Sunday, May 4, 2025: 9:00 AM - 4:00 PM
Seattle Convention Center | Summit
Posted Room Name: Poster Area, Exhibit Hall
Track
Thoracic
105th Annual Meeting
Presentations
Introduction:
Pectus excavatum is a congenital chest wall deformity characterized by a sunken sternum, which can result in both cosmetic and physiological concerns. While traditional surgical techniques, such as the Nuss and Ravitch procedures, are commonly used, they are associated with significant morbidity, extended recovery times, and potential complications. This study presents a "Pectus Up" , novel and safe operation technique aimed at reducing these risks while maintaining or improving the correction of the deformity.
Methods:
Between 15-38 years of age patients with pectus excavatum underwent the novel procedure at UK, Ireland, India and Australia. The operation is as follows: the Pectus Up implant is placed on top of the sternum, at the subpectoral level, in the most sunken area of the chest. Subsequently, by means of an elevation system, the sternum is lifted to the desired position and is fixed with the implant.. Intraoperative and postoperative outcomes, including operative time, blood loss, length of hospital stay, and complication rates, were recorded and compared with historical controls who underwent traditional procedures.
Results:
The novel procedure took average of 45 minutes compared to 90-120 minutes for NUSS procedure and around 180minute for Ravitch Procedure, with small incision in front of chest. There is minimal blood loss. There is no necessity of thoracoscope. The average hospital stay was reduced to 2 days compared to 5 -7days for NUSS or Ravitch Procedure. No major complications, such as infection or bar displacement, pneumothorax, haemothorax , were observed in this cohort. Patient satisfaction scores were high reporting significant improvement in both the cosmetic and physiological aspects of the condition. The pain management with much easier without cryoablation or epidural. Patients with pectus up needed oral analgesics for average of 2 weeks ,compared to 4-6 weeks of oral analgesics treatment for NUSS and Ravitch procedure.
Conclusion:
This study demonstrates that the novel surgical technique for pectus excavatum is not only safe but also offers advantages over traditional methods, including reduced morbidity and improved patient outcomes. Further studies with a larger cohort and longer follow-up are recommended to confirm these findings.
Authors
shyam Kolvekar (1), Karen REdmond (2)
Institutions
(1) Advanced Cardiothoracic Consultants, LLC, London, United Kingdom, (2) The Mater Hospital, Dublin, NA
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Poster Presenter
shyam Kolvekar, Advanced Cardiothoracic Consultants, LLC
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London
United Kingdom
Objective: During esophageal cancer surgery, Lugol's iodine staining is commonly used to identify tumor regions. However, this method has limitations, such as insufficient specificity and significant background interference. This study aims to develop a new technique based on a near-infrared fluorescence EGFR & c-MET targeted probe for rapid intraoperative imaging of esophageal cancer regions and tumor margin assessment.
Methods: First, the expression of EGFR and c-MET was verified in esophageal cancer tissue slices using immunohistochemistry. Imaging experiments were then conducted on ex vivo esophageal cancer samples during surgery. After tumor resection, the traditional Lugol's iodine staining method was used to image the tumor area. The samples were subsequently incubated with the EGFR & c-MET targeted probe. After 20 minutes, the samples were imaged using a near-infrared fluorescence imaging system. Finally, The imaging results were compared with pathological and immunohistochemical findings.
Results: A total of 58 esophageal cancer tissue slices were analyzed. Immunohistochemical results showed high expression of EGFR alone, C-MET alone, and both EGFR & c-MET in 15 cases (25.9%), 22 cases (37.9%), and 8 cases (13.8%), respectively. High expression of at least one marker (EGFR or C-MET) was found in 45 cases (77.6%). Imaging experiments were conducted on 15 ex vivo esophageal cancer samples (18 lesions). The success rates for identifying cancer regions using Lugol's iodine staining and targeted fluorescence probe imaging were 88.9% and 83.3%, respectively. However, Lugol's iodine staining produced five false-positive areas, which were confirmed to be non-cancerous by pathology. Compared to traditional Lugol's iodine staining, targeted fluorescence imaging significantly reduced background interference, with an average signal-to-background ratio of 2.9 ± 0.4 and no false positives. Notably, fluorescence imaging detected a lesion approximately 3 mm in diameter, which was confirmed as esophageal cancer by pathology but was not detected by Lugol's iodine staining.
Conclusions: The EGFR & c-MET targeted probe allows for the identification of esophageal cancer lesions and the detection of small lesions during surgery. It offers improved specificity compared to traditional Lugol's iodine staining. This technology holds the potential to assist surgeons in accurately identifying esophageal cancer lesions intraoperatively and assessing tumor margins.
Authors
Jiahui Mi (1), Kezhong Chen (1), Yun Li (1), Fan Yang (1), Jian Zhou (1)
Institutions
(1) Department of Thoracic Surgery, Peking University People's Hospital, Beijing, China
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Poster Presenter
Jiahui Mi, Peking University People’s Hospital
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Boston, Beijing
China
Objective: Despite the known benefits of lung cancer screening (LCS), rates of completion are low. Of further concern are high no-show rates for scheduled screening exams, presenting challenges in balancing early detection with appropriate resource utilization. We identified factors associated with non- or delayed attendance to scheduled LCS exams in order to develop targeted patient interventions.
Methods: We retrospectively reviewed a database of patients referred for LCS between 1/1/2021 and 12/31/2023. Sociodemographic and clinical characteristics were collected, and appointment status of scheduled low-dose CT (LDCT) was reviewed. Patients were categorized as having completed screening if they attended their first CT appointment or completed it within 60 days after no-show or cancellation. Incomplete screening was defined as having never completed an exam or completion greater than 60 days after no-show or cancellation. Factors associated with incomplete screening were identified with multivariable analyses.
Results: A total of 8,399 patients were referred for LCS over the study period. Of these, 5,024 patients were scheduled for LCS, and 4,503 patients (89.6%) were categorized as having completed their LCS exam (Figure 1A). Most patients within this group attended their screening appointment as scheduled (3,618, 80.3%), while 15.0% (N=675) attended their LDCT within 60 days of a cancellation and 4.7% (N=210) had a no-show event and subsequently completed screening within 60 days. Alternatively, 521 patients (10.4% of all patients scheduled) were categorized as having incomplete screening, whereby 25 patients completed after 60 days following a no-show, 24 completed after 60 days following a cancellation, and 472 never completed LDCT. On multivariable analysis, older age, female sex, married status, former smoker status as opposed to current smoker and undergoing shared decision-making (SDM) were significantly associated with likelihood of completing LCS (Figure 1B).
Conclusions: As eligible patients are scheduled for LDCT, continued programmatic efforts are needed to ensure screening exams are completed. Patients at risk for incomplete screening include younger patients, those not married, men, current smokers and absence of SDM. Further understanding of these barriers has helped us identify patients for a randomized trial for targeted intervention which we anticipate will improve compliance for LCS completion.
Authors
Neel Chudgar (1), Albert Dweck (2), Grace Ha (3), Rajika Jindani (1), Agastya Vaidya (2), Shira Weinberg (2), Tanner Nelson (2), Tamar Nobel (1), Marc Vimolratana (1), Brendon Stiles (1)
Institutions
(1) Montefiore Medical Center, Bronx, NY, (2) Albert Einstein College of Medicine, Bronx, NY, (3) Montefiore Medical Center, New York, NY
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Poster Presenter
Neel Chudgar, Montefiore Medical Center
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New Rochelle, NY
United States
Background: For locally advanced esophageal squamous cell carcinoma, patients with positive lymph nodes after neoadjuvant chemotherapy combined with surgery often have a high recurrence rate and poor prognosis. Currently, there is no recommended adjuvant treatment.
Methods: We conducted a prospective, non-randomized, open-label, controlled clinical study to evaluate the value of checkpoint inhibitors as adjuvant treatment for patients with squamous esophageal carcinoma. Stage II or III esophageal squamous cell carcinoma patients who received neoadjuvant chemotherapy and R0 resection with positive lymph nodes were enrolled and allocated to receive Toripalimab (240 mg every 3 weeks) or the clinical observation group at a 1:1 ratio. The study period lasted up to 1 year. The primary endpoint of the study was disease-free survival. Survival analysis was described using Kaplan-Meier curves, and Log-rank test was used to compare differences in clinical characteristics between groups.
Results: The median follow-up time for the entire group was 37 months (from the time of surgery to the last follow-up time in July 2024). The 1-year and 3-year DFS rates were 75.0% vs. 46.2% and 57.8% vs. 37.8% (P = 0.043) in the immunotherapy group and the clinical observation group, respectively; the corresponding OS rates were 92.9% vs. 80.4% and 85.6% vs. 43.5% (P = 0.031). The mean duration of toripalimab intervention in the immunotherapy group was 6 months (0.7-12.0 months). The incidence of any-grade TRAEs was 71.4% in the immunotherapy group, higher than 46.2% in the clinical observation group, but the difference was not statistically significant (P = 0.059). TRAEs were mainly grade 1-2, and the proportion of grade ≥3 TRAEs was 25.0% and 11.5% (P = 0.298) in the two groups, respectively; no patients in either group died due to adverse reactions.
Conclusion: In patients with positive lymph nodes after esophageal squamous cell carcinoma resection who have undergone neoadjuvant chemotherapy, patients who receive adjuvant treatment with Toripalimab have significantly longer disease-free survival and overall survival compared to patients in the clinical observation group, with manageable safety.
Authors
Liang Dai (1), Keneng Chen (2), Yaya Wu (3)
Institutions
(1) Peking University Cancer Hospital, Beijing, Beijing, (2) Peking University Cancer Hospital, Hai Dian District, Bei Jing, (3) Peking University Cancer Hospital, Bei Jing, Bei Jing
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Poster Presenter
Liang Dai, Peking University Cancer Hospital
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Beijing, Beijing
China
Objective: We recently presented a negative randomized trial comparing cryo-analgesia at 6 intercostal levels for 120 seconds with our standard of care. Several patients in the trial complained of prolonged pain and neuropathy. We hypothesized that by decreasing the number of intercostal spaces treated and the treatment time, cryo-analgesia may reduce the consumption of narcotics.
Methods: This study was a quality improvement project. We treated 60 consecutive patients (QI) undergoing elective robotic pulmonary resections. Fifteen patients were excluded due to opioid or gabapentin use. Patients received intercostal nerve block with bupivacaine and lidocaine (INB) and cryotherapy to 3 levels for 90 seconds. Results were compared to the results of the randomized trial, which had two cohorts: the cryotherapy cohort (Cryo) was treated with cryoablation of six intercostal nerves for 120 seconds in addition to INB. The standard of care cohort (SOC) was treated with INB only. Primary outcomes were opioid use in-hospital and totaled up to the first postop visit measured by morphine milligram equivalents (MME). Secondary outcomes included patient-reported pain as assessed by the visual analog scale (VAS) and the difference in incentive spirometry (IS) between preoperative value and postoperative days (POD) 1 and 2.
Results: 148 patients were analyzed (Cryo N=51, SOC N=52, QI N=45). There was no difference in baseline characteristics, procedure type, or length of stay. There was no difference in inpatient MME, outpatient MME, or total MME up to the first postoperative visit. The difference between preoperative IS and IS at postoperative days 1 and 2 was insignificant. Pain scores were similar among the 3 groups (Table 1).
Conclusions: Modifying the cryo-analgesia protocol to include fewer levels and less time did not improve opioid consumption, incentive spirometry, or pain scores in patients undergoing lung resection. The technology should not be used outside of clinical trials.
Authors
Benny Weksler (1), Lauren Drake (2), Kara Specht (3), Pam Kuchta (3), Lawrence Crist (2), Hiran Fernando (4)
Institutions
(1) Allegheny Health network, Pittsburgh, PA, (2) Allegheny Health Network, Pittsburgh, PA, (3) Allegheny General Hospital, Pittsburgh, PA, (4) Allegheny General Hospital, Oakmont, PA
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Poster Presenter
Lauren Drake, Allegheny Health network
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Pittsburgh, PA
United States
Objective:Lung adenocarcinoma (LUAD), the most prevalent form of lung cancer. The transition from adenocarcinoma in situ (AIS), and minimally invasive adenocarcinoma (MIA) to invasive adenocarcinoma (IAC) is not fully understood. Intratumoral microbiota may play a role in LUAD progression, but comprehensive stage-wise analysis is lacking.
Methods:Tumor and bronchoalveolar lavage fluid (BALF) samples from patients with AIS/MIA or IAC were collected for next-generation sequencing to characterize microbial diversity and composition. DNA extraction involved lysing samples with nuclease and protease, followed by homogenization and elution. Sequencing libraries were prepared and sequenced on the Illumina platform. Whole exome sequencing was performed to identify somatic mutations and genetic variants. Bioinformatics analysis, including taxonomic annotation with Kraken2 and de novo assembly with MEGAHIT, was conducted to process metagenomic data. Correlation analysis was performed to link microbial species with mutated genes using custom R scripts.
