Search

The Lung Cancer Screening Trial demonstrated improved overall survival (OS) and lung cancer specific survival (LCSS), likely due to finding early-stage NSCLC. The purpose of our investigation is to evaluate whether long-term surveillance strategies (4+ years after surgical resection of the initial lung cancer(1LC)) would be beneficial in NSCLC patients by assessing the rates of second lung cancers(2LC) and the OS/LCSS in patients undergoing definitive surgery in 1LC as compared to 2LC (48 months after 1LC) populations.SEER13/18 database was reviewed for patients during 1998-2013. Log-rank tests were used to determine the OS/LCSS differences between the 1LC and 2LC in the entire surgical group(EG) and in those having an early-stage resectable tumors (ESR, tumors4 cm, node negative). Joinpoint analysis was used to determine rates of second cancers 4-10 year after 1LC using SEER-9 during years 1985-2014.The rate of 2LCs was significantly less than all other second cancers until 2001 when the incidence of 2LCs increased sharply and became significantly greater than all other second cancers in females starting in year 2005 and in men starting in year 2010. OS/LCSS, adjusted for propensity score by using inverse probability weighting, demonstrated similar OS, but worse LCSS for 2LCs in the EG, but similar OS/LCSSs in the ESR group.Because the rate of 2LCs are increasing and because the OS/LCSS of the 1LC and 2LC are similar in early-stage lesions, we feel that continued surveillance of patients in order to find early-stage disease may be beneficial.

Limited stage (LS) small cell lung cancer (SCLC) has traditionally been treated with chemoradiation but the potential role of surgical treatment in early stage disease remains a topic of debate.

Contemporary modalities for cardiopulmonary support during lung transplantation include traditional cardiopulmonary bypass (CPB) and venoarterial extracorporeal membrane oxygenation (VA-ECMO). While highly effective, both are associated with morbidities such as arteriopathy and bleeding diathesis. In this report, we describe a novel approach for cardiopulmonary support during double lung transplantation in a patient with end-stage lung disease, pulmonary hypertension and moderate right ventricle (RV) dysfunction, using a percutaneous dual lumen cannula placed via the jugular vein which allowed us to achieve both RV bypass and membrane oxygenation. The cannula was left in place to provide ongoing RV support and the patient was successfully decannulated at bedside on post-operative day (POD) 2. Lack of arterial cannulation, percutaneous access, and bedside decannulation are benefits of this strategy, rendering this approach a useful addition to the armamentarium for CPB techniques in lung transplantation.

Large case series and randomized trials over the past 25 years have consistently demonstrated thoracoscopic interruption of the sympathetic chain to be a safe and effective treatment of focal primary hyperhidrosis. The surgical technique has evolved toward less-invasive and less-extensive procedures in an effort to minimize perioperative morbidity and effectively balance postoperative compensatory sweating with symptomatic relief. This review summarizes available evidence regarding the surgical approach and the optimal level of interruption of the sympathetic chain based on a patient's presenting distribution of pathologic sweating.

Current National Comprehensive Cancer Network guidelines recommend postoperative radiation therapy (PORT) for patients with resected non-small cell lung cancer (NSCLC) with N2 involvement. We investigated the relationship between nodal stage and local-regional recurrence (LR), distant recurrence (DR) and overall survival (OS) for patients having an R0 resection.A multi-institutional database of consecutive patients undergoing R0 resection for stage I-IIIA NSCLC from 1995 to 2008 was used. Patients receiving any radiation therapy before relapse were excluded. A total of 1241, 202, and 125 patients were identified with N0, N1, and N2 involvement, respectively; 161 patients received chemotherapy. Cumulative incidence rates were calculated for LR and DR as first sites of failure, and Kaplan-Meier estimates were made for OS. Competing risk analysis and proportional hazards models were used to examine LR, DR, and OS. Independent variables included age, sex, surgical procedure, extent of lymph node sampling, histology, lymphatic or vascular invasion, tumor size, tumor grade, chemotherapy, nodal stage, and visceral pleural invasion.The median follow-up time was 28.7 months. Patients with N1 or N2 nodal stage had rates of LR similar to those of patients with N0 disease, but were at significantly increased risk for both DR (N1, hazard ratio [HR] = 1.84, 95% confidence interval [CI]: 1.30-2.59; P=.001; N2, HR = 2.32, 95% CI: 1.55-3.48; P.001) and death (N1, HR = 1.46, 95% CI: 1.18-1.81; P.001; N2, HR = 2.33, 95% CI: 1.78-3.04; P.001). LR was associated with squamous histology, visceral pleural involvement, tumor size, age, wedge resection, and segmentectomy. The most frequent site of LR was the mediastinum.Our investigation demonstrated that nodal stage is directly associated with DR and OS but not with LR. Thus, even some patients with, N0-N1 disease are at relatively high risk of local recurrence. Prospective identification of risk factors for local recurrence may aid in selecting an appropriate population for further study of postoperative radiation therapy.

