Thorac Cardiovasc Surg 2007; 55(2): 112-119
DOI: 10.1055/s-2006-924626
Original Thoracic

© Georg Thieme Verlag KG Stuttgart · New York

Is Lobe-Specific Lymph Node Dissection Appropriate in Lung Cancer Patients Undergoing Routine Mediastinoscopy?

A. Turna1 , O. Solak1 , A. Kilicgun1 , M. Metin1 , A. Sayar1 , A. Gürses1
  • 1Department of Thoracic Surgery, Yedikule Teaching Hospital for Chest Diseases and Thoracic Surgery, Istanbul, Turkey
Further Information

Publication History

received March 21, 2006

Publication Date:
21 March 2007 (online)

Abstract

Background: The extent and the necessity of lymph node dissection has yet to be defined after resectional surgery for lung cancer. We aimed to analyze the lobe-specific extent of lymph node positivity in patients who underwent preoperative mediastinoscopy as a routine strategy. Methods: A total of 280 patients with non-small cell lung cancer with negative mediastinoscopy were operated on in our center between January 1997 and June 2003. Hilar and mediastinal lymphadenectomy was performed in every patient. Results: The most commonly involved lymph nodes were found to be paratracheal station lymph nodes (n = 83; 96.5 %) for right upper lobe tumors, subcarinal station lymph nodes (n = 52; 88.1 %) for right lower lobe carcinomas, aorticopulmonary lymph nodes (n = 62; 92.5 %) for left upper lobe and subcarinal station lymph nodes (n = 49; 96.0 %) for left lower lobe tumors. In the patients with right upper lobe, right lower lobe and left lower lobe tumors, the presence of a tumor at these stations was found to be an indicator for poor prognosis (p = 0.033, p = 0.0038 and p = 0.0016, respectively). Patients with multiple station N2 disease did not survive beyond 3 years. Conclusions: In patients who underwent routine mediastinoscopy, lobe-specific lymph node dissection could be recommended. Patients with multilevel N2 involvement did not seem to benefit from resectional surgery.

References

  • 1 Funatsu T, Matsubara Y, Ikeda S. et al . Preoperative mediastinoscopic assessment of N factors and the need for mediastinal lymph node dissection in T1 lung cancer.  J Thorac Cardiovasc Surg. 1994;  108 321-328
  • 2 Naruke T. Mediastinal lymph node dissection. Shields TW General Thoracic Surgery (5th edition). Philadelphia; Lippincott Williams and Wilkins 2000: 1343-1356
  • 3 Izbicki J R, Passlick B, Pantel K. et al . Effectiveness of radical systematic mediastinal lymphadenectomy in non-small cell lung cancer: results of a randomized trial.  Ann Surg. 1998;  227 138-144
  • 4 Asamura H, Nakayama H, Tsuchiya R. et al . Lobe-specific extent of systematic lymph node dissection for non-small cell lung carcinomas according to a retrospective study of metastasis and prognosis.  J Thorac Cardiovasc Surg. 1999;  118 270-275
  • 5 Mountain C F. Revisions in the international system for staging lung cancer.  Chest. 1997;  111 1710
  • 6 Naruke T, Suemasu K, Ishikawa S. Lymph node mapping and curability at various levels of metastasis in resected lung cancer.  J Thorac Cardiovasc Surg. 1978;  76 832-839
  • 7 Naruke T, Goya T, Tsuchiya R. et al . Prognosis and survival in resected lung cancer based on the new international staging system.  J Thoracic Cardiovasc Surg. 1988;  96 440-447
  • 8 Miller D L, McMaus K G, Allen M S. et al . Results of surgical resection in patients with N2 non-small cell lung cancer.  Ann Thorac Surg. 1994;  57 1096-1101
  • 9 Naruke T, Tsuchiya R, Kondo H. et al . Lymph node sampling in lung cancer: how should it be done?.  Eur J Cardiothorac Surg. 1999;  16 (Suppl 1) S17-S24
  • 10 Okada M, Tsubota N, Yoshimura M. et al . Prognosis of completely resected pN2 non-small cell lung carcinomas: what is the significant node that affects survival?.  J Thorac Cardiovasc Surg. 1999;  117 1102-1111
  • 11 Graham A N, Chan K J, Pastorino U. et al . Systemic nodal dissection in the intrathoracic staging of patients with non-small cell lung cancer.  J Thorac Cardiovasc Surg. 1999;  117 246-251
  • 12 Gonzales-Stawinsky G V, Lemaire A, Merchant F. et al . A comparative analysis of positron emission tomography and mediastinoscopy in staging of non-small cell lung cancer.  J Thorac Cardiovasc Surg. 2003;  126 1900-1905
  • 13 Keller S M, Adak S, Wagner H. et al . Mediastinal lymph node dissection improves survival in patients with stages II and III a non-small cell lung cancer.  Ann Thorac Surg. 2000;  70 358-365
  • 14 Sayar A, Turna A, Kilicgun A. et al . Prognostic significance of surgical-pathologic multiple station N1 disease in non-small cell carcinoma of the lung.  Eur J Cardiothorac Surg. 2004;  25 434-438
  • 15 Roberts J R, Blum M G, Arildsen R. et al . Prospective comparison of radiologic, thoracoscopic, and pathologic staging in patients with early non-small cell lung cancer.  Ann Thorac Surg. 1999;  68 1154-1158
  • 16 Mouroux J, Venissac N, Alifano M. Combined video-assisted mediastinoscopy and video-assisted thoracoscopy in the management of lung cancer.  Ann Thorac Surg. 2001;  72 1698-1704
  • 17 Hammoud Z T, Anderson R C, Meyers B F. et al . The current role of mediastinoscopy in the evaluation of thoracic disease.  J Thorac Cardiovasc Surg. 1999;  118 894-899
  • 18 Ferguson M K. Optimal management when unsuspected N2 nodal disease is identified during thoracotomy for lung cancer: cost-effectiveness analysis.  J Thorac Cardiovasc Surg. 2003;  126 1935-1942
  • 19 Little A G, DeHoyos A, Kirgan D M. et al . Intraoperative lymphatic mapping for non-small cell lung cancer: the sentinel node technique.  J Thorac Cardiovasc Surg. 1999;  117 220-224
  • 20 Liptay M J, Masters G A, Winchester D J. et al . Intraoperative radioisotope sentinel lymph node mapping in non-small cell lung cancer.  Ann Thorac Surg. 2000;  70 384-390
  • 21 Soltesz E G, Kim S, Laurence R G. et al . Intraoperative sentinel lymph node mapping of the lung using near-infrared fluorescent quantum dots.  Ann Thorac Surg. 2005;  79 269-277

MD, PhD, FETCS Akif Turna

Department of Thoracic Surgery
Yedikule Teaching Hospital for Chest Diseases and Thoracic Surgery

Cami sok. no: 32/22

Sahrayicedid. Kadikoy

81080 Istanbul

Turkey

Phone: + 90 21 64 11 36 75

Fax: + 90 21 24 11 66 51

Email: akif.turna@gmail.com