Results: Metagenomic analysis revealed a distinct microbial profile in IAC compared to AIS/MIA, with increased abundance of Bacteroidetes and Firmicutes in the IAC group. Bosea sp. and Microbacterium paludicola, were less abundant in IAC, suggesting a potential protective role in early-stage disease. Conversely, Mycolicibacterium species were more prevalent in IAC, indicating a possible contribution to disease progression. Genetic sequencing identified PTPRZ1 strongly correlating with microbial composition, suggesting a mechanistic link between microbiota and genetic alterations in LUAD.
Conclusion:This study characterizes microbial communities in various stages of LUAD, revealing links between microbiota and genetic mutations. The unique microbiota suggests its role in LUAD progression and as a therapeutic target.
Authors
Yang Haoshuai (1), Chaoyang Liang (2), Deruo Liu (3), Zhenrong Zhang (4)
Institutions
(1) China-Japan Friendship Hospital, Beijing, Beijing, (2) China-Japan Friendship Hospital, Beijing, NA, (3) China Japan Friendship Hospital, Beijing, Beijing, (4) N/A, Beijing, China
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Poster Presenter
Haoshuai Yang, China Japan Friendship Hospital
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Beijing, Beijing
China
Objective: To evaluate the role of out of sequence (OOS) offers (aka open offers) on donor lung allocation, and assess the association of the new lung composite allocation score (CAS) system with out of sequence offers.
Methods: A retrospective review was conducted of the UNOS Potential Transplant Recipient dataset spanning from January 2006 to March 2024. Match run data on allocation of organs for adult (18+) lung transplant (LTx) recipients was analyzed. Only organs that were ultimately transplanted were analyzed and multiorgan recipients were excluded.
Results: Between 2006 and 2024, we identified 36,229 donor lungs allocated through the standard sequence and 1,550 donor lungs allocated via exception (i.e., OOS). Lungs placed OOS demonstrated male predominance (994[64.1%] vs 21,790[60.1%]), increased use of cigarettes >20 pack-years (166[10.7%] vs 3,125[8.6%]), and were more likely DCD donors (102[6.6%] vs 1,637[4.5%]). OOS organs were less likely to have a documented pulmonary infection (918[59.2%] vs 22,545[62.2%]). Blood type A and B were less likely to be allocated OOS, whereas type O was more likely (1,001[64.6%] vs 18,454[51.2%]). Donor age and cause of death were not significantly different. Recipients of OOS lung offers tended to be older (64 vs 60), white race (1,298[84.1%] vs 28,497[78.7%]), and undergoing single LTx (781[50.4%] vs 9,531[26.3%]). Overall, OOS recipients demonstrated lower average LAS and CAS scores, lower rates of LTx from inpatient (ICU and general ward), and lower ventilator and ECMO bridge rates. Recipients were more likely to have obstructive lung disease. Geographic distribution of OOS offers demonstrates regional variations (Figure 1). The overall rates of OOS lung offers demonstrated a decline from 2006 to 2008 after the implementation of LAS. Since 2023, when LAS was replaced by CAS, there has been a rise in OOS offer rates from 4% to 10%.
Conclusions: The rate of OOS lung offers demonstrates variability correlated to changes in the allocation systems, and is perhaps an unintended consequence of the new CAS system. Overall, single LTx appears to require OOS offers most commonly, despite these lungs not generally meeting extended criteria. Generally, the accepting centers appear to be utilizing these organs for patients prioritized lower in the CAS who may be experiencing inordinately long wait times. These findings may represent opportunities to optimize lung allocation and the new CAS system.
Authors
Kunal Patel (1), Oliver Jawitz (2), Ahmed Gurses (1), Jacob Klapper (2), Matthew Hartwig (3)
Institutions
(1) Duke University Medical Center, Durham, NC, (2) Duke University Hospital, Durham, NC, (3) Duke Hospital, Durham, NC
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Poster Presenter
Kunal Patel, Duke University Medical Center
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Durham, NC
United States
Objective: Randomized trials underscore the safety of minimally invasive surgery (MIS) and indicate a growing preference for MIS over open procedures. This study investigates the utilization of elective open thoracotomy for managing lung cancer at a high-volume cancer-designated institution. It aims to identify scenarios where an elective open approach remains pertinent.
Methods: Patients with NSCLC who underwent resection between 2018 and 2024 (n = 3191) via MIS (n = 2676) were compared to those who underwent elective open surgery (n = 515). Preoperative characteristics were compared using Chi-square, Fisher's exact, and Kruskal-Wallis tests. A nomogram was constructed from a multivariable logistic regression model for the outcome of elective open surgery vs MIS. The model included factors defined a-priori to be clinically relevant, as well as factors with p<0.05 in univariable analyses.
Results: Univariate analysis identified factors influencing the choice of elective open surgery vs MIS, including age, sex, smoking history, cardiac comorbidity, FEV1, DLCO, prior same-sided lung surgery, tumor size on CT, tumor SUV, clinical stage, induction therapy, type of resection, and histologic subtype. Multivariable analysis revealed significant associations with age (OR 0.98, 95% CI: [0.97, 1.0]), male sex (OR 1.28 [1.0, 1.63]), prior same-sided lung surgery (OR 2.13 [1.18, 3.72]), primary tumor SUV (OR 1.03 [1.02, 1.05]), clinical stage: stage IB (OR 2.1 [1.4, 3.1]), IIA (OR 4.1 [2.4, 7.0]), IIB (OR 2.8 [1.8, 4.1]), IIIA: T1-2bN2 (OR 3.6 [2.3, 5.6]), IIIA: T4N0 (OR 7.4 [3.7, 15]), IIIA: T3-4N1 (OR 9.2 [3.9, 22.6]), locoregional recurrence (OR 4.1 [2.0, 8.5]), receipt of induction chemotherapy (OR 1.9 [1.2, 3.0]), adenosquamous histology (OR 2.5 [1.1, 2.1]), planned bilobectomy (OR 3.2 [1.5, 7.2]), and planned pneumonectomy (OR 13.2 [3.1, 95.3]). A nomogram based on these factors was constructed (Figure 1).
Conclusions: Elective open surgery continues to play a critical role in managing a specific subset of NSCLC patients, particularly those with larger, more aggressive tumors, advanced clinical stages, and a history of induction therapy. It is imperative to integrate open surgery where indicated into thoracic surgical training programs. Ensuring adequate exposure to open procedures will equip the next generation of thoracic surgeons with the skills necessary to offer optimal surgical care to diverse NSCLC patient profiles.
Authors
Matthew Skovgard (1), Kay See Tan (1), Benjamin Resio (1), Stijn Vanstraelen (1), Prasad Adusumilli (1), Manjit Bains (1), Matthew Bott (1), Robert Downey (1), Katherine Gray (1), James Huang (1), James Isbell (1), Daniela Molena (1), Bernard Park (1), Valerie Rusch (1), Smita Sihag (1), David Jones (1), Gaetano Rocco (1)
Institutions
(1) Memorial Sloan Kettering Cancer Center, New York, NY
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Poster Presenter
Matthew Skovgard, Memorial Sloan Kettering Cancer Center
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New York, NY
United States
Objective:
Small subpleural lung nodules are often challenging to localize during minimally invasive thoracic surgery. This study evaluated the feasibility of dye localization using the robotic bronchoscopy system to help localize the lesion in anticipation of resection from a multi-institution experience.
Methods:
Consecutive patients undergoing surgical resection of lung nodules with the aid of dye localization using robotic bronchoscopy between 8/7/2020 and 10/5/2022 from three different institutions were included in the study. The IRB approved this work, and informed consent was waived due to the study's retrospective nature. Clinico-demographic and operative and post-operative outcome data were obtained retrospectively using a prospectively maintained database.
Results:
Surgical resections were performed on 288 patients with 318 lung nodules. The mean diameter of lung nodules was 14 mm, with 40.7% of nodules located deeper than 10 mm from the pleura (Table 1). The dye injection was successful in all cases, with 0% procedure termination. The median dye marking procedure time was 29 minutes, including cases where a biopsy was performed in addition to dye marking, and the median operative time was 125 minutes. The dye was visible during resection in 98.6% of lesions. All procedures were performed via a minimally invasive approach. Wedge resections were performed on 176 nodules (55.3%), and segmentectomies and lobectomies were performed on 103 (32.4%) and 39 (12.3%) nodules, respectively. No intra-operative complications related to the dye localization were reported, with a median length of hospitalization of 1.2 days. All lung nodules intended for treatment were resected. The pathology of the nodule consisted of 195 (61.3%) non-small cell lung cancer, 15 carcinoids, 45 metastatic cancer, 51 benign, and 12 others.
Conclusion:
Dye localization of lung nodules using robotic bronchoscopy appears to be a safe and effective method of identifying the location of small subpleural nodules that can facilitate local resection with minimal added operative time.
Authors
Emily Cerier (1), Patrick Ross (2), Luis Herrera (3), Juan Escalon (3), Ali Jiwani (3), Austin Chang (1), Ankit Bharat (1), Samuel Kim (1)
Institutions
(1) Northwestern University Feinberg School of Medicine, Chicago, IL, (2) Main Line Health System, Wayne, PA, (3) Orlando Health, Orlando, FL
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Poster Presenter
♦Samuel Kim, Northwestern University Feinberg School of Medicine
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Chicago, IL
United States
Introduction: Coalterations in key oncogenic pathways significantly influence the progression and prognosis of non-small cell lung cancer (NSCLC). However, the impact of a tumor's genomic profile on overall survival (OS) in resected NSCLC remains understudied. To that end, this study aimed to assess the prevalence of genomic coalterations and their association with OS in resected NSCLC.
Methods: The Memorial Sloan Kettering CHORD database was queried for patients with Stage 0-III NSCLC who underwent surgical resection, accessed via cBioPortal. Patients were stratified by disease stage and race. Coalteration patterns among the 55 most frequently altered genomic loci were analyzed using log odds ratios and false discovery rates for both the entire cohort and racial subgroups. OS was assessed using Cox regression analysis, with mortality hazard ratios (MHRs) adjusted for age, stage, and race.
Results: A total of 4,067 patients with Stage 0-III NSCLC who underwent surgical resection were identified. The median age was 73 years (IQR:60-86). The majority were White (82.4%), with smaller proportions identifying as Asian (7.5%) and Black (4.6%). Most patients had Stage I disease (54.2%), followed by Stage II (29.4%) and III (16.1%). Among the cohort, coalterations were common (Figure A). Fewer significant coalterations were observed in Asian and Black patients (Figure B-D). Coalterations between TP53 and CDKN2A [MHR:1.2 (95CI: 1.02-1.4); p=0.026], KEAP1 [MHR:1.21 (95CI: 1.01-1.46); p=0.037], or MYC [MHR:1.63 (95CI: 1.27-2.1); p=<0.001] were associated with worse overall survival in surgically resected NSCLC compared to TP53 alteration alone. Likewise, STK11 and MYC coalteration was associated with poorer OS compared to STK11 alteration alone [MHR:1.53 (95CI: 1.04-2.26); p=0.032]. Conversely, co-occurrent EGFR alteration was associated with better OS compared to TP53 [MHR:0.79 (95CI: 0.67-0.94); p=0.007] or NOTCH4 [MHR:0.28 (95CI: 0.09-0.9); p=0.032] alteration alone. ALK coalterations showed no significant impact on OS.
Conclusions: Genomic coalterations are common in resected NSCLC and vary by racial group. Even after adjusting for clinicodemographic and sociocultural factors known to impact NSCLC outcomes, coalterations have varying associations with survival. These findings highlight the need to consider genomic profile as part of treatment planning, even for patients for whom primary operative management is indicated.
Authors
HUNTER STECKO (1), Jenna Aziz (2), Aaron Guo (2), Robert Merritt (2)
Institutions
(1) Ohio State Wexner Medical Center, COLUMBUS, OH, (2) Ohio State Wexner Medical Center, Columbus, OH
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Poster Presenter
HUNTER STECKO, Ohio State Wexner Medical Center
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COLUMBUS, OH
United States
Objective: To identify patient groups with favorable prognoses, especially within the surgical curative time window in stage I lung cancer, we investigated clinicopathologic features associated with recurrence after complete resection for stage I lung cancer.
Methods: We performed a retrospective analysis of patients with pathologic stage I lung cancer who underwent R0 resection between 2008 and 2015. Exclusion criteria included a history of lung cancer, induction or adjuvant therapy, and incomplete data. Uni- and multivariate Cox regression analyzed the association between clinicopathologic features and disease recurrence and identified protective factors.
