Video-assisted thoracic surgery systematic mediastinal nodal dissection and stage migration: impact on clinical pathway
| Autor: | Ali Zamir Khan, Sanjay Jogai, Ivan Brown, Bruce J. Addis, Khalid Amer, Steven Harden, Charles Peebles, Neeta Singh |
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| Rok vydání: | 2010 |
| Předmět: |
Pulmonary and Respiratory Medicine
Adult Male medicine.medical_specialty Lung Neoplasms medicine.medical_treatment Blood Loss Surgical Preoperative care Multimodal Imaging Pneumonectomy Carcinoma Non-Small-Cell Lung medicine Humans Stage (cooking) Lung cancer Aged Neoplasm Staging Aged 80 and over Mediastinoscopy business.industry Thoracic Surgery Video-Assisted Mediastinum General Medicine Length of Stay Middle Aged medicine.disease Surgery Dissection medicine.anatomical_structure Cardiothoracic surgery Lymphatic Metastasis Positron-Emission Tomography Critical Pathways Adenocarcinoma Feasibility Studies Lymph Node Excision Female Radiology Cardiology and Cardiovascular Medicine business Tomography X-Ray Computed |
| Zdroj: | European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery. 40(6) |
| ISSN: | 1873-734X |
| Popis: | OBJECTIVES The aim of this study is to investigate the role of routine systematic mediastinal nodal dissection (SND) performed during video-assisted thoracic surgery (VATS) major pulmonary resections (VMPRs) as a staging strategy for non-small-cell lung cancer (NSCLC), compared with preoperative staging by conventional positron emission tomography (PET) and computed tomography (CT) imaging. METHODS All patients suspected of having early lung cancer (T1-2, N0-1 and M0) were staged preoperatively by CT/PET. During VMPR, all lymph nodes on the right side at stations 2-4, 7, 8, 9, 10 and 11 and on the left stations 4-6, 7, 8, 9, 10, 11 and 3 when indicated were dissected en bloc. Histology was provided on the paraffin-embedded nodes, and patients staged accordingly. Preoperative and postoperative stagings were compared. Stage migration and impact on clinical pathway were noted. Stage IIa and higher were referred for adjuvant chemotherapy. RESULTS Between April 2007 and January 2011, 106 consecutive patients with suspected primary NSCLC proceeded to VMPR+SND. Histology confirmed NSCLC in 96 patients. Forty-five were men and 51 women. Median age was 68.6 (range 42.8-84.7) years. As many as 91 (94.8%) patients underwent lobectomy, three (3.1%) bilobectomy and two (2.1%) pneumonectomy. PET accurately correlated with SND histological diagnosis in 42 (43.8%) patients. The unexpected N2 disease in cN0-1 was 9/86 (10.5%). SND resulted in 25 stage migrations, upstaged 16 (16.6%) and down-staged nine (9.4%) patients. All upstagings were adenocarcinoma. Four (4.2%) PET-negative patients had multi-station N2 disease. SND resulted in changing the clinical pathway for 19 (20%) patients. Fourteen (14.6%) patients upstaged to qualify for chemotherapy, and 5/9 (5.2%) down-staged patients were saved the chemotherapy. There was no morbidity or mortality attributable to this added procedure. CONCLUSIONS SND during VMPR is safe and should be routinely performed even when nodal metastases is considered unlikely. VATS-SND is more accurate than PET in staging the mediastinum for NSCLC. PET sensitivity is significantly reduced in adenocarcinoma and might result in stage migration. Adjuvant multidisciplinary treatment should be based on SND staging. |
| Databáze: | OpenAIRE |
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