) showed both a higher prevalence of pT1-tumors (52.8% versus 29.6%; p 30 pack-year smoking history; age 55–74 years). The supply component simulates the number of thoracic surgeons. SABR was introduced into the model to predict changes in the number of operable NSCLC per thoracic surgeon, modeling 30%, 60%, and 90% compliance with SABR for stage IA and then for both stage IA/IB NSCLC. Results: In the absence of SABR, the volume of operative NSCLC per surgeon increases by a peak of 49.4% (year 2027) and then gradually declines to present day volume by 2049. Figure 1 shows this trend, along with predicted variation in operative NSCLC per surgeon given varying compliance with SABR for stage IA lung cancer. More dramatic decreases are seen with increasing compliance with SABR for stages IA/IB NSCLC. If the number of new surgeons entering the workforce per year were reduced by 33%, operative volume per surgeon would increase by a peak of 57.1% (30% stage IA SABR compliance) and would decrease by up to 49.1% (90% stage IA SABR compliance).
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Lisbon – Portugal – 2015
ABSTRACTS
Monday A.M.
Abstracts 003 - 009
Conclusion: With the implementation of SABR for treatment of early NSCLC there would be a decrease in operative volume. The impact depends upon the stage of NSCLC for which SABR is recommended and on compliance. A national strategy for thoracic surgery workforce planning is necessary given the complex interaction of CT screening and the treatment of medically operable early NSCLC with SABR. Disclosure: No significant relationships.
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23rd European Conference on General Thoracic Surgery
ABSTRACTS
B-005 LOCOREGIONAL RECURRENCE AFTER SEGMENTECTOMY FOR CLINICAL T1AN0M0 NON-SMALL CELL LUNG CANCER WITH RADIOLOGICAL SOLID APPEARANCE ON THIN-SECTION COMPUTED TOMOGRAPHY Aritoshi Hattori, K. Suzuki, T. Matsunaga, K. Takamochi, S. Oh General Thoracic Surgery, Juntendo University, Tokyo, Japan Objectives: We aimed to identify clinicopathological features of locoregional recurrence after segmentectomy for clinical-T1aN0M0 radiologically invasive non-small cell lung cancer (NSCLC). Methods: Between 2008 and 2014, 353 patients underwent pulmonary lobectomy or segmentectomy with nodal dissection for clinical-T1aN0M0 radiologically invasive NSCLC, which showed 0.5 ≤consolidation tumor ratio (CTR) ≤1.0 on thin-section computed tomography (CT). Cox proportional hazard model was used to determine the significant clinical factors for locoregional recurrence after pulmonary lobectomy or segmentectomy. Results: Lobectomy was performed in 270 (76.5%) patients and segmentectomy in 83 (23.5%). Oncological aspects were significantly worse in patients underwent lobectomy than those in segmentectomy (CEA: p=0.0114, SUVmax, tumor size, CTR, pathological-stage, lymphovascular invasion: p