Results: In total, 1503 patients met the inclusion criteria and 224 developed recurrence. The 5-year cumulative incidence of recurrence was 14.9%. Consolidation tumor ratio < 0.75, stage IA1, absence of lymphovascular invasion, lepidic-predominant adenocarcinoma, and solid component ≤ 10mm were independent protective factors. A systemic risk stratification method was thereby established. Patients with no less than 4 protective factors were classified into the low-risk group (n=223); those with 1-3 factors into the intermediate-risk group (n=1232), and the rest into the high-risk group (n=48). Kaplan-Meier curves showed statistically significant differences in recurrence-free survival (RFS) among the 3 groups (p < 0.001). The low-risk group, representing the curative time window population, achieved a 100% 5-year RFS, whereas 83.2% in the intermediate-risk group and 64.6% in the high-risk group. Subsequently, we further identified 3 additional protective factors from the intermediate-risk group: subsolid nodule, age ≤ 65, and stage ≤ IA2. Patients meeting all these criteria were classified into the relatively low-risk group, showing significant differences in 5-year RFS compared to the relatively high-risk group (94.0% vs 81.0%, p < 0.001).
Conclusion: Recurrence after resection for stage I lung cancer remains an issue for select patients. Commonly reported clinicopathologic features can be used to define patients with favorable prognoses and should be considered when assessing the prognosis of patients with stage I disease, thereby endeavoring the concept of the curative time window and enhancing treatment efficacy for this population.
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Poster Presenter
Tong Li, Fudan University Shanghai Cancer Center
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Shanghai, Xinjiang
China
Objective
A high PRA prior to lung transplantation places recipients at risk for rejection and mortality. However, the effect of donor-recipient immunologic characteristics on these outcomes is less clear. This study aimed to assess the impact of donor-recipient HLA matching on post-transplant survival and morbidity using a national transplant database.
Methods
A retrospective review of lung transplant recipients from the United Network for Organ Sharing (UNOS) database between 2000 and 2023 was conducted. Patients were stratified by PRA levels: normal (<49%) and high (≥50%). Recipients with high PRA who were HLA matched to their donors at ≥ 3 alleles were identified. The primary outcome was 1-year post-transplant survival, assessed using Kaplan-Meier estimates. Survival rates were also compared within the high PRA subgroup based on HLA matching status. Multivariable regression was performed on high PRA-HLA matched recipients to evaluate whether HLA matching reduced the odds of rejection or infection.
Results
Out of 31,303 lung transplant recipients in the UNOS database, 1,930 (6%) had high PRA. Among these, 343 (18%) were HLA matched to their donors. One-year survival was significantly lower in high PRA recipients. However, within the high PRA subgroup, HLA matching significantly improved one-year survival (Figure). Multivariable regression analysis revealed that HLA matching significantly reduced the odds of graft rejection (OR 0.73, 95% CI 0.55-0.97) and trended toward reducing hospitalizations for infections (OR 0.79, 95% CI 0.62-1.02). Subgroup analysis revealed that patients transplanted at high-volume centers had significantly lower odds of hospitalization for infection (OR 0.71, 95% CI 0.59-0.87).
Conclusion
As previously demonstrated, a high PRA increases the risk of post-transplant mortality. However, modifying recipient-donor immunologic compatibility by HLA matching improves 1-year survival and significantly reduces the risk of rejection in high PRA recipients. Consideration of transplanting high PRA patients in high volume centers may reduce future morbidity, hospitalization time, and financial burden. Future studies will analyze the interaction between immunosuppression regimen and HLA matching in high PRA lung transplant recipients.
Authors
David Herbst (1), Clayton Rust (2), Christopher He (3), Lucy Avant (3), Ailin Tang (3), Rachel Holstein (3), Supreet Randhawa (3), Reshma Kodimerla (3), Helen Abadiotakis (3), Ahanna Onyenso (3), James Sherrer (3), Stephanie Tom (3), Catherine McGeoch (3), Ikenna Obi (3), James Keiler (3), Tyson McLeish (4), Muath Bishawi (3), Mani Daneshmand (3), Joshua Chan (5)
Institutions
(1) Emory Univ School of Medicine, Atlanta, GA, (2) Carlyle Fraser Heart Center, Emory University Cardiothoracic Research Laboratory, Atlanta, GA, (3) Emory University School of Medicine, Atlanta, GA, (4) N/A, Milwaukee, WI, (5) N/A, Atlanta, GA
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Poster Presenter
David Herbst, Emory Univ School of Medicine
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Atlanta, GA
United States
Objectives: This study aims to evaluate the influence of margin distance and lymphadenectomy on recurrence after wedge resection versus segmentectomy for clinical stage IA non-small cell lung cancer (cIA NSCLC).
Methods: We retrospectively reviewed prospectively collected data of patients who underwent thoracoscopic sublobar resection for cIA NSCLC from November 2016 to December 2023. Recurrence was analyzed using a time-to-event approach. Multivariable Cox regression analysis was performed to identify associations with recurrence-free survival (RFS). Propensity score matching (PSM) was applied to minimize bias in preoperative characteristics between the wedge resection and segmentectomy groups. The Kaplan-Meier method with the log-rank test and the Aalen-Johansen estimator with Gray's test were used to assess differences in RFS in the overall cohort and subgroups.
Results: A total of 334 patients were included, with 201 undergoing wedge resection and 133 undergoing segmentectomy. Multivariable analysis identified segmentectomy (hazard ratio [HR] 0.47, p = 0.003), margin distance ≥ 2.0 cm (HR 0.51, p = 0.016), ≥ 10 total lymph nodes (HR 0.33, p = 0.001), ≥ 1 N1 station (HR 0.49, 0.002), and ≥ 3 N2 stations (HR 0.67, p = 0.038) as predictive factors for improved RFS after sublobar resection. Margin-to-tumor ratio ≥ 1 was not a significant factor. The wedge resection group was less likely to achieve appropriate margin distance and lymph nodes dissection compared to the segmentectomy group both before and after PSM with p < 0.001. With a mean follow-up period of three years, the wedge resection group had poorer 5-year RFS compared to the segmentectomy group before PSM (45.8% vs. 76.6%, p <0.001) and after PSM (51.8% vs. 75.7%, p = 0.012). However, RFS was nearly similar between the two groups when margin distances were ≥ 2.0 cm, ≥ 10 total lymph nodes, or ≥ 3 N2 stations before PSM. After PSM, RFS remained comparable for margin distances ≥ 2.0 cm and ≥ 1 N1 stations. (Table 1) No significant difference was found in specific recurrence or cause of death between the two groups across all subgroups.
Conclusion: Segmentectomy offers superior survival compared to wedge resection for clinical stage IA NSCLC, with better resection margins, more extensive lymph node removal, and a lower recurrence rate. However, when margin distance and lymphadenectomy are optimized, wedge resection may achieve a comparable prognosis.
Authors
Lin Huang (1), Rene Petersen (1)
Institutions
(1) Department of Cardiothoracic Surgery, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
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Poster Presenter
*Rene Petersen, Copenhagen University
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Copenhagen
Denmark
Objective: To compare intraoperative and postoperative opioid consumption, as well as clinical outcomes, between robot-assisted thoracoscopic surgery (RATS) and uniportal video-assisted thoracoscopic surgery (U-VATS) in patients undergoing pulmonary resection for non-small cell lung cancer (NSCLC). Methods: We conducted a retrospective analysis at a cancer specialty hospital using data extracted from the CN-PRO-Lung3, an ongoing longitudinal prospective cohort study. For our analysis, we included patients from CN-PRO-Lung3 who were enrolled between April 2021 and November 2022 and met our study criteria. The inclusion criteria were: patients who underwent RATS or U-VATS; had postoperative pathology confirming primary lung cancer; and received sublobar resection, lobectomy, or extended resection surgery. The exclusion criteria were: patients who had secondary surgeries; had non-specific resection types; or had received preoperative neoadjuvant therapy. The primary outcome was opioid usage, measured intraoperatively and postoperatively using oral morphine equivalents (OME). Secondary outcomes included various perioperative clinical outcomes. Baseline characteristics and postoperative outcomes were compared between the RATS and U-VATS groups using appropriate statistical tests such as the Mann-Whitney U test, chi-square test, and Fisher's exact test. Results: After identifying 1,737 patients from the cohort, a total of 1,057 patients were included in the analysis. RATS was associated with a higher frequency of lobectomy (57.51% vs. 40.39%, p < 0.001) and systematic lymph node dissection (56.48% vs. 23.84%, p < 0.001). Intraoperatively, RATS patients received a higher total OME (median 94.2 mg vs. 84.9 mg, p = 0.003). Postoperatively, 89.12% of RATS patients received opioids compared to 56.94% of U-VATS patients (p < 0.001), with RATS patients also receiving a higher total OME postoperatively (median 48 mg vs. 42 mg, p < 0.001). Additionally, RATS was associated with higher rates of perioperative complications classified as Clavien-Dindo grade ≥2 (13.47% vs. 4.98%, p < 0.001). Conclusions: RATS is associated with increased intraoperative and postoperative opioid consumption and higher rates of significant perioperative complications compared to U-VATS. These findings suggest that while RATS may offer certain surgical advantages, it may also entail greater analgesic needs and a higher risk of complications.
Authors
Xing Wei (1), Rumei Xiang (2), Wei Dai (1), Ding Yang (3), Hongfan Yu (4), Lin Huang (5), Yangjun Liu (6), Kunpeng Zhang (7), Qiuling Shi (2), Qiang Li (1)
Institutions
(1) Department of Thoracic Surgery, Sichuan Cancer Hospital & Institute, Chengdu, Sichuan, (2) School of Public Health, Chongqing Medical University, Chongqing, Chongqing, (3) Department of Thoracic Surgery, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, (4) College of Biomedical Engineering, Chongqing Medical University, Chongqing, Chongqing, (5) Department of Cardiothoracic Surgery, Copenhagen University Hospital, Copenhagen, (6) Department of Medical Epidemiology and Biostatistics, Karolinska Institute, Stockholm, (7) Department of Thoracic Surgery, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, Shanghai
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Poster Presenter
Xing Wei, Sichuan Cancer Hospital & Institute
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Chengdu, Sichuan
China
Objectives: Intraoperative molecular imaging (IMI) can improve the localization of semi solid and ground glass opacities and enhance the ability to perform sublobar resection. This report encompasses our experience following the integration of a folate receptor (FR)-targeted fluorescent agent into a minimally invasive thoracic surgery practice for purposes of the management of ground glass and semi solid lesions.
Methods: Cases from June 2023 through October 2024 were reviewed to identify all patients with one or more semi solid or ground glass opacity with plans for sublobar pulmonary resection. Pafolacianine infusion was performed within 24 hours of surgery. Pre-operative CT scans were used to determine lesion size and depth. The lung was inspected for fluorescence using a proprietary imaging system.
Results: There were 42 patients (28 females, 14 males, mean age 69 years) encompassing 53 separate lesions. Multiple lesions were targeted in 16.7% of patients (7/42). The median lesion size was 14 mm (range 6-32 mm), and median depth was 3 mm (range 1-27 mm). Minimally invasive (robotic n=20 VATS n=22) resection was performed in all patients (segmentectomy n=13, wedge resection n=19, segmentectomy and wedge resection n=3, lobectomy n=4). The overall rate of sublobar resection was 90.4% (38/42). In 40.4% (17/42) of patients, the target lesions were not detectable under visual inspection with white light but were visualized with IMI. Lesion depth was higher in lesions not visualized with IMI compared to those that were visualized (11.6 mm vs. 5.2 mm, p=0.008). Final histology demonstrated malignancy in 86.7% (46/53). Benign lesions included granuloma and parenchymal scar. All final margins were negative.
Conclusions: This is the first report of experience with pafolacianine for cancer in the lung with a specific focus on localization of semi solid and ground glass opacities. These data reflect a meaningful practice change for the surgical management of these often hard to localize, small and multifocal lesions. Moreover, the use of IMI during resection of these early stage lung cancers enhances the ability to perform sublobar, parenchymal sparing resections.
Authors
Ryan Levy (1), Nicholas Baker (2), Navid Ajabshir (3), Tadeusz Witek (4), Omar Awais (5), Evan Alicuben (6)
Institutions
(1) University of Pittsburgh School of Medicine, Pittsburgh, PA, (2) West Virginia University School of Medicine, Morgantown, WV, (3) University of Pittsburgh Medical Center, Pittsburgh, PA, (4) UPMC Presbyterian, Pittsburgh, PA, (5) UPMC Mercy Hospital, Pittsburgh, PA, (6) University of Pittsburgh Medical Center, Oakmont, PA
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Poster Presenter
Navid Ajabshir, University of Pittsburgh Medical Center
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Allison Park, PA
United States
Objective:
Clinical trials have shown a sublobar resection to be non-inferior to lobectomy for the treatment of clinical stage IA non-small cell lung cancer (NSCLC) without nodal disease on pre or intraoperative nodal sampling. However, patients may be understaged clinically and its unknown whether a completion lobectomy is beneficial among those with a sublobar resection in this setting.