Introduction The use of a bronchial genomic classifier has been shown to improve the diagnostic accuracy of bronchoscopy for suspected lung cancer by identifying patients who may be more suitable for radiographic surveillance as opposed to invasive procedures. Our objective was to assess the cost-effectiveness of bronchoscopy plus a genomic classifier versus bronchoscopy alone in the diagnostic work-up of patients at intermediate risk for lung cancer. Methods A decision-analytic Markov model was developed to project the costs and effects of two competing strategies by using test performance from the Airway Epithelial Gene Expression in the Diagnosis of Lung Cancer–1 and Airway Epithelial Gene Expression in the Diagnosis of Lung Cancer–2 studies. The diagnostic accuracy of noninvasive and invasive follow-up, as well as associated adverse event rates, were derived from published literature. Procedure costs were based on claims data and 2016 inpatient and outpatient reimbursement amounts. The model projected the number of invasive follow-up procedures, 2-year costs and quality-adjusted life-years (QALYs) by strategy, and resulting incremental cost-effectiveness ratio discounted at 3% per annum. Results Use of the genomic classifier reduced invasive procedures by 28% at 1 month and 18% at 2 years, respectively. Total costs and QALY gain were similar with classifier use ($27,221 versus $27,183 and 1.512 versus 1.509, respectively), resulting in an incremental cost-effectiveness ratio of $15,052 per QALY. Conclusions Our analysis suggests that the use of a genomic classifier is associated with meaningful reductions in invasive procedures at about equal costs and is therefore a high-value strategy in the diagnostic work-up of patients at intermediate risk of lung cancer.

Background Research suggests a benefit from a skills curriculum emphasizing error prevention, identification, and management. Our purpose was to identify common errors committed by trainees during simulated thoracoscopic lobectomy for use in developing an error-based curriculum. Methods Twenty-one residents (postgraduate years 1 to 8) performed a thoracoscopic left upper lobectomy on a previously validated simulator. Videos of the procedure were reviewed in a blinded fashion using a checklist listing 66 possible cognitive and technical errors. Results Of the 21 residents, 15 (71%) self-reported completing the anatomic lobectomy; however, only 7 (33%) had actually divided all of the necessary structures correctly. While dissecting the superior pulmonary vein, 16 residents (76%) made at least one error. The most common (n = 13, 62%) was dissecting individual branches rather than the entire vein. On the bronchus, 14 (67%) made at least one error. Again, the most common (n = 9, 43%) was dissecting branches. During these tasks, cognitive errors were more common than technical errors. While dissecting arterial branches, 18 residents (86%) made at least one error. Technical and cognitive errors occurred with equal frequency during arterial dissection. The most common arterial error was excess tension on the vessel (n = 10, 48%). Conclusions Curriculum developers should identify skill-specific technical and judgment errors to verify the scope of errors typically committed. For a thoracoscopic lobectomy curriculum, emphasis should be placed on correct identification of anatomic landmarks during dissection of the vein and airway and on proper tissue handling technique during arterial dissection.

