PS02.128: SENSE OR NONSENSE OF A PALLIATIVE ESOPHAGECTOMY IN CASE OF UNEXPECTED OLIGOMETASTATIC DISEASE

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The mode of death in the non-heart-beating donor has an impact on lung graft quality

Objective: We hypothesised that the agonal phase prior to cardiac death may negatively influence the quality of the pulmonary graft recovered from non-heart-beating donors (NHBDs). Different modes of death were compared in an experimental model. Methods: Non-heparinised pigs were divided into three groups (n=6 per group). Animals in group I [FIB] were sacrificed by ventricular fibrillation resulting in immediate circulatory arrest. In group II [EXS], animals were exsanguinated (45+/-11min). In group III [HYP], hypoxic cardiac arrest (13+/-3min) was induced by disconnecting the animal from the ventilator. Blood samples were taken pre-mortem in HYP and EXS for measurement of catecholamine levels. After 1h of in situ warm ischaemia, unflushed lungs were explanted and stored for 3h (4 degrees C). Left lung performance was then tested during 60min in our ex vivo reperfusion model. Total protein concentration in bronchial lavage fluid was measured at the end of reperfusion. Results: Pre-mortem noradrenalin (mcgl(-1)) concentration (baseline: 0.03+/-0) increased to a higher level in HYP (50+/-8) vs EXS (15+/-3); p=0.0074. PO(2) (mmHg) at 60min of reperfusion was significantly worse in HYP compared to FIB (445+/-64 vs 621+/-25; p<0.05), but not to EXS (563+/-51). Pulmonary vascular resistance (dynesscm(-5)) was initially higher in EXS (p<0.001) and HYP (NS) vs FIB (15824+/-5052 and 8557+/-4933 vs 1482+/-61, respectively) but normalised thereafter. Wet-to-dry weight ratio was higher in HYP compared to FIB (5.2+/-0.3 vs 4.7+/-0.2, p=0.041), but not to EXS (4.9+/-0.2). Total protein (gl(-1)) concentration was higher, although not significant in HYP and EXS vs FIB (18+/-6 and 13+/-4 vs 4.5+/-1.3, respectively). Conclusion: Pre-mortem agonal phase in the NHBD induces a sympathetic storm leading to capillary leak with pulmonary oedema and reduced oxygenation upon reperfusion. Graft quality appears inferior in NHBD lungs when recovered in controlled (HYP) vs uncontrolled (EXS and FIB) setting.status: publishe

Survival after resection of synchronous bilateral lung cancer

Objective: Due to recent advances in imaging, the incidence of patients presenting with bilateral lung lesions is increasing. A single contralateral lung lesion can be an isolated metastasis or a synchronous second primary lung cancer. For the revision of the TNM in 2009, the International Association for the Study of Lung Cancer Staging Committee proposes that patients with contralateral lung nodules remain classified as M1 disease. In this retrospective study, the survival after resection of synchronous bilateral lung cancer is evaluated. Methods: From our database of bronchial carcinoma, all patients with bilateral synchronous lung lesions between 1990 and 2007 were retrieved. We analysed 57 patients in which, after functional assessment and thorough staging, the decision was taken to treat the disease with bilateral resection. All these files were retrospectively reviewed. Twenty-one patients were excluded from this analysis because only one side was resected (n = 15) or one of the lesions was non-neoplastic on final pathology (n = 6). Results: Thirty-six patients underwent bilateral resection for synchronous multiple primary lung cancer. All resections were performed as sequential procedures. In 23 patients, one side was anatomically resected (2 pneumonectomies) and the contralateral side was resected by limited resection. In 10 patients a bilateral lobectomy was performed, and 3 patients had bilateral limited resections. Postoperative mortality was 2.8%. Eighteen patients had a tumour with a different histological pattern, confirmed by comparing both specimens by an experienced senior pathologist. The median survival after resection of synchronous bilateral lung cancer in our series was 25.4 months with a 5-year survival rate of 38%. There was no significant difference in survival between patients with different versus same histology. This survival is much higher compared to the survival of assumed stage IV disease. Conclusions: Our study shows that selected patients with bilateral lung cancer may benefit from an aggressive approach, with acceptable morbidity and mortality, and rewarding long-term survival. Patients with a single contralateral lung lesion should not be treated as disseminated disease (stage IV). After extensive searching for metastatic spread, bilateral surgical resection should be considered in fit patients.status: publishe

RA09.02: LYMPH NODE RESPONSE AFTER NEOADJUVANT CHEMORADIATION THERAPY FOR ESOPHAGEAL ADENOCARCINOMA: TIME FOR AN APPROPRIATE YPN CLASSIFICATION

Background Response of the primary tumor and lymph node involvement are the most important prognosticators in resected patients with esophageal adenocarcinoma after neoadjuvant chemoradiation. Response on the primary tumor is well established using T(umor) R(egression) G(rading). However, little is known about the prognostic value of lymph node response in these patients. Methods Hematoxylin-eosin slides of 193 adenocarcinoma patients with clinical suspicion of lymph node involvement (cN+) and treated with neoadjuvant chemoradiation therapy between 2008 and 2015 were all reassessed by a senior pathologist. Lymph node response (LNR) was defined as a combination of central fibrosis and at least one other characteristic such as hemosiderin pigment, acellular mucin pools, foam cells, giant cells or calcifications. Lymph nodes were categorized in four categories: 1° as positive (ypN+) when viable tumor was found according to TNM 8th edition. 2° as negative (ypN0) in absence of any viable tumor. 3° as lymph nodes with signs of LNR (LNR+). 4° as lymph nodes without signs of LNR (LNR-). All patients were grouped according to lymph node positivity and lymph node regression. Multivariate and survival analysis were performed by Cox proportional hazard regression analysis. Results Thirty-four patients were ypN + /LNR + , 60 were ypN + /LNR-, 41 were ypN0/LNR + and 58 were ypN0/LNR-. Median overall survival was respectively 41.0 months, 18.5 months, 31.2 months and 62.9 months. Survival was significantly different between ypN0 groups (P = 0.045) but not between ypN + groups (P = 0.299). Multivariate analysis showed that LNR was an independent prognosticator (P = 0.011). Conclusion In cN + esophageal adenocarcinoma patients treated with neoadjuvant chemoradiation with final pathology being ypN0 after esophagectomy, median overall survival is doubled when no signs of LNR were found suggesting these patients were in fact true N0 and that ypN0/LNR + have a similar prognosis as ypN + /LNR + . Using these four categories of ypN allows for more precise evaluation of the impact of induction therapy.status: publishe

A harmonised European training syllabus for thoracic surgery: report from the ESTS/ERS task force group

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A harmonized European training syllabus for thoracic surgery: report from the ESTS-ERS task force

Training of European thoracic surgeons is subject to huge variations in terms of length of training, content of training and operative experience during training. Harmonization of training outcomes has been approached by creating the European Board of Thoracic Surgery, which has been accredited by the European Union of Medical Specialists (UEMS); however, a clear description of the content of training is lacking. Building on their recognized experience with curriculum building, task forces of the European Respiratory Society and the European Society of Thoracic Surgery agreed on a joint task force on training in thoracic surgery. The goal of this study is to report on the mission statement developed from the UEMS-driven survey, describe the Delphi method and the observed results and present the first large consensus-based syllabus. The working group is currently working on a description of the curriculum and assessment of learning outcomes.status: publishe