Methods:
The National Cancer Database was queried for patients with surgically treated primary NSCLC for cStage IA1-2 without prior neoadjuvant treatment and stratified by those that were upstaged beyond pStage IA on final pathology. Patients were propensity-matched by surgical treatment to investigate the role of sublobar resection among upstaged using nearest-neighbor method. The outcome of interest was survival which was compared using Kaplan-Meier method. Univariable and multivariable analysis was performed using a Cox proportional hazards model.
Results:
Among patients that met inclusion criteria (n=159,692), 44,089 were upstaged beyond pStage 1A (38.1%). The most common reason for upstage was T status (n=5,431, 69.2%) followed by N (n=8,082, 18.4%), and both T and N (n=5,431, 12.4%). Age, male, non-white race, prior procedures, longer staging-surgical interval, upper lobe tumors, higher Charles-Deyo score, T1a or T1b were associated with increased odds of upstaging. Upstaging by T and N status had worse survival to those upstaged only by T or N status. Segmentectomy and lobectomy had similar overall survival rates after propensity matching for type of resection. Wedge resections were associated with higher positive margins, lower lymph nodes examined, higher need for adjuvant radiotherapy, and worse survival. Survival was similar by type of resection among those upstaged to pN1, pN2 or the composite of these after matching. Decreased survival was specific to wedge resections with ≤12 lymph nodes examined.
Conclusions:
A significant amount of patients with clinical stage 1A NSCLC are upstaged after resection. Preoperatively, clinical T stage serves as the main predictor of pathologic upstaging. Those upstaged have worsened survival, particularly if due to nodal metastases. The type of resection (lobectomy, segmentectomy, wedge) does not influence survival as long as an adequate lymph node dissection is performed. This does not support the need for a completion lobectomy after a sublobar resection for patients with pathological staging beyond stage 1A.
Authors
Miguel Leiva-Juarez (1), Sidhu Gangadharan (1), Jennifer Wilson (1), Richard Whyte (1), Michael Kent (1)
Institutions
(1) Beth Israel Deaconess Medical Center, Boston, MA
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Poster Presenter
Miguel Leiva-Juarez, Beth Israel Deaconess Medical Center, Harvard Medical School
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Boston, MA
United States
Objective: Mediastinal parathyroid adenomas (MPAs) are challenging to locate and resect, but single-photon emission CT with CT (SPECT-CT) has high sensitivity and specificity for localizing MPAs. The objective of this study is to characterize the thoracic surgical approach based on localization by SPECT-CT and assess success rate of resection by biochemical resolution of hyperparathyroidism (HPT).
Methods: A retrospective review of 73 patients who underwent resection of MPAs localized on SPECT-CT at a quaternary institution from 2017 to 2024 was performed. Descriptive statistics were used to analyze demographics, symptoms, lab values, imaging findings, operative details, and postoperative (post-op) courses. The Student's t-test was used to analyze the difference between the parathyroid hormone (PTH) and calcium (CA) levels before and after surgery.
Results: The majority were female with ages ranging 17-84. All but two patients (97%) were symptomatic preoperatively (pre-op) with almost half experiencing fatigue, neurocognitive symptoms, or bone and muscle pain, and about a third had nephrolithiasis. Almost all had prior operations, and a quarter had multiple prior surgeries. All had positive SPECT-CT localization pre-op with 60% in the left infra-innominate thymus, 28% in the right infra-innominate thymus, 8% in the aortopulmonary (PA) window, 3% in the right supra-innominate thymus, and 1% in the tracheoesophageal (TE) groove. All infra-innominate adenomas were approached supine with three robotic trocars. The six PA window and one TE groove adenoma were approached in the lateral decubitus position robotically or via an axillary thoracotomy. Partial sternotomy was used for both supra-innominate adenomas. There were six patients that did not have parathyroid tissue identified on pathology. However, despite this, all patients who underwent tissue resection had normalization of post-op PTH and CA. The average pre-op PTH was 195 and was reduced to 30 post-op (p<0.01). Similarly, average pre-op CA was 11 and dropped to 9 post-op (p<0.01). One case was aborted secondary to PA hematoma, four patients had self-limiting post-op complications, and 1 patient had vocal cord immobility requiring injection. There were no mortalities (Table).
Conclusions: SPECT-CT was able to localize 100% of the mediastinal parathyroid adenomas preoperatively, which guided the operative approach with 100% success in normalizing PTH and CA after adenoma resection.
Authors
Crystal Zhang (1), Amanda Shelowitz (1), Andi Diamond (1), Mary Carolyn Vinson (1), Jonathan Daniel (1), Eric Sommers (1)
Institutions
(1) Tampa General Hospital, Tampa, FL
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Poster Presenter
Crystal Zhang, Tampa General Hospital
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Tampa, FL
United States
Objective:
Delay from diagnosis to treatment of early-stage lung cancer negatively affects survival. Due to variable wait times for different biopsy modalities, diagnostic wedge resection is often required at the time of planned oncologic resection. With a benign resection rate of 20-25% these operations can be viewed as potentially unnecessary surgeries. We compared two approaches for diagnosis and treatment for patients with a high pretest probability of resectable malignancy to demonstrate methods to mitigate delays to treatment
Methods:
Patients from 2021 to 2024 with a lung nodule who did not have a prior attempt at diagnosis and had a Mayo Clinic solitary pulmonary nodule malignancy risk score ≥ 90% were offered a Single Anesthetic robotic bronchoscopy with Biopsy, followed by anatomic Resection, if indicated (SABR). The control group included contemporaneous patients undergoing traditional surgical wedge resection (WR) for diagnosis, followed by anatomic resection if indicated. All patients with benign diagnoses that did not undergo surgery were followed until their nodule decreased in size or resolved.
Results:
A total of 138 patients were identified (65 SABR, 73 WR). There were no differences in clinical characteristics or nodule location between the two groups. The mean time from clinic to definitive treatment was 30 ± 21 days in the SABR group and 32 ± 23 days in the diagnostic surgery group (p=0.545). Mean nodule size was larger (2.0 ± 0.9 vs 1.7 ± 0.7, p=0.006) and mean OR time was longer (218 ± 76 minutes vs 113 ± 43 minutes, p<0.001) in the SABR group. There were no differences in post-operative complications or 90-day readmission between groups. Eleven SABRs were stopped at biopsy alone due to a diagnosis precluding surgical resection (Figure 1). Benign resection rate of 7.6% in the SABR group was significantly lower than the rate of 21.9% in the diagnostic surgery group (p = 0.037). All SABRs that were stopped at biopsy with a benign diagnosis had a decrease in nodule size or repeat benign biopsy within 6 months of their bronchoscopy.
Conclusion:
Combined robotic bronchoscopy with biopsy and anatomic lung resection under a single period of anesthesia significantly reduces the rate of benign and unnecessary surgery, as well as mitigates delay from diagnosis to surgery.
Authors
Lucas Weiser (1), Woosik Yu (2), Claire Perez (3), Kellie Knabe (3), Sevannah Soukiasian (4), Charles Fuller (3), Raffaele Rocco (1), Andrew Brownlee (5), Harmik Soukiasian (3)
Institutions
(1) Cedars Sinai Medical Center, Los Angeles, CA, (2) Ajou University Hospital, Los Angeles, CA, (3) Cedars-Sinai Medical Center, Los Angeles, CA, (4) Cedars Sinai Medical Center, Encino, CA, (5) Cedars-Sinai Medical Center, Studio City, CA
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Poster Presenter
Claire Perez, Cedars-Sinai Medical Center
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Los Angeles, CA
United States
Objective:
Today, lung cancer screening programs for patients with a risk profile detect a large number of incidental lung lesions. The correct classification of these nodules regarding their malignancy is paramount. For incidental findings, the Brock model is commonly used today to calculate the probability of malignancy. In this study, we evaluated the predictive accuracy of the Brock model in comparison to the LIONS PREY model. Both models consider patient and nodule related parameters. In contrast to the Brock model, the LIONS PREY model takes into account prognosis-relevant risk factors such as the size progression of a nodule and tobacco consumption (see below).
Methods:
We retrospectively included all patients who underwent resection of a pulmonary lesion at our lung cancer center between August 2022 and August 2024. Patients whose clinical parameters were not fully available for calculating one of the two score systems were excluded from the study. Two study groups were formed (group M: malignant lesions; group B: benign lesions). We evaluated the predictive accuracy of the Brock model and LIONS PREY model based on calibration (observed/expected ratio), discrimination (area under ROC curve), and the total number of correctly classified patients (OCC).
Results:
During the treatment period, 776 patients were resected at our center. In this real-world setting, 424 patients (54.6%) were excluded due to unrecorded parameters. Finally, 304 patients in group M and 48 in group B were analyzed. With an OCC of 95.4%, the LIONS PREY model showed a significantly (p=0.0027) higher precision than the Brock model at 64.1%. The calibration of the LIONS PREY model (O/E ratio: 1.1) was significantly (p=0.031) superior to that of the Brock model (1.4). According to a DeLong analysis, the discriminatory power of the LIONS PREY model (AUC: 0.92; 95% CI: 0.89-0.95) was significantly (p=0.008) better than that of the Brock model (AUC: 0.62; 95% CI: 0.56-0.68).
Conclusions:
The success of a lung cancer screening program is directly linked to a reliable model to predict malignancy. Regarding predictive accuracy, the new LIONS PREY model appears superior to the established Brock model.
Authors
Fabian Doerr (1), Konstantinos Grapatsas (1), Natalie Baldes (1), Filiz Oezkan (2), Michael Forsting (3), Dirk Theegarten (4), Kaid Darwiche (2), Hubertus Hautzel (5), Martin Stuschke (6), Christian Taube (2), Marcel Wiesweg (7), Martin Schuler (7), Servet Bölükbas (1)
Institutions
(1) University Medical Center Essen, Ruhrlandklinik, Department of Thoracic Surgery, Essen, Germany, (2) University Medical Center Essen, Ruhrlandklinik, Department of Pulmonary Medicine, Essen, Germany, (3) University Medical Center Essen, Institute for Diagnostic and Interventional Radiology, Essen, Germany, (4) University Medical Center Essen, Institute of Pathology, Essen, Germany, (5) University Medical Center Essen, Department of Nuclear Medicine, Essen, Germany, (6) University Medical Center Essen, Department of Radiation Therapy, Essen, Germany, (7) University Medical Center Essen, Department of Medical Oncology, Essen, Germany
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Poster Presenter
Fabian Doerr, University Medical Center Essen - Ruhrlandklinik
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Germany
Objective: The proportion of lung transplant (LTx) candidates 65 years or older has nearly doubled in the last decade, and recipients aged >70 have begun to be transplanted in high volume centers. However, outcomes in this age group remain infrequently reported. We sought to examine outcomes in the 70+ age group, with comparison to those aged 60-65 and 65-70 years old.
Methods: We conducted a single-center retrospective review of LTx performed between 2008-2021 at our institution using the Lung Transplant Program Database. We excluded patients <60, multiorgan transplant, redo LTx, and those with concurrent cardiac surgery. Baseline characteristics and post-operative outcomes were compared between groups aged 60-65, 65-70, and >70. The Kaplan–Meier method was used to estimate median time to death and chronic lung allograft dysfunction (CLAD). Univariable and multivariable cox proportional hazards regression models examined the association between time to death or CLAD and 19 donor or recipient characteristics.
Results: 802 patients underwent LTx of which 397 (50%) were 60-65, 286 (35%) were 65-70, and 119 (15%) were >70. Primary indications for LTx were interstitial lung disease and chronic obstructive pulmonary disease in all age groups. Patients aged >70 had similar ICU length of stay and the same number of ICU readmissions. We found no difference between age groups for rates of reintubation, tracheostomy, and hospital re-admission. When looking at type of LTx, bilateral LTx was more common (599; 75%). Single LTx was increasingly common with advancing age in groups 60-65 (73; 18%), 65-70 (80; 28%), and 70+ (50; 42%) (p< <0.001). Median overall survival and time to CLAD are examined in Figure 1. After adjustment, age was not a predictor of death or CLAD. Single LTx had a higher rate of death in Cox models (HR 1.45, p=0.03), but similar mortality at 1 year (p=0.35). Those with Cytomegalovirus (CMV) mismatch had higher rates of CLAD. Primary causes of death in patients >70 were infection (17; 25%), CLAD (12; 18%), and malignancy (9; 13%).
Conclusions: LTx can be performed safely and with comparable outcomes in recipients aged ≥70 years. Further study into recipient risk factors such as frailty and the treatment of infectious complications and malignancy after LTx may improve outcomes in this group. We found equivalent short-term but worse long-term outcomes with single LTx; the role of single LTx in this age group needs further study.
