22ND EUROPEAO N C NFERENCE ON GENERAL THORACIC SURGERY COPENHAGEN – DENMARK 2014 22 nd European Conference European onGeneral ABSTRACTS 15 –18June2014 Copenhagen www.ests.org of Thoracic of Thoracic Surgeons SocietyEuropean – Thoracic SurgeryThoracic Denmark 22nd European Conference on General Thoracic Surgery 15 – 18 June 2014 Bella Center, Copenhagen, Denmark 01 ests2014_toc.indd 1 14.05.2014 14:05:18 22nd European Conference on General Thoracic Surgery 2 01 ests2014_toc.indd 2 14.05.2014 14:05:18 Copenhagen – Denmark – 2014 TABLE OF CONTENTS TABLE OF CONTENTS Monday, 16 June 2014 Session I/ Brompton 5 Session II/ Videos 17 Session III/ Pulmonary Non Neoplastic 23 Session IV/ Young Investigators Award 32 Session V/ Pulmonary Neoplastic I 51 Session VI/ Innovative/Experimental 63 Oscar Night Videos 78 Tuesday, 17 June 2014 Session VIII/ Mixed Thoracic I 85 Session IX/ Mixed Thoracic II 97 Session X/ Pulmonary Neoplastic II 109 Session XI/ Videos II 123 Session XII/ Interesting Cases 129 Session XIII/ Oesophagus/Mediastinum 134 Session XIV/ Airway/Transplantation 146 Session XV/ Chest Wall/Diaphragm/Pleura 155 Session XVI/ MITIG – VATS RESECTIONS 166 Posters 178 Nurse Symposium-Oral 332 Nurse Symposium-Posters 342 List of Authors 361 3 01 ests2014_toc.indd 3 14.05.2014 14:05:18 22nd European Conference on General Thoracic Surgery ABSTRACTS 4 02_ests2014.indd 4 14.05.2014 14:07:30 Abstracts 001 - 006 Copenhagen – Denmark – 2014 ABSTRACTS Monday A.M. MONDAY, 16 JUNE 2014 08:30 - 10:30 SESSION I: BROMPTON B-001 ERGON – TRIAL: ERGONOMIC EVALUATION OF SINGLE-PORT ACCESS VERSUS THREE-PORT ACCESS VIDEO-ASSISTED THORACIC SURGERY Luca Bertolaccini1, A. Viti1, A. Terzi2 1Thoracic Surgery, S. Croce e Carle Hospital, Cuneo, Italy 2Thoracic Surgery, Sacred Heart Hospital, Negrar, Italy Objectives: Video-Assisted Thoracic Surgery (VATS) single-port-approach seems to be logical evolution of standard three-port-approach. To compare, in clinical settings, the ergonomic characteristics of Uniportal VATS and three-port VATS. Methods: Posture analysis during 100 VATS wedge-resections (50 Uniportal VATS vs. 50 three-port VATS). Most demanding procedures, such as major lung-resection, were excluded. Body-pos- ture assessment of operating surgeon was performed by measurement of head-trunk axial rota- tion and head’s flexion in sagittal plane. Screen height, distance, inclination could be adjusted to operator preference. We recorded eye-height and viewing-distance (eye-to-monitor) to cal- culate viewing direction (neck flexion/extension combined effort and angle-of-gaze performed by extraocular musculature). Mental workload was assessed by National Aeronautics Space Administration Task Load indeX (NASA-TLX), multidimensional tool rating workloads on six scales (mental, physical, and temporal demand; effort; performance; frustration). Power analy- sis was performed to calculate sample size for paired analysis ( =0.05, =0.80). Pearson’s χ2 test and Fisher’s exact test were used to calculate probability value for variables comparison. Cohen’s effect sizes were calculated to estimate difference magnitude.α β Results: All procedures were completed without any adverse events. Statistically significant reduction in head-trunk axial rotation was achieved in Uniportal VATS. Neck-flexion was significantly improved in Uniportal VATS (preventing extension of neck). Viewing-direction significantly declined (p=0.01161) in three-port VATS. Angle of gaze was not influenced by monitor po- sition (p=0.56431). Global NASA-TLX- score (overall workload) was significantly higher (p=0.0409) during three-port VATS. NASA-TLX-score on frustration was significantly higher with Uniportal VATS (p=0.02188). Physical demand of three-port VATS was significantly greater than Uniportal VATS (p=0.00629). Analysis on temporal demand showed similar re- sults. 5 02_ests2014.indd 5 14.05.2014 14:07:30 22nd European Conference on General Thoracic Surgery ABSTRACTS Ergonomic characteristics recorded in 100 VATS wedge resections (50 Uniportal VATS vs. 50 three-port access VATS). (§ ) Effect sizes were calculated only for statistically significant results. (¥) Viewing direction = Sin [(eye height – screen height)/viewing distance] N.A. = Not Applicable. Uniportal Three-port p value Effect Size (§) VATS VATS Head-trunk axial rotation 2.13±3.56 9.65±5.45 0.02844 1.63370 (degree) Mean head’s flexion, sagittal 3.46±2.23 4.32±1.23 0.75791 N.A. plane (degree) Viewing direction (¥) -4.26±3.32 -15.47±4.69 0.01161 2.72694 NASA Task Load indeX - Global 39.71±3.54 23.46±2.92 0.04090 5.00790 - Mental demand 39.52±3.21 28.94±3.33 0.18325 N.A. - Physical demand 24.32±3.53 47.47±2.66 0.00629 7.40700 - Temporal demand 41.88±3.63 40.67±5.53 0.89327 N.A. - Effort 21.33±4.52 48.72±4.33 0.00106 6.18840 - Performance 37.13±5.25 39.84±4.94 0.75791 N.A. - Frustration 45.68±3.64 26.24±3.31 0.02188 5.5879 Conclusions: Uniportal VATS significantly improve the posture of surgeons: surgeons can stand straight in front of monitor with minimal neck-extension/rotation. Surprisingly, frustration is major in Uniportal VATS. Future research efforts will include establishment of VATS ergonomic guide- lines and investigation of their influence on potential change in physical workload. Disclosure: No significant relationships. 6 02_ests2014.indd 6 14.05.2014 14:07:31 Abstracts 001 - 006 Copenhagen – Denmark – 2014 ABSTRACTS Monday A.M. B-002 ALSO IN THE NETHERLANDS INCREASED POSTOPERATIVE MORTALITY AFTER LUNG CANCER SURGERY ON FRIDAYS Peter Plaisier1, A. Maat2, R. Damhuis3 1Surgery, Albert Schweitzer Hospital, Dordrecht, Netherlands 2Cardiothoracic Surgery, Erasmus Medical Center, Rotterdam, Netherlands 3Epidemiology, Dutch National Cancer Registry, Utrecht, Netherlands Objectives: A recent study reported on the association between postoperative mortality [POM] and the day of week of elective surgical procedures [BMJ 2013;346:f2424]. For lung surgery, POM was significantly increased as soon as procedures were carried out on Fridays (odds-ratio: 1.75). Aim of this study was to investigate whether this finding would also apply to the Netherlands. Methods: Data were retrieved from the Dutch National Cancer Registry regarding patients operated for primary non-small cell carcinoma during the period 2005-2010. Excluded were children, pa- tients diagnosed in our country but operated abroad, and non-anatomical resections. POM was defined as death within 30 days after operation independent of cause of death or hospital dis- charge. Using multivariate logistic regression, a prediction model was developed based on the variables age, sex, type of operation and period. This case-mix model was applied to examine day of the week of operation, hospital volume and surgical technique (VATS versus open). Results: The series comprised 9,579 patients (37% female, 63% male) with 36% ≥70yrs. Overall POM was 2.7%, declining from 3.3% in 2005-2007 to 2.1% in 2008-2010; the proportion of pneumo- nectomies dropped from 17 to 12%. POM increased with age and was higher for men. Hospital volume (p=0.57) and surgical technique (p=0.24) were not of prognostic significance. POM for operations on Monday-Thursday (85%) was 2.5% against 4.0% for operations on Fridays (13%). This difference remained significant after correction for case mix (odds ratio : 1.59; 95% confidence interval : 1.14-2.21). POM for urgent (i.e. non-elective) operations during the weekend (2%) was 6.8%. Conclusions: This study confirms increased POM for lung cancer surgery performed on Fridays. Since the underlying cause could not be determined from our data, clinical audits are needed to investi- gate our hypothesis that this phenomenon is caused by limited staffing during weekends pro- hibiting early detection and adequate management of complications. Disclosure: No significant relationships. 7 02_ests2014.indd 7 14.05.2014 14:07:31 22nd European Conference on General Thoracic Surgery ABSTRACTS B-003 LUNG TRANSPLANTATION WITH DONORS 60 YEARS AND OLDER I. Lopez, Alberto Jauregui, J. Sole, M. Deu, L. Romero, J. Perez, I. Bello, M. Wong, M. Canela Thoracic Surgery, Vall d´Hebron Hospital, Barcelona, Spain Objectives: The objective of this study was to compare the outcomes in lung transplantation between or- gans from donors older and younger than 60 years. Methods: We performed a retrospective observational study comparing the group of patients receiving organs from donors 60 years or older (group A) or younger than 60 years (group B). We ana- lysed 293 consecutive adult lung transplants between January 2007 and December 2012, 75 (25.6%) in group A and 218 (74.4%) group B. Postoperative outcomes and global survival rate were evaluated. Pearson’s chi-squared, ANOVA, Mann Whitney U and Kaplan-Meier with Log-Rank test were used for comparisons. Results: The percentage of donors 60 years and older used in our center has been increasing from 12.2% in 2007 to 34.9% in 2012. The donor mean age was 63.7 years (r: 60-71) in group A and 41.6 years (r: 13-59) in group B. Regarding donor characteristics, there were fewer smokers (27% vs 42.9%; p= 0.016) and fewer donors with thoracic trauma (0% vs 5.6%; p= 0.038) or purulent secretions (4% vs 15.1%; p= 0.011) in group A. Regarding recipient characteristics, the mean age was higher in group A (54.7 vs 49.3 years; p< 0.001). The 30-day and in-hospital postop- erative mortality in group A and B was 5.3% vs 9.2% (p= 0.291) and 14.7% vs 12% (p= 0.547). Postoperative morbidity and median hospital stay (32.5 vs 40 days; p= 0.160) were similar in both groups. There were no statistically significant differences between groups A and B in terms of survival at 1, 2 and 3 years: 79.7, 67.8 and 65.8% vs 81.1, 76.4 and 69.5% (p= 0.336).