Background When a long segment of trachea is resected and grafted with a bioabsorbable scaffold, chronic contraction of the graft occurs, leading to substantial delayed native tracheal axial approximation. This phenomenon may allow for safe two-stage end-to-end tracheal reconstruction of large tracheal defects. We performed this trial to confirm that delayed tracheal axial approximation occurs in a mature animal model and to test the surgical feasibility of two-stage end-to-end tracheal reconstruction. Methods Five dogs (weight, 19 to 21 kg) underwent cervical tracheal resection and replacement (50 mm) with use of a conduit of a copolymer of L-lactide and ɛ-caprolactone reinforced with polyglycolic acid. A silicone stent (70 mm) was placed to prevent graft collapse. Postoperative bronchoscopy and computed tomography were scheduled to assess tracheal approximation and graft absorption. Native tracheal end-to-end reconstructive surgical procedures were planned at 9 months, when the defect that had been grafted decreased to less than 25 mm in length. Results Suture-related granulation tissue in the airway of one dog, which prevented operation. The grafted area length in four animals ranged from 19 mm to 23 mm 9 months after operation. These animals then underwent tracheal reconstructive surgical procedures consisting of resection of the grafted area and end-to-end native tracheal reanastomosis without postoperative stent placement. All surgical procedures were successful, and there were no procedural deaths or postoperative complications after the second operation for as long as 2 months. Conclusions Delayed tracheal axial approximation after bioabsorbable grafting was confirmed in a mature animal model and allowed two-stage end-to-end tracheal reconstruction of large tracheal defects.

Smoking is the leading cause of preventable death worldwide. Smoking cessation programs that include counseling and pharmacotherapy have been proved to be effective in achieving long-standing abstinence. Smoking cessation is associated with significant improvements in quality of life, mortality, life expectancy, and postsurgical complication rates. Contrary to general belief, smoking cessation close to the time of elective surgery does not increase the risk of pulmonary complications. Longer-term quit rates are generally higher in cohorts who quit in anticipation of surgery compared with those quitting for general health considerations. A team approach and adherence to the guidelines for smoking cessation improves long-term chances of success.

Aim To determine the frequency with which a subcarinal collection is present at computed tomography (CT) following mediastinoscopy and to determine the CT features of the collection. Materials and methods All patients who underwent uncomplicated mediastinoscopy during a 1-year period were retrospectively identified. This list was cross-referenced to determine those patients who also underwent CT within 15 days after the procedure. Each post-mediastinoscopy CT examination was assessed in consensus by three fellowship-trained thoracic radiologists for the presence of subcarinal abnormalities, which were also characterized in terms of their size and density. Additional CT findings were recorded, including tracheobronchial wall thickening, paratracheal collections, mediastinal fat stranding, and mediastinal air. Results The study cohort included 10 patients (seven men and three women) with mean age of 65 years (range 49–81 years). CT was performed a mean of 11 days following mediastinoscopy. The most common CT finding was an oval subcarinal collection in nine of 10 cases (size 1.1–3.2 cm). In all nine cases, the subcarinal collections were consistently lower in attenuation than the subcarinal lymph node in the same region on the pre-procedure CT examination. Other CT findings included anterior tracheobronchial wall thickening (n = 7); paratracheal collection (n = 6); mediastinal fat stranding (n = 6); and mediastinal air in (n = 4) cases. Conclusion A subcarinal collection was identified in 90% of cases following mediastinoscopy. Its rapid development and characteristic appearance help to distinguish it from a lymph node.

Background Tracheobronchomalacia is an underrecognized cause of dyspnea, recurrent respiratory infections, and cough. Surgical stabilization with posterior membranous tracheobronchoplasty has been shown to be effective in selected patients with severe disease. This study examines the technical details and complications of this operation. Methods A prospectively maintained database of tracheobronchomalacia patients was queried retrospectively to review all consecutive tracheobronchoplasties performed from October 2002 to June 2009. Posterior splinting was performed with polypropylene mesh. Patient demographics, surgical outcomes, and operative data were reviewed. Results Sixty-three patients underwent surgical correction of tracheal and bilateral bronchial malacia. Twenty-three patients had chronic obstructive pulmonary disease, 18 had asthma, 5 had Mounier-Kuhn syndrome, and 4 had interstitial lung disease. Seven patients had a previous tracheotomy. Operative time was 373 ± 93 minutes. Median length of stay was 8 days (range, 4 to 92 days), of which 3 days (range, 0 to 91 days) were in intensive care. Seventy-five percent of patients were discharged home (28% with visiting nurse follow-up), and 25% went to a rehabilitation facility. Two patients (3.2%) died postoperatively—1 of worsening usual interstitial pneumonia, and the other of massive pulmonary embolism. Complications included a new respiratory infection in 14 patients, pulmonary embolism in 2, and atrial fibrillation in 6. Six patients required reintubation, and 9 received a postoperative tracheotomy; 47 patients required postoperative aspiration bronchoscopy. Conclusions In experienced hands, tracheobronchoplasty can be performed with a very low mortality rate and an acceptable perioperative complications rate in patients with significant pulmonary comorbidity. Intervention for postoperative respiratory morbidity is often necessary.