Authors
Andreea Matei (1), Tessa Bray (1), Meghan Aversa (2), Ella Huszti (2), Qixuan Li (2), Marcelo Cypel (2), Laura Donahoe (2), Marc Deperrot (2), Andrew Pierre (2), Jonathan Yeung (2), Thomas Waddell (2), Kazuhiro Yasufuku (2), Shaf Keshavjee (2), Elliot Wakeam (2)
Institutions
(1) University of Toronto, Toronto, Ontario, (2) Toronto Lung Transplant Program, Toronto, Ontario
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Poster Presenter
Andreea Matei, University of Toronto
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Toronto, ON
Canada
OBJECTIVE
Neoadjuvant chemoimmunotherapy trials have reported high efficacy on non-small cell lung cancer (NSCLC), but surgical data may not accurately reflect real-world outcomes. We sought to analyze outcomes of minimally invasive and open resection of NSCLC after neoadjuvant chemoimmunotherapy relative to pathologic treatment response.
METHODS
Data from 4 centers in the US and Germany were combined for all patients undergoing resection after neoadjuvant checkpoint-inhibitor and chemotherapy for locoregionally advanced NSCLC between 2000-2024. Outcomes were compared between robotic-assisted (RATS) and video-assisted thoracoscopic (VATS) versus open surgery and stratified by pathologic stage and treatment response.
RESULTS
A total of 148 patients were included, of which 114 (77.0%) underwent RATS/VATS and 34 (23.0%) open resection. RATS/VATS was more commonly used for lobectomy and segmentectomy (93.9% vs. 58.8% open), and less frequently for bilobectomy (2.6% vs. 14.7% open) or pneumonectomy (2.6% vs. 26.5% open, p<0.0001). Conversion to open (n=10) was often a result of difficult dissection due to fibrosis (70%) and occurred more frequently with VATS (30%) than RATS (4.3%). The highest rate of RATS/VATS was observed for patients with a complete pathologic response (pathCR, 45.6% vs. 14.7%, p=0.0012), whereas open resection was more often used for larger residual tumors (mean size, RATS/VATS 2.7 cm vs. open 4.8 cm, p=0.0004) and higher ypT stage (ypT3/4, RATS/VATS 11.4 % vs. open 32.4%, p=0.0004; FIGURE). Complete lymph node downstaging (ypN0/cN+) was similarly high between RATS/VATS and open resection patients (58.3% vs. 64.1%, p=0.78). Compared to open surgery, RATS/VATS was associated with shorter length of hospital stay (mean 5 days vs. 8.4 days, p<0.0001), and fewer major complications such as pneumonia (4.4% vs. 17.6%, p=0.0097), hemorrhage requiring transfusion (2.6% vs. 11.8%, p=0.028), and unexpected return to the OR (2.6% vs. 20.6%, p=0.0003). The 60-day mortality rate was 1.8% after RATS/VATS and 2.9% after open surgery.
CONCLUSIONS
This multi-institutional study demonstrates that minimally invasive resection by RATS or VATS is possible in most patients after neoadjuvant chemoimmunotherapy, especially after complete pathologic response. Open surgery is more often performed for patients with large residual tumors or those requiring extended resections. Postoperative outcomes are significantly better after minimally invasive resection.
Authors
Peter Kneuertz (1), Nestor Villamizar (2), Nasser Altorki (3), Philipp Schnorr (4), Desmond D'Souza (1), Dao Nguyen (2), Dan Jones (3), Joachim Schmidt (5), Ioana Baiu (1), Mahmoud Abdel-Rasoul (1), Robert Merritt (1)
Institutions
(1) The Ohio State University Wexner Medical Center, Columbus, OH, (2) University of Miami School of Medicine, Miami, FL, (3) Weill Cornell Medicine/NYP Hospital, New York, NY, (4) Helios Klinikum Bonn/Rhein-Sieg, Bonn, (5) University of Bonn, Bonn
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Poster Presenter
*Peter Kneuertz, Ohio State University
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Columbus, OH
United States
Objective: Biopsies obtained from primary oesophageal squamous cell carcinoma (ESCC) guide diagnosis and treatment. However, spatial intra-tumoral heterogeneity (ITH) influences biopsy-derived information and patient responsiveness to therapy. Here, we aimed to elucidate the spatial ITH of ESCC and matched lymph node metastasis (LNmet).
Methods: Primary tumour superficial (PTsup), deep (PTdeep) and LNmetsubregions of patients with locally advanced resectable ESCC were evaluated using whole-exome sequencing (WES), whole-transcriptome sequencing and spatially resolved digital spatial profiling (DSP). To validate the findings, immunohistochemistry was conducted and a single-cell transcriptomic dataset was analysed.
Results: WES revealed 15.72%, 5.02% and 32.00% unique mutations in PTsup, PTdeepand LNmet, respectively. Copy number alterations and phylogenetic trees showed spatial ITH among subregions both within and among patients. Driver mutations had a mixed intra-tumoral clonal status among subregions. Transcriptome data showed distinct differentially expressed genes among subregions. LNmetexhibited elevated expression of immunomodulatory genes and enriched immune cells, particularly when compared with PTsup(all P < .05). DSP revealed orthogonal support of bulk transcriptome results, with differences in protein and immune cell abundance between subregions in a spatial context. The integrative analysis of multi-omics data revealed complex heterogeneity in mRNA/protein levels and immune cell abundance within each subregion.
Conclusions: This study comprehensively characterised spatial ITH in ESCC, and the findings highlight the clinical significance of unbiased molecular classification based on multi-omics data and their potential to improve the understanding and management of ESCC. The current practices for tissue sampling are insufficient for guiding precision medicine for ESCC, and routine profiling of PTdeepand/or LNmetshould be systematically performed to obtain a more comprehensive understanding of ESCC and better inform treatment decisions.
Authors
Yu Feng (1), haitao huang (2), Dong Jiang (3), Jun Zhao (3)
Institutions
(1) First affliated Hospital of Soochow University, Suzhou, Jiangsu, (2) N/A, nantong, China, (3) the First Affiliated Hospital of Soochow University, Suzhou, NA
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Poster Presenter
Yu Feng, First affliated Hospital of Soochow University
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Suzhou, Jiangsu
China
Objective:
To analyze national trends in the adoption of robotic-assisted thoracoscopic surgery (RATS) for lung cancer resections as compared to video-assisted thoracoscopic surgery (VATS) and open approaches across different geographic regions and institution types in the National Cancer Database (NCDB).
Methods:
This is a retrospective cohort study of individuals ≥18 years in the NCDB who underwent a lung resection for non-small cell lung cancer stage I-IIIa between 2010-2021. The data was stratified by facility type (community and academic), surrounding area population (metropolitan, urban, and rural), and geographic location. Stratified linear regressions were used to calculate the average annual change in the proportion of resections via RATS. Multivariable logistic regressions with interaction terms were used to determine if the change in rates of RATS annually varied by facility type, surrounding population, and location.
Results:
A total of 301,123 oncologic lung resections were included in this study. The number of open resections declined from 16,530 in 2010 to 5,629 in 2021. RATS increased from 733 in 2010 to 10,657 in 2021, while VATS reached a maximum of 10,692 in 2017 and then steadily decreased to 7,434 in 2021. The total number of RATS surpassed VATS in 2019, with 9,579 and 9,454 cases respectively, and RATS accounted for 65.4% of minimally invasive cases by 2021.
Academic programs were found to be increasing the proportion of their RATS resections at a faster rate than community programs. Similarly, facilities in metropolitan settings are adopting robotic resections at a faster rate than in urban and rural areas. Analyses on geographic locations revealed that the rate of RATS adoption varied significantly by region, with the East South-Central region having the slowest adoption rate, whereas the South Atlantic and East North-Central regions had the highest rate of increase in adoption of RATS (Figure 1). Despite these different rates of adoption, RATS lung resections are increasing ubiquitously across institution type, surrounding area, and geographic location.
Conclusions:
RATS for oncologic lung resection is rapidly increasing and surpassed VATS and open resections in 2019. RATS resections are increasing most rapidly in academic and metropolitan programs, and certain geographic regions. Understanding these trends in RATS adoption is essential for optimizing patient care and advancing surgical practice.
Authors
Hayley Reddington (1), Jiddu Guart (1), Zachary Ballinger (1), Rachel Huselid (1), Isabel Cristina Emmerick (1), Allison Crawford (1), Mark Maxfield (1), Karl Uy (1), Feiran Lou (1)
Institutions
(1) UMass Chan Medical School, Department of Surgery, Division of Thoracic Surgery, Worcester, MA
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Poster Presenter
Jiddu Guart, UMASS Medical School
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Pawtucket, RI
United States
Objective: To evaluate whether a single anesthesia event (SAE), which combines diagnosis (obtained via robotic bronchoscopy) and treatment (via robotic surgery), reduces time to treatment initiation (TTI) and cost compared to the standard of care in patients with early-stage lung cancer.
Methods: Patients who underwent biopsy and resection for early-stage lung cancer from October 2021 to August 2024 were identified and grouped based on type of surgical event: SAE vs. standard of care. In the SAE cohort, patients underwent biopsy, rapid on-site evaluation (ROSE), and resection during a single anesthetic encounter. In the standard of care cohort, patients underwent biopsy of a suspicious pulmonary lesion on a separate day from the subsequent surgical resection of the lesion (traditional). Patient characteristics and outcomes were retrospectively analyzed and compared between the two cohorts.
Results: A total of 61 patients (42 traditional, 19 SAE) were included in this study. There were no significant differences in terms of age, gender, preoperative FEV1, preoperative DLCO, and smoking history in pack-years. All but one patient (traditional) had stage 1 disease, though median nodule size was higher in the traditional cohort (2.1 vs 1.5 p=.0342). Adenocarcinoma was the most common histologic type in both cohorts. The median number of days from diagnostic CT to tumor resection was 84.5 days for the traditional patients vs. 48.0 days for the patients that underwent SAE (p<0.0001). The median number of days from the initial consultation with the pulmonologist to tumor resection was 62.5 days for the traditional cohort vs. 38.0 days for the SAE cohort (p=0.0021). Length of stay was 1 day shorter for the SAE cohort (2 vs 3; P=.3511). There were no complications in the SAE cohort, compared to 11 in the traditional cohort. There was no significant difference in cost between the two pathways, but the Net Revenue was higher in the SAE cohort (p=.0348)
Conclusions: When compared to the traditional pathway, the SAE approach to diagnosing and treating lung cancer reduces the TTI compared to the standard of care. In addition, the SAE approach resulted in fewer complications, a shorter length of stay, and increased net revenue. We propose that this more streamlined approach decreases patient anxiety while not negatively impacting patient outcomes.
Authors
Jordan Dozier (1), Brian Pettiford (2), Reginald Du (3), Christopher Zumwalt (3), Katrina Jiang (4)
Institutions
(1) Ochsner Medical Center, new orleans, LA, (2) N/A, N/A, (3) Ochsner Health, New Orleans, LA, (4) Ochsner Medical Center, Sacramento, CA
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Poster Presenter
Jordan Dozier, Ochsner Medical Center
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new orleans, LA
United States
Title: Perioperative Outcomes of Minimally Invasive Surgery After Systemic Neoadjuvant Therapy in Patients with Non-Small Cell Lung Cancer
Authors: Shanique Ries, Amber Shahid, Claudia Pedroza, Kyle Mitchell, Zamaan Hooda, Mara B. Antonoff, Wayne L. Hofstetter, Reza J. Mehran, Ravi Rajaram, Stephen G. Swisher, Garrett L. Walsh, Ara A. Vaporciyan, David C. Rice
Objective: Increased use of neoadjuvant immunotherapy and targeted therapies has revolutionized the management of locally advanced Non-Small Cell Lung Cancer (NSCLC). While these treatments enhance tumor response and survival, they also introduce surgical challenges, especially for minimally invasive surgery (MIS). We assessed perioperative outcomes among patients undergoing MIS and open thoracotomy (OT) for resection of NSCLC following systemic neoadjuvant therapy (NeoRx).
Methods: A review was conducted using a prospective clinical database of patients with NSCLC treated by surgical resection after NeoRx between January 2014 and December 2023. Patients were grouped according to surgical approach. Inverse Probability of Treatment Weighting (IPTW) was used to balance relevant clinical variables. Weighted logistic regression models compared perioperative outcomes between OT and MIS and between video-assisted thoracoscopic surgery (VATS) and robotic-assisted thoracoscopic surgery (RATS). Multivariable logistic regression analysis (MVA) assessed risk factors for conversion to OT.
