Use of a Surgical Specimen-Collection Kit to Improve Mediastinal Lymph-Node Examination of Resectable Lung Cancer
| Autor: | Thomas F. O'Brien, Jeffrey B Gibson, Edward T. Robbins, Robert A. Ramirez, Xinhua Yu, Glenn P. Schoettle, Alim Khandekar, Laura Elizabeth Miller, Samuel G. Robbins, Raymond U. Osarogiagbon, Christopher G. Wang |
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| Rok vydání: | 2012 |
| Předmět: |
Pulmonary and Respiratory Medicine
medicine.medical_specialty Staging business.industry Non–small-cell lung cancer Perioperative medicine.disease Mediastinal Neoplasm Metastasis Surgery Dissection Oncology Surgical resection Mediastinal lymph node Mediastinal lymph nodes medicine Carcinoma Adenocarcinoma Quality improvement business Lung cancer |
| Zdroj: | Journal of Thoracic Oncology. 7:1276-1282 |
| ISSN: | 1556-0864 |
| DOI: | 10.1097/jto.0b013e318257fbe5 |
| Popis: | Introduction:Pathologic examination of mediastinal lymph nodes (MLNs) after resection of non–small-cell lung cancer is critical in the determination of prognosis and postoperative management. Although systematic nodal dissection is recommended, the quality of pathologic lymph-node staging often falls short of recommendations in practice. We tested the feasibility of improving pathologic lymph-node staging of resectable non–small-cell lung cancer by using a prelabeled specimen-collection kit.Methods:Case-control study with comparison of 51 resections, using a special lymph-node collection kit, with 51 controls matched for surgeon, extent of resection, pathologist, and T category. Appropriate statistical methods were used for all comparisons.Results:The median number of MLNs examined increased from one in the control group, to six in the case group (p < 0.001). The percentage of resections attaining the National Comprehensive Cancer Network-recommended quality of MLN examination, and the proportion that would have been eligible for recent landmark postresection adjuvant therapy trials increased significantly (p < 0.001). The duration of surgery and postoperative complication rates were similar between cases and controls. Eighteen percent of kit cases had positive MLN, compared with 8% of controls.Conclusions:The use of a specialized specimen-collection kit for MLN examination was feasible, markedly improved MLN staging, and showed a trend toward increased detection of patients with MLN metastasis, with only a modest increase in duration of surgery, and no increase in perioperative morbidity, mortality, or hospital length of stay. |
| Databáze: | OpenAIRE |
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