Objective An increasing proportion of patients with stage I non-small cell lung cancer (NSCLC) is undergoing sublobar resection (L−). However, there is little information about the risks and correlates of local recurrence (LR) after such surgery, especially compared with patients undergoing lobectomy (L+). Methods Ninety-three and 318 consecutive patients with stage I NSCLC underwent L− and L+, respectively, from 2000 to 2006. Median follow-up was 34 months. Results In the L− group, the LR rates at 2, 3, and 5 years were 13%, 24%, and 40%, respectively. The risk of LR was significantly associated with tumor grade, tumor size, and T stage. The crude risk of LR was 33.8% (21 of 62) for patients whose tumors were grade ≥ 2. In the L+ group, the LR rates at 2, 3, and 5 years were 14%, 19%, and 24%, respectively. The risk of LR significantly increased with increasing tumor size, length of hospital stay, and the presence of diabetes. The L− group experienced a significant increase in failure in the bronchial stump/staple line compared with the L+ group (10% vs 3%; P = .04) and nonsignificant trends toward increased ipsilateral hilar and subcarinal failure rates. Conclusions Patients with stage I NSCLC who undergo L− have an increased risk of LR compared with patients undergoing L+, particularly when they have tumors grade ≥ 2 or tumor size > 2 cm. If L− is considered, additional local therapy should be considered to reduce this risk of LR, especially with tumors grade ≥ 2 or size > 2 cm.

We review the evidence for optimal surgical management and adjuvant therapy for patients with stages I and II non-small cell lung cancer (NSCLC) along with factors associated with increased risks of recurrence. Based on the current evidence, we recommend optimal use of mediastinal lymph node dissection, adjuvant chemotherapy, and post-operative radiation therapy, and make suggestions for areas to explore in future prospective randomized clinical trials.

Purpose We recently demonstrated that diabetes mellitus was an independent risk factor for local recurrence (LR) for patients undergoing resection of non-small cell lung cancer (NSCLC). This investigation was performed to confirm or refute this finding in a different patient cohort. Materials and methods Patients were eligible if they did not have a second primary cancer within 5 years of the original diagnosis, had at least 3-month follow-up, and did not receive radiotherapy. There were 373 and 168 patients in the original (P1) and confirmatory (P2) cohorts, respectively, with 66 and 30 patients with diabetes. Results The median follow-up was 33 months (range, 3–98 months). Diabetes was an independent risk factor for LR in a Cox model in both the P2 ( p =0.05, hazard ratio [HR] 2.15) and P1 ( p =0.008, HR 1.90) cohorts, separately from BMI, glucose control, and the presence of the metabolic syndrome. The rates of LR in the patients with diabetes after combining the cohorts at 2, 3, and 5 years were 23%, 33%, and 56%, respectively; these rates were 15%, 19%, and 26% in non-diabetics. In multivariate Cox regression and competing risk analysis of the combined cohorts, the HRs for LR in patients with diabetes exceeded those of more established risk factors for LR including a 1-cm increase in tumor size and lymphovascular invasion. Conclusions Diabetes was confirmed to be an independent predictor of the risk of LR following resection of NSCLC.

Malignant pleural mesothelioma (MPM) incidence continues to rise in Europe [1]. The UK has one of the highest national incidences in the world, due to peak between 2011 and 2015 [2] and Western Australia is believed to have the highest regional incidence [3]. There is likely to be an increasing incidence of this disease in countries where asbestos use continues and where its use is not well-regulated [4]. There is an important role for thoracic surgeons in helping to provide a prompt and reliable diagnosis and in palliation of pleural fluid so surgeons will continue to be involved in the care of these patients, but the benefits of various forms of extirpative surgery are contentious and as yet unresolved. Consideration of clinical trials of surgery continues in the UK as a sequel to the Mesothelioma and Radical Surgery (MARS) trial [5] and across Europe as a sequel to European Organisation for Research and Treatment of Cancer (EORTC) 08031 [6]. In planning future studies, it is essential to gauge the prior beliefs and opinions of surgeons; recruitment is inevitably difficult and a randomised study of an intervention is only achievable where there is some balance of prior belief for and against effectiveness. The Thoracic Domain of the European Association for Cardio-Thoracic Surgery (EACTS) proposed a survey of opinions and beliefs on the perceived effects and benefits of different surgical strategies; the survey was adopted by the European Society of Thoracic Surgeons (ESTS) and the Society of Thoracic Surgeons (STS). It should be noted that the survey was completed before MARS or EORTC 08031 results were known.

We report a case of a rare, large mediastinal liposarcoma diagnosed in a 74-year-old woman after a syncopal episode. Chest roentgenogram and computed tomographic scan showed a large mass occupying most of the right chest and abutting the great vessels and pericardium. A thoracoscopic approach was used for exploration and surgical excision of this large mediastinal mass. Despite the large size of the mass, the thoracoscopic approach offered excellent visualization of all the mass attachments and required only a small extension of the access incision for tumor removal. The mass was a well-differentiated liposarcoma, which was completely resected with clear margins. The patient remains disease-free almost 3 years after the resection.

Patients undergoing lung volume reduction surgery (LVRS) and those supported by mechanical ventilation are among our most vulnerable patients. Prolonged air leak in these fragile patients can have dire and fatal consequences. This article describes the incidence of prolonged air leak in these populations,thecausesascribedtotheirdevelopment,and strategies that may be applied to their prevention and treatment. PROLONGED AIR LEAK AFTER LVRS LVRS originated in the work of Brantigan and colleagues, 1 published in 1959. The operation received little attention but was resurrected by Cooper and colleagues 2 in 1993. It became a meaningful treatment of severe emphysema during the 1990s. The theoretical benefits included reduction in airway resistance by restoring lung elastic recoil and the tethering function on small airways; restoration of normal chest wall recoil; improved ventilation-perfusion matching; and reduction in end-expiratory volume, allowing for optimized diaphragmatic excursion and generation of negative intrathoracic pressure. 3,4 LVRS

resulted in a mean of 40% excess volume in the target when using only a 3D scan for volume generation. The over treated volume was greater in conv vs SBRT (p Z .002). An average of 13.2% (20.8% for SBRT and 4.9% for conv) of the 4D PTV was excluded from the 3D PTV. The percentage of the 4D PTV missed by 3D PTvs was greater with SBRT plans compared to both min and max conv expansions (p Z .015). In 9/11 SBRT cases, the ITV was missed by the 3D PTV radially, but never in the CC plane. The 4D PTV was missed radially in all 11 tumors, and the CC direction in 4, by the 3D PTV. The geometric centers of GTV and ITV were deviant by 0.13 mm laterally, 0.52 in the AP direction and 0.92 mm in the CC plane. The difference of geometric centers between GTV and ITV in the CC direction was greater in conv vs SBRT volumes (p Z .04). Conclusions: Based on the small series of patients evaluated, utilization of a 4D scan may result in less irradiation of normal tissue with conventional fractionation. ITV also allows for increased accuracy in target delineation for SBRT, which may be missed if only a 3D scan is used. Differences in geometric centers between GTV and ITV suggest that a standard radial expansion is not ideal. Therefore, generation of volumes for treatment of NSCLC should derive from a combination of 3D and 4D CT simulation. Analysis of additional patients is in process. Author Disclosure: K. Patel: None. M.C. Garofalo: None. B. Yi: None. C.G. Morris: None. S.J. Feigenberg: None.

7542 Background: To assess surgical, histopathologic, and patient-related factors associated with isolated brain metastases (IBM) in patients with stages I-IIIA non-small cell carcinoma (NSCLC) who underwent a definitive surgical resection ± adjuvant chemotherapy as compared to patients developing other distal metastases (ODM). Methods: 593 consecutive patients who underwent a definitive surgical resection ± adjuvant chemotherapy for NSCLC from 2000–2007 were qualified for analysis if they did not receive any adjuvant/neo-adjuvant radiotherapy, had at least three months of follow-up, and did not have a history of other cancers within 5 years of the diagnosis of their NSCLC. Univariate and multi-variate analyses were performed to assess risk factors for IBM as the only site of metastatic relapse and compare these risk factors to those of patients with ODM. Results: After a median follow-up of 33 months, 92 patients (25 IBM and 67 ODM) presented with distal metastases. Median time to the development of IBM ...

7069 Background: We recently demonstrated that DM was an independent risk factor for LR for patients undergoing resection of NSCLC. This investigation was performed to confirm or refute this findin...

7585 Background: Small cell lung cancer (SCLC) rarely presents as I/II Disease. In order to assess the incidence, treatment and prognosis of this early-stage SCLC, we used the Surveillance, Epidemiology and End Results database. Furthermore, since some investigators are irradiating growing and/or PET Scan positive nodules without biopsy, presenting characteristics of surgically-resected Stage I SCLC were compared to those of non-small cell lung cancer (NSCLC). Methods: The SEER 17 Database from 1988–2003 was accessed for all patients with early-stage SCLC. Presenting characteristics of surgically-resected Stage I SCLC were compared to those of resected Stage I NSCLC using chi-square and Wilcoxon Rank Sum tests. The logrank test was used to compare the differences in Survival(S) resulting from the various treatments options for early-stage SCLC. Results: 1,615 patients were identified with early-stage SCLC with greater than 3 months of follow-up. The median S was 20 months for the entire group. Over the time period of our study, the incidence of early stage SCLC as a percentage of all SCLCs and all lung cancers (SCLCs and NSCLCs) remained stable and ranged from 3.00–4.96% and 0.09–0.16% respectively. Surgically-resected Stage I SCLC did not differ from NSCLC in regards to patient characteristics (age, sex, race) or tumor location, but SCLC was found to have significantly smaller tumor size (p< 0.0001). Lobectomy or greater resections without radiotherapy were associated with a greater median S than those treated with segmental/wedge resections and those treated with radiotherapy alone (44 vs 29 months, p=0.03 and 20 months, p No significant financial relationships to disclose.

7583 Background: To examine the effects of different definitions of local recurrence on the reported patterns of failure and associated risk factors in patients undergoing potentially curative resection of Stage I non-small cell lung cancer (NSCLC). Methods: The study included 306 consecutive patients treated from 2000–2005 without radiotherapy. Local recurrence was defined as either: “radiation” (i.e., recurrences confined to the post-operative radiotherapy fields used in the Phase III trial of adjuvant radiotherapy by Trodella et al) (LRR), including the bronchial stump, staple line, the ipsilateral hilum, and ipsilateral mediastinum; or “comprehensive” (LRC), including these sites plus the ipsilateral lung and contralateral mediastinal and hilar nodes. Results: The median follow-up was 33 months. Proportions of LRC and LRR at 2, 3 and 5 years were 14%, 21% and 29%; and 7%, 12%, and 16%, respectively. Significant risk factors for LRC on multivariable analysis were diabetes, lymphatic vascular invasion and tumor size; significant factors for LRR were resection of less than a lobe and lymphatic vascular invasion. Distant (non-local) relapse proportions using these definitions at 2, 3 and 5 years were 10%, 12%, and 18%; and 14%, 19%, and 29%, respectively. Significant risk factors for distant failure were histology when using the LRC definitions and tumor size using the LRR definition. Conclusions: Local recurrence increased nearly two-fold when a broad definition was used, rather than a narrow one. The definition also affected which factors were significantly associated with both local and distant failure on multivariate analysis. Comparable definitions must be used when analyzing different series. No significant financial relationships to disclose.

7572 Background: To assess surgical, histopathologic and patient-related factors associated with local, distant and overall recurrence in patients with Stages I-IIIA Non-Small Cell Cancer (NSCLC) w...

7536 Background: Node postive presentations of Bronchioloalveolar Carcinoma are quite rare. The purpose of our investigation is to assess whether disease-specific survival (DSS) and overall surviva...

7632 Background: In 1999 the World Health Organization (WHO) changed its definition of bronchioloalveolar carcinoma (BAC). We examined the effects of this change. Methods: Patients included in the Surveillance, Epidemiology, and End Results program from 1992–2002 with Stages I-IIIB non-small cell lung carcinoma (NSCLC) who underwent a definitive surgical procedure were divided into a Cohort A (1,348 patients with BAC diagnosed from 2000–2002), Cohort B (2,955 patients diagnosed with BAC from 1992–1998), and Cohort C (36,861 patients with other NSCLC from the entire period). Overall survival (OS) and disease-free survival (DFS) rates were compared according to potential prognostic factors, including use of a matched-pair analysis. We also compared the demographic, histopathologic, and treatment factors associated with the three groups. Results: The proportion of BAC increased both as a percentage of NSCLC and as a percentage of adenocarcinoma for cohort A(12.5%, 22%) as compared to Cohort B(10.9%, 20%). The proportions of patients with smaller tumor size, female sex, non-black or non-white race, resections less than a pneumonectomy, no radiotherapy, Stage I disease, and well- differentiated tumor grade were similar between Cohorts A and B and statistically different between them and Cohort C. Cohorts A and B also had very similar OS/DFS to each other. Matched patients with Stage I cancer in Cohort A had better OS than in Cohort C; OS was similar for other stages. DFS was improved for all stages in Cohort A as compared to Cohort C (except for Stage II). Conclusions: Patients with BAC diagnosed before or after 1999 have similar outcomes to each other and better outcomes than patients with other NSCLCs. Furthermore, both BAC groups had analogous patient demographic, histopathologic and treatment factors, but differed from those of non-BAC NSCLC during this time period. Surgically-resected BAC defined using the 1999 WHO criteria remains distinctly different than non-BAC NSCLC. Therefore recommendations for adjuvant therapy may need to be different for this patient population. No significant financial relationships to disclose.

7604 Background: It is uncertain if LA affects overall survival (OS) or disease-free survival (DFS) rates for patients with stage I NSCLC and, if performed, what is the minimum number of nodes that should be recovered. Methods: 24,273 patients with stage I NSCLC diagnosed from 1992–2002 underwent a definitive surgical procedure and were included in the SEER data-base. For patients diagnosed from 1998–2002, outcome was examined separately for patients having only N1 (2,683 patients) or N2 nodal (1,019 patients) dissections. Results: For the entire population, LA was associated with an increase in the 5-year OS rate from 41.7% to 58.4% (p No significant financial relationships to disclose.

7065 Background: N2 nodal downstaging following neoadjuvant therapy for Stage IIIA(N2) NSCLC correlates with improved survival after lung resection. Pathologic assessment of nodes following neoadjuvant therapy may avoid unnecessary thoracotomy. Repeat mediastinoscopy has increased risk and limited efficacy. VATS may provide a safe alternative for restaging. Methods: The primary objective of this prospective multi-institutional study was to determine the feasibility of VATS restaging of ipsilateral nodes in mediastinoscopy proven stage IIIA(N2) NSCLC following 2 cycles neoadjuvant platinum-based chemotherapy (chemo) and/or ≥ 40 Gy radiotherapy (XRT) prior to thoracotomy. The goal of VATS re-staging was to biopsy 3 (-) lymph node stations, 1 (+) N2 node, or pleural carcinomatosis. Results: 70 evaluable patients (pts) were accrued from 10 institutions, 47% male, 97% white, and 71% aged between 50 and 69 years. 60% had performance status (PS) = 0, 40% PS = 1. 47 pts (67%) had XRT, 68 (97%) had chemo. Number o...