Results: Of 2,137 patients, 546 (25.5%) had NeoRx. 405 (74.2%) underwent OT and 141 (25.8%) had MIS, including 82 (58.2%) RATS and 59 (41.8%) VATS. Analysis with IPTW revealed OT had shorter operation time (mean ∆ 43 min, p<0.001) but higher blood loss (mean ∆ 115 ml, p<0.001) and higher risk for atrial arrhythmia (OR 3.02, p=0.02). Conversion to OT occurred in 20 (14.2%) MIS patients and was higher for VATS than RATS (25.4% vs. 6.1%, OR 15.3, p<0.001). Rate of R0 resection was slightly lower with VATS than RATS (89% vs. 96%, OR 4.52, p=0.029). In MVA, conversion to OT was independently associated with VATS (OR 7.31, p=0.009), non-adenocarcinoma histology (OR 6.12, p=0.017) and year of surgery (OR 1.4, p=0.03).
Conclusion: Apart from lower blood loss, less atrial arrhythmias and longer operative times, lung resection by MIS after NeoRx has similar perioperative outcomes to thoracotomy. MIS is feasible in this patient population and RATS and adenocarcinoma histology are associated with a lower risk of conversion.
Authors
David Rice (1), Shanique Ries (2), Amber Shahid (3), Claudia Pedroza (4), Kyle Mitchell (5), Zamaan Hooda (3), Mara Antonoff (6), Wayne Hofstetter (7), Reza Mehran (8), Ravi Rajaram (3), Stephen Swisher (5), Garrett Walsh (8), Ara Vaporciyan, MD (9)
Institutions
(1) MD Anderson Cancer Center, Houston, TX, (2) University of Texas MD Anderson Cancer Center, Stamford, CT, (3) University of Texas MD Anderson Cancer Center, Houston, TX, (4) The University of Texas Health Science Center, Houston, TX, (5) The University of Texas MD Anderson Cancer Center, Houston, TX, (6) MD Anderson Cancer Center, Bellaire, TX, (7) The University of Texas M.D. Anderson Cancer Center, Houston, TX, (8) University of Texas, Houston, TX, (9) UT MD Anderson Cancer Center, Bellaire, TX
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Poster Presenter
Shanique Ries, University of Texas MD Anderson Cancer Center
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Houston, TX
United States
Objective: Unlike sublobar resection, the prognostic impact of margin distance has not been fully evaluated in patients who underwent lobectomy for stage I non-small cell lung cancer (NSCLC). We investigated the prognostic value of the resection margin distance and determine the cutoff value in these patients.
Methods: Between 2011 and 2021, data of patients with completely resected stage I NSCLC after lobectomy were analyzed. The margin distance and ratio were defined as the distance from the primary tumor to the bronchial resection margin and the margin distance divided tumor size. The optimal cutoff value was selected using a maximally selected log-rank statistic.
Results: A total of 3,727 patients were included as the final cohort, of whom 211 (5.7%), 1202 (32.3%), 1175 (31.5%), and 1139 (30.6%) patients were in stages IA1, IA2, IA3, and IB, respectively. The most optimal cutoffs for the margin distance and the margin ratio for cancer recurrence within 5 years were 25mm and 1.5, respectively. In the multivariable analysis, the margin distance (<25mm vs. ≥25mm; hazard ratio [HR], 1.34; 95% confidence interval [CI], 1.11–1.61; p = 0.002) and the margin ratio (<1.5 vs. ≥1.5; HR, 1.40; 95% CI, 1.14 to 1.71; p <0.001) were significant factors for recurrence-free survival in patients after lobectomy for stage I NSCLC.
Conclusion: The margin distance has a significant prognostic impact in patients who underwent lobectomy for stage I NSCLC. Cutoff values of margin distance ≥25mm and margin ratio ≥1.5 could help clinicians enact proper treatment strategies and surveillance for these patients.
Authors
Shia Kim (1), Geun Dong Lee (2), Sehoon Choi (3), Hyeong Ryul Kim (4), Yong-Hee Kim (4), Dong Kwan Kim (4), Seung-Il Park (4), Jae Kwang Yun (5)
Institutions
(1) Asan Medical Center, Seoul, South Korea, (2) Asan Medical Center, Seoul, Songpa-gu, (3) Asan Medical Center, Seoul, Seoul, (4) Asan Medical Center, Songpa-gu, Seoul, (5) Asan Medical Center, Seoul, NA
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Poster Presenter
Shia Kim, Asan Medical Center
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Seoul
South Korea
Objective. Aim of the study is to evaluate the role of consolidation-to-tumor ratio increase during the preoperative radiological follow up as a prognostic factor in completely resected lung adenocarcinomas presenting as part-solid nodules.
Methods. In this retrospective single-center study, completely resected part-solid adenocarcinoma in the period between May 2016 and December 2023 were evaluated. Only patients undergoing at least two computed tomography (CT) scans in the preoperative period (interscan period 1-12 months) were enrolled. Solid component and overall tumor mean diameter as well as CTR were assessed at diagnosis and within 1-month from surgery. Disease free survival (DFS) was estimated by Kaplan Meier method according to solid component, overall tumor diameter or CTR increase. Cox regression was performed including main clinical, radiological and pathological variables as well as solid component, overall tumor diameter or CTR increase.
Results. 104 patients were enrolled. Median preoperative follow-up was 6 months (IQR 3-12). Overall, CTR increase was observed in 39 (37.5%) patients while overall tumor growth and solid component growth were observed in 44 (42.3%) and 46 (44.2%) patients, respectively. According to Kaplan-Meier estimation (figure 1a), patients with CTR increase had a worse 3-year DFS compared to those with stable or diminished CTR (55.2% versus 87.2%; p=0.009). Similarly, solid component increase (61% versus 87.7%; p=0.03) but no overall tumor dimension increase (71.3% versus 77.9%; p=0.35) were associated with worse DFS. At univariable analysis (Figure 1b), prognostic factors for DFS were smoking history (0.01), upstaging (0.013), CTR increase (0.014) and solid component increase (0.037). To avoid potential multicollinearity, CTR increase, and solid component increase were evaluated separately in multivariable analysis (Figure 1c). Smoking history and upstaging were associated to DFS in both multivariable analyses. When evaluated singularly, CTR increase was independently associated with DFS (p=0.03) while solid component increase failed to predict DFS (p=0.05)
Conclusion. CTR increase during preoperative follow up can be useful to identify those part-solid lung adenocarcinoma at higher risk of recurrence despite complete resection. If confirmed and validated in further studies, these results may help to better stratify patients with part-solid nodules prognosis and to tailor surgical strategy.
Authors
Riccardo Tajè (1), Filippo Tommaso Gallina (2), Mauro Caterino (3), Daniele Forcella (4), Alexandro Patirelis (5), Gabriele Alessandrini (3), Fabiana Letizia Cecere (3), Federico Cappelli (3), Isabella Sperduti (6), Paolo Visca (4), Enrico Melis (3), Antonello Vidiri (3), Federico Cappuzzo (4), Francesco Facciolo (4), Vincenzo Ambrogi (7)
Institutions
(1) Tor Vergata University, rome, Rome, (2) McGill University Health Centre, Rome, QC, (3) IRCCS National Cancer Institute Regina Elena, rome, NA, (4) IRCCS Regina Elena National Cancer Institute, Rome, NA, (5) Tor Vergata University, rome, NA, (6) Biostatistics, Regina Elena National Cancer Institute, IRCCS, Rome, Italy, Rome, Rome, (7) Tor Vergata University, Rome, Italy
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Poster Presenter
Riccardo Tajè, "Tor Vergata" University of Rome, Rome, Italy
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rome, Rome
Italy
Objective:
Neoadjuvant therapy followed by esophagectomy is the standard treatment for esophageal cancer. Achieving a pathological complete response (pCR) after neoadjuvant chemoradiation therapy (nCRT) improves outcomes, but recurrence and metastasis patterns in pCR versus residual disease patients are unclear. This study compares these patterns in patients who achieved pCR versus those with residual disease.
Methods:
This retrospective multi-institutional study included esophageal cancer patients treated with nCRT followed by esophagectomy between 2008 and 2023. Patients were divided into two groups: those who achieved pCR and those with residual disease. Data on patient characteristics, metastatic patterns, adjuvant therapy, and perioperative outcomes were collected.
Results:
Recurrence occurred in 41% of patients (95/232), with 13% (5/39) in the pCR group and 47% (90/193) in the residual disease group. Metastasis patterns differed significantly: liver metastasis was most common in residual disease patients (34% vs. 10%, p=0.035), thoracic metastasis occurred in 23% of the residual disease group and 7% of the pCR group (p=0.047), and peritoneal metastases were more frequent in patients with residual disease (12% vs. rare in pCR group, p=0.042). Patients with residual disease also experienced a higher rate of metastasis to multiple sites.Immunotherapy was more frequently administered to patients with residual disease (42% vs. 18%, p<0.001). Patients receiving immunotherapy had lower recurrence rates (27.3% vs. 45.7%, p=0.014). Logistic regression identified immunotherapy as a significant protective factor against recurrence (OR=0.159, 95% CI [0.035–0.712], p=0.016).Logistic regression also showed that residual disease was a strong predictor of metastasis (OR=2.65, 95% CI [1.12–6.28], p=0.027). Immunotherapy significantly reduced the risk of metastasis (OR=0.16, 95% CI [0.035–0.71], p=0.016), and greater nodal involvement was associated with an increased risk of metastasis (OR=1.82, 95% CI [1.05–3.16], p=0.033).
Conclusion:
Patients with residual disease after nCRT are at higher risk of developing distant metastases,particularly to the liver, thorax, and peritoneum.Immunotherapy is associated with reduced recurrence and better outcomes. Further research is needed to optimize treatment strategies, especially for patients with residual disease following nCRT.
Authors
Ahmed Elkamel (1), Shamele Battan-Wraith (2), Kevin Wang (3), Timothy Harris (3), Anthony Maltagliati (3), Evelyn Alexander (3), Mazin Abdalgadir (3), Praveen Sridhar (4), Stephanie Worrell (3)
Institutions
(1) Banner/University of Arizona, tucson, AZ, (2) Banner/University of Arizona, Toronto, ON, (3) University of Arizona, Tucson, AZ, (4) University of Arizona Department of Surgery, Tucson, AZ
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Poster Presenter
Ahmed Elkamel, Banner/University of Arizona
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tucson, AZ
United States
Objective:
To assess the optimal time interval between two subsequent surgeries that can bring survival benefits to patients with bilateral synchronous multiple primary lung cancer (sMPLC), and to evaluate the association between the time interval and prognosis.
Methods:
This multi-institutional cohort study included 901 patients with bilateral sMPLC who underwent two surgeries between January 2017 and December 2022 at six academic institutions in China. Patients were divided into three groups based on the time interval between their 1st and 2nd surgeries: Group-I (≤ 75 days), Group-II (75-180 days), and Group-III (> 180 days). The study evaluated overall survival (OS) and disease-free survival (DFS) using Kaplan-Meier analysis and multivariable Cox regression to explore the prognostic significance of the time intervals between surgeries.
Results:
The median age of the patients was 59 years (interquartile range: 53-65 years). Group-I included 239 patients (26.5%), Group-II had 344 patients (38.2%), and Group-III had 318 patients (35.3%). Two lesions were identified in 436 patients (48.4%), while 48 patients (5.3%) had more than five lesions. The median OS time from the second surgery for the entire cohort was 49.2 months. Patients in Group-II (75-180 days between surgeries) showed the most favorable clinical outcomes compared to Group-I and Group-III (log-rank: OS, P = 0.0031; DFS, P < 0.0001) (Figure 1A and 1B ). In multivariable Cox regression analyses, patients in Group-I (HR, 2.832; 95% CI, 1.025-7.82; P = 0.045) and Group-III (HR, 4.998; 95% CI, 1.862-13.417; P = 0.001) were significantly associated with worse prognosis compared to Group-II. Additionally, Group-III had a higher incidence of postoperative complications, while Group-I showed significantly reduced lung function.
Conclusions:
For patients with bilateral sMPLC, the time interval between the two surgeries is a crucial factor influencing prognosis. The optimal time interval appears to be between 75 and 180 days, which is associated with better survival outcomes and fewer complications compared to shorter or longer intervals.
Authors
Wei Guo (1), Jie He (2)
Institutions
(1) Cancer Hospital, Chinese Academy of Medical Sciences, Beijng, Beijing, (2) CICAMS, Beijing
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Poster Presenter
Wei Guo, Cancer Hospital, Chinese Academy of Medical Sciences
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Beijng, Beijing
China
Object
Surgical treatment of non-small cell lung cancer (NSCLC) invading the spine is controversial. We evaluated surgical results and long-term outcomes of patients with T4 NSCLC who underwent vertebral resection (VR) infiltrated by lung tumor.
Methods
Retrospective analysis of 18 consecutive patients undergoing VR for NSCLC invading the spine between 2003 and 2023 was performed. Eleven patients (61.1%) received induction therapy. Vertebral resection was divided into 5 types; type 1 (Figure 1, A): only transverse process; type 2A (Figure 1, B): transverse process with a portion of the vertebral body; type 2B (Figure 1, C) : a portion of vertebral body without transverse process; type 3 (Figure 1, D), hemivertebrectomy; type 4 (Figure 1, E): total vertebrectomy.
Results
There were 16 men with a median age of 62 years (range, 41-80). Ten patients (55.5%) had induction therapy. Vertebral resection included 4 type 1 resection, 7 type 2A, 4 type 2B, 2 type 3, and 1 type 4. Pneumonectomy was performed in 3 patients, lobectomy in 9, segmentectomy in 3 and wedge in 3. Complete resection was achieved in 16 patients (88.8%). Surgical nodal status was N0 in 11 patients, N1 in 4, and N2 in 3, each. There was no postoperative mortality. Morbidity was observed in 7 patients (38.9%), including 1 (5.5%) neurologic complication, 3 (16.7%) ARDS, and 3 (16.7%) cardiac. Eight patients (44.4%) are alive without disease after e mean follow up of 48.6 months. The 1- and 5-year predicted survivals were 79% and 40.4%, respectively. Patients without nodal involvement had the best prognosis (56.3% vs 0%; p=0.0009). Induction therapy did not influence survival and morbidity.
Conclusions
Resection of NSCLC with vertebrectomy is technically demanding and is associated with acceptable morbidity. However, an encouraging long-term survival observed in this series suggest that resection could be a valid option in selected patients with vertebral invasion by NSCLC.
Authors
Domenico Galetta (1), Lorenzo Spaggiari (2)
Institutions
(1) Division of Thoracic Surgery, San Giovanni Bosco Hospital, Turin, Italy, (2) European Institute of Oncology, Milan, Lombardia
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Poster Presenter
Domenico Galetta, European Institute of Oncology
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Milano, Turin
Italy
Objective
The role of robotic surgery in locally advanced non-small cell lung cancer (NSCLC) is controversial. We evaluated the safety and effectiveness of robotic lobectomy after induction therapy (IT) by analyzing surgical and long-term outcomes. We compared outcomes of patients who received IT followed by lobectomy, via robotic surgery or thoracotomy.
Methods
Patients with locally advanced NSCLC and treated with radical surgery after IT between December 2008 and May 2024 in two distinct hospital were identified. Surgical outcomes and long-term survival were assessed using univariate analysis, Kaplan-Meier and Cox proportional hazard analysis. Propensity score-matched comparisons was used to assess the potential impact of selection bias.
Results
We identified 348 patients who underwent lobectomy for NSCLC after IT in the study period. The primary data set analyzed included 198 patients (145 open and 54 robotic surgeries). Propensity score matching yielded 50 pairs of patients. There was no difference between the two matched groups in terms of age, sex, smoke status, pulmonary and cardiac co-morbidities, body mass index, laterality, ASA score, histology, and type of IT. There was a significant difference in the median operative time (145 minute for open vs 186 minutes for robotic, p=0.02), estimates blood loss (180 ml for open vs 80 for robotic, p=0.01), number of dissected lymph nodes (22 for open vs. 27 for robotic; p=0.02), and hospital stay (6.2 days vs 4.5 days). There was no difference in terms of morbidity and mortality between the two groups (p=0.37 and p=0.48, respectively). No difference was observed between the two cohorts, either in terms of recurrence-free survival (hazard ratio: 1.07; p=0.43) or overall survival (hazard ratio: 0.74; p = 0.37). 5-year disease-free interval and overall survival were 22.6% and 50.6%, respectively, in open group, and 23.4% and 51.1%, respectively, in robotic group.
Conclusions
Robotic lobectomy in patients treated with IT for locally advanced NSCLC is feasible and effective and does not appear to compromise oncologic outcomes.
Authors
Domenico Galetta (1), Lorenzo Spaggiari (2)
Institutions
(1) Division of Thoracic Surgery, San Giovanni Bosco Hospital, Turin, Italy, (2) European Institute of Oncology, Milan, Lombardia
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Poster Presenter
Domenico Galetta, European Institute of Oncology
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Milano, Turin
Italy
Objective: Quality metrics based on short-term peri-operative outcomes are increasingly used to compare care across institutions. This study evaluated whether short-term quality metrics for non-small cell lung cancer (NSCLC) resections predict long-term survival outcomes.
Methods: Centers in the National Cancer Database that performed ≥ 30 pulmonary resections for NSCLC between 2010 and 2019 were ranked based on previously established measures of major postoperative morbidity, defined as a composite of 30-day mortality, unplanned readmissions and hospital stays longer than 14 days. Mortality was weighted at 4 times the value of morbidity (unplanned readmissions and prolonged hospital stays) in the composite. Centers were stratified into quintiles, with the top quintile (least morbid) designated as high-quality. The impact of institutional quality on long-term survival was assessed with Kaplan-Meier analysis and Cox proportional hazards modeling.
Results: The study included 198,115 patients from 928 centers. High-quality centers had a 30-day postoperative mortality rate of 0.8% (362/47,321) and a median morbidity rate of 5% (Interquartile Range [IQR] 4.0%, 5.9%) compared to a 2.4% postoperative mortality rate (3,614/150,794) and a median morbidity rate of 10.8% (IQR 8.7%, 14.0%) at non-high-quality centers (p<0.001 for both mortality and morbidity). Patients treated at high-quality centers had improved long-term survival compared to patients treated at non-high-quality institutions in both univariable (5-year survival 71.5% [95% Confidence Interval {CI} 71.0-71.9%] vs 62.6% [95% CI 62.3-62.8%], p<0.0001) and multivariable analysis (hazard ratio [HR] 0.72 [95% CI 0.71-0.74], p<0.001) that included stage and other factors (Figure). Sensitivity analysis of stage IA patients treated with lobectomy and no induction therapy showed similar benefits to having surgery at a high-quality institution in both univariable (5-year survival 79% [95% CI 78.3-79.7%] vs 73.2% [95% CI 72.8-73.6%], p<0.001) and multivariable (HR 0.76 [95% CI 0.73-0.78], p<0.001) analyses.
Conclusion: Patients who underwent lung cancer resection at institutions deemed high-quality based on short-term perioperative outcomes also had better long-term survival, suggesting that short-term perioperative outcome-based quality metrics are sufficient in predicting long-term outcomes in lung cancer resections of NSCLC.
Authors
Mark Berry (1), David Richard P. Woodson (2), Ntemena Kapula (3), Douglas Liou (3), Irmina Elliott (4), Joseph Shrager (5)
Institutions
(1) Leland Stanford Junior University, Stanford, CA, (2) Stanford Unversity, Stanford, CA, (3) Stanford University Medical Center, Stanford, CA, (4) N/A, Stanford, CA, (5) Stanford University, Stanford, CA
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Poster Presenter
David Richard Woodson, Stanford Hospital
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Atlanta, GA
United States
OBJECTIVE:
Over 800,000 individuals undergo lung cancer screening via low-dose computed tomography (LDCT) annually. Although LDCT is primarily used as a tool to screen for lung cancer, it can also provide important data about patients' cardiovascular health through the measurement of coronary calcium scores (CCS). The CCS is a measure of the total area of calcium deposits visible in the coronary arteries, with higher scores reflecting increased risk of coronary artery disease (CAD). In this study, we aimed to explore the utility of coronary calcium scores detected on LDCT during lung cancer screening.
METHODS:
We retrospectively reviewed records of patients undergoing lung cancer screening at a single institution from 11/1/2011 to 1/18/2024. Patients who underwent screening with alternate imaging modalities were excluded from the analysis. The CCS is classified into five categories based on the risk of CAD: high (>400), moderate (101-400), mild (11-100), minimal (1-10), and non-identified (0). Primary variables analyzed included patient demographics, rates of specialist referral, and the frequency of subsequent intervention. Continuous variables were presented as medians with interquartile ranges (IQR).
RESULTS:
A total of 758 patients underwent LDCT; of these, 357 (47.1%) had a reported CCS. The median CCS was 107.0 (IQR: 3.2–387.0); there were 88 (24.6%) patients with a high CCS, 67 (18.8%) with a moderate CCS, 26 (7.3%) with a mild CCS, 96 (26.9%) with a minimal CCS, and 80 (22.4%) with a non-identified CCS. Patients with a high CCS were more often male, above 60 years old, and have a history of diabetes and hypertension (p < 0.001). Additionally, patients with a high CCS were more likely to be covered by Medicare (64% vs. 49%, p = 0.015), though rates of minority race were similar (9.1% vs. 17%, p = 0.065). Of the patients with a high CCS, 26 (29.5%) were referred to a cardiologist and 33 (37.5%) had an established cardiologist and were advised to follow up with them. In this subset of patients, 6 (10.2%) underwent initiation or adjustment of medication.
CONCLUSIONS:
A significant portion of patients undergoing LDCT for lung cancer screening were found to have an elevated CCS. This finding leads to increased specialist referrals and follow-up appointments with subsequent medical intervention. LDCT can be effectively used to determine risk for coronary artery disease, especially in patients with barriers to care.
Authors
Parth Patel (1), Mark Shacker (1), Claire Woods (1), Artur Rybachok (1), Stephanie Gerardin (2), Cindy Stotts (2), Enise Yoo-Liu (2), Jasmine Huang (2)
Institutions
(1) Creighton University School of Medicine, Phoenix, AZ, (2) Norton Thoracic Institute, Phoenix, AZ
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Poster Presenter
Parth Patel, Creighton University
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Phoenix, AZ
United States
Objective: Direct and robotic minimally invasive lung transplant (MILTx) techniques offer enhanced recovery and improved early pulmonary function when compared to traditional approaches, but the impact on pulmonary function after 3 months is unknown. We sought to characterize the impact of surgical approach on pulmonary function at 1-year in a large single center cohort of lung transplant patients.
Methods: A prospective institutional registry was used to identify patients who underwent lung transplants between January 2017 and October 2023. Patients were stratified by surgical approach, MILTx (mini-thoracotomy 6-8cm +/-robotic assistance) or traditional (sternotomy, clamshell, thoracotomy). Post-COVID acute respiratory distress syndrome, preoperative ECMO, and repeat or multiorgan transplants were excluded. The primary outcome was mean 1-year FEV1. Secondary outcomes included: severe primary graft dysfunction within 72-hours, ICU length of stay, and 1-year mortality. Multivariate logistic and linear regression models were applied to adjust for clinically relevant characteristics.
Results: Of the 227 patients undergoing lung transplant, 40% (n=91) underwent MILTx and 60% (n=136) underwent traditional approach. MILTx patients were older (66 [61.0-70.0] vs 63 [53.0-68.5], p<0.05) with better functional status (severe: 12% vs 22%, p<0.05) receiving fewer bilateral lungs (49% vs 63%, p<0.05) from younger donors (34 [22-46] vs 39 [28.5-48], p<0.05). Restrictive lung disease was more common in the MILTx cohort (89% vs 72%, p<0.05). There was no difference in 1-year mortality between groups (94% vs 89%, p=0.18). Pulmonary function was improved in MILTx at 6-months (FEV1 83 [78-88] vs 73 [69-77], p<0.05) and 1-year (FEV1 83 [77-88] vs 75 [71-80], p<0.05). The maximum FEV1 was higher in MILTx (89 [84-94] vs 82 [78-85], p<0.05) and was achieved early (223 days [167-279] vs 310 days [266-354], p<0.05) after transplant. The ICU length of stay was shorter with MILTx by 3 days (4.7 [3.6-8] vs 7.7 [4-16], p<0.05) Adjusted rates of severe primary graft dysfunction (OR 0.48 [0.19-1.22], p=0.12) and 30-day readmission (OR 0.89 [0.39-2.00], p=0.76) were similar between groups.
Conclusion: Direct and robotic minimally invasive lung transplant was associated with shorter ICU length of stay, earlier, and sustained improvements in pulmonary function at up to 1-year without compromising morbidity, mortality, or graft function.
Authors
Allen Razavi (1), Aminah Sallam (2), Derrick Tam (3), Kevin Japardi (1), Vikram Krishna (1), Lucas Weiser (2), Claire Perez (1), Reinaldo Rampolla (1), Dominic Emerson (1), Pedro Catarino (2), Dominick Megna (4)
Institutions
(1) Cedars-Sinai Medical Center, Los Angeles, CA, (2) Cedars Sinai Medical Center, Los Angeles, CA, (3) Cedars Sinai Medical Center, Toronto, ON, (4) UW Medical Center - Montlake, N/A
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Poster Presenter
Allen Razavi, Cedars-Sinai Medical Center
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LOS ANGELES, CA
United States
Objective
Currently, U.S. national guidelines do not recommend routine screening for brain metastases with brain MRI for patients with T1N0 non-small-cell lung cancer (NSCLC). The objective of this study is to evaluate the prevalence and predictors of brain metastases in patients with T1 N0 NSCLC.
Methods
The Surveillance, Epidemiology, and End Results (SEER) database was utilized to identify adults with primary NSCLC between 2010-2019. Patients with concomitant cancer diagnoses and with missing variables were excluded from analysis. Patients were considered to have undergone pre-treatment brain MRI if the imaging occurred within two months of diagnosis. Outcomes of interest included the presence of, and factors correlated with having brain metastases. Multivariable logistic regression was utilized to adjust outcomes for age, sex, race, comorbid conditions, T-status and tumor histopathology, reported as adjusted odds ratios (aOR) with 95% confidence intervals.
Results
Of 37,737 adults with T1N0 disease included for analysis, 18,629 (49.4%) underwent a brain MRI at time of diagnosis and 1,690 (4.5%) were noted to have a brain metastasis. Those with brain metastases were younger (72.8 vs 74.0 years, p<0.001), more frequently male (46.6 vs 43.9%, p=0.03), more likely to identify as Black (8.2 vs 6.8%, p=0.01), and more likely to have any smoking history (88.8 vs 85.8%, p<0.001). Compared to those without brain metastases, this cohort was more frequently Stage T1c (53.8 vs 45.1%, p<0.001) and diagnosed with Adenocarcinoma (54.8 vs 44.1%, p<0.001) and Large Cell Carcinoma (2.2 vs 1.02%, p<0.001) rather than Squamous Cell Carcinoma (17.4 vs 22.6%, p<0.001). On multivariable-adjusted analysis, factors associated with increased likelihood of having brain metastases included younger age (aOR: 0.98 per year, 95% CI: 0.98-0.99, Figure), Black race (aOR: 1.15, 95% CI: 1.01-1.31, ref: White), smoking status (aOR: 1.33, 95% CI: 1.14-1.54). Stage T1c (aOR: 1.35, 95% CI: 1.11-1.65, ref: T1a, Figure), Adenocarcinoma (aOR: 1.76, 95% CI: 1.55-1.99) and Large Cell Carcinoma (aOR: 3.39, 95% CI: 1.83-3.61, ref: Squamous Cell Carcinoma).
Conclusions
In this national analysis of T1N0 NSCLC, the prevalence of brain metastases was 4.5%. In the setting of T1N0Mx NSCLC, evaluation with brain imaging may be considered in patients with high risk features, such as those with T1c Adenocarcinoma.
Authors
Catherine Williamson (1), Alexandra Potter (1), Soneesh Kothagundla (1), Camille Mathey-Andrews (1), Jane Yanagawa (2), Mongwei Lin (3), Michael Lanuti (4), Chi-Fu Yang (1)
Institutions
(1) Massachusetts General Hospital, Boston, MA, (2) David Geffen School of Medicine at UCLA, Los Angeles, CA, (3) National Taiwan University, Taipei, NA, (4) Harvard University, Boston, MA
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Poster Presenter
*Chi-Fu Yang, Massachusetts General Hospital
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Winchester, MA
United States
Objective
Robotic navigational bronchoscopy (RNB) and biopsy can provide diagnosis prior to surgical resection for suspicious pulmonary nodules. There are limited patient and nodule characteristics known to predict those requiring surgery after robotic bronchoscopy. We applied a machine learning model to predict those who were eligible for curative surgery after RNB.
Methods
Using a peer reviewed, automated machine learning tool that automatically prepares data for model development, we assessed our institutional robotic bronchoscopy patients. The primary endpoint was curative surgery or no surgery after RNB. Area Under the Curve (AUC) was utilized to assess algorithm and model performance and predictive ability. Also known as receiver operating characteristics, AUC graphs show classifiers' performance by plotting the true positive rate and false positive rate. Machine learning algorithms in our model included Category Gradient Boosting, Decision Tree, Extreme Gradient Boosting, Logistic Regression, and Random Forest. Mutual Information Median Scores and MultiSURF Median Scores were assessed for each model to provide a unique and specific level of importance to each datapoint and variable.
Results
A total of 1,091 RNB patients were included; 262 (24%) underwent curative intent surgery and 829 (76%) did not. Our analysis included 41 variables, consisting of 38,257 unique datapoints. AUC graphs demonstrated all algorithms performed well (Figure 1): Extreme Gradient Boosting had an AUC of 0.838, Category Gradient Boosting had an AUC of 0.823, Decision Tree had an AUC of 0.794, Logistic Regression had an AUC of 0.808, and Random Forest had an AUC of 0.824. As a comparison, industry standard AUCs as well as Society of Thoracic Surgeons Risk Calculator AUCs range between 0.7 and 0.8.
Based on Mutual Information Median Scores and MultiSURF Median Scores, the most important variables were whether a radial endobronchial ultrasound was used, whether the bronchoscopy was diagnostic or not, the location of the nodule, and number of nodules biopsied.
Conclusions
Our machine learning models, evaluating 41 different variables with an AUC ranging between 0.794 - 0.838, can effectively aid in post-bronchoscopy triage, especially in non-diagnostic cases, helping direct patients to medical or surgical clinics by determining likelihood of requiring subsequent surgery.
Authors
Zachary Brennan (1), Claire Perez (2), Lucas Weiser (3), Kellie Knabe (2), Charles Fuller (2), Sevannah Soukiasian (4), Rafaelle Rocco (2), Andrew Brownlee (5), Harmik Soukiasian (2)
Institutions
(1) Cedars-Sinai Medical Center, Gainesville, CA, (2) Cedars-Sinai Medical Center, Los Angeles, CA, (3) Cedars Sinai Medical Center, Los Angeles, CA, (4) Cedars Sinai Medical Center, Encino, CA, (5) Cedars-Sinai Medical Center, Studio City, CA
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Poster Presenter
Zachary Brennan, Cedars-Sinai Medical Center
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Los Angeles, CA
United States
Background
Neoadjuvant therapy followed by surgery is preferred for locally advanced esophageal squamous cell carcinoma (ESCC), but the necessity of adjuvant therapy remains controversial. Tumor regression grade (TRG) reflects the response to neoadjuvant therapy and may predict patient prognosis, yet its role in guiding adjuvant therapy remains unexplored. This study aimed to explore the role of TRG and other clinical characteristics in predicting the efficacy of postoperative adjuvant therapy in ESCC patients receiving neoadjuvant therapy.
Methods
This study included patients who underwent R0 esophagectomy for thoracic ESCC after neoadjuvant therapy between January 2016 and December 2021 across three high-volume centers. Patients were assessed by TRG and divided into good responders (TRG 0-1) and poor responders (TRG 2-3).
Results
Among 416 patients with a median follow-up of 52 months, adjuvant therapy extended median survival by 8 months, which was statistically insignificant (p=0.28). The 3-year and 5-year OS rates were 68.2% and 58% in the adjuvant therapy group, compared to 64.8% and 54% in the observation group. In the TRG 0-1 subgroup, those receiving adjuvant therapy had 3-year and 5-year OS rates of 94.6% and 86.8%, compared to 78.8% and 71.6% for the observation group (P = 0.02). Multivariable Cox regression showed adjuvant therapy was associated with reduced mortality in the TRG 0-1 (HR 0.32; 95% CI 0.14-0.73; P = 0.006), positive lymph nodes (HR 0.53; 95% CI 0.36-0.78; P = 0.001), and ypT3-4 subgroups (HR 0.63; 95% CI 0.43-0.92; P = 0.017).
Conclusions
TRG is a promising predictor of the prognostic value of adjuvant therapy in ESCC patients. Patients with a good TRG response, positive lymph nodes and ypT3-4 stage benefit from adjuvant therapy.
Authors
yizhou huang (1), Maohui Chen (2), Chun Chen (3), Bin Zheng (2)
Institutions
(1) Fujian Medical University Union Hospital, Fujian, (2) Fujian Medical University Union Hospital, China, (3) Fujian Medical University Union Hospital, Fu Zhou, Fujian
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Poster Presenter
Bin Zheng, Fujian Medical University Union Hospital
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Fu Zhou, Fujian
China
Objective: Current guidelines recommend invasive mediastinal nodal staging (IMNS) in patients with synchronous primary lung cancer (SPLC) being considered for curative resection. The goal of this study was to investigate the utilization rate of IMNS and incidence of occult nodal disease in SPLC.
Methods: Patients with SPLC identified on pre-operative imaging and surgically resected from January 2000 to September 2022 were identified from a single center prospectively maintained database. Exclusion criteria included recurrent and metachronous lung cancer, metastatic disease, carcinoid-only histology, lack of pre-operative PET/CT, and neoadjuvant therapy. Pearson's Chi-squared test and Fisher's exact test were used to compare categorical variables. The Wilcoxon rank sum test was used to compare continuous variables.
Results: 676/11,403 patients had SPLC and underwent resection during the study period. Of these, 25% (167/676) underwent invasive mediastinal nodal staging (IMNS) via endobronchial ultrasound (EBUS, N=91), mediastinoscopy (N=73), or both (N=3) with a median of 3 lymph node stations sampled. 11 patients had positive N1 nodes and 36 patients had positive N2 nodes after IMNS. 132 patients underwent neoadjuvant therapy. Only 544 patients who underwent up-front surgery were included in subsequent analyses. Of these, 18% (100/544) underwent IMNS. Patients who underwent IMNS had higher Tstage, increased SUVmax and involvement of bilateral lungs (all p<0.001). Of the 35 patients who were cN0 by PET/CT and underwent EBUS, no patients had N2 disease and one patient had N1 disease discovered after EBUS. No cN0/cN1 patients had positive N2 nodes after IMNS but 12% (10/82) had occult pN2 disease post-resection. Overall, 14% (71/521) of cN0 patients had occult nodal disease after surgery, with 6% (31/521) having pN2 disease.
Conclusions: Selective use of IMNS in staging of cN0/N1 SPLC results in acceptably low pN2 rates. Selection of patients with SPLC for IMNS should be individualized based on Tstage, increased SUVmax, and synchronous bilateral lesions.
Authors
Nanruoyi Zhou (1), Stella Tsui (1), Nicolas Toumbacaris (1), Kay See Tan (1), Joe Dycoco (1), Alexis Chidi (1), Katherine Gray (1), Smita Sihag (1), Bernard Park (1), Matthew Bott (1), Prasad Adusumilli (1), Daniela Molena (1), Valerie Rusch (1), James Huang (1), Manjit Bains (1), Gaetano Rocco (1), James Isbell (1), David Jones (1)
Institutions
(1) Memorial Sloan Kettering Cancer Center, New York, NY
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Poster Presenter
Nanruoyi Zhou, Memorial Sloan Kettering Cancer Center
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New York, NY
United States
Objective
Bridging sick patients to lung transplant (LTx) with ECMO has been more commonly performed in the past decade. As transplant candidates age this strategy is more commonly considered for elderly patients. The outcomes of elderly patients in this sickest cohort for LTx are not clear.
Methods
Retrospective analysis of patients undergoing LTx with ECMO as a bridge using United Network of Organ Sharing registry data from 2013 to 2023 was performed. The cohort was stratified based on patients' age: 60 or older and younger than 60. Post-transplant survival and risk factors were investigated in this elderly cohort using Chi-square and ANOVA tests for nominal and continuous variables, respectively. Survival was assessed with Kaplan-Meier analysis, Cox proportional hazard models, and log-rank tests. Multivariate analysis was performed to identify risk factors.
Results
Of 23,513 patients who received LTx during the study period 1546 patients (6.6%) underwent with ECMO as a bridge. Of those 360 patients (23.3%) were older than 60 (mean age 64.3 ± 3.4 years). Interstitial lung disease was the most common etiology (66.9%). Elderly group was less pulmonary hypertensive, (29.9 ± 12.6 mmHg vs 34.3 ± 15.8 mmHg, p<0.001) and underwent single lung transplant more commonly (15.0% vs 3.2%, p<0.001). Elderly cohort was less likely to be mechanically ventilated pre-ECMO (71.6% vs 76.9 %, p = 0.043). There were no significant differences in post-operative ECMO (p=0.837) and renal replacement therapy (p=0.939). Survival of the elderly group was significantly lower at 1, 3 and 5 years (83% vs 76%, 67% vs 57% and 56% vs 45%, p<0.001) than that of younger patients. Survival of the elderly recipients who received single LTx was significantly lower at 1, 3 and 5 years (78% vs 63%, 61% vs 35% and 47% vs 23%, p<0.003) than that of double recipients. Less BOS/CLAD (3.0% vs 15.5%, p<0.003) and more infection (17.9% vs 27.2%, p<0.003) were the cause of death in the elderly group. In multivariate analysis risk factors for outcome were BMI (p<0.001), single LTx (p<0.001), ischemic time (p<0.001) and length of stay (p<0.001), however, age was no longer significant (p=0.331).
Conclusions
The sickest elderly patients with advanced lung disease whose survival is extremely limited without LTx gain reasonable survival benefits with ECMO as a bridge. Age may not be the most crucial factor when elderly patients are considered for ECMO bridge to LTx.
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Poster Presenter
Roh Yanagida, Temple University Hospital
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Philadelphia